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Shah LM, Patel H, Faisaluddin M, Kwapong YA, Patel BA, Choi E, Satti DI, Oyeka CP, Hegde S, Dani SS, Sharma G. Rural/urban disparities in the trends and outcomes of peripartum cardiomyopathy in delivery hospitalizations. Curr Probl Cardiol 2024; 49:102433. [PMID: 38301915 DOI: 10.1016/j.cpcardiol.2024.102433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Rural-urban disparities in peripartum cardiomyopathy (PPCM) are not well known. We examined rural-urban differences in maternal, fetal, and cardiovascular outcomes in PPCM during delivery hospitalizations. METHODS We used 2003-2020 data from the National Inpatient Sample for delivery hospitalizations in individuals with PPCM. The 9th and 10th editions of the International Classification of Diseases were used to identify PPCM and cardiovascular, maternal, and fetal outcomes. Rural and urban hospitalizations for PPCM were 1:1 propensity score-matched using relevant clinical and sociodemographic variables. Odds of in-hospital mortality were assessed using logistic regression. RESULTS Among 72,880 delivery hospitalizations with PPCM, 4,571 occurred in rural locations, while 68,309 occurred in urban locations. After propensity matching, there were a total of 4,571 rural-urban pairs. There was significantly higher in-hospital mortality in urban compared to rural hospitalizations (adjusted OR 1.54, 95% CI 1.10-1.89). Urban PPCM hospitalizations had significantly higher cardiogenic shock (2.9% vs. 1.3%), mechanical circulatory support (1.0% vs. 0.6%), cardiac arrest (2.3% vs. 0.9%), and VT/VF (4.5% vs. 2.1%, all p <.05). Additionally, urban PPCM hospitalizations had worse maternal and fetal outcomes as compared to rural hospitalizations, including higher preterm delivery, gestational diabetes, and fetal death (all p<.05). Notably, significantly more rural individuals were transferred to a short-term hospital (including tertiary care centers) compared to urban individuals (13.5% vs. 3.2%, p<.0001). CONCLUSIONS There are significant rural-urban disparities in delivery hospitalizations with PPCM. Worse outcomes were associated with urban hospitalizations, while rural PPCM hospitalizations were associated with increased transfers, suggesting inadequate resources and advanced sickness.
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Affiliation(s)
- Lochan M Shah
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Harsh Patel
- Department of Cardiology, Southern Illinois University, Springfield, IL, United States
| | | | - Yaa A Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Bhavin A Patel
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI, United States
| | - Eunjung Choi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Danish Iltaf Satti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Chigolum P Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Shruti Hegde
- Department of Cardiology, Southern Illinois University, Springfield, IL, United States
| | - Sourbha S Dani
- Lahey Hospital & Medical Center, Boston, MA, United States
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States; Inova Schar Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, United States.
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Shah LM, Patel H, Kwapong Y, Patel BA, Choi E, Satti DI, Oyeka C, Hegde S, Dani SS, Sharma G. RURAL/URBAN DISPARITIES IN PERIPARTUM CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Gao Y, Shah LM, Ding J, Martin SS. US Trends in Cholesterol Screening, Lipid Levels, and Lipid-Lowering Medication Use in US Adults, 1999 to 2018. J Am Heart Assoc 2023; 12:e028205. [PMID: 36625302 PMCID: PMC9973640 DOI: 10.1161/jaha.122.028205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023]
Abstract
Background Understanding current trends in cholesterol screening, lipid levels, and lipid management therapies may inform health policy and practice. Methods and Results In 50 928 US adult National Health and Nutrition Examination Survey (NHANES) participants, trends were assessed in cholesterol screening, mean levels of total cholesterol, triglycerides, low-density-lipoprotein cholesterol, and lipid-lowering medication use from 1999 through 2018. Point estimates were also calculated using the 2017 to March 2020 prepandemic data set. The age- and sex-adjusted proportion of having cholesterol screened within 5 years increased from 63.2% (95% CI, 60.0-66.3) in 1999 to 2000 to 72.5% (95% CI, 69.5-75.3) in 2017 to 2018 (P<0.001 for linear trend). Mean total cholesterol decreased from 203.3 mg/dL (95% CI, 201.0-205.7) in 1999 to 2000 to 188.4 mg/dL in 2017 to 2018 (95% CI, 185.4-191.5) (P<0.001 for nonlinear trend). The mean triglyceride level decreased from 121.3 mg/dL (95% CI, 116.4-126.4) in 1999 to 2000 to 91.4 mg/dL (95% CI, 88.4-94.6) in 2017 to 2018 (P<0.001 for nonlinear trend). Low-density lipoprotein cholesterol decreased from 127.9 mg/dL (95% CI, 125.3-130.5) in 1999 to 2000 to 111.7 mg/dL (95% CI, 109.0-114.4) in 2017 to 2018 (P<0.001 for nonlinear trend). Among statin-eligible US adults, the proportion of statin use increased from 14.9% (95% CI, 12.2-17.9) in 1999 to 2000 to 27.8% (95% CI, 23.0-33.2) in 2017 to 2018 (P<0.001 for nonlinear trend). Statin use increased in adults with diabetes aged 40 to 75 years from 21.4% in 1999 to 2000 to 51.9% in 2017 to 2018 (P<0.001 for overall linear trend). Statin use plateaued in all other groups. The proportions of using ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors were 3.7% (95% CI, 1.3-9.8) and 0.03% (95% CI, 0.01-0.15) in 2017 to March 2020, respectively. Conclusions From 1999 through 2018, cholesterol screening increased while mean total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels decreased, with a modest increase in statin use and low uptake of nonstatin therapy in the US population.
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Affiliation(s)
- Yumin Gao
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins University School of MedicineBaltimoreMD
| | - Lochan M. Shah
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins University School of MedicineBaltimoreMD
| | - Jie Ding
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins University School of MedicineBaltimoreMD
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins University School of MedicineBaltimoreMD
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Shah LM. An Insight for Sore Eyes. Am J Med 2022; 135:1387-1388. [PMID: 35580722 DOI: 10.1016/j.amjmed.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/21/2022] [Accepted: 04/09/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Lochan M Shah
- Johns Hopkins Bayview Medical Center, Baltimore, Md.
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Shah LM, Yang WE, Demo RC, Lee MA, Weng D, Shan R, Wongvibulsin S, Spaulding EM, Marvel FA, Martin SS. Correction: Technical Guidance for Clinicians Interested in Partnering With Engineers in Mobile Health Development and Evaluation. JMIR Mhealth Uhealth 2022; 10:e41813. [PMID: 35981322 PMCID: PMC9437783 DOI: 10.2196/41813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lochan M Shah
- Johns Hopkins University School of MedicineBaltimore, MDUnited States
| | - William E Yang
- Johns Hopkins University School of MedicineBaltimore, MDUnited States
| | - Ryan C Demo
- Johns Hopkins University Whiting School of EngineeringBaltimore, MDUnited States
| | - Matthias A Lee
- Johns Hopkins University Whiting School of EngineeringBaltimore, MDUnited States
| | - Daniel Weng
- Johns Hopkins University School of MedicineBaltimore, MDUnited States
| | - Rongzi Shan
- Johns Hopkins University School of MedicineBaltimore, MDUnited States
- David Geffen School of Medicine at University of California, Los AngelesLos Angeles, CAUnited States
| | - Shannon Wongvibulsin
- Johns Hopkins University School of MedicineBaltimore, MDUnited States
- Johns Hopkins University Whiting School of EngineeringBaltimore, MDUnited States
| | - Erin M Spaulding
- Johns Hopkins University School of NursingBaltimore, MDUnited States
| | | | - Seth S Martin
- Johns Hopkins University School of MedicineBaltimore, MDUnited States
- Johns Hopkins University Whiting School of EngineeringBaltimore, MDUnited States
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Kwapong YA, Boakye E, Obisesan OH, Shah LM, Ogunwole SM, Hays AG, Blumenthal RS, Creanga AA, Blaha MJ, Cainzos-Achirica M, Nasir K, Douglas PS, Wang X, Sharma G. Nativity-Related Disparities in Preterm Birth and Cardiovascular Risk in a Multiracial U.S. Cohort. Am J Prev Med 2022; 62:885-894. [PMID: 35597568 DOI: 10.1016/j.amepre.2021.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Having a preterm birth is associated with future cardiovascular risk. Non-Hispanic Black women have higher rates of preterm birth than non-Hispanic White and Hispanic women, but nativity-related disparities in preterm birth are not well understood. METHODS Data from 6,096 women in the Boston Birth Cohort: non-Hispanic Black (2,699), non-Hispanic White (997), or Hispanic (2,400), were analyzed in June 2021. Differences in cardiovascular risk factors were assessed. The association of preterm birth with nativity and duration of U.S. residence were investigated using multivariable logistic regression. RESULTS U.S.-born women in all 3 racial-ethnic groups had a higher prevalence of obesity, smoking, and severe stress than foreign-born women. Foreign-born non-Hispanic Black and Hispanic women had lower odds of preterm birth than U.S.-born counterparts (non-Hispanic Black: AOR=0.79, 95% CI=0.65, 0.97; Hispanic: AOR=0.72, 95% CI=0.56, 0.93). In all the 3 groups, foreign-born women with shorter (<10 years) duration of U.S. residence had lower odds of preterm birth than the U.S.-born women (non-Hispanic Black: AOR=0.57, 95% CI=0.43, 0.75; Hispanic: AOR=0.72, 95% CI=0.55, 0.94; non-Hispanic White: AOR=0.46, 95% CI=0.25, 0.85), whereas the odds of preterm birth in foreign-born women with ≥10 years of residence were not significantly different. CONCLUSIONS Foreign-born women had better cardiovascular risk profiles in all groups and lower odds of preterm birth in non-Hispanic Black and Hispanic groups. In all the 3 groups, a shorter duration of U.S. residence was associated with lower odds of preterm birth. Further studies are needed to understand the biological and social determinants underlying these nativity-related disparities and the impact of acculturation.
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Affiliation(s)
- Yaa A Kwapong
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ellen Boakye
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Olufunmilayo H Obisesan
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lochan M Shah
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - S Michelle Ogunwole
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allison G Hays
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Roger S Blumenthal
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andreea A Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael J Blaha
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Miguel Cainzos-Achirica
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Khurram Nasir
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Pamela S Douglas
- Duke Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Garima Sharma
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Shah LM, Gao Y, Ding J, Martin SS. TRENDS IN CHOLESTEROL TESTING AND LIPID LEVELS IN US ADULTS, 1999-2018. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shah LM, Kwapong YA, Boakye E, Ogunwole SM, Bennett WL, Blumenthal RS, Hays AG, Blaha MJ, Nasir K, Zakaria S, Wang G, Wang X, Sharma G. Racial Disparities in Gestational Diabetes by Maternal Nativity and Length of US Residence in an Urban Low-income Population in the United States. CJC Open 2022; 4:540-550. [PMID: 35734520 PMCID: PMC9207772 DOI: 10.1016/j.cjco.2022.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/08/2022] [Indexed: 12/11/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is associated with increased risk of cardiovascular disease (CVD). Racial/ethnic differences in GDM prevalence have been described, but disparities by nativity and duration of US residence are not well studied. Methods We analyzed data from 6088 women (mean age: 27.5 years [standard deviation: 6.3 years]) from the Boston Birth Cohort who self-identified as non-Hispanic Black (NHB; n = 2697), Hispanic (n = 2395), or non-Hispanic White (NHW; n = 996). Using multivariable logistic regression, we examined the cross-sectional association of nativity and duration of US residence (< 10 vs ≥ 10 years) with GDM within each race/ethnicity group. Results Foreign-born NHB, NHW, and Hispanic women with a duration of US residence of < 10 years had a lower prevalence of CVD risk factors than those with US residence of ≥ 10 years, respectively, as follows: smoking (NHB: 1.7% vs 3.1%; NHW: 5.7% vs 8.1%; Hispanic: 0.4% vs 2.6%); obesity (NHB: 17.1% vs 23.4%; NHW: 3.8% vs 15.6%; Hispanic: 10.9% vs 22.7%); and severe stress (NHB: 8.7% vs 11.9%; NHW: 5.7% vs 28.1%; Hispanic: 3.8% vs 7.3%). In analyses adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women with a duration of US residence of < 10 years had higher odds of having GDM (adjusted odds ratio: 1.60, 95% confidence interval: 0.99-2.60), compared with their US-born counterparts, whereas foreign-born Hispanic women with a duration of US residence of < 10 years had lower odds of having GDM (adjusted odds ratio: 0.54, 95% confidence interval: 0.32-0.91). The odds of having GDM in Hispanic and NHB women with a duration of US residence of ≥ 10 years were not significantly different from those of their US-born counterparts. Conclusions The “healthy immigrant effect” and its waning with longer duration of US residence apply to the prevalence of GDM among Hispanic women but not NHB women. Further research on the intersectionality of race and nativity-based disparities is needed.
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Shah LM, Varma B, Nasir K, Walsh MN, Blumenthal RS, Mehta LS, Sharma G. Reducing disparities in adverse pregnancy outcomes in the United States. Am Heart J 2021; 242:92-102. [PMID: 34481757 DOI: 10.1016/j.ahj.2021.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
There is growing evidence that rural and racial disparities and social determinants of health (SDOH) impact adverse pregnancy outcomes (APOs) and overall maternal mortality in the United States. These APOs, such as preeclampsia, preterm birth, and intrauterine growth restriction, are in-turn associated with increased risk of future cardiovascular disease (CVD) later in life. Importantly, SDOH such as socioeconomic disadvantages, poor health literacy, transportation barriers, lack of access to adequate health care, food insecurity, and psychosocial stressors have cascading effects on APOs and downstream cardiovascular health. These SDOH are also deeply intertwined with and compounded by existing racial and rural disparities. Pregnancy thus provides a unique opportunity to identify at-risk women from a social determinants perspective, and provide early interventions to optimize long-term CVD and mitigate cardiovascular health disparities. Addressing the challenges posed by these disparities requires a multi-pronged approach and involves national, regional, and individual level solutions. Eliminating disparities will necessitate a nationwide obligation to ensure health care equity via enhanced health insurance coverage, resource investment, and public and clinician accountability.
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Shah LM, Wand A, Ying W, Hays AG, Blumenthal RS, Barouch LA, Zakaria S, Sharma G. Prevention Starts in the Womb: Opportunities for Addressing Cardiovascular Risk Factors During Pregnancy and Beyond. Methodist Debakey Cardiovasc J 2021; 17:48-59. [PMID: 34824681 PMCID: PMC8588699 DOI: 10.14797/mdcvj.696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 12/31/2022] Open
Abstract
Early identification and mitigation of sex-specific cardiovascular disease risk factors is a potential trajectory-changing strategy to improve lifelong cardiovascular health in women. These sex-specific risk factors include adverse pregnancy outcomes, polycystic ovarian syndrome, and premature menopause. We start by discussing the impact and management of risk factors for adverse pregnancy outcomes as an upstream intervention for cardiovascular disease risk reduction and then address the long-term effect and mitigation of sex-specific risk factors for cardiovascular disease.
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Affiliation(s)
- Lochan M Shah
- Johns Hopkins University School Of Medicine, Baltimore, Maryland, US
| | - Alison Wand
- Johns Hopkins University School Of Medicine, Baltimore, Maryland, US
| | - Wendy Ying
- Johns Hopkins University School Of Medicine, Baltimore, Maryland, US
| | - Allison G Hays
- Johns Hopkins University School Of Medicine, Baltimore, Maryland, US
| | | | - Lili A Barouch
- Johns Hopkins University School Of Medicine, Baltimore, Maryland, US
| | - Sammy Zakaria
- Johns Hopkins University School Of Medicine, Baltimore, Maryland, US
| | - Garima Sharma
- Johns Hopkins University School Of Medicine, Baltimore, Maryland, US
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Yang WE, Spaulding EM, Lumelsky D, Hung G, Huynh PP, Knowles K, Marvel FA, Vilarino V, Wang J, Shah LM, Xun H, Shan R, Wongvibulsin S, Martin SS. Correction: Strategies for the Successful Implementation of a Novel iPhone Loaner System (iShare) in mHealth Interventions: Prospective Study. JMIR Mhealth Uhealth 2021; 9:e31472. [PMID: 34543222 PMCID: PMC8491118 DOI: 10.2196/31472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.2196/16391.].
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Affiliation(s)
- William E Yang
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Erin M Spaulding
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - David Lumelsky
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - George Hung
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | | | - Kellen Knowles
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Francoise A Marvel
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Valerie Vilarino
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Jane Wang
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Lochan M Shah
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Helen Xun
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Rongzi Shan
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Shannon Wongvibulsin
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Department of Biomedical Engineering, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Seth S Martin
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Huang HY, Shah LM, McNally JS, Sant T, Hutchins TA, Goldstein ED, Peckham ME. COVID-19-Associated Myelitis Involving the Dorsal and Lateral White Matter Tracts: A Case Series and Review of the Literature. AJNR Am J Neuroradiol 2021; 42:1912-1917. [PMID: 34413066 DOI: 10.3174/ajnr.a7256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/30/2021] [Indexed: 11/07/2022]
Abstract
Coronavirus disease 2019 (COVID-19) myelitis is a rare condition, most commonly presenting with nonenhancing central expansile cord T2 signal changes. A single case report has also described longitudinal involvement of the dorsal columns. We present 5 cases of COVID-19-associated myelitis with tract-specific involvement of the dorsal and lateral columns and discuss potential pathophysiologic pathways for this unique pattern.
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Affiliation(s)
- H Y Huang
- From the Department of Neurology (H.Y.H., E.D.G.), University of Utah, Salt Lake City, Utah
| | - L M Shah
- Departments of Radiology and Imaging Sciences (L.M.S., J.S.M., T.A.H., M.E.P.), University of Utah, Salt Lake City, Utah
| | - J S McNally
- Departments of Radiology and Imaging Sciences (L.M.S., J.S.M., T.A.H., M.E.P.), University of Utah, Salt Lake City, Utah
| | - T Sant
- School of Medicine (T.S.), University of Utah, Salt Lake City, Utah
| | - T A Hutchins
- Departments of Radiology and Imaging Sciences (L.M.S., J.S.M., T.A.H., M.E.P.), University of Utah, Salt Lake City, Utah
| | - E D Goldstein
- From the Department of Neurology (H.Y.H., E.D.G.), University of Utah, Salt Lake City, Utah
| | - M E Peckham
- Departments of Radiology and Imaging Sciences (L.M.S., J.S.M., T.A.H., M.E.P.), University of Utah, Salt Lake City, Utah
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Turner BE, Magnani CJ, Frolov A, Weeks BT, Steinberg JR, Huda N, Shah LM, Zuroff L, Gu BJ, Rasmussen H, Edwards JG, Save AV, Shen M, Ren M, Bryant BR, Ma Q, Feng AY, Liang AC, Santini VE. Neurology trial registrations on ClinicalTrials.gov between 2007 and 2018: A cross-sectional analysis of characteristics, early discontinuation, and results reporting. J Neurol Sci 2021; 428:117579. [PMID: 34332371 DOI: 10.1016/j.jns.2021.117579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increasing neurological disease burden and advancing treatment options require clinical trials to expand the evidence base of clinical care. We aimed to characterize neurology clinical trials registered between October 2007 and April 2018 and identify features associated with early discontinuation and results reporting. METHODS We compared 16,994 neurology (9.4%) and 163,714 non-neurology comparison trials registered to ClinicalTrials.gov. Trials therapeutic focus within neurology was assigned via combination programmatic and manual review. We performed descriptive analyses of trial characteristics, cox regression of early discontinuation, and multivariable logistic regression for results reporting within 3 years of completion. RESULTS Most neurology trials were academic-funded (58.5%) followed by industry (31.9%) and US-government (9.6%). Neurology trials focused more on treatment than prevention compared to non-neurology studies. Of neurology trials, 11.3% discontinued early, and 32.2% of completed trials reported results by April 30, 2018. In multivariable analysis accounting for time-to-event, neurology trials were at lower risk of discontinuation than non-neurology trials (adjusted hazard 0.83, p < 0.0001). Both academic and government-funded trials had greater risk of discontinuation than industry (adjusted hazard 0.57 and 0.46, respectively). Among completed trials, government-funded studies (adjusted odds ratio 2.12, p < 0.0001) had highest odds of results reporting while academic trials reported less (adjusted odds ratio 0.51, p < 0.0001). CONCLUSIONS Funding source is associated with trial characteristics and outcomes in neurology. Improvements in trial completion and timely dissemination of results remain urgent goals for the field.
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Affiliation(s)
- Brandon E Turner
- Stanford University School of Medicine, Stanford, CA, United States of America; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Christopher J Magnani
- Stanford University School of Medicine, Stanford, CA, United States of America; Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Alexander Frolov
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Brannon T Weeks
- Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jecca R Steinberg
- Stanford University School of Medicine, Stanford, CA, United States of America; Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, United States of America
| | - Naureen Huda
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Lochan M Shah
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Leah Zuroff
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ben Jiahe Gu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Hannah Rasmussen
- Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jeffrey G Edwards
- Stanford University School of Medicine, Stanford, CA, United States of America
| | - Akshay V Save
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Max Shen
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Mark Ren
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Qian Ma
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Austin Y Feng
- Stanford University School of Medicine, Stanford, CA, United States of America
| | - Amy C Liang
- Highland Hospital Emergency Medicine, Oakland, CA, United States of America
| | - Veronica E Santini
- Stanford University School of Medicine, Stanford, CA, United States of America
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14
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Marvel FA, Spaulding EM, Lee MA, Yang WE, Demo R, Ding J, Wang J, Xun H, Shah LM, Weng D, Carter J, Majmudar M, Elgin E, Sheidy J, McLin R, Flowers J, Vilarino V, Lumelsky DN, Bhardwaj V, Padula WV, Shan R, Huynh PP, Wongvibulsin S, Leung C, Allen JK, Martin SS. Digital Health Intervention in Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2021; 14:e007741. [PMID: 34261332 PMCID: PMC8288197 DOI: 10.1161/circoutcomes.121.007741] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thirty-day readmissions among patients with acute myocardial infarction (AMI) contribute to the US health care burden of preventable complications and costs. Digital health interventions (DHIs) may improve patient health care self-management and outcomes. We aimed to determine if patients with AMI using a DHI have lower 30-day unplanned all-cause readmissions than a historical control. METHODS This nonrandomized controlled trial with a historical control, conducted at 4 US hospitals from 2015 to 2019, included 1064 patients with AMI (DHI n=200, control n=864). The DHI integrated a smartphone application, smartwatch, and blood pressure monitor to support guideline-directed care during hospitalization and through 30-days post-discharge via (1) medication reminders, (2) vital sign and activity tracking, (3) education, and (4) outpatient care coordination. The Patient Activation Measure assessed patient knowledge, skills, and confidence for health care self-management. All-cause 30-day readmissions were measured through administrative databases. Propensity score-adjusted Cox proportional hazard models estimated hazard ratios of readmission for the DHI group relative to the control group. RESULTS Following propensity score adjustment, baseline characteristics were well-balanced between the DHI versus control patients (standardized differences <0.07), including a mean age of 59.3 versus 60.1 years, 30% versus 29% Women, 70% versus 70% White, 54% versus 54% with private insurance, 61% versus 60% patients with a non ST-elevation myocardial infarction, and 15% versus 15% with high comorbidity burden. DHI patients were predominantly in the highest levels of patient activation for health care self-management (mean score 71.7±16.6 at 30 days). The DHI group had fewer all-cause 30-day readmissions than the control group (6.5% versus 16.8%, respectively). Adjusting for hospital site and a propensity score inclusive of age, sex, race, AMI type, comorbidities, and 6 additional confounding factors, the DHI group had a 52% lower risk for all-cause 30-day readmissions (hazard ratio, 0.48 [95% CI, 0.26-0.88]). Similar results were obtained in a sensitivity analysis employing propensity matching. CONCLUSIONS Our results suggest that in patients with AMI, the DHI may be associated with high patient activation for health care self-management and lower risk of all-cause unplanned 30-day readmissions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03760796.
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Affiliation(s)
- Francoise A. Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Erin M. Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., W.V.P., J.K.A.)
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (E.M.S., S.S.M.)
| | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD (M.A.L., R.Y., S.S.M.)
| | - William E. Yang
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD (M.A.L., R.Y., S.S.M.)
| | - Jie Ding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
| | - Jane Wang
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
| | - Helen Xun
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Lochan M. Shah
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Daniel Weng
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | | | - Maulik Majmudar
- Massachusetts General Hospital, Boston (J.C., M.M.)
- Harvard Medical School, Boston, MA (M.M.)
| | - Eric Elgin
- Reading Hospital, West Reading, PA (E.E., J.S., R.M., J.F.)
| | - Julie Sheidy
- Reading Hospital, West Reading, PA (E.E., J.S., R.M., J.F.)
| | - Renee McLin
- Reading Hospital, West Reading, PA (E.E., J.S., R.M., J.F.)
| | | | - Valerie Vilarino
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.N.L.)
| | - David N. Lumelsky
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.N.L.)
| | - Vinayak Bhardwaj
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., W.V.P., J.K.A.)
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (E.M.S., S.S.M.)
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD (M.A.L., R.Y., S.S.M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
- Massachusetts General Hospital, Boston (J.C., M.M.)
- Harvard Medical School, Boston, MA (M.M.)
- Reading Hospital, West Reading, PA (E.E., J.S., R.M., J.F.)
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.N.L.)
- Department of Pharmaceutical and Health Economics, School of Pharmacy (W.V.P.)
- University of Southern California, Los Angeles, CA (W.V.P.)
- Leonard D. Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA (W.V.P.)
- Johns Hopkins Health System, Baltimore, MD (C.L.)
| | - William V. Padula
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., W.V.P., J.K.A.)
- Department of Pharmaceutical and Health Economics, School of Pharmacy (W.V.P.)
- University of Southern California, Los Angeles, CA (W.V.P.)
- Leonard D. Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA (W.V.P.)
| | - Rongzi Shan
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
| | - Pauline P. Huynh
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Shannon Wongvibulsin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Curtis Leung
- Johns Hopkins Health System, Baltimore, MD (C.L.)
| | - Jerilyn K. Allen
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., W.V.P., J.K.A.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
| | - Seth S. Martin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (E.M.S., S.S.M.)
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD (M.A.L., R.Y., S.S.M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
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15
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Shah LM, Ding J, Spaulding EM, Yang WE, Lee MA, Demo R, Marvel FA, Martin SS. Sociodemographic Characteristics Predicting Digital Health Intervention Use After Acute Myocardial Infarction. J Cardiovasc Transl Res 2021; 14:951-961. [PMID: 33999374 PMCID: PMC8127845 DOI: 10.1007/s12265-021-10098-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Increasing evidence suggests that digital health interventions (DHIs) are an effective tool to reduce hospital readmissions by improving adherence to guideline-directed therapy. We investigated whether sociodemographic characteristics influence use of a DHI targeting 30-day readmission reduction after acute myocardial infarction (AMI). Covariates included age, sex, race, native versus loaner iPhone, access to a Bluetooth-enabled blood pressure monitor, and disease severity as marked by treatment with CABG. Age, sex, and race were not significantly associated with DHI use before or after covariate adjustment (fully adjusted OR 0.98 (95%CI: 0.95-1.01), 0.6 (95%CI: 0.29-1.25), and 1.22 (95% CI: 0.60-2.48), respectively). Being married was associated with high DHI use (OR 2.12; 95% CI 1.02-4.39). Our findings suggest that DHIs may have a role in achieving equity in cardiovascular health given similar use by age, sex, and race. The presence of a spouse, perhaps a proxy for enhanced caregiver support, may encourage DHI use.
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Affiliation(s)
- Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jie Ding
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin M Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), an AHA SFRN Center for Health Technology and Innovation, Baltimore, MD, USA
| | - William E Yang
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthias A Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Francoise A Marvel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), an AHA SFRN Center for Health Technology and Innovation, Baltimore, MD, USA.
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
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16
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Woldu B, Shah LM, Shaddeau AK, Goerlich E, Zakaria S, Hays AG, Vaught AJ, Creanga AA, Blumenthal RS, Sharma G. The Role of Biomarkers and Imaging to Predict Preeclampsia and Subsequent Cardiovascular Dysfunction. Curr Treat Options Cardio Med 2021. [DOI: 10.1007/s11936-021-00913-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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17
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Fisher J, Krisa L, Middleton DM, Leiby BE, Harrop JS, Shah LM, Schwartz ED, Doshi A, Faro SH, Mohamed FB, Flanders AE. Validation of the National Institute of Neurological Disorders and Stroke Spinal Cord Injury MRI Common Data Elements Instrument. AJNR Am J Neuroradiol 2021; 42:787-793. [PMID: 33574102 DOI: 10.3174/ajnr.a7000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The National Institute of Neurological Disorders and Stroke common data elements initiative was created to provide a consistent method for recording and reporting observations related to neurologic diseases in clinical trials. The purpose of this study is to validate the subset of common data elements related to MR imaging evaluation of acute spinal cord injury. MATERIALS AND METHODS Thirty-five cervical and thoracic MR imaging studies of patients with acute spinal cord injury were evaluated independently in 2 rounds by 5 expert reviewers. Intra- and interrater agreement were calculated for 17 distinct MR imaging observations related to spinal cord injury. These included ordinal, categoric, and continuous measures related to the length and location of spinal cord hemorrhage and edema as well as spinal canal and cord measurements. Level of agreement was calculated using the interclass correlation coefficient and kappa. RESULTS The ordinal common data elements spinal cord injury elements for lesion center and rostral or caudal extent of edema or hemorrhage demonstrated agreement ranging from interclass correlation coefficient 0.68 to 0.99. Reproducibility ranged from 0.95 to 1.00. Moderate agreement was observed for absolute length of hemorrhage and edema (0.54 to 0.60) with good reproducibility (0.78 to 0.83). Agreement for the Brain and Spinal Injury Center score showed the lowest interrater agreement with an overall kappa of 0.27 (0.20, 0.34). For 7 of the 8 variables related to spinal cord injury, agreement improved between the first and second evaluation. Continuous diameter measures of the spinal cord and spinal canal using interclass correlation coefficient varied substantially (0.23 to 0.83). CONCLUSIONS Agreement was more consistent for the ordinal measures of spinal cord injury than continuous measures. Good to excellent agreement on length and location of spinal cord hemorrhage and edema can be achieved with ordinal measures alone.
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Affiliation(s)
- J Fisher
- From the Departments of Radiology (J.F., D.M.M., S.H.F., F.B.M., A.E.F.)
| | - L Krisa
- Physical Therapy/Occupational Therapy (L.K.)
| | - D M Middleton
- From the Departments of Radiology (J.F., D.M.M., S.H.F., F.B.M., A.E.F.)
| | | | - J S Harrop
- Neurosurgery (J.S.H.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - L M Shah
- Department of Radiology (L.M.S.), University of Utah, Salt Lake City, Utah
| | - E D Schwartz
- Department of Radiology (E.D.S.), Saint Elizabeth's Medical Center, Brighton, Massachusetts
| | - A Doshi
- Department of Radiology (A.D.), Mount Sinai Medical Center, New York, New York
| | - S H Faro
- From the Departments of Radiology (J.F., D.M.M., S.H.F., F.B.M., A.E.F.)
| | - F B Mohamed
- From the Departments of Radiology (J.F., D.M.M., S.H.F., F.B.M., A.E.F.)
| | - A E Flanders
- From the Departments of Radiology (J.F., D.M.M., S.H.F., F.B.M., A.E.F.)
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18
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Wongvibulsin S, Habeos EE, Huynh PP, Xun H, Shan R, Porosnicu Rodriguez KA, Wang J, Gandapur YK, Osuji N, Shah LM, Spaulding EM, Hung G, Knowles K, Yang WE, Marvel FA, Levin E, Maron DJ, Gordon NF, Martin SS. Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review. J Med Internet Res 2021; 23:e18773. [PMID: 33555259 PMCID: PMC7899799 DOI: 10.2196/18773] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/22/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. Objective The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Methods Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Results Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Conclusions Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions.
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Affiliation(s)
| | | | - Pauline P Huynh
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Helen Xun
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rongzi Shan
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | | | - Jane Wang
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.,UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | | | - Ngozi Osuji
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - George Hung
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kellen Knowles
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - William E Yang
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Francoise A Marvel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eleanor Levin
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, United States
| | - David J Maron
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Neil F Gordon
- INTERVENT International, Savannah, GA, United States.,Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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19
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Yang WE, Shah LM, Spaulding EM, Wang J, Xun H, Weng D, Shan R, Wongvibulsin S, Marvel FA, Martin SS. The role of a clinician amid the rise of mobile health technology. J Am Med Inform Assoc 2021; 26:1385-1388. [PMID: 31373364 DOI: 10.1093/jamia/ocz131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/05/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
Mobile health (mHealth) interventions have demonstrated promise in improving outcomes by motivating patients to adopt and maintain healthy lifestyle changes as well as improve adherence to guideline-directed medical therapy. Early results combining behavioral economic strategies with mHealth delivery have demonstrated mixed results. In reviewing these studies, we propose that the success of a mHealth intervention links more strongly with how well it connects patients back to routine clinical care, rather than its behavior modification technique in isolation. This underscores the critical role of clinician-patient partnerships in the design and delivery of such interventions, while also raising important questions regarding long-term sustainability and scalability. Further exploration of our hypothesis may increase opportunities for multidisciplinary clinical teams to connect with and engage patients using mHealth technologies in unprecedented ways.
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Affiliation(s)
- William E Yang
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Jane Wang
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Helen Xun
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rongzi Shan
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Francoise A Marvel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seth S Martin
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Yang WE, Spaulding EM, Lumelsky D, Hung G, Huynh PP, Knowles K, Marvel FA, Vilarino V, Wang J, Shah LM, Xun H, Shan R, Wongvibulsin S, Martin SS. Strategies for the Successful Implementation of a Novel iPhone Loaner System (iShare) in mHealth Interventions: Prospective Study. JMIR Mhealth Uhealth 2019; 7:e16391. [PMID: 31841115 PMCID: PMC6937543 DOI: 10.2196/16391] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background As smartphone ownership continues to rise, health care systems and technology companies are driven to develop mobile health (mHealth) interventions as both diagnostic and therapeutic tools. An important consideration during mHealth intervention development is how to achieve health equity despite demographic differences in smartphone ownership. One solution is through the recirculation of loaner smartphones; however, best practices for implementing such programs to optimize security, privacy, scalability, and convenience for participants are not well defined. Objective In this tutorial, we describe how we implemented our novel Corrie iShare program, a 30-day loaner iPhone and smartwatch recirculation program, as part of a multi-center mHealth intervention to improve recovery and access to guideline-directed therapy following acute myocardial infarction. Methods We conducted a prospective study utilizing a smartphone app and leveraged iOS enterprise features as well as cellular data service to automate recirculation. Results Our configuration protocol was shortened from 1 hour to 10 minutes. Of 200 participants, 92 (46.0%) did not own an iPhone and would have been excluded from the study without iShare. Among iShare participants, 72% (66/92) returned their loaned smartphones. Conclusions The Corrie iShare program demonstrates the potential for a sustainable and scalable mHealth loaner program, enabling broader population reach while optimizing user experience. Implementation may face institutional constraints and software limitations. Consideration should be given to optimizing loaner returns.
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Affiliation(s)
- William E Yang
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Erin M Spaulding
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - David Lumelsky
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - George Hung
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | | | - Kellen Knowles
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Francoise A Marvel
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Valerie Vilarino
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Jane Wang
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Lochan M Shah
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Helen Xun
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Rongzi Shan
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Shannon Wongvibulsin
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Department of Biomedical Engineering, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Seth S Martin
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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21
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Shah LM, Yang WE, Demo RC, Lee MA, Weng D, Shan R, Wongvibulsin S, Spaulding EM, Marvel FA, Martin SS. Technical Guidance for Clinicians Interested in Partnering With Engineers in Mobile Health Development and Evaluation. JMIR Mhealth Uhealth 2019; 7:e14124. [PMID: 31094337 PMCID: PMC6540720 DOI: 10.2196/14124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/23/2019] [Indexed: 02/03/2023] Open
Abstract
The explosion of mobile health (mHealth) interventions has prompted significant investment and exploration that has extended past industry into academia. Although research in this space is emerging, it focuses on the clinical and population level impact across different populations. To realize the full potential of mHealth, an intimate understanding of how mHealth is being used by patients and potential differences in usage between various demographic groups must also be prioritized. In this viewpoint, we use our experiences in building an mHealth intervention that incorporates an iOS app, Bluetooth-enabled blood pressure cuff, and Apple Watch to share knowledge on (1) how user interaction data can be tracked in the context of health care privacy laws, (2) what is required for effective, nuanced communication between clinicians and engineers to design mHealth interventions that are patient-centered and have high clinical impact, and (3) how to handle and set up a process to handle user interaction data efficiently.
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Affiliation(s)
- Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - William E Yang
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ryan C Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States
| | - Matthias A Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rongzi Shan
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.,David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Shannon Wongvibulsin
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States
| | - Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
| | - Francoise A Marvel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Seth S Martin
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States
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22
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Shah LM, Turner Z, Bessone SK, Winesett SP, Stanfield A, Kossoff EH. How often is antiseizure drug-free ketogenic diet therapy achieved? Epilepsy Behav 2019; 93:29-31. [PMID: 30831398 DOI: 10.1016/j.yebeh.2019.01.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
The ketogenic diet (KD) is often started not only for seizure reduction but also to potentially wean antiseizure drugs (ASDs) in children with epilepsy. Although there have been several publications regarding ASD reduction on the KD, it is unknown how often complete medication withdrawal occurs. We reviewed the charts of all children started on the KD at Johns Hopkins Hospital and Johns Hopkins All Children's Hospital from 1/11 to 4/18. Children were defined as achieving drug-free diet (DFD) status if they started the KD on at least 1 ASD and achieved a period of time where they were on the KD alone. Over the time period, 232 children were evaluated; DFD status occurred in 43 (18.5%), of which 32 (13.8% of the full cohort) remained off ASDs for the remainder of their KD treatment course. Eleven children restarted ASD after a mean of 7 months. Children achieving DFD therapy were more likely to be younger, have fewer ASDs at KD onset, have Glut1 deficiency or epilepsy with myoclonic-atonic seizures, but were less likely to have Lennox-Gastaut syndrome or a gastrostomy tube.
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Affiliation(s)
- Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zahava Turner
- Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stacey K Bessone
- Neuroscience Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - S Parrish Winesett
- Neuroscience Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Anthony Stanfield
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric H Kossoff
- Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA.
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23
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Shah LM, Kranz PG, Anzai Y, Hutchins TA, Gibbs WN, Pierson N, Aldred BW, Wiggins RH. Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision. AJNR Am J Neuroradiol 2018; 39:2378-2384. [PMID: 30385469 DOI: 10.3174/ajnr.a5867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patient preparation for myelography and postprocedural monitoring varies widely between practices, despite published guidelines. Our aim was to examine the current practice variations in discontinuing reportedly seizure threshold-lowering medications before myelography and to assess the reported incidence of postmyelographic seizures. MATERIALS AND METHODS An e-mail survey was sent to American Society of Neuroradiology members concerning the number of postmyelographic seizures experienced in the past 5 years, the presence of an institutional policy for discontinuing seizure threshold-lowering medications, and the type of myelographic contrast used. We compared the postmyelographic seizure frequency in the responses. RESULTS Of 700 survey responses, 57% reported that they do not discontinue seizure threshold-lowering medications before myelography. Most (97%) indicated never having a patient experience a seizure following myelography. The number of postmyelographic seizures between those who discontinue seizure threshold-lowering medications and those who do not was not statistically significant (OR = 2.13; 95% CI, 0.91-4.98; P = .08). Most (95%) reported using nonionic hypo-osmolar agents. CONCLUSIONS Survey results revealed widely variable practices for patient myelography preparation and postprocedural monitoring. We found no difference in reported seizures between those who discontinued seizure threshold-lowering medications and those who did not. In light of our findings, we propose that discontinuing reportedly seizure threshold-lowering medications is not warranted with the current nonionic water-soluble contrast agents and may be potentially harmful in some instances. This work supports revision of existing recommendations to withhold such medications before myelography.
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Affiliation(s)
- L M Shah
- From the Department of Radiology and Imaging Sciences University (L.M.S., Y.A., T.A.H., N.P., B.W.A., R.H.W.), Utah Health Sciences Center, Salt Lake City, Utah
| | - P G Kranz
- Department of Radiology (P.G.K.), Duke University Medical Center, Durham, North Carolina
| | - Y Anzai
- From the Department of Radiology and Imaging Sciences University (L.M.S., Y.A., T.A.H., N.P., B.W.A., R.H.W.), Utah Health Sciences Center, Salt Lake City, Utah
| | - T A Hutchins
- From the Department of Radiology and Imaging Sciences University (L.M.S., Y.A., T.A.H., N.P., B.W.A., R.H.W.), Utah Health Sciences Center, Salt Lake City, Utah
| | - W N Gibbs
- Department of Radiology (W.N.G.), Keck Medical Center of University of Southern California, Los Angeles, California
| | - N Pierson
- From the Department of Radiology and Imaging Sciences University (L.M.S., Y.A., T.A.H., N.P., B.W.A., R.H.W.), Utah Health Sciences Center, Salt Lake City, Utah
| | - B W Aldred
- From the Department of Radiology and Imaging Sciences University (L.M.S., Y.A., T.A.H., N.P., B.W.A., R.H.W.), Utah Health Sciences Center, Salt Lake City, Utah
| | - R H Wiggins
- From the Department of Radiology and Imaging Sciences University (L.M.S., Y.A., T.A.H., N.P., B.W.A., R.H.W.), Utah Health Sciences Center, Salt Lake City, Utah
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24
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Rogers DM, Shah LM, Wiggins RH. The Central Vein: FLAIR Signal Abnormalities Associated with Developmental Venous Anomalies in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:2007-2013. [PMID: 30337437 DOI: 10.3174/ajnr.a5819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/09/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Demyelination is a recently recognized cause of FLAIR hyperintensities associated with developmental venous anomalies. Our purpose was to quantify the prevalence of white matter signal abnormalities associated with developmental venous anomalies in patients with multiple sclerosis compared with controls. MATERIALS AND METHODS A retrospective, blinded, multireader study compared the prevalence of FLAIR hyperintense signal abnormalities adjacent to developmental venous anomalies in patients with MS compared with controls (patients with developmental venous anomalies without MS). Study findings were positive if a central vein was demonstrated using FLAIR and contrast-enhanced fat-saturated T1 sequences. Imaging parameters also included developmental venous anomaly location, developmental venous anomaly drainage, white matter lesion size, and depth of white matter lesions. Clinical parameters included age, sex, and the presence of confounding variables (hypertension, diabetes, migraines, and/or vasculopathy). RESULTS FLAIR signal abnormality was present around 47.3% (35/74) of developmental venous anomalies in patients with MS, and 13.5% (10/74) of developmental venous anomalies in the control group (P < .001). The multivariate logistic regression model controlling for covariates (including migraines, hypertension, diabetes mellitus, vasculopathy, age, sex, and drainage direction of developmental venous anomalies) showed that the odds of FLAIR hyperintensity around developmental venous anomalies was 6.7-fold higher in patients with MS (relative risk MS = 6.68; 95% CI, 2.79-15.97; P < .001). CONCLUSIONS The association of developmental venous anomalies and FLAIR hyperintensities was more common in patients with MS, which suggests that the underlying demyelinating pathologic process of MS may be the cause of this propensity in patients with MS. Impaired venous drainage in the territory of developmental venous anomalies may predispose to development of these lesions, and an associated central vein is helpful in understanding an atypical location of MS plaques.
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Affiliation(s)
- D M Rogers
- From the Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah.
| | - L M Shah
- From the Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - R H Wiggins
- From the Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah
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25
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Peckham ME, Shah LM, Tsai AC, Quigley EP, Cramer J, Hutchins TA. C1 Posterior Arch Flare Point: A Useful Landmark for Fluoroscopically Guided C1-2 Puncture. AJNR Am J Neuroradiol 2018; 39:1562-1567. [PMID: 29930095 DOI: 10.3174/ajnr.a5706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/04/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The C1-2 intrathecal puncture is routinely performed when lumbar puncture is not feasible. Usage has steadily decreased in part because of the perceived high risk of injury to the cervical cord. Up to this point, vague fluoroscopic guidelines have been used, creating uncertainty about the actual needle location relative to the spinal cord. We present a novel osseous landmark to aid in C1-2 intrathecal puncture, corresponding to the posterior spinal cord margin on lateral fluoroscopic views. This landmark, which we have termed the "flare point," represents the triangular "flaring" of the posterior C1 arch at its junction with the anterior arch. MATERIALS AND METHODS Cervical spine CT myelograms were reviewed. High-resolution axial images were reformatted into the sagittal plane, and maximum-intensity-projection images were created to simulate a lateral fluoroscopic view. Tangential lines were drawn along the superior cortices of the anterior and posterior C1 arches, with the point of intersection used to approximate the flare point. Chart review was performed for all C1-2 punctures using the flare point technique in the past 3 years. RESULTS Forty-two cervical myelograms were reviewed. The average flare point was 0.2 ± 0.5 mm posterior to the dorsal spinal cord margin. In 37/42 subjects, the flare point was localized posterior to the spinal cord. Targeting by means of the flare point was used in 16 C1-2 punctures without complications. CONCLUSIONS The C1 posterior arch flare point accurately approximates the dorsal spinal cord margin on myelography. Targeting between the flare point and the spinolaminar line, at the mid-C1-2 interspace, allows safe and optimal needle positioning.
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Affiliation(s)
- M E Peckham
- From the Departments of Radiology and Imaging Sciences (M.E.P., L.M.S., A.T., E.P.Q., T.A.H.), University of Utah, Salt Lake City, Utah
| | - L M Shah
- From the Departments of Radiology and Imaging Sciences (M.E.P., L.M.S., A.T., E.P.Q., T.A.H.), University of Utah, Salt Lake City, Utah
| | - A C Tsai
- From the Departments of Radiology and Imaging Sciences (M.E.P., L.M.S., A.T., E.P.Q., T.A.H.), University of Utah, Salt Lake City, Utah
| | - E P Quigley
- From the Departments of Radiology and Imaging Sciences (M.E.P., L.M.S., A.T., E.P.Q., T.A.H.), University of Utah, Salt Lake City, Utah
| | - J Cramer
- Department of Radiology (J.C.), University of Nebraska Medical Center, Omaha, Nebraska
| | - T A Hutchins
- From the Departments of Radiology and Imaging Sciences (M.E.P., L.M.S., A.T., E.P.Q., T.A.H.), University of Utah, Salt Lake City, Utah
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26
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Peckham ME, Hutchins TA, Stilwill SE, Mills MK, Morrissey BJ, Joiner EAR, Sanders RK, Stoddard GJ, Shah LM. Localizing the L5 Vertebra Using Nerve Morphology on MRI: An Accurate and Reliable Technique. AJNR Am J Neuroradiol 2017; 38:2008-2014. [PMID: 28775057 DOI: 10.3174/ajnr.a5311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/23/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Multiple methods have been used to determine the lumbar vertebral level on MR imaging, particularly when full spine imaging is unavailable. Because postmortem studies show 95% accuracy of numbering the lumbar vertebral bodies by counting the lumbar nerve roots, attention to lumbar nerve morphology on axial MR imaging can provide numbering clues. We sought to determine whether the L5 vertebra could be accurately localized by using nerve morphology on MR imaging. MATERIALS AND METHODS One hundred eight cases with full spine MR imaging were numbered from the C2 vertebral body to the sacrum with note of thoracolumbar and lumbosacral transitional states. The origin level of the L5 nerve and iliolumbar ligament were documented in all cases. The reference standard of numbering by full spine imaging was compared with the nerve morphology numbering method. Five blinded raters evaluated all lumbar MRIs with nerve morphology technique twice. Prevalence and bias-adjusted κ were used to measure interrater and intrarater reliability. RESULTS The L5 nerve arose from the 24th presacral vertebra (L5) in 106/108 cases. The percentage of perfect agreement with the reference standard was 98.1% (95% CI, 93.5%-99.8%), which was preserved in transitional and numeric variation states. The iliolumbar ligament localization method showed 83.3% (95% CI, 74.9%-89.8%) perfect agreement with the reference standard. Inter- and intrarater reliability when using the nerve morphology method was strong. CONCLUSIONS The exiting L5 nerve can allow accurate localization of the corresponding vertebrae, which is essential for preprocedure planning in cases where full spine imaging is not available. This neuroanatomic method displays higher agreement with the reference standard compared with previously described methods, with strong inter- and intrarater reliability.
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Affiliation(s)
- M E Peckham
- From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.)
| | - T A Hutchins
- From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.)
| | - S E Stilwill
- Musculoskeletal Division (S.E.S., M.K.M., R.K.S.)
| | - M K Mills
- Musculoskeletal Division (S.E.S., M.K.M., R.K.S.)
| | - B J Morrissey
- Departments of Radiology and Imaging Sciences (B.J.M., E.A.R.J.), University of Utah Health Sciences Center, Salt Lake City, Utah
| | - E A R Joiner
- Departments of Radiology and Imaging Sciences (B.J.M., E.A.R.J.), University of Utah Health Sciences Center, Salt Lake City, Utah
| | - R K Sanders
- Musculoskeletal Division (S.E.S., M.K.M., R.K.S.)
| | - G J Stoddard
- From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.)
| | - L M Shah
- From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.)
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27
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Rogers DM, Peckham ME, Shah LM, Wiggins RH. Association of Developmental Venous Anomalies with Demyelinating Lesions in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2017; 39:97-101. [PMID: 28912286 DOI: 10.3174/ajnr.a5374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 07/12/2017] [Indexed: 11/07/2022]
Abstract
We present 5 cases of demyelination in patients diagnosed with multiple sclerosis that are closely associated with a developmental venous anomaly. Although the presence of a central vein is a known phenomenon with multiple sclerosis plaques, demyelination occurring around developmental venous anomalies is an underreported phenomenon. Tumefactive demyelination can cause a diagnostic dilemma because of its overlapping imaging findings with central nervous system neoplasm. The relationship of a tumefactive plaque with a central vein can be diagnostically useful, and we suggest that if such a lesion is closely associated with a developmental venous anomaly, an inflammatory or demyelinating etiology should be a leading consideration.
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Affiliation(s)
- D M Rogers
- From the Department of Radiology and Imaging Science, University of Utah Medical Center, Salt Lake City, Utah.
| | - M E Peckham
- From the Department of Radiology and Imaging Science, University of Utah Medical Center, Salt Lake City, Utah
| | - L M Shah
- From the Department of Radiology and Imaging Science, University of Utah Medical Center, Salt Lake City, Utah
| | - R H Wiggins
- From the Department of Radiology and Imaging Science, University of Utah Medical Center, Salt Lake City, Utah
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28
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Abstract
Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat. Our goal with this review was to describe our techniques for lumbar puncture in the difficult patient, with emphasis on using fluoroscopy in the obese patient and to suggest maneuvers that might make the procedure easier. Combining our experience from performing these procedures on an obese population, we would like to share our tips, especially with trainees early in their career.
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Affiliation(s)
- P A Hudgins
- From the Department of Radiology and Imaging Sciences (P.A.H., A.J.F.), Division of Neuroradiology, Emory University School of Medicine, Atlanta, Georgia
| | - A J Fountain
- From the Department of Radiology and Imaging Sciences (P.A.H., A.J.F.), Division of Neuroradiology, Emory University School of Medicine, Atlanta, Georgia
| | - P R Chapman
- Department of Radiology (P.R.C.), University of Alabama, Tuscaloosa, Alabama
| | - L M Shah
- Department of Radiology and Imaging Sciences (L.M.S.), University of Utah, Salt Lake City, Utah
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29
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Ledbetter LN, Salzman KL, Shah LM. Imaging Psoas Sign in Lumbar Spinal Infections: Evaluation of Diagnostic Accuracy and Comparison with Established Imaging Characteristics. AJNR Am J Neuroradiol 2016; 37:736-41. [PMID: 26585257 DOI: 10.3174/ajnr.a4571] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar discitis-osteomyelitis has imaging characteristics than can overlap with noninfectious causes of back pain. Our aim was to determine the added accuracy of psoas musculature T2 hyperintensity (imaging psoas sign) in the MR imaging diagnosis of lumbar discitis-osteomyelitis. MATERIALS AND METHODS This retrospective case-control study evaluated lumbar spine MR imaging examinations, during a 30-month period, that were requested for the evaluation of discitis-osteomyelitis. Of this pool, 50 age-matched control patients were compared with 51 biopsy-proved or clinically diagnosed patients with discitis-osteomyelitis. Two reviewers, blinded to the clinical information, assessed the randomly organized MR imaging examinations for abnormalities of the psoas musculature, vertebral bodies, discs, and epidural space. RESULTS Psoas T2 hyperintensity demonstrated a high sensitivity (92.1%; 95% CI, 80%-97.4%) and specificity (92%; 95% CI, 80%-97.4%), high positive likelihood ratio (11.5; 95% CI, 4.5-29.6), low negative likelihood ratio (0.09; 95% CI, 0.03-0.20), and individual area under the receiver operating characteristic curve of 0.92; 95% CI, 0.87-0.97. Identification of psoas T2 abnormality significantly improved (P = .02) the diagnostic accuracy of discitis-osteomyelitis in noncontrast examinations from an area under the receiver operator characteristic curve of the established variables (vertebral body T2 and T1 signal, endplate integrity, disc T2 signal, and disc height) from 0.93 (95% CI, 0.88-0.98) to 0.98 (95% CI, 0.96-1.0). Psoas T2 abnormalities also had the highest interobserver reliability with a κ coefficient of 0.78 (substantial agreement). CONCLUSIONS Psoas T2 hyperintensity, the imaging psoas sign, is highly correlated with discitis-osteomyelitis. T2 hyperintensity in the psoas musculature, particularly when there is clinical suspicion of spinal infection, improves the diagnostic accuracy of discitis-osteomyelitis compared with routine noncontrast variables alone.
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Affiliation(s)
- L N Ledbetter
- From the Department of Radiology (L.N.L.), University of Kansas Medical Center, Kansas City, Kansas
| | - K L Salzman
- Department of Radiology (K.L.S., L.M.S.), University of Utah, Salt Lake City, Utah
| | - L M Shah
- Department of Radiology (K.L.S., L.M.S.), University of Utah, Salt Lake City, Utah
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Abstract
BACKGROUND AND PURPOSE The STIR sequence is routinely used to assess acute traumatic osseous injury. Because the composition of the odontoid in older individuals may be altered with osteopenia and decreased vascularity, the STIR sequence may not accurately depict the acuity of an odontoid fracture. The purpose of this study was to evaluate the reliability of the STIR sequence to differentiate acute-versus-chronic type II odontoid fractures in older patients, particularly those with osteopenia. MATERIALS AND METHODS A retrospective review was performed for patients with type II odontoid fractures during a 10-year period with both CT and MR imaging performed within 24 hours of injury. Patients were paired with controls of similar ages and were grouped by age. The STIR images were evaluated in a blinded fashion for the presence of hyperintensity in the odontoid. Demographic and clinical characteristics were also recorded. RESULTS Seventy-five patients with type II odontoid fracture and 75 healthy controls (mean and median age of 57 years) were identified. The sensitivity of STIR to detect fracture in the age group 57 years and older was significantly worse than that in the age group younger than 57 years (54% and 82%, respectively; P = .018). CONCLUSIONS Older patients, particularly those with osteopenia, may have acute odontoid injuries without corresponding STIR hyperintensity. Additionally, interobserver agreement in STIR interpretation decreases with increasing patient age. As such, in this patient population, in which the presence of bone marrow edema as an indicator of fracture acuity may impact therapeutic decisions, correlation with CT findings and clinical history is crucial.
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Affiliation(s)
- F D Lensing
- From the Departments of Radiology (F.D.L., R.H.W., L.M.S.)
| | - E F Bisson
- Neurosurgery (E.F.B.), University of Utah Health Sciences Center, Salt Lake City, Utah
| | - R H Wiggins
- From the Departments of Radiology (F.D.L., R.H.W., L.M.S.)
| | - L M Shah
- From the Departments of Radiology (F.D.L., R.H.W., L.M.S.)
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Walker BS, Shah LM, Osborn AG. Calcified cerebral emboli, a "do not miss" imaging diagnosis: 22 new cases and review of the literature. AJNR Am J Neuroradiol 2014; 35:1515-9. [PMID: 24651819 DOI: 10.3174/ajnr.a3892] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Calcified cerebral emboli are a rarely reported but devastating cause of stroke and may be the first manifestation of vascular or cardiac disease. Our aim was to evaluate the diagnosis, prevalence, imaging appearance, presumed embolic source, treatment, and outcome of patients with calcified cerebral emboli. MATERIALS AND METHODS Our radiology information system was searched for all CT scans by using keywords "calcified," "emboli," and their permutations. The radiology information system was also searched to identify all "stroke" CT reports to calculate the prevalence of calcified cerebral emboli. We also performed a MEDLINE search to identify all published case reports. RESULTS Twenty-two cases were identified from our database, and 48 were cases reported from the literature. The middle cerebral artery was the site of 83% of calcified emboli. Presumed sources were calcific aortic stenosis (36%), carotid atherosclerotic plaque (30%), and mitral annular calcification (11%). Spontaneous embolism occurred in 86%. Surgical treatment was performed in 34% of patients. Sixty-four percent of the patients with calcified aortic stenosis underwent aortic valve replacement. Among those with identifiable arterial disease, 53% underwent endarterectomy. Forty-one percent of patients experienced at least 1 recurrent stroke. The prevalence of calcified cerebral emboli identified on stroke CT scans at our institution was 2.7%. Seventy-three percent of cases were correctly identified. Twenty-seven percent were misdiagnosed on initial interpretation, while 9% were overlooked on preliminary interpretation. CONCLUSIONS Calcified cerebral emboli are more common than previously assumed, are frequently overlooked or misinterpreted, affect clinical course when diagnosed, and carry substantial risk for recurrent stroke.
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Affiliation(s)
- B S Walker
- From the Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah.
| | - L M Shah
- From the Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - A G Osborn
- From the Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
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Abstract
BACKGROUND AND PURPOSE Advances in multidetector CT provide exquisite detail with improved delineation of the normal anatomic structures in the head and neck. The carotid body is 1 structure that is now routinely depicted with this new imaging technique. An understanding of the size range of the normal carotid body will allow the radiologist to distinguish patients with prominent normal carotid bodies from those who have a small carotid body paraganglioma. MATERIALS AND METHODS We performed a retrospective analysis of 180 CTAs to assess the imaging appearance of the normal carotid body in its expected anatomic location. RESULTS The carotid body was detected in >80% of carotid bifurcations. The normal size range measured from 1.1 to 3.9 mm ± 2 SDs, which is consistent with the reported values from anatomic dissections. CONCLUSIONS An ovoid avidly enhancing structure at the inferomedial aspect of the carotid bifurcation within the above range should be considered a normal carotid body. When the carotid body measures >6 mm, a small carotid body paraganglioma should be suspected and further evaluated.
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Affiliation(s)
- R P Nguyen
- Departments of Radiology, University of Utah Health Sciences Center, Salt Lake City, USA
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Abstract
The TMAs are a group of microvascular occlusive disorders characterized by thrombocytopenia and intravascular hemolysis. Literature review reveals a spectrum of neuroimaging findings, including a single case report of multifocal hemorrhagic infarctions. We present a series of 12 patients with TMA demonstrating a similar pattern of multifocal cortical and subcortical hemorrhagic infarctions.
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Affiliation(s)
- T N Ellchuk
- Department of Radiology, University of Utah, Salt Lake City, Utah 84132-2140, USA
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Gaughen JR, Bourne TD, Aregawi D, Shah LM, Schiff D. Focal neuronal gigantism: a rare complication of therapeutic radiation. AJNR Am J Neuroradiol 2009; 30:1933-5. [PMID: 19574493 DOI: 10.3174/ajnr.a1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Radiation therapy, a mainstay in the treatment of many brain tumors, results in a variety of well-documented acute and chronic complications. Isolated cortical damage following irradiation represents an extremely rare delayed therapeutic complication, described only twice in the medical literature. We report this rare delayed complication in a patient following treatment of a right frontal anaplastic oligodendroglioma.
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Affiliation(s)
- J R Gaughen
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA.
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Shah LM, DeStefano MS, Cynamon MH. Enhanced in vitro activity of WR99210 in combination with dapsone against Mycobacterium avium complex. Antimicrob Agents Chemother 1996; 40:2644-5. [PMID: 8913480 PMCID: PMC163591 DOI: 10.1128/aac.40.11.2644] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
WR99210, a dihydrofolate reductase inhibitor, has promising in vitro activity against Mycobacterium avium complex (MAC). The in vitro activities of WR99210 alone and in combination with a fixed concentration of dapsone (0.5 microgram/ml) were evaluated against 35 clinical MAC isolates by a broth dilution method. The MIC at which 50% of isolates were inhibited (MIC50) and MIC90 of WR99210 alone were 2 and 8 micrograms/ml, respectively. The MIC50 and MIC90 of WR99210 in combination with dapsone were 0.25 and 4 micrograms/ml, respectively. Overall, 75% of the MAC isolates displayed enhanced susceptibility to the combination.
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Affiliation(s)
- L M Shah
- Veterans Affairs Medical Center, Syracuse, New York 13210, USA
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37
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Shah LM, Meyer SC, Cynamon MH. Enhanced in vitro activity of pyrimethamine in combination with dapsone against Mycobacterium avium complex. Antimicrob Agents Chemother 1996; 40:2426-7. [PMID: 8891158 PMCID: PMC163548 DOI: 10.1128/aac.40.10.2426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The in vitro activities of pyrimethamine and dapsone alone and in combination were evaluated against 23 clinical isolates of Mycobacterium avium complex. The broth dilution MICs of dapsone and pyrimethamine alone ranged from 16 to > 64 micrograms/ml. Pyrimethamine in combination with a fixed concentration of dapsone at 0.5 microgram/ml showed enhanced activity, with an MIC range of 0.5 to 16 micrograms/ml.
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Affiliation(s)
- L M Shah
- Veterans Affairs Medical Center, Syracuse, New York, USA
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38
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Abstract
The identification is made in normal mice of the stages in T cell development at which the rearranged beta chain of the T cell receptor (TCR) is utilized to promote T cell maturation, independent of the TCR alpha chain. In addition, evidence is provided that utilization of beta chains in T cell progenitors does not preclude differentiation to TCR gamma delta + T cells. This is consistent with the view that an initial consequence of beta chain expression by early thymocytes is clonal expansion, increasing the size of the pool of useful precursors. This allows the proposal to be made that allelic exclusion may be a byproduct of cell cycle regulation during early thymocyte differentiation, which may in turn explain why the efficiency of allelic exclusion varies at different TCR or immunoglobulin loci.
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MESH Headings
- Animals
- Base Sequence
- Carrier Proteins/metabolism
- Cell Differentiation
- DNA/genetics
- DNA Primers/genetics
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor
- Hyaluronan Receptors
- Mice
- Mice, Inbred C57BL
- Models, Biological
- Molecular Sequence Data
- Polymerase Chain Reaction
- Polymorphism, Restriction Fragment Length
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
- Receptors, Cell Surface/metabolism
- Receptors, Interleukin-2/metabolism
- Receptors, Lymphocyte Homing/metabolism
- T-Lymphocyte Subsets/cytology
- T-Lymphocyte Subsets/immunology
- T-Lymphocytes/cytology
- T-Lymphocytes/immunology
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Affiliation(s)
- E C Dudley
- Department of Biology, Yale University, New Haven, Connecticut 06511
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