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Meisel T, Mian S, Nguyen A, Ayesha B. Rare presentation of thrombosis with bleeding in Behcet's disease. BMJ Case Rep 2023; 16:e256329. [PMID: 38061856 PMCID: PMC10711884 DOI: 10.1136/bcr-2023-256329] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Behcet's disease (BD) is a rare autoimmune and autoinflammatory disease characterised by recurrent oral and genital aphthous ulcers as well as gastrointestinal, ocular, neurological, articular and vascular inflammation. Patients are at risk for both thrombotic events and bleeding, so providers are often challenged in deciding whether to start patients on anticoagulation. We report a rare, complex case of a patient with BD who presented with massive gastrointestinal bleeding. This case report highlights the management of recurrent thrombosis due to protein C and S deficiency in a patient with BD who also presents with acute gastrointestinal bleeding.
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Affiliation(s)
- Talia Meisel
- Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Montefiore Medical Center, Bronx, New York, USA
| | - Sundus Mian
- Montefiore Medical Center, Bronx, New York, USA
| | - Andy Nguyen
- Montefiore Medical Center, Bronx, New York, USA
| | - Bibi Ayesha
- Rheumatology, Montefiore Hospital and Medical Center, Bronx, New York, USA
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Skwiersky S, Rosengarten S, Meisel T, Macaluso F, Chang M, Thomson A, Da Silva B, Oommen A, Salvani J, Banerji MA. Sugar is not always sweet: exploring the relationship between hyperglycemia and COVID-19 in a predominantly African American population. BMJ Open Diabetes Res Care 2022; 10:10/4/e002692. [PMID: 36002176 PMCID: PMC9412045 DOI: 10.1136/bmjdrc-2021-002692] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/22/2022] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The purpose of this study is to examine the effect of admission glucose in patients hospitalized with COVID-19 with and without diabetes mellitus in a largely African American cohort. DESIGN AND METHODS This study included 708 adults (89% non-Hispanic Black) admitted with COVID-19 to an urban hospital between 1 March and 15 May 2020. Patients with diabetes were compared with those without and were stratified based on admission glucose of 140 and 180 mg/dL. Adjusted ORs were calculated for outcomes of mortality, intubation, intensive care unit (ICU) admission, acute kidney injury (AKI), and length of stay based on admission glucose levels. RESULTS Patients with diabetes with admission glucose >140 mg/dL (vs <140 g/dL) had 2.4-fold increased odds of intubation (95% CI 1.2 to 4.6) and 2.1-fold increased odds of ICU admission (95% CI 1.0 to 4.3). Patients with diabetes with admission glucose >180 mg/dL (vs <180 g/dL) had a 1.9-fold increased mortality (95% CI 1.2 to 3.1). Patients without diabetes with admission glucose >140 mg/dL had a 2.3-fold increased mortality (95% CI 1.3 to 4.3), 2.7-fold increased odds of ICU admission (95% CI 1.3 to 5.4), 1.9-fold increased odds of intubation (95% CI 1.0 to 3.7) and 2.2-fold odds of AKI (95% CI 1.1 to 3.8). Patients without diabetes with glucose >180 mg/dL had 4.4-fold increased odds of mortality (95% CI 1.9 to 10.4), 2.7-fold increased odds of intubation (95% CI 1.2 to 5.8) and 3-fold increased odds of ICU admission (95% CI 1.3 to 6.6). CONCLUSION Our results show hyperglycemia portends worse outcomes in patients with COVID-19 with and without diabetes. While our study was limited by its retrospective design, our findings suggest that patients presenting with hyperglycemia require closer observation and more aggressive therapies.
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Affiliation(s)
- Samara Skwiersky
- Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sabrina Rosengarten
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Talia Meisel
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
- Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Francesca Macaluso
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Megan Chang
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
- Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Alastair Thomson
- Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Brandon Da Silva
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
- Stanford Medicine, Stanford University, Stanford, California, USA
| | - Alvin Oommen
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
- Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Jerome Salvani
- Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mary Ann Banerji
- Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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Phanhdone T, Drummond P, Meisel T, Friede N, Di Rocco A, Chodosh J, Fleisher J. Barriers to Vaccination Among People with Parkinson's Disease and Implications for COVID-19. J Parkinsons Dis 2021; 11:1057-1065. [PMID: 33935103 DOI: 10.3233/jpd-202497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) are at higher risk of vaccine-preventable respiratory infections. However, advanced, homebound individuals may have less access to vaccinations. In light of COVID-19, understanding barriers to vaccination in PD may inform strategies to increase vaccine uptake. OBJECTIVE To identify influenza and pneumococcal vaccination rates, including barriers and facilitators to vaccination, among homebound and ambulatory individuals with PD and related disorders. METHODS Cross-sectional US-based study among individuals with PD, aged > 65 years, stratified as homebound or ambulatory. Participants completed semi-structured interviews on vaccination rates and barriers, and healthcare utilization. RESULTS Among 143 participants, 9.8% had missed all influenza vaccinations in the past 5 years, and 32.2% lacked any pneumococcal vaccination, with no between-group differences. Homebound participants (n = 41) reported difficulty traveling to clinic (p < 0.01) as a vaccination barrier, and despite similar outpatient visit frequencies, had more frequent emergency department visits (31.7% vs. 9.8%, p < 0.01) and hospitalizations (14.6% vs. 2.9%, p = 0.03). Vaccine hesitancy was reported in 35% of participants, vaccine refusal in 19%, and 13.3% reported unvaccinated household members, with no between-group differences. Nearly 13% thought providers recommended against vaccines for PD patients, and 31.5% were unsure of vaccine recommendations in PD. CONCLUSION Among a sample of homebound and ambulatory people with PD, many lack age-appropriate immunizations despite ample healthcare utilization. Many participants were unsure whether healthcare providers recommend vaccinations for people with PD. In light of COVID-19, neurologist reinforcement that vaccinations are indicated, safe, and recommended may be beneficial.
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Affiliation(s)
- Tiffany Phanhdone
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patrick Drummond
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Talia Meisel
- College of Medicine, SUNY Downstate Health Sciences University, , Brooklyn, NY, USA
| | | | | | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York, NY, USA.,VA New York Harbor Healthcare System, Medicine Service, New York, NY, USA
| | - Jori Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Skwiersky S, Rosengarten S, Chang M, Thomson A, Meisel T, Macaluso F, Da Silva B, Oommen A, Banerji MA. Sugar Is Not Always Sweet: Exploring the Relationship Between Hyperglycemia and COVID-19 in a Predominantly African American Population. J Endocr Soc 2021. [PMCID: PMC8089731 DOI: 10.1210/jendso/bvab048.713] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: A relationship between hyperglycemia and outcomes in patients with COVID-19 has been proposed, however there is a paucity of literature on this. In this study, we examined the effect of admission glucose in diabetics and non-diabetics on outcomes in patients hospitalized with COVID-19. Our study uniquely examines this association in a largely African American cohort, a population disproportionately affected by COVID-19. Methods: In this retrospective cohort study, we analyzed all adults admitted with COVID-19 to a designated COVID hospital in Brooklyn, NY from March 1 to May 15, 2020. Diabetics were compared to non-diabetics, and were further stratified based on admission glucoses of 140 and 180 mg/dL. Diagnosis of diabetes was based on history and/or Hba1c > 6.5%. Univariate, multiple and logistic regressions were used for analyses, examining outcomes of mortality, intubation, ICU admission, acute kidney injury (AKI), and length of stay based on admission glucose levels, while controlling for age, gender, lab values (serum creatinine and WBC), and comorbidities including hypertension, cardiovascular disease, and obesity. Outcomes are presented as an adjusted odds ratio (OR) with 95% confidence interval (95% CI). Results: 708 patients were analyzed; 54% diabetics, 83.5% non-Hispanic Blacks, 51% male with a mean age of 68, BMI of 29 kg/m2 and crude mortality rate of 40%. The length of hospital stay was greater in diabetics than non-diabetics, (13±26 days vs 9.5±18.5 days, p<0.05). Diabetics with an admission glucose > 140 mg/dL (vs<140 g/dL) had a 2.4-fold increased odds of both intubation and ICU admission (95% CI: 1.2, 4.5; 1.3, 4.6). Diabetics with admission glucoses > 180 mg/dL (vs <180 g/dL) had a 1.8-fold increased mortality (95% CI: 1.2, 2.9). Non-diabetics with admission glucoses >140 mg/dL (vs<140 g/dL) had a two-fold increased mortality (95% CI: 1.2, 3.5), 3.5-fold increased odds of ICU admission (95% CI: 1.8,6.6) and a 2.3-fold increased odds of both intubation and AKI (95% CI: 1.3, 4.2; 1.3,4.2). Non-diabetics with a glucose >180 mg/dL (vs <180 g/dL) had a four-fold increased mortality (95% CI: 1.8, 8.8), 2.7-fold increased odds of intubation (95% CI: 1.3, 5.6) and 2.9-fold increased odds of ICU admission (95% CI: 1.3, 6.2). Conclusion: Our results show hyperglycemia portends worse outcomes in diabetics and non-diabetics with COVID-19. Elevated admitting glucoses >180 mg/dL increased odds of mortality four-fold in non-diabetics and 1.8- fold in diabetics. In COVID-19, diabetic patients had a 37% greater length of hospital stay than non-diabetics. Whether hyperglycemia is a marker or a cause of more severe COVID-19 is unknown. These findings suggest that patients presenting with hyperglycemia require closer observation and more aggressive therapies. This raises the testable hypothesis that intensive glucose control may improve outcomes in patients with COVID-19.
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Affiliation(s)
| | | | - Megan Chang
- SUNY DOWNSTATE MEDICAL CENTER, Brooklyn, NY, USA
| | | | - Talia Meisel
- SUNY DOWNSTATE MEDICAL CENTER, Brooklyn, NY, USA
| | | | | | - Alvin Oommen
- SUNY DOWNSTATE MEDICAL CENTER, Brooklyn, NY, USA
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Meiser A, Knoll H, Meisel T, Schröder M, Volk T. [Treatment of extreme anemia with polymerized bovine hemoglobin : Case report and review of the literature]. Anaesthesist 2020; 70:308-315. [PMID: 33001238 PMCID: PMC8026446 DOI: 10.1007/s00101-020-00864-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/20/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
This article reports the case of a 29-year-old female Jehovah's Witness with severe anemia after intrauterine fetal death in the 25th week of gestation, complicated by vaginal bleeding, acute renal failure and hemolysis. Due to her religious beliefs the patient categorically refused blood transfusions. Despite adhering to the recommendations for patient blood management, the hemoglobin (Hb) level gradually decreased to 1.9 g/dl on day 10, when she fainted and had to be sedated and invasively ventilated. Inhalative isoflurane was chosen for sedation because of its potential organ-protective effects and because it provides deep sedation with reduced oxygen requirements, while enabling rapid neurological examination during the sedation windows as well as regular and calm spontaneous breathing. Posthypoxic encephalopathy was demonstrated clinically and electroencephalographically by seizure activity during the sedation windows. Anticonvulsive treatment was started. At a hemoglobin of 1.8 g/dl, she received 2 units of polymerized bovine hemoglobin (Hemopure®, Hemoglogin Oxygen Therapeutics LLC, Souderton, PA, USA), repeated several times on subsequent days because of its short half-life. Considerable methemoglobinemia was noted. After subtracting methemoglobin, the hemoglobin rose by 0.4-0.8 g/dl after each 2 units, initially increasing the oxygen binding capacity of the blood by 33%. After a full neurological recovery and weaning from the ventilator but still on hemodialysis, the patient was transferred to another hospital after 38 days.If allogeneic blood transfusion is not an option, administration of polymerized bovine hemoglobin can temporarily increase the oxygen transport capacity as a last resort treatment. Reduction of oxygen requirements by deep inhaled sedation with isoflurane also seems beneficial and provides advantages.
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Affiliation(s)
- A Meiser
- Interdisziplinäre Operative Intensivstation, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland.
| | - H Knoll
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - T Meisel
- Interdisziplinäre Operative Intensivstation, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - M Schröder
- Interdisziplinäre Operative Intensivstation, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - T Volk
- Interdisziplinäre Operative Intensivstation, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
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McFarlane IM, Bhamra MS, Amarnani A, Zhaz SY, Kolla S, Alvarez MR, Mo G, Srinivasan M, Hevroni G, Meisel T, Hasan A, Baguidy MS, Hadaddin M, Melamed A, Koci K, Taklalsingh N, Pathiparampil J, Freeman L, Kaplan I, Kabani N, Ozeri DJ, Watler E, Frefer M, Vaitkus V, Matthew K, Arroyo-Mercado F, Lyo H, Feoktistov A, Sanchez R, Soliman F, Valdez FR, Dronamraju V, Trevisonno M, Grant C, Clerger G, Sun K, Amin K, Dawkins M, Green J, Fahmy S, Jayarangaiah A, Waite SA, Burza A. Prevalence of Malignancy Among Urban Black Rheumatoid Arthritis Patients. Int J Clin Res Trials 2020; 5. [PMID: 32661506 DOI: 10.15344/2456-8007/2020/145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients have an increased risk of malignancy with postulated risk factors that include chronic inflammation, smoking and the use of immunosuppressants have been postulated as drivers of higher malignancies rates. Our study aimed to describe the prevalence and type of malignancies encountered in an urban, predominantly Black RA patient population. METHODS Cross sectional analysis of 1142 patients with RA diagnosis by ICD-codes of which 501 cases met the inclusion criteria for the study. Blacks accounted for 88.4% of the study population. Fifty-six patients had cancer recorded in their medical records and these cases were further reviewed for tumor type, timing of diagnosis and patient clinical characteristics. RESULTS The cancer prevalence was 11.2% (56/501) in our Black RA population being studied. Mean age at cancer diagnosis was 59.9 ± 5.2 for the patients who developed cancer before RA diagnosis and 58.25 ± 16.02 for those who developed malignancy after RA diagnosis. There were 18 breast cancers, 4 colon and 4 cervical cancers; for lung, multiple myeloma, thyroid, squamous cell carcinoma and pancreas there were 3 cases each; for endometrial, Non-Hodgkin's lymphoma, meningioma and prostate, 2 cases each and 1 each for urinary bladder, esophageal adenocarcinoma, lymphoma, glioblastoma, liver, Hodgkin's lymphoma, sarcoma, ovary and renal cell carcinoma. No differences were found in years of RA duration, joint erosion, joint space narrowing or SENS score except for significantly higher ESR among the cancer group and RF seropositivity in the non-cancer group.Therapeutic modalities were not significantly different between the cancer and no cancer groups. CONCLUSION Breast cancer was the most prevalent malignancy among our Black RA population. Further studies are needed to identify the contributing factors to the malignancy risk of breast cancer in our Black RA population and whether it is gender-related since RA is more prevalence in women.
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Affiliation(s)
- Isabel M McFarlane
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Manjeet S Bhamra
- Department of Medicine, Division of Rheumatology SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Abhimnayu Amarnani
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Su Yien Zhaz
- NCH Healthcare System Department of Rheumatology, Naples, FL 34110, USA
| | - Srinivas Kolla
- Department of Radiology SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
| | - Milena Rodriguez Alvarez
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - George Mo
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Maya Srinivasan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Gil Hevroni
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Talia Meisel
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Abida Hasan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Marie S Baguidy
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Michael Hadaddin
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Adielle Melamed
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Kristaq Koci
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Nicholas Taklalsingh
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Joshy Pathiparampil
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Latoya Freeman
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Ian Kaplan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Naureen Kabani
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | | | - Elsie Watler
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Mosab Frefer
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Vytas Vaitkus
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Keron Matthew
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Fray Arroyo-Mercado
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Helen Lyo
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Aleksander Feoktistov
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Randolph Sanchez
- Department of Rheumatology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Faisal Soliman
- Department of Internal Medicine, Baptist Memorial Hospital-Tipton, 1995 Highway 51, South Covington, TN 38019, USA
| | - Felix Reyes Valdez
- Department of Pulmonary and Critical Care, Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY 10468, USA
| | - Veena Dronamraju
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Michael Trevisonno
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Christon Grant
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Guerrier Clerger
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Kunfeng Sun
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Khabbab Amin
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Makeda Dawkins
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Jason Green
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Samir Fahmy
- NCH Healthcare System Department of Rheumatology, Naples, FL 34110, USA
| | - Apoorva Jayarangaiah
- Department of Internal Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, NY, USA
| | - Stephen Anthony Waite
- Department of Radiology SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
| | - Aaliya Burza
- Department of Medicine, Division of Pulmonary and Critical Care State, SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
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Fleisher JE, Sweeney MM, Oyler S, Meisel T, Friede N, Di Rocco A, Chodosh J. Disease severity and quality of life in homebound people with advanced Parkinson disease: A pilot study. Neurol Clin Pract 2019; 10:277-286. [PMID: 32983607 DOI: 10.1212/cpj.0000000000000716] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022]
Abstract
Background As Parkinson disease (PD) progresses, symptoms increase, quality of life (QoL) declines, and individuals may become homebound, often losing access to neurologic care. We aimed to determine whether facilitating expert in-home care could improve our understanding of disease progression, treatment options, and unmet needs in this vulnerable population, and whether such a model could mitigate decline in QoL. Methods Patients with PD meeting Medicare homebound criteria were eligible for quarterly interdisciplinary home visits over 12 months. Each visit entailed an evaluation by a movement disorders neurologist, social worker, and nurse, including history, examination, medication reconciliation, psychosocial evaluation, pharmacologic and nonpharmacologic management, and service referrals. Disease severity, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS), and QoL using the Neuro-QoL were measured at visits 1 and 4. Results Of 27 enrolled patients, 23 completed 4 visits, with high retention and high patient- and caregiver-reported satisfaction. The mean age at baseline was 80.9 years (SD 7.8) with a mean total UPDRS of 65.0 (SD 20.0). After one year of home visits, total UPDRS worsened by a mean of 11.8 points (p < 0.01) without a change in any of 8 QoL domains (p = 0.19-0.95). Conclusions Homebound individuals with advanced PD receiving interdisciplinary home visits experienced no significant decline in QoL over 1 year, despite disease progression. Our findings highlight the disease severity and impaired QoL of the advanced, homebound PD population, and the potential for novel approaches to foster continuity of care.
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Affiliation(s)
- Jori E Fleisher
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Meghan M Sweeney
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Sarah Oyler
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Talia Meisel
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Naomi Friede
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Alessandro Di Rocco
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Joshua Chodosh
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
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Fleisher JE, Sweeney MM, Oyler S, Meisel T, Friede N, Di Rocco A, Chodosh J. Disease severity and quality of life in homebound people with advanced Parkinson disease: A pilot study. Neurol Clin Pract 2019. [PMID: 32983607 DOI: 10.1212/cpj.0000000000000716 10.1212/cpj.0000000000000716] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background As Parkinson disease (PD) progresses, symptoms increase, quality of life (QoL) declines, and individuals may become homebound, often losing access to neurologic care. We aimed to determine whether facilitating expert in-home care could improve our understanding of disease progression, treatment options, and unmet needs in this vulnerable population, and whether such a model could mitigate decline in QoL. Methods Patients with PD meeting Medicare homebound criteria were eligible for quarterly interdisciplinary home visits over 12 months. Each visit entailed an evaluation by a movement disorders neurologist, social worker, and nurse, including history, examination, medication reconciliation, psychosocial evaluation, pharmacologic and nonpharmacologic management, and service referrals. Disease severity, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS), and QoL using the Neuro-QoL were measured at visits 1 and 4. Results Of 27 enrolled patients, 23 completed 4 visits, with high retention and high patient- and caregiver-reported satisfaction. The mean age at baseline was 80.9 years (SD 7.8) with a mean total UPDRS of 65.0 (SD 20.0). After one year of home visits, total UPDRS worsened by a mean of 11.8 points (p < 0.01) without a change in any of 8 QoL domains (p = 0.19-0.95). Conclusions Homebound individuals with advanced PD receiving interdisciplinary home visits experienced no significant decline in QoL over 1 year, despite disease progression. Our findings highlight the disease severity and impaired QoL of the advanced, homebound PD population, and the potential for novel approaches to foster continuity of care.
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Affiliation(s)
- Jori E Fleisher
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Meghan M Sweeney
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Sarah Oyler
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Talia Meisel
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Naomi Friede
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Alessandro Di Rocco
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Joshua Chodosh
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
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9
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Nwabuobi L, Barbosa W, Sweeney M, Oyler S, Meisel T, Di Rocco A, Chodosh J, Fleisher JE. Sex-related differences in homebound advanced Parkinson's disease patients. Clin Interv Aging 2019; 14:1371-1377. [PMID: 31534322 PMCID: PMC6681424 DOI: 10.2147/cia.s203690] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/01/2019] [Accepted: 05/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background Women with Parkinson’s disease (PD) are more likely to be older, have greater disease severity and comorbidities, and yet are less likely to receive care from a neurologist, as compared with men with PD. Within the PD population, homebound individuals are a particularly vulnerable group facing significant barriers to care, yet within this understudied population, sex-related differences have not been reported. Purpose To identify and describe differences in homebound men and women with advanced PD and related disorders, participating in an interdisciplinary home visit program. Patients and methods This was an exploratory analysis of homebound patients seen between February 2014 and July 2016 using data collected via in-person interviews and chart review. Results We enrolled 85 patients, of whom 52% were women. PD was the most common diagnosis (79%), followed by dementia with Lewy bodies (5%), and other atypical parkinsonism (16%). Men were more likely to have a PD dementia diagnosis than women (17.1% vs 2.3%, p=0.03). Women were more likely to live alone (18.1% of women had no caregiver vs 2.4% of men, p=0.05). Conclusion The role of the caregiver in facilitating safe aging-in-place is crucial. Among homebound individuals with advanced PD, women were far more likely to live alone. The absence of a spouse or care partner may be due in part to variable sex-based life expectancies. Our findings suggest that homebound women with advanced PD may face greater barriers to accessing support.
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Affiliation(s)
- Lynda Nwabuobi
- Department of Neurology, Movement Disorders Division, Columbia University Medical Center, New York, NY, USA
| | | | - Meghan Sweeney
- Department of Palliative Care, Kaiser Permanente, Lafayette, CO, USA
| | - Sarah Oyler
- Intermountain Neurosciences Institute, Intermountain Medical Center, Murray, UT, USA
| | - Talia Meisel
- State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, USA
| | - Alessandro Di Rocco
- Department of Neurology, Movement Disorders Division, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, New York University Langone Health, New York, NY, USA.,Veterans Affairs NY Harbor Healthcare System, NY, New York, USA
| | - Jori E Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, USA
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10
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Fleisher J, Barbosa W, Sweeney MM, Oyler SE, Lemen AC, Fazl A, Ko M, Meisel T, Friede N, Dacpano G, Gilbert RM, Di Rocco A, Chodosh J. Interdisciplinary Home Visits for Individuals with Advanced Parkinson's Disease and Related Disorders. J Am Geriatr Soc 2018; 66:1226-1232. [PMID: 29608779 DOI: 10.1111/jgs.15337] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Parkinson's disease (PD) is a complex, multisymptom, neurodegenerative disease affecting primarily older adults. With progression, many individuals become homebound and removed from coordinated, expert care, resulting in excess morbidity, mortality, and healthcare expenditures in acute care settings and institutions. Home visit care models have achieved the triple aim of improving individual and population health while reducing costs in many frail, community-dwelling geriatric cohorts. This study details a novel, interdisciplinary home visit program specifically designed for individuals with PD and related disorders and their family caregivers built upon best practice principles in the care of multimorbid older adults. At each quarterly home visit, a movement disorders-trained neurologist, social worker, and nurse work in parallel with the individual and caregiver to complete a history, physical, detailed medication reconciliation, psychosocial needs assessment, and home safety assessment. A comprehensive, person-centered plan is agreed upon, referrals to community resources are made, standardized documentation is shared, and follow-up communication is instituted. In the first 2 years, 272 visits were conducted with 85 individuals who represent one of the oldest, most disabled PD populations reported. Satisfaction with and retention in the program were high. This study represents the first translation of the success of interdisciplinary and home-based geriatric care models to a population with a specific neurological disease. Preliminary evidence supports the need for such programs in vulnerable populations. Future studies will prospectively assess person-centered outcomes, the effect of using telemedicine on sustainability, and cost effectiveness.
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Affiliation(s)
- Jori Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush Medical College, Rush Medical University, Chicago, Illinois.,Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York
| | - William Barbosa
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Meghan M Sweeney
- Kaiser Permanente, Department of Palliative Care, Lafayette, Colorado
| | - Sarah E Oyler
- Movement Disorders, Intermountain Medical Center, Murray, Utah
| | - Amy C Lemen
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Arash Fazl
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Mia Ko
- Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Talia Meisel
- Downstate Medical Center College of Medicine, State University of New York, Brooklyn, New York
| | - Naomi Friede
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Geraldine Dacpano
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Rebecca M Gilbert
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Alessandro Di Rocco
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, School of Medicine, New York University, New York, New York.,Medicine Service, Veterans Affairs New York Harbor Healthcare System, New York, New York
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11
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Blecker S, Meisel T, Dickson VV, Shelley D, Horwitz LI. "We're Almost Guests in Their Clinical Care": Inpatient Provider Attitudes Toward Chronic Disease Management. J Hosp Med 2017; 12:162-167. [PMID: 28272592 PMCID: PMC5520967 DOI: 10.12788/jhm.2699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Many hospitalized patients have at least 1 chronic disease that is not optimally controlled. The purpose of this study was to explore inpatient provider attitudes about chronic disease management and, in particular, barriers and facilitators of chronic disease management in the hospital. METHODS We conducted a qualitative study of semi-structured interviews of 31 inpatient providers from an academic medical center. We interviewed attending physicians, resident physicians, physician assistants, and nurse practitioners from various specialties about attitudes, experiences with, and barriers and facilitators towards chronic disease management in the hospital. Qualitative data were analyzed using constant comparative analysis. RESULTS Providers perceived that hospitalizations offer an opportunity to improve chronic disease management, as patients are evaluated by a new care team and observed in a controlled environment. Providers perceived clinical benefits to in-hospital chronic care, including improvements in readmission and length of stay, but expressed concerns for risks related to adverse events and distraction from the acute problem. Barriers included provider lack of comfort with managing chronic diseases, poor communication between inpatient and outpatient providers, and hospital-system focus on patient discharge. A strong relationship with the outpatient provider and involvement of specialists were facilitators of inpatient chronic disease management. CONCLUSIONS Providers perceived benefits to in-hospital chronic disease management for both processes of care and clinical outcomes. Efforts to increase inpatient chronic disease management will need to overcome barriers in multiple domains. Journal of Hospital Medicine 2017;12:162-167.
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Affiliation(s)
- Saul Blecker
- Department of Population Health, New York University School of Medicine, New York, New York
- Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center, New York, New York
- Department of Medicine, New York University School of Medicine, New York, New York
- Address for correspondence and reprint requests: Saul Blecker, MD, MHS, New York University School of Medicine, 227 E. 30th St., Room 648, New York, NY 10016; Telephone: 646-501-2513; Fax: 646-501-2706;
| | - Talia Meisel
- Department of Population Health, New York University School of Medicine, New York, New York
| | | | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, New York
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Leora I. Horwitz
- Department of Population Health, New York University School of Medicine, New York, New York
- Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center, New York, New York
- Department of Medicine, New York University School of Medicine, New York, New York
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Lippert CM, Meisel T, Becht E, Staehler G. A new concept of continuous gemcitabine infusion: Fixed-dose-rate gemcitabine plus Platinum in metastatic transitional cancer –preliminary results of a phase I study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4641] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. M. Lippert
- Heidelberg University, Lambsheim, Germany; Heidelberg University, Heidelberg, Germany; Northwest-Hospital, Frankfurt University, Frankfurt, Germany
| | - T. Meisel
- Heidelberg University, Lambsheim, Germany; Heidelberg University, Heidelberg, Germany; Northwest-Hospital, Frankfurt University, Frankfurt, Germany
| | - E. Becht
- Heidelberg University, Lambsheim, Germany; Heidelberg University, Heidelberg, Germany; Northwest-Hospital, Frankfurt University, Frankfurt, Germany
| | - G. Staehler
- Heidelberg University, Lambsheim, Germany; Heidelberg University, Heidelberg, Germany; Northwest-Hospital, Frankfurt University, Frankfurt, Germany
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Moser J, Wegscheider W, Meisel T, Fellner N. An uncertainty budget for trace analysis by isotope-dilution ICP-MS with proper consideration of correlation. Anal Bioanal Chem 2003; 377:97-110. [PMID: 12898118 DOI: 10.1007/s00216-003-2028-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2003] [Revised: 04/17/2003] [Accepted: 05/05/2003] [Indexed: 11/28/2022]
Abstract
Isotope-dilution mass spectrometry (IDMS) is considered to be a method without significant correction factors. It is also believed that this method is well understood. But unfortunately a large number of different uncertainty budgets have been published that consider different correction factors. These differences lead to conflicting combined uncertainties especially in trace analysis. It is described how the known correction factors must be considered in the uncertainty budget of values determined by IDMS combined with ICP-MS (ICP-IDMS). The corrections applied are dead time, background, interference, mass discrimination, blank correction and air buoyancy.IDMS measurements consist always of a series of isotope abundance ratio measurements and can be done according to different measurement protocols. Because the measurement protocols of IDMS are often rather sophisticated, correlations of influence quantities are difficult to identify. Therefore the measurement protocol has to be carefully considered in the specification of the measurand and a strategy is presented to properly account for these correlations. This will be exemplified for the estimation of mass fractions of platinum group elements (PGEs) and Re in the geological reference material UB-N (from CRPG-CNRS, Nancy in France) with ICP-IDMS. The PGEs with more than one isotope and the element Re are measured with on-line cation-exchange chromatography coupled to a quadrupole ICP-MS. All contents are below 10 microg kg(-1). Only osmium is separated from the matrix by direct sparging of OsO(4) into the plasma. This leads to transient signals for all PGEs and Re. It is possible to estimate the combined uncertainties and keep them favourably small despite the low contents, the transient signals and the sophisticated correction model.
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Affiliation(s)
- J Moser
- Department of General and Analytical Chemistry, University of Leoben, 8700 Leoben, Austria.
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Meisel T, Moser J, Wegscheider W. Recognizing heterogeneous distribution of platinum group elements (PGE) in geological materials by means of the Re-Os isotope system. Fresenius J Anal Chem 2001; 370:566-72. [PMID: 11496988 DOI: 10.1007/s002160100791] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The identification of uncertainties caused by sample inhomogeneity, as distinct from those caused by sample preparation and measurement, is a challenging task. Use of chemometric methods to separate and estimate these contributions to the combined standard uncertainty of a measurement (uc) of an analytical result requires complex experiments. The difficulty of platinum group element measurement makes this task even more complex. But unless it can be demonstrated that sample inhomogeneity is the major contributor to the high variability of an analytical result one should be careful not to mistakenly attribute this to a nugget effect. In this contribution we are able to demonstrate in two special cases that irreproducible results (up to 90% RSD) for analysis of Os and Re in the pg g(-1) to ng g(-1) range are truly caused by a nugget effect and not by inadequacies of the analytical method.
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Affiliation(s)
- T Meisel
- General and Analytical Chemistry, University of Leoben, Austria.
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Meisel T, Moser J, Fellner N, Wegscheider W, Schoenberg R. Simplified method for the determination of Ru, Pd, Re, Os, Ir and Pt in chromitites and other geological materials by isotope dilution ICP-MS and acid digestion. Analyst 2001; 126:322-8. [PMID: 11284333 DOI: 10.1039/b007575m] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A method for the determination of low Ru, Pd, Re, Os, Ir and Pt abundances in geological reference materials by isotope dilution inductively coupled plasma mass spectrometry (ICP-MS) after acid digestion in a high pressure asher (HPA-S) is presented. The digestion technique is similar to that using Carius tubes but easier to handle and reaches higher temperatures. Osmium can be determined as OsO4 with ICP-MS directly after digestion through a sparging technique. The remaining elements are preconcentrated by means of anion column chromatography. The resin is digested directly without elution leading to high yields but this causes problems if Zr is present at higher levels in the silicate rich materials. The analytical results for international platinum group element (PGE) reference materials, chromitite CHR-Bkg, basalt TDB-1 and gabbro WGB-1, are presented and compared with literature data, demonstrating the validity of the described method. Although higher in concentration, PGEs determined for reference material WGB-1 were worse than for TDB-1 indicating a more inhomogeneous distribution of the platinum group mineral phases. The low PGE abundance chromitite standard, CHR-Bkg, is likely to be homogeneous for Ru, Re, Os and Ir and is recommended as a reference material for the study of chromitites. Detection limits (3s x total procedure blank) range from 0.012 ng (Re and Os) to 0.77 ng (Pt), which could be further improved by applying higher quality acids.
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Affiliation(s)
- T Meisel
- General and Analytical Chemistry, University of Leoben, Franz-Josef-Str. 18, A-8700 Leoben, Austria.
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Bondeson E, Meisel T, Eggertsen R. [A simple health control for the elderly. Screening for vitamin B12 deficiency and thyroid disease]. Lakartidningen 1997; 94:4329-32. [PMID: 9424529] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Screening for vitamin B12 deficiency and thyroid disease is cheap and enables early diagnosis to be made and treatment to be started while it is still simple and can prevent the development of such serious conditions as dementia, depression, or irreversible tissue damage. In 1995-6, 83% (126/151) of all 75-year-olds in Härryda, a district (population 28,500) to the east of Gothenburg, agreed to undergo a health control designed to detect hypo- or hyper-thyroidism or vitamin B12 deficiency among elderly residents without symptoms (or with atypical symptoms not easily recognised). Of the 126 participants, four (3%) had low plasma cobalamin (vitamin B12) levels (a figure similar to or lower than those reported by others), and were treated with vitamin B12 after further examination; eight (6%) had serum thyroid stimulating hormone (TSH) levels below the lower normal limit, though further examination showed all eight to be euthyroid; and two (1.6%) were diagnosed as being hypothyroid (a lower prevalence than figures reported elsewhere), and were treated with laevothyroxine. The findings suggest that such screening might be useful in primary care. However, the clinical diagnosis of vitamin B12 deficiency, and of hypo- or hyperthyroidism, is often difficult, especially in the elderly; and although a low serum TSH level is also considered to be a reliable marker of hyperthyroidism, like others this study showed that it may occur even in the absence of disease. Thus, serum TSH and plasma B12 levels are useful screening variables, but need to be complemented by other tests before diagnosis is set.
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Cserfalvi T, Meisel T, Pungor E. Determination of the electrokinetic potential of dispersion and macromolecular colloids by measurement of the streaming potential. I. ACTA ACUST UNITED AC 1974. [DOI: 10.1016/s0022-0728(74)80075-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Erdey L, Balla J, Halmos Z, Meisel T. Analysis of the products of hydroammonolysis of acetone. J Chromatogr A 1970. [DOI: 10.1016/s0021-9673(00)84003-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Erdey L, Meisel T, Mohos B, Tüdös F. Electron spin resonance analysis of the redox indicator variamine blue II. Talanta 1967; 14:1477-85. [DOI: 10.1016/0039-9140(67)80170-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/1967] [Accepted: 06/16/1967] [Indexed: 11/15/2022]
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Erdey L, M�zor L, Meisel T. Argentometrische Mikrobestimmung organischer Halogen-verbindungen nach Verbrennung in Anwesenheit von Variaminblau als Indikator. Mikrochim Acta 1958. [DOI: 10.1007/bf01258893] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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