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Your search keyword '"Blecker, Saul"' showing total 287 results
Start Over Author "Blecker, Saul" Publication Type Academic Journals
287 results on '"Blecker, Saul"'

2. Interindividual Variability in Self-Monitoring of Blood Pressure Using Consumer-Purchased Wireless Devices

Author

Zheng, Yaguang, Zhang, Yanfu, Huang, Heng, Tison, Geoffrey H, Burke, Lora E, Blecker, Saul, Dickson, Victoria Vaughan, Olgin, Jeffrey E, Marcus, Gregory M, and Pletcher, Mark J

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Cardiovascular, Humans, Male, Middle Aged, Female, Blood Pressure, Prospective Studies, Blood Pressure Monitoring, Ambulatory, Longitudinal Studies, Hypertension, blood pressure, blood pressure monitoring, mobile health, self, Nursing, Midwifery
Abstract

BackgroundEngagement with self-monitoring of blood pressure (BP) declines, on average, over time but may vary substantially by individual.ObjectivesWe aimed to describe different 1-year patterns (groups) of self-monitoring of BP behaviors, identify predictors of those groups, and examine the association of self-monitoring of BP groups with BP levels over time.MethodsWe analyzed device-recorded BP measurements collected by the Health eHeart Study-an ongoing prospective eCohort study-from participants with a wireless consumer-purchased device that transmitted date- and time-stamped BP data to the study through a full 12 months of observation starting from the first day they used the device. Participants received no instruction on device use. We applied clustering analysis to identify 1-year self-monitoring, of BP patterns.ResultsParticipants had a mean age of 52 years and were male and White. Using clustering algorithms, we found that a model with three groups fit the data well: persistent daily use (9.1% of participants), persistent weekly use (21.2%), and sporadic use only (69.7%). Persistent daily use was more common among older participants who had higher Week 1 self-monitoring of BP frequency and was associated with lower BP levels than the persistent weekly use or sporadic use groups throughout the year.ConclusionWe identified three distinct self-monitoring of BP groups, with nearly 10% sustaining a daily use pattern associated with lower BP levels.

Published
2023

9. Mineralocorticoid receptor antagonist use after hospitalization of patients with heart failure and post-discharge outcomes: a single-center retrospective cohort study

Author

Durstenfeld, Matthew S, Katz, Stuart D, Park, Hannah, and Blecker, Saul

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Cardiovascular, Clinical Research, Good Health and Well Being, Aged, Aged, 80 and over, Drug Prescriptions, Drug Utilization, Female, Heart Failure, Humans, Male, Middle Aged, Mineralocorticoid Receptor Antagonists, New York City, Patient Admission, Patient Discharge, Patient Readmission, Practice Patterns, Physicians', Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Mineralocorticoid, Aldosterone, Hospitalization, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

BackgroundMineralocorticoid receptor antagonists (MRA) are an underutilized therapy for heart failure with a reduced ejection fraction (HFrEF), but the current impact of hospitalization on MRA use is not well characterized. The objective of this study was to describe contemporary MRA prescription for heart failure patients before and after the full scope of hospitalizations and the association between MRA discharge prescription and post-hospitalization outcomes.MethodsWe conducted a retrospective cohort study at an academic hospital system in 2013-2016. Among 1500 included hospitalizations of 1009 unique patients with HFrEF and without MRA contraindication, the mean age was 71.9 ± 13.6 years and 443 (29.5%) were female. We compared MRA prescription before and after hospitalizations with McNemar's test and between patients with principal and secondary diagnoses of HFrEF with the chi-square test, and association of MRA discharge prescription with 30-day and 180-day mortality and readmissions using generalized estimating equations.ResultsMRA prescriptions increased from 303 (20.2%) to 375 (25.0%) at discharge (+4.8%, p

Published
2019

17. Understanding provider use of a new clinical decision support tool aimed at reducing excess telemetry in an academic health system: A retrospective study.

Author

Hatley, Maya, Korostoff‐Larsson, Olivia, Malik, Tahir, Blecker, Saul, and Eaton, Kevin P.

Subjects
MEDICAL care use, ACADEMIC medical centers, CORONARY care units, CLINICAL decision support systems, RETROSPECTIVE studies, BEHAVIOR, BIOTELEMETRY, MEDICAL records, ACQUISITION of data, PHYSICIAN practice patterns, CONFIDENCE intervals, STROKE, PHYSICIANS, PATIENT monitoring, TIME
Abstract

Rationale: Cardiac monitoring has often been identified as an area of overutilization and remains a limited resource in many hospitals. With the aim of reducing telemetry overuse, we added clinical decision support to our health system's telemetry order with guidance on appropriate indications for monitoring. The new order requires selection of an appropriate clinical indication. Aims and Objectives: In this study, we aimed to understand provider engagement with this tool by assessing concordance between selected indications within the order and the clinical presence of those conditions as documented within the patient chart. Methods: We randomly selected 100 telemetry orders from July to October 2022 across four different hospitals at NYU Langone Health. Two independent, blinded reviewers used a structured protocol to identify documentation of actual indications for telemetry in each selected chart. We calculated the rate of concordance between indications selected in the order and indications that were determined to be clinically present on chart review. Results: There were 30,839 telemetry orders placed during the study timeframe. Overall concordance between the selection within the order and the actual indication was 48% (95% confidence interval [CI], 38.21%−57.79%). We observed especially low concordance rates for vague indications, such as 'Other', and for 'Confirmed Stroke', which was the only indication allowing for indefinite telemetry. Conclusion: The overall low concordance suggests a disconnect between the support tool and clinical practice. Providers are more likely to select an indication that reduces downstream work regardless of a patient's true clinical indication. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Clinical Decision Support for Hypertension Management in Chronic Kidney Disease: A Randomized Clinical Trial.

Author

Samal, Lipika, Kilgallon, John L., Lipsitz, Stuart, Baer, Heather J., McCoy, Allison, Gannon, Michael, Noonan, Sarah, Dunk, Ryan, Chen, Sarah W., Chay, Weng Ian, Fay, Richard, Garabedian, Pamela M., Wu, Edward, Wien, Matthew, Blecker, Saul, Salmasian, Hojjat, Bonventre, Joseph V., McMahon, Gearoid M., Bates, David W., and Waikar, Sushrut S.

Published
2024
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35. Evaluating Whether an Inpatient Initiative to Time Lab Draws in the Evening Reduces Anemia.

Author

Zaretsky, Jonah, Eaton, Kevin P, Sonne, Christopher, Zhao, Yunan, Jones, Simon, Hochman, Katherine, and Blecker, Saul

Subjects
ANEMIA, HEMOGLOBINS, POSTURE, MORNING
Abstract

Background: Hospital acquired anemia is common during admission and can result in increased transfusion and length of stay. Recumbent posture is known to lead to lower hemoglobin measurements. We tested to see if an initiative promoting evening lab draws would lead to higher hemoglobin measurements due to more time in upright posture during the day and evening. Methods: We included patients hospitalized on 2 medical units, beginning March 26, 2020 and discharged prior to January 25, 2021. On one of the units, we implemented an initiative to have routine laboratory draws in the evening rather than the morning starting on August 26, 2020. There were 1217 patients on the control unit and 1265 on the intervention unit during the entire study period. First we used a linear mixed-effects model to see if timing of blood draw was associated with hemoglobin level in the pre-intervention period. We then compared levels of hemoglobin before and after the intervention using a difference-in-difference analysis. Results: In the pre-intervention period, evening blood draws were associated with higher hemoglobin compared to morning (0.28; 95% CI, 0.22–0.35). Evening blood draws increased with the intervention (10.3% vs 47.9%, P > 0.001). However, the intervention floor was not associated with hemoglobin levels in difference-in-difference analysis (coefficient of −0.15; 95% CI, −0.51–0.21). Conclusions: While evening blood draws were associated with higher hemoglobin levels, an intervention that successfully changed timing of routine labs to the evening did not lead to an increase in hemoglobin levels. [ABSTRACT FROM AUTHOR]

Published
2023
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