721 results on '"Sun, Benjamin"'
Search Results
2. Plasma proteomic associations with genetics and health in the UK Biobank
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Sun, Benjamin B., Chiou, Joshua, Traylor, Matthew, Benner, Christian, Hsu, Yi-Hsiang, Richardson, Tom G., Surendran, Praveen, Mahajan, Anubha, Robins, Chloe, Vasquez-Grinnell, Steven G., Hou, Liping, Kvikstad, Erika M., Burren, Oliver S., Davitte, Jonathan, Ferber, Kyle L., Gillies, Christopher E., Hedman, Åsa K., Hu, Sile, Lin, Tinchi, Mikkilineni, Rajesh, Pendergrass, Rion K., Pickering, Corran, Prins, Bram, Baird, Denis, Chen, Chia-Yen, Ward, Lucas D., Deaton, Aimee M., Welsh, Samantha, Willis, Carissa M., Lehner, Nick, Arnold, Matthias, Wörheide, Maria A., Suhre, Karsten, Kastenmüller, Gabi, Sethi, Anurag, Cule, Madeleine, Raj, Anil, Burkitt-Gray, Lucy, Melamud, Eugene, Black, Mary Helen, Fauman, Eric B., Howson, Joanna M. M., Kang, Hyun Min, McCarthy, Mark I., Nioi, Paul, Petrovski, Slavé, Scott, Robert A., Smith, Erin N., Szalma, Sándor, Waterworth, Dawn M., Mitnaul, Lyndon J., Szustakowski, Joseph D., Gibson, Bradford W., Miller, Melissa R., and Whelan, Christopher D.
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- 2023
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3. Rare variant associations with plasma protein levels in the UK Biobank
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Dhindsa, Ryan S., Burren, Oliver S., Sun, Benjamin B., Prins, Bram P., Matelska, Dorota, Wheeler, Eleanor, Mitchell, Jonathan, Oerton, Erin, Hristova, Ventzislava A., Smith, Katherine R., Carss, Keren, Wasilewski, Sebastian, Harper, Andrew R., Paul, Dirk S., Fabre, Margarete A., Runz, Heiko, Viollet, Coralie, Challis, Benjamin, Platt, Adam, Vitsios, Dimitrios, Ashley, Euan A., Whelan, Christopher D., Pangalos, Menelas N., Wang, Quanli, and Petrovski, Slavé
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- 2023
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4. Associations of plasma proteomics with type 2 diabetes and related traits: results from the longitudinal KORA S4/F4/FF4 Study
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Luo, Hong, Bauer, Alina, Nano, Jana, Petrera, Agnese, Rathmann, Wolfgang, Herder, Christian, Hauck, Stefanie M., Sun, Benjamin B., Hoyer, Annika, Peters, Annette, and Thorand, Barbara
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- 2023
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5. Promises and Challenges of populational Proteomics in Health and Disease
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Sun, Benjamin B., Suhre, Karsten, and Gibson, Bradford W.
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- 2024
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6. Traversing Steep and Granular Martian Analog Slopes With a Dynamic Quadrupedal Robot
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Kolvenbach, Hendrik, Arm, Philip, Hampp, Elias, Dietsche, Alexander, Bickel, Valentin, Sun, Benjamin, Meyer, Christoph, and Hutter, Marco
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Computer Science - Robotics - Abstract
Celestial bodies such as the Moon and Mars are mainly covered by loose, granular soil, a notoriously challenging terrain to traverse with (wheeled) robotic systems. Here, we present experimental work on traversing steep, granular slopes with the dynamically walking quadrupedal robot SpaceBok. To adapt to the challenging environment, we developed passive-adaptive planar feet and optimized grouser pads to reduce sinkage and increase traction on planar and inclined granular soil. Single-foot experiments revealed that a large surface area of 110cm2 per foot reduces sinkage to an acceptable level even on highly collapsible soil (ES-1). Implementing several 12mm grouser blades increases traction by 22% to 66% on granular media compared to grouser-less designs. Together with a terrain-adapting walking controller, we validate - for the first time - static and dynamic locomotion on Mars analog slopes of up to 25{\deg}(the maximum of the testbed). We evaluated the performance between point- and planar feet and static and dynamic gaits regarding stability (safety), velocity, and energy consumption. We show that dynamic gaits are energetically more efficient than static gaits but are riskier on steep slopes. Our tests also revealed that planar feet's energy consumption drastically increases when the slope inclination approaches the soil's angle of internal friction due to shearing. Point feet are less affected by slippage due to their excessive sinkage, but in turn, are prone to instabilities and tripping. We present and discuss safe and energy-efficient global path-planning strategies for accessing steep topography on Mars based on our findings.
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- 2021
7. Evaluating Sex Disparities in the Emergency Department Management of Patients With Suspected Acute Coronary Syndrome
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Preciado, Salena M, Sharp, Adam L, Sun, Benjamin C, Baecker, Aileen, Wu, Yi-Lin, Lee, Ming-Sum, Shen, Ernest, Ferencik, Maros, Natsui, Shaw, Kawatkar, Aniket A, Park, Stacy J, and Redberg, Rita F
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Biomedical and Clinical Sciences ,Clinical Sciences ,Health Services ,Heart Disease ,Emergency Care ,Heart Disease - Coronary Heart Disease ,Cardiovascular ,Clinical Research ,7.3 Management and decision making ,Management of diseases and conditions ,Acute Coronary Syndrome ,Aged ,Critical Pathways ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Retrospective Studies ,Risk Assessment ,Sex Factors ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Study objectiveWe compare clinical management and outcomes of emergency department (ED) encounters by sex after implementation of a clinical care pathway in 15 community EDs that standardized recommendations based on patient risk, using the History, ECG, Age, Risk Factors, and Troponin (HEART) score.MethodsThis was a retrospective analysis of adult ED encounters evaluated for suspected acute coronary syndrome with a documented HEART score from May 20, 2016, to December 1, 2017. The primary outcomes were hospitalization or 30-day stress testing. Secondary outcomes included 30-day acute myocardial infarction or all-cause death (major adverse cardiac event). A generalized estimating equation regression model was used to compare the odds of hospitalization or stress testing by sex; we report HEART scores (0 to 10) stratified by sex and describing major adverse cardiac events.ResultsA total of 34,715 adult ED encounters met the inclusion criteria (56.0% women). A higher proportion of women were classified as low risk (60.5% versus 52.4%; odds ratio [OR] 1.39; 95% confidence interval [CI] 1.33 to 1.45). Women were hospitalized or received stress testing less frequently than men for low HEART scores (18.8% versus 22.8%; OR 0.79; 95% CI 0.73 to 0.84) and intermediate ones (46.7% versus 49.7%; OR 0.88; 95% CI 0.83 to 0.95), but similarly for high-risk ones (74.1% versus 74.4%; OR 0.99; 95% CI 0.77 to 1.28). Women had 18% lower odds of hospitalization or noninvasive cardiac testing (OR 0.82; 95% CI 0.78 to 0.86), even after adjusting for HEART score and comorbidities. Men had higher risks of major adverse cardiac events than women for all HEART score categories but the risk for men was significantly higher among low-risk HEART scores (0.4% versus 0.1%).ConclusionWomen with low-risk HEART scores are hospitalized or stress tested less than men, which is likely appropriate, and women have better outcomes than men. Use of the HEART score has the potential to reduce sex disparities in acute coronary syndrome care.
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- 2021
8. Genome-Wide Association Study Identifies 4 Novel Risk Loci for Small Intestinal Neuroendocrine Tumors Including a Missense Mutation in LGR5
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Giri, Anil K., Aavikko, Mervi, Wartiovaara, Linnea, Lemmetyinen, Toni, Karjalainen, Juha, Mehtonen, Juha, Palin, Kimmo, Välimäki, Niko, Tamlander, Max, Saikkonen, Riikka, Karhu, Auli, Morgunova, Ekaterina, Sun, Benjamin, Runz, Heiko, Palta, Priit, Luo, Shuang, Joensuu, Heikki, Mäkelä, Tomi P., Kostiainen, Iiro, Schalin-Jäntti, Camilla, FinnGen, Palotie, Aarno, Aaltonen, Lauri A., Ollila, Saara, and Daly, Mark J.
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- 2023
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9. FinnGen provides genetic insights from a well-phenotyped isolated population
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Kurki, Mitja I., Karjalainen, Juha, Palta, Priit, Sipilä, Timo P., Kristiansson, Kati, Donner, Kati M., Reeve, Mary P., Laivuori, Hannele, Aavikko, Mervi, Kaunisto, Mari A., Loukola, Anu, Lahtela, Elisa, Mattsson, Hannele, Laiho, Päivi, Della Briotta Parolo, Pietro, Lehisto, Arto A., Kanai, Masahiro, Mars, Nina, Rämö, Joel, Kiiskinen, Tuomo, Heyne, Henrike O., Veerapen, Kumar, Rüeger, Sina, Lemmelä, Susanna, Zhou, Wei, Ruotsalainen, Sanni, Pärn, Kalle, Hiekkalinna, Tero, Koskelainen, Sami, Paajanen, Teemu, Llorens, Vincent, Gracia-Tabuenca, Javier, Siirtola, Harri, Reis, Kadri, Elnahas, Abdelrahman G., Sun, Benjamin, Foley, Christopher N., Aalto-Setälä, Katriina, Alasoo, Kaur, Arvas, Mikko, Auro, Kirsi, Biswas, Shameek, Bizaki-Vallaskangas, Argyro, Carpen, Olli, Chen, Chia-Yen, Dada, Oluwaseun A., Ding, Zhihao, Ehm, Margaret G., Eklund, Kari, Färkkilä, Martti, Finucane, Hilary, Ganna, Andrea, Ghazal, Awaisa, Graham, Robert R., Green, Eric M., Hakanen, Antti, Hautalahti, Marco, Hedman, Åsa K., Hiltunen, Mikko, Hinttala, Reetta, Hovatta, Iiris, Hu, Xinli, Huertas-Vazquez, Adriana, Huilaja, Laura, Hunkapiller, Julie, Jacob, Howard, Jensen, Jan-Nygaard, Joensuu, Heikki, John, Sally, Julkunen, Valtteri, Jung, Marc, Junttila, Juhani, Kaarniranta, Kai, Kähönen, Mika, Kajanne, Risto, Kallio, Lila, Kälviäinen, Reetta, Kaprio, Jaakko, Kerimov, Nurlan, Kettunen, Johannes, Kilpeläinen, Elina, Kilpi, Terhi, Klinger, Katherine, Kosma, Veli-Matti, Kuopio, Teijo, Kurra, Venla, Laisk, Triin, Laukkanen, Jari, Lawless, Nathan, Liu, Aoxing, Longerich, Simonne, Mägi, Reedik, Mäkelä, Johanna, Mäkitie, Antti, Malarstig, Anders, Mannermaa, Arto, Maranville, Joseph, Matakidou, Athena, Meretoja, Tuomo, Mozaffari, Sahar V., Niemi, Mari E. K., Niemi, Marianna, Niiranen, Teemu, O´Donnell, Christopher J., Obeidat, Ma´en, Okafo, George, Ollila, Hanna M., Palomäki, Antti, Palotie, Tuula, Partanen, Jukka, Paul, Dirk S., Pelkonen, Margit, Pendergrass, Rion K., Petrovski, Slavé, Pitkäranta, Anne, Platt, Adam, Pulford, David, Punkka, Eero, Pussinen, Pirkko, Raghavan, Neha, Rahimov, Fedik, Rajpal, Deepak, Renaud, Nicole A., Riley-Gillis, Bridget, Rodosthenous, Rodosthenis, Saarentaus, Elmo, Salminen, Aino, Salminen, Eveliina, Salomaa, Veikko, Schleutker, Johanna, Serpi, Raisa, Shen, Huei-yi, Siegel, Richard, Silander, Kaisa, Siltanen, Sanna, Soini, Sirpa, Soininen, Hilkka, Sul, Jae Hoon, Tachmazidou, Ioanna, Tasanen, Kaisa, Tienari, Pentti, Toppila-Salmi, Sanna, Tukiainen, Taru, Tuomi, Tiinamaija, Turunen, Joni A., Ulirsch, Jacob C., Vaura, Felix, Virolainen, Petri, Waring, Jeffrey, Waterworth, Dawn, Yang, Robert, Nelis, Mari, Reigo, Anu, Metspalu, Andres, Milani, Lili, Esko, Tõnu, Fox, Caroline, Havulinna, Aki S., Perola, Markus, Ripatti, Samuli, Jalanko, Anu, Laitinen, Tarja, Mäkelä, Tomi P., Plenge, Robert, McCarthy, Mark, Runz, Heiko, Daly, Mark J., and Palotie, Aarno
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- 2023
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10. Not all HEART scores are created equal: identifying “low‐risk” patients at higher risk
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Ioannides, Kimon LH, Sun, Benjamin C, Baecker, Aileen S, Redberg, Rita F, Lee, Ming‐Sum, Ferencik, Maros, Wu, Yi‐Lin, Shen, Ernest, Zheng, Chengyi, Musigdilok, Visanee, Park, Stacy J, and Sharp, Adam L
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Epidemiology ,Health Sciences ,Heart Disease ,Clinical Research ,Cardiovascular ,Atherosclerosis ,Prevention ,Patient Safety ,Heart Disease - Coronary Heart Disease ,acute coronary syndrome ,chest pain ,coronary artery disease ,HEART score ,myocardial infarction - Abstract
ObjectiveWe sought to identify sub-groups of "low-risk" HEART score patients (history, ECG, age, risk factors, and troponin) at elevated risk of acute myocardial infarction or death within 30 days.MethodsWe performed a secondary analysis of prospective emergency department (ED) encounters for suspected acute coronary syndrome in a large health system with low-risk HEART scores (0-5 points). Logistic regression using the 5 components of the HEART score analyzed the increase risk attributable to points from each of the 5 score components.ResultsOf 30,971 encounters among 28,992 unique patients, 135 (0.44%, 95% confidence interval [CI] = 0.37-0.51) experienced acute myocardial infarction or death. Risk increased for each component of the HEART score from 0 to 1 to 2 points (history, 0.4% to 0.5% to 0.6%; ECG, 0.3% to 0.7% to 0.7%; age, 0.2% to 0.3% to 0.7%; risk factors, 0.1% to 0.4% to 0.8%), except troponin, which had the highest risk with 1 point (troponin, 0.4% to 2.7% to 0.9%). Odds ratios from our regression, which adjusts for other components, showed a similar pattern (from 1 vs 0 and 2 vs 0 points, respectively: history, 1.0 and 1.8; ECG, 2.2 and 3.5; age, 1.2 and 2.1; risk factors, 2.4 and 4.2; and troponin, 6.0 and 3.6).ConclusionAmong "low-risk" suspected acute coronary syndrome encounters, increasing points within each of the 5 categories demonstrated small increases in risk of death or acute myocardial infarction, with the troponin and ECG components representing the largest risk increases.
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- 2020
11. The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope
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Chang, Anna Marie, Hollander, Judd E, Su, Erica, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Aging ,Aged ,Aged ,80 and over ,Cohort Studies ,Female ,Humans ,Inpatients ,Length of Stay ,Male ,Middle Aged ,Syncope ,case management ,geriatrics ,InterQual ,syncope ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
BackgroundMcKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown.ObjectiveWe sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope.MethodsWe conducted a secondary analysis of a cohort study of adults ≥60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights.ResultsWe analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 ± 9.0 years. The median LOS was 32.6 h (interquartile range 24.2-71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9-63.6%) and the specificity was 47.8% (95% confidence interval 45.0-50.5%).ConclusionsIn older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.
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- 2020
12. Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score
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Probst, Marc A, Gibson, Thomas, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Aging ,Cardiovascular ,Neurosciences ,Heart Disease ,Clinical Research ,Emergency Care ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Aged ,Area Under Curve ,Cardiovascular Diseases ,Emergency Service ,Hospital ,Female ,Health Status Indicators ,Humans ,Male ,Practice Guidelines as Topic ,Prospective Studies ,Risk Assessment ,Syncope ,United States ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Study objectiveOlder adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes.MethodsWe performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome.ResultsWe enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670).ConclusionAmong older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.
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- 2020
13. Practice Gap in Atrial Fibrillation Oral Anticoagulation Prescribing at Emergency Department Home Discharge
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Kea, Bory, Waites, Bethany T., Lin, Amber, Raitt, Merritt, Vinson, David R., Ari, Niroj, Welle, Luke, Sill, Andrew, Button, Dana, and Sun, Benjamin C.
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atrial fibrillation ,emergency department ,cardiology consult ,warfarin ,anticoagulation - Abstract
Introduction: Current U.S. cardiology guidelines recommend oral anticoagulation (OAC) to reduce stroke risk in selected patients with atrial fibrillation (AF), but no formal AF OAC recommendations exist to guide emergency medicine clinicians in the acute care setting. We sought to characterize emergency department (ED) OAC prescribing practices after an ED AF diagnosis.Methods: This retrospective study included index visits for OAC-naive patients ≥18 years old who were discharged home from the ED at an urban, academic, tertiary hospital with a primary diagnosis of AF from 2012-2014. Five hypothesis-blinded, chart reviewers abstracted data from patient problem lists and medical history in the electronic health record to assess stroke (CHA2DS2-VASc) and bleeding risk (HAS-BLED). The primary outcome was the provision of an OAC prescription at discharge in OAC-naive patients with high stroke risk. Descriptive statistics and multivariable logistic regression assessed associations between OAC prescription and patient characteristics.Results: We included 138 patient visits in our analysis, of whom 39.9% (n = 55) were low stroke risk (CHA2DS2-VASc = 0 in males and 1 in females), 15.9% (n = 22) were intermediate risk (CHA2DS2-VASc = 1 in males), and 44.2% (n = 61) were high risk (CHA2DS2-VASc ≥ 2). Of patients with high stroke risk and low-to-intermediate bleeding risk (n = 57), 80.7% were not prescribed an OAC at discharge. Cardiology consultation and female gender, but not stroke risk (CHA2DS2-VASc score), were predictors of an ED provider prescribing an OAC to an OAC-naive AF patient at ED discharge.Conclusion: The majority of OAC-eligible patients were discharged home without an OAC prescription. In OAC-naive patients discharged home from the ED, cardiology consultation and female gender were associated with OAC prescription. Our findings suggest that access to expert opinion may improve provider comfort with OAC prescribing and highlight the need for improved guidelines specific to ED-management of AF.
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- 2020
14. Orthostatic vital signs do not predict 30 day serious outcomes in older emergency department patients with syncope: A multicenter observational study
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White, Jennifer L, Hollander, Judd E, Chang, Anna Marie, Nishijima, Daniel K, Lin, Amber L, Su, Erica, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Nicks, Bret A, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Clinical Research ,Cardiovascular ,Heart Disease ,Emergency Care ,Aged ,Aged ,80 and over ,Case-Control Studies ,Electrocardiography ,Emergency Service ,Hospital ,Female ,Heart Diseases ,Humans ,Male ,Middle Aged ,Physical Examination ,Prospective Studies ,Syncope ,Vital Signs ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
BackgroundSyncope is a common chief complaint among older adults in the Emergency Department (ED), and orthostatic vital signs are often a part of their evaluation. We assessed whether abnormal orthostatic vital signs in the ED are associated with composite 30-day serious outcomes in older adults presenting with syncope.MethodsWe performed a secondary analysis of a prospective, observational study at 11 EDs in adults ≥ 60 years who presented with syncope or near syncope. We excluded patients lost to follow up. We used the standard definition of abnormal orthostatic vital signs or subjective symptoms of lightheadedness upon standing to define orthostasis. We determined the rate of composite 30-day serious outcomes, including those during the index ED visit, such as cardiac arrhythmias, myocardial infarction, cardiac intervention, new diagnosis of structural heart disease, stroke, pulmonary embolism, aortic dissection, subarachnoid hemorrhage, cardiopulmonary resuscitation, hemorrhage/anemia requiring transfusion, with major traumatic injury from fall, recurrent syncope, and death) between the groups with normal and abnormal orthostatic vital signs.ResultsThe study cohort included 1974 patients, of whom 51.2% were male and 725 patients (37.7%) had abnormal orthostatic vital signs. Comparing those with abnormal to those with normal orthostatic vital signs, we did not find a difference in composite 30-serious outcomes (111/725 (15.3%) vs 184/1249 (14.7%); unadjusted odds ratio, 1.05 [95%CI, 0.81-1.35], p = 0.73). After adjustment for gender, coronary artery disease, congestive heart failure (CHF), history of arrhythmia, dyspnea, hypotension, any abnormal ECG, physician risk assessment, medication classes and disposition, there was no association with composite 30-serious outcomes (adjusted odds ratio, 0.82 [95%CI, 0.62-1.09], p = 0.18).ConclusionsIn a cohort of older adult patients presenting with syncope who were able to have orthostatic vital signs evaluated, abnormal orthostatic vital signs did not independently predict composite 30-day serious outcomes.
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- 2019
15. EXACT Trial: Results of the Phase 1 Dose-Escalation Study
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Povsic, Thomas J., Henry, Timothy D., Traverse, Jay H., Anderson, R. David, Answini, Geoffrey A., Sun, Benjamin C., Arnaoutakis, George J., Boudoulas, Konstantinos D., Williams, Adam R., Dittrich, Howard C., Tarka, Elizabeth A., Latter, David A., Ohman, E. Magnus, Peterson, Mark W., Byrnes, Dawn, Pepine, Carl J., DiCarli, Marcelo F., Crystal, Ronald G., Rosengart, Todd K., and Mokadam, Nahush A.
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- 2023
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16. Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis
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Probst, Marc A, Su, Erica, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Aging ,Clinical Research ,Aged ,Aged ,80 and over ,Emergency Service ,Hospital ,Female ,Hospitalization ,Humans ,Incidence ,Male ,Medically Unexplained Symptoms ,Middle Aged ,Patient Discharge ,Propensity Score ,Prospective Studies ,Risk Assessment ,Syncope ,United States ,Clinical Sciences ,Emergency & Critical Care Medicine - Abstract
Study objectiveMany adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days.MethodsWe performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs) in the United States. We enrolled adults (≥60 years) who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days.ResultsWe enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%) and the discharged group (2.82%) (risk difference 2.07%; 95% confidence interval -0.24% to 4.38%).ConclusionIn our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.
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- 2019
17. Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes
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Chang, Anna Marie, Hollander, Judd E, Su, Erica, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Clinical Research ,Aging ,Heart Disease ,Aged ,Aged ,80 and over ,Cardiovascular Diseases ,Case-Control Studies ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Prospective Studies ,Recurrence ,Risk Assessment ,Risk Factors ,Syncope ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode.MethodsThis study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events.ResultsThe study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90-1.31; p = 0.387).ConclusionIn older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.
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- 2019
18. Do High‐sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?
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Clark, Carol L, Gibson, Thomas A, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Cardiovascular ,Emergency Care ,Heart Disease ,Prevention ,Clinical Research ,Adult ,Aged ,Biomarkers ,Case-Control Studies ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Natriuretic Peptide ,Brain ,Peptide Fragments ,Prospective Studies ,Syncope ,Troponin T ,Clinical Sciences ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
OBJECTIVES:An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope. METHODS:A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. RESULTS:The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%-5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%-33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%-5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%-32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. CONCLUSIONS:hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.
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- 2019
19. Opioid prescribing patterns after dental visits among beneficiaries of Medicaid in Washington state in 2014 and 2015
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Obadan-Udoh, Enihomo, Lupulescu-Mann, Nicoleta, Charlesworth, Christina J, Muench, Ulrike, Jura, Matthew, Kim, Hyunjee, Schwarz, Eli, Mertz, Elizabeth, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Dentistry ,Dental/Oral and Craniofacial Disease ,Substance Misuse ,Prescription Drug Abuse ,Clinical Research ,Analgesics ,Opioid ,Female ,Humans ,Medicaid ,Practice Patterns ,Physicians' ,Retrospective Studies ,United States ,Washington ,Oral health care ,Schedule II substances ,opioids ,prescription drug monitoring programs ,public insurance - Abstract
BACKGROUND:Dentists contribute to the prevailing opioid epidemic in the United States. Concerning the population enrolled in Medicaid, little is known about dentists' opioid prescribing. METHODS:The authors performed a retrospective cohort study of beneficiaries of Medicaid in Washington state with dental claims in 2014 and 2015. The primary outcome was the proportion of dental visits associated with an opioid prescription. The authors categorized visits as invasive or noninvasive by using procedure codes and each beneficiary as being at low or high risk by using his or her prescription history from the prescription drug monitoring program. RESULTS:A total of 126,660 (10.3%) of all dental visits, most of which were invasive (66.9%), among the population enrolled in Medicaid in Washington state was associated with opioid prescriptions. However, noninvasive dental visits and visits for beneficiaries who had prior high-risk prescription use were associated with significantly higher mean days' supply and mean quantity of opioids prescribed. Results from the multivariate logistic regression showed that the probability of having an opioid-associated visit increased by 35.6 percentage points when the procedures were invasive and by 11.1 percentage points when the beneficiary had prior high-risk prescription use. CONCLUSIONS:This baseline of opioid prescribing patterns after dental visits among the population enrolled in Medicaid in Washington state in 2014 and 2015 can inform future studies in which the investigators examine the effect of policies on opioid prescribing patterns and reasons for the variability in the dosage and duration of opioid prescriptions associated with noninvasive visits. PRACTICAL IMPLICATIONS:Dentists must exercise caution when prescribing opioids during invasive visits and to patients with prior high-risk prescription use.
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- 2019
20. Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope
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Bastani, Aveh, Su, Erica, Adler, David H, Baugh, Christopher, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Malveau, Susan E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, Yagapen, Annick N, Weiss, Robert E, and Sun, Benjamin C
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Cardiovascular ,Lung ,Aging ,Clinical Research ,Heart Disease ,Emergency Care ,Aged ,Aged ,80 and over ,Case-Control Studies ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Prospective Studies ,Risk Assessment ,Syncope ,Clinical Sciences ,Emergency & Critical Care Medicine - Abstract
Study objectiveControversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients.MethodsFrom April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (≥60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of 30-day death or serious clinical events. Data were analyzed with descriptive statistics and multivariate logistic regression analysis adjusting for relevant demographic or historical variables.ResultsA total of 3,581 patients (mean age 72.8 years; 51.6% men) were enrolled in the study. There were 1,380 patients (39%) presenting with near-syncope and 2,201 (61%) presenting with syncope. Baseline characteristics revealed a greater incidence of congestive heart failure, coronary artery disease, previous arrhythmia, nonwhite race, and presenting dyspnea in the near-syncope compared with syncope cohort. There were no differences in the primary outcome between the groups (near-syncope 18.7% versus syncope 18.2%). A multivariate logistic regression analysis identified no difference in 30-day serious outcomes for patients with near-syncope (odds ratio 0.94; 95% confidence interval 0.78 to 1.14) compared with syncope.ConclusionNear-syncope confers risk to patients similar to that of syncope for the composite outcome of 30-day death or serious clinical event.
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- 2019
21. Predictors of Clinically Significant Echocardiography Findings in Older Adults with Syncope: A Secondary Analysis
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Probst, Marc A, Gibson, Thomas A, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Cardiovascular ,Clinical Research ,Aging ,Heart Disease ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Aged ,Echocardiography ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Predictive Value of Tests ,Prospective Studies ,Risk Assessment ,Sensitivity and Specificity ,Syncope ,Clinical Sciences ,General & Internal Medicine - Abstract
BackgroundSyncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization.ObjectiveTo develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope.DesignProspective, observational cohort study from April 2013 to September 2016.SettingEleven EDs in the United States.PatientsWe enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE).MeasurementsThe primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography.ResultsA total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%).ConclusionsIf validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography.RegistrationClinicalTrials.gov Identifier NCT01802398.
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- 2018
22. Genetic associations of protein-coding variants in human disease
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Sun, Benjamin B., Kurki, Mitja I., Foley, Christopher N., Mechakra, Asma, Chen, Chia-Yen, Marshall, Eric, Wilk, Jemma B., Chahine, Mohamed, Chevalier, Philippe, Christé, Georges, Palotie, Aarno, Daly, Mark J., and Runz, Heiko
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- 2022
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23. Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome?
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Sharp, Adam L., Kawatkar, Aniket A., Baecker, Aileen S., Redberg, Rita F., Lee, Ming-Sum, Ferencik, Maros, Wu, Yi-Lin, Shen, Ernest, Zheng, Chengyi, Park, Stacy, Goodacre, Steve, Thokala, Praveen, and Sun, Benjamin C.
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- 2022
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24. Genetic map of regional sulcal morphology in the human brain from UK biobank data
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Sun, Benjamin B., Loomis, Stephanie J., Pizzagalli, Fabrizio, Shatokhina, Natalia, Painter, Jodie N., Foley, Christopher N., Jensen, Megan E., McLaren, Donald G., Chintapalli, Sai Spandana, Zhu, Alyssa H., Dixon, Daniel, Islam, Tasfiya, Ba Gari, Iyad, Runz, Heiko, Medland, Sarah E., Thompson, Paul M., Jahanshad, Neda, and Whelan, Christopher D.
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- 2022
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25. Mendelian randomization with fine-mapped genetic data: choosing from large numbers of correlated instrumental variables
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Burgess, Stephen, Zuber, Verena, Valdes-Marquez, Elsa, Sun, Benjamin B, and Hopewell, Jemma C
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Statistics - Methodology - Abstract
Mendelian randomization uses genetic variants to make causal inferences about the effect of a risk factor on an outcome. With fine-mapped genetic data, there may be hundreds of genetic variants in a single gene region any of which could be used to assess this causal relationship. However, using too many genetic variants in the analysis can lead to spurious estimates and inflated Type 1 error rates. But if only a few genetic variants are used, then the majority of the data is ignored and estimates are highly sensitive to the particular choice of variants. We propose an approach based on summarized data only (genetic association and correlation estimates) that uses principal components analysis to form instruments. This approach has desirable theoretical properties: it takes the totality of data into account and does not suffer from numerical instabilities. It also has good properties in simulation studies: it is not particularly sensitive to varying the genetic variants included in the analysis or the genetic correlation matrix, and it does not have greatly inflated Type 1 error rates. Overall, the method gives estimates that are not so precise as those from variable selection approaches (such as using a conditional analysis or pruning approach to select variants), but are more robust to seemingly arbitrary choices in the variable selection step. Methods are illustrated by an example using genetic associations with testosterone for 320 genetic variants to assess the effect of sex hormone-related pathways on coronary artery disease risk, in which variable selection approaches give inconsistent inferences.
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- 2017
26. Outcomes of Patients With Syncope and Suspected Dementia
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Holden, Timothy R, Shah, Manish N, Gibson, Tommy A, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Clinical Research ,Patient Safety ,Emergency Care ,Aging ,Dementia ,Acquired Cognitive Impairment ,Brain Disorders ,Clinical Sciences ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesSyncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia.MethodsThis multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death.ResultsOverall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days.ConclusionsPatients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
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- 2018
27. ECG Predictors of Cardiac Arrhythmias in Older Adults With Syncope
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Nishijima, Daniel K, Lin, Amber L, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Clinical Research ,Emergency Care ,Heart Disease ,Aged ,Aged ,80 and over ,Electrocardiography ,Emergency Service ,Hospital ,Female ,Follow-Up Studies ,Humans ,Incidence ,Male ,Middle Aged ,Prognosis ,Prospective Studies ,Risk Assessment ,Risk Factors ,Survival Rate ,Syncope ,United States ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Study objectiveCardiac arrhythmia is a life-threatening condition in older adults who present to the emergency department (ED) with syncope. Previous work suggests the initial ED ECG can predict arrhythmia risk; however, specific ECG predictors have been variably specified. Our objective is to identify specific ECG abnormalities predictive of 30-day serious cardiac arrhythmias in older adults presenting to the ED with syncope.MethodsWe conducted a prospective, observational study at 11 EDs in adults aged 60 years or older who presented with syncope or near syncope. We excluded patients with a serious cardiac arrhythmia diagnosed during the ED evaluation from the primary analysis. The outcome was occurrence of 30-day serous cardiac arrhythmia. The exposure variables were predefined ECG abnormalities. Independent predictors were identified through multivariate logistic regression. The sensitivities and specificities of any predefined ECG abnormality and any ECG abnormality identified on adjusted analysis to predict 30-day serious cardiac arrhythmia were also calculated.ResultsAfter exclusion of 197 patients (5.5%; 95% confidence interval [CI] 4.7% to 6.2%) with serious cardiac arrhythmias in the ED, the study cohort included 3,416 patients. Of these, 104 patients (3.0%; 95% CI 2.5% to 3.7%) had a serious cardiac arrhythmia within 30 days from the index ED visit (median time to diagnosis 2 days [interquartile range 1 to 5 days]). The presence of nonsinus rhythm, multiple premature ventricular conductions, short PR interval, first-degree atrioventricular block, complete left bundle branch block, and Q wave/T wave/ST-segment abnormalities consistent with acute or chronic ischemia on the initial ED ECG increased the risk for a 30-day serious cardiac arrhythmia. This combination of ECG abnormalities had a similar sensitivity in predicting 30-day serious cardiac arrhythmia compared with any ECG abnormality (76.9% [95% CI 67.6% to 84.6%] versus 77.9% [95% CI 68.7% to 85.4%]) and was more specific (55.1% [95% CI 53.4% to 56.8%] versus 46.6% [95% CI 44.9% to 48.3%]).ConclusionIn older ED adults with syncope, approximately 3% receive a diagnosis of a serious cardiac arrhythmia not recognized on initial ED evaluation. The presence of specific abnormalities on the initial ED ECG increased the risk for 30-day serious cardiac arrhythmias.
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- 2018
28. Predictors of Short-Term Outcomes after Syncope: A Systematic Review and Meta-Analysis
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Gibson, Thomas A., Weiss, Robert E., and Sun, Benjamin C.
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syncope ,meta-analysis - Abstract
Introduction: We performed a systematic review and meta-analysis to identify predictors of serious clinical outcomes after an acute-care evaluation for syncope. Methods: We identified studies that assessed for predictors of short-term (≤30 days) serious clinical events after an emergency department (ED) visit for syncope. We performed a MEDLINE search (January 1, 1990 - July 1, 2017) and reviewed reference lists of retrieved articles. The primary outcome was the occurrence of a serious clinical event (composite of mortality, arrhythmia, ischemic or structural heart disease, major bleed, or neurovascular event) within 30 days. We estimated the sensitivity, specificity, and likelihood ratio of findings for the primary outcome. We created summary estimates of association on a variable-by-variable basis using a Bayesian random-effects model. Results: We reviewed 2,773 unique articles; 17 met inclusion criteria. The clinical findings most predictive of a short-term, serious event were the following: 1) An elevated blood urea nitrogen level (positive likelihood ratio [LR+]: 2.86, 95% confidence interval [CI] [1.15, 5.42]); 2); history of congestive heart failure (LR+: 2.65, 95%CI [1.69, 3.91]); 3) initial low blood pressure in the ED (LR+: 2.62, 95%CI [1.12, 4.9]); 4) history of arrhythmia (LR+: 2.32, 95%CI [1.31, 3.62]); and 5) an abnormal troponin value (LR+: 2.49, 95%CI [1.36, 4.1]). Younger age was associated with lower risk (LR-: 0.44, 95%CI [0.25, 0.68]). An abnormal electrocardiogram was mildly predictive of increased risk (LR+ 1.79, 95%CI [1.14, 2.63]). Conclusion: We identified specific risk factors that may aid clinical judgment and that should be considered in the development of future risk-prediction tools for serious clinical events after an ED visit for syncope.
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- 2018
29. Genetic determinants of the human plasma proteome and their application in biology and disease
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Sun, Benjamin Boyang and Butterworth, Adam
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572 ,Genomics ,Proteomics ,GWAS ,pQTL ,Mendelian randomisation - Abstract
Proteins are the primary functional units of biology and the direct targets of most drugs, yet there is limited knowledge of the genetic factors determining inter-individual variation in protein levels (protein quantitative trait loci (pQTLs)). Limitations in high-throughput proteomic measurement technology have meant well-powered genome-wide association studies for large number of proteins so far have lagged behind many of the other "omic" studies such as transcriptomics and metabolomics. This is made more challenging by the complexity of human plasma, characterised by high dynamic range spanning several magnitudes of concentrations and a large number of low abundance proteins. By using an expanded high-throughput multiplex aptamer-based proteomic assay with more than twice the proteome coverage of previous studies, I am able to greatly expand on existing knowledge on genetic determinants of human plasma proteins through testing 10.6 million DNA variants against levels of 2,994 proteins in 3,301 individuals. I identify 1,927 genetic associations with 1,478 proteins, replicating many previous associations as well as gaining novel insights into the genetic architecture of the human plasma proteome. I use several approaches to highlight the application of pQTLs to biology and disease. I show several examples linking distant pQTLs to biologically plausible genes and demonstrate the mediation of distant pQTL by local protein levels, highlighting the role of protein-protein interactions. In addition, I find epistatic effects of genetically determined phenotypes (blood group and secretor status) on protein levels. Through linking previous disease associations, I show that disease associated variants are enriched for pQTLs and I provide insights into possible mechanisms underpinning some of the disease loci. Finally, I identify causal roles for protein biomarkers in disease through multivariable Mendelian randomisation (MR) analysis, leveraging on the simultaneous measurement of multiple functionally related proteins in a locus to account for potential pleiotropic effects. Whereas MR studies of plasma proteins have been constrained by availability of few suitable genetic instruments, the data generated here remedy this bottleneck by furnishing an extensive toolkit. Overall, the work within this thesis foreshadows major advances in post-genomic science through increasing application of novel bioassay technologies to major population biobanks.
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- 2017
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30. Abstract 14139: Differential Benefit of Non-Invasive Cardiac Stress Testing by HEART Score Risk Stratification
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Kawatkar, Aniket A, Sharp, Adam, Baecker, Aileen, Redberg, Rita F, Lee, Mingsum, Ferencik, Maros, Goodacre, Steve, Thokala, Praveen, Wu, Yi-Lin, Shen, Ernest, zheng, chengyi, Musigdilok, Visanee, and Sun, Benjamin
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- 2022
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31. Abstract 13239: Variation in Cost by HEART Score in Patients With Suspected Acute Coronary Syndrome
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Kawatkar, Aniket A, Sharp, Adam, Baecker, Aileen, Redberg, Rita F, Lee, Mingsum, Ferencik, Maros, Goodacre, Steve, Thokala, Praveen, Wu, Yi-Lin, Shen, Ernest, zheng, chengyi, Musigdilok, Visanee, and Sun, Benjamin
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- 2022
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32. Author Correction: FinnGen provides genetic insights from a well-phenotyped isolated population
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Kurki, Mitja I., Karjalainen, Juha, Palta, Priit, Sipilä, Timo P., Kristiansson, Kati, Donner, Kati M., Reeve, Mary P., Laivuori, Hannele, Aavikko, Mervi, Kaunisto, Mari A., Loukola, Anu, Lahtela, Elisa, Mattsson, Hannele, Laiho, Päivi, Della Briotta Parolo, Pietro, Lehisto, Arto A., Kanai, Masahiro, Mars, Nina, Rämö, Joel, Kiiskinen, Tuomo, Heyne, Henrike O., Veerapen, Kumar, Rüeger, Sina, Lemmelä, Susanna, Zhou, Wei, Ruotsalainen, Sanni, Pärn, Kalle, Hiekkalinna, Tero, Koskelainen, Sami, Paajanen, Teemu, Llorens, Vincent, Gracia-Tabuenca, Javier, Siirtola, Harri, Reis, Kadri, Elnahas, Abdelrahman G., Sun, Benjamin, Foley, Christopher N., Aalto-Setälä, Katriina, Alasoo, Kaur, Arvas, Mikko, Auro, Kirsi, Biswas, Shameek, Bizaki-Vallaskangas, Argyro, Carpen, Olli, Chen, Chia-Yen, Dada, Oluwaseun A., Ding, Zhihao, Ehm, Margaret G., Eklund, Kari, Färkkilä, Martti, Finucane, Hilary, Ganna, Andrea, Ghazal, Awaisa, Graham, Robert R., Green, Eric M., Hakanen, Antti, Hautalahti, Marco, Hedman, Åsa K., Hiltunen, Mikko, Hinttala, Reetta, Hovatta, Iiris, Hu, Xinli, Huertas-Vazquez, Adriana, Huilaja, Laura, Hunkapiller, Julie, Jacob, Howard, Jensen, Jan-Nygaard, Joensuu, Heikki, John, Sally, Julkunen, Valtteri, Jung, Marc, Junttila, Juhani, Kaarniranta, Kai, Kähönen, Mika, Kajanne, Risto, Kallio, Lila, Kälviäinen, Reetta, Kaprio, Jaakko, Kerimov, Nurlan, Kettunen, Johannes, Kilpeläinen, Elina, Kilpi, Terhi, Klinger, Katherine, Kosma, Veli-Matti, Kuopio, Teijo, Kurra, Venla, Laisk, Triin, Laukkanen, Jari, Lawless, Nathan, Liu, Aoxing, Longerich, Simonne, Mägi, Reedik, Mäkelä, Johanna, Mäkitie, Antti, Malarstig, Anders, Mannermaa, Arto, Maranville, Joseph, Matakidou, Athena, Meretoja, Tuomo, Mozaffari, Sahar V., Niemi, Mari E. K., Niemi, Marianna, Niiranen, Teemu, O´Donnell, Christopher J., Obeidat, Ma´en, Okafo, George, Ollila, Hanna M., Palomäki, Antti, Palotie, Tuula, Partanen, Jukka, Paul, Dirk S., Pelkonen, Margit, Pendergrass, Rion K., Petrovski, Slavé, Pitkäranta, Anne, Platt, Adam, Pulford, David, Punkka, Eero, Pussinen, Pirkko, Raghavan, Neha, Rahimov, Fedik, Rajpal, Deepak, Renaud, Nicole A., Riley-Gillis, Bridget, Rodosthenous, Rodosthenis, Saarentaus, Elmo, Salminen, Aino, Salminen, Eveliina, Salomaa, Veikko, Schleutker, Johanna, Serpi, Raisa, Shen, Huei-yi, Siegel, Richard, Silander, Kaisa, Siltanen, Sanna, Soini, Sirpa, Soininen, Hilkka, Sul, Jae Hoon, Tachmazidou, Ioanna, Tasanen, Kaisa, Tienari, Pentti, Toppila-Salmi, Sanna, Tukiainen, Taru, Tuomi, Tiinamaija, Turunen, Joni A., Ulirsch, Jacob C., Vaura, Felix, Virolainen, Petri, Waring, Jeffrey, Waterworth, Dawn, Yang, Robert, Nelis, Mari, Reigo, Anu, Metspalu, Andres, Milani, Lili, Esko, Tõnu, Fox, Caroline, Havulinna, Aki S., Perola, Markus, Ripatti, Samuli, Jalanko, Anu, Laitinen, Tarja, Mäkelä, Tomi P., Plenge, Robert, McCarthy, Mark, Runz, Heiko, Daly, Mark J., and Palotie, Aarno
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- 2023
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33. Fifteen new risk loci for coronary artery disease highlight arterial-wall-specific mechanisms
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Howson, Joanna MM, Zhao, Wei, Barnes, Daniel R, Ho, Weang-Kee, Young, Robin, Paul, Dirk S, Waite, Lindsay L, Freitag, Daniel F, Fauman, Eric B, Salfati, Elias L, Sun, Benjamin B, Eicher, John D, Johnson, Andrew D, Sheu, Wayne HH, Nielsen, Sune F, Lin, Wei-Yu, Surendran, Praveen, Malarstig, Anders, Wilk, Jemma B, Tybjærg-Hansen, Anne, Rasmussen, Katrine L, Kamstrup, Pia R, Deloukas, Panos, Erdmann, Jeanette, Kathiresan, Sekar, Samani, Nilesh J, Schunkert, Heribert, Watkins, Hugh, Do, Ron, Rader, Daniel J, Johnson, Julie A, Hazen, Stanley L, Quyyumi, Arshed A, Spertus, John A, Pepine, Carl J, Franceschini, Nora, Justice, Anne, Reiner, Alex P, Buyske, Steven, Hindorff, Lucia A, Carty, Cara L, North, Kari E, Kooperberg, Charles, Boerwinkle, Eric, Young, Kristin, Graff, Mariaelisa, Peters, Ulrike, Absher, Devin, Hsiung, Chao A, Lee, Wen-Jane, Taylor, Kent D, Chen, Ying-Hsiang, Lee, I-Te, Guo, Xiuqing, Chung, Ren-Hua, Hung, Yi-Jen, Rotter, Jerome I, Juang, Jyh-Ming J, Quertermous, Thomas, Wang, Tzung-Dau, Rasheed, Asif, Frossard, Philippe, Alam, Dewan S, Majumder, Abdulla al Shafi, Di Angelantonio, Emanuele, Chowdhury, Rajiv, Chen, Yii-Der Ida, Nordestgaard, Børge G, Assimes, Themistocles L, Danesh, John, Butterworth, Adam S, and Saleheen, Danish
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Biological Sciences ,Genetics ,Atherosclerosis ,Cardiovascular ,Human Genome ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Biotechnology ,Aetiology ,2.1 Biological and endogenous factors ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Arteries ,Cell Adhesion ,Chemotaxis ,Leukocyte ,Coronary Artery Disease ,Energy Metabolism ,Female ,Genetic Predisposition to Disease ,Genome-Wide Association Study ,Genotype ,Histone Code ,Humans ,Male ,Muscle ,Smooth ,Vascular ,Polymorphism ,Single Nucleotide ,Quantitative Trait Loci ,Risk Factors ,CARDIoGRAMplusC4D ,EPIC-CVD ,Medical and Health Sciences ,Developmental Biology ,Agricultural biotechnology ,Bioinformatics and computational biology - Abstract
Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Although 58 genomic regions have been associated with CAD thus far, most of the heritability is unexplained, indicating that additional susceptibility loci await identification. An efficient discovery strategy may be larger-scale evaluation of promising associations suggested by genome-wide association studies (GWAS). Hence, we genotyped 56,309 participants using a targeted gene array derived from earlier GWAS results and performed meta-analysis of results with 194,427 participants previously genotyped, totaling 88,192 CAD cases and 162,544 controls. We identified 25 new SNP-CAD associations (P < 5 × 10-8, in fixed-effects meta-analysis) from 15 genomic regions, including SNPs in or near genes involved in cellular adhesion, leukocyte migration and atherosclerosis (PECAM1, rs1867624), coagulation and inflammation (PROCR, rs867186 (p.Ser219Gly)) and vascular smooth muscle cell differentiation (LMOD1, rs2820315). Correlation of these regions with cell-type-specific gene expression and plasma protein levels sheds light on potential disease mechanisms.
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- 2017
34. Minimizing Attrition for Multisite Emergency Care Research
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Nicks, Bret A, Shah, Manish N, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Malveau, Susan E, Nishijima, Daniel K, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, Yagapen, Annick N, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Health Services ,Health and social care services research ,8.1 Organisation and delivery of services ,Aftercare ,Aged ,Data Collection ,Emergency Medical Services ,Health Services Research ,Humans ,Male ,Medical Records ,Middle Aged ,Multicenter Studies as Topic ,Patient Dropouts ,Patient Selection ,Prospective Studies ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Loss to follow-up of enrolled patients (a.k.a. attrition) is a major threat to study validity and power. Minimizing attrition can be challenging even under ideal research conditions, including the presence of adequate funding, experienced study personnel, and a refined research infrastructure. Emergency care research is shifting toward enrollment through multisite networks, but there have been limited descriptions of approaches to minimize attrition for these multicenter emergency care studies. This concept paper describes a stepwise approach to minimize attrition, using a case example of a multisite emergency department prospective cohort of over 3,000 patients that has achieved a 30-day direct phone follow-up attrition rate of
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- 2017
35. Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain
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Hoppe, Jason A., McStay, Christopher, Sun, Benjamin, and Capp, Roberta
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opioid prescribing ,decision-making - Abstract
Introduction: Despite treatment guidelines suggesting alternatives, as well as evidence of a lackof benefit and evidence of poor long-term outcomes, opioid analgesics are commonly prescribedfor back pain from the emergency department (ED). Variability in opioid prescribing suggests a lackof consensus and an opportunity to standardize and improve care. We evaluated the variation inattending emergency physician (EP) opioid prescribing for patients with uncomplicated, low acuityback pain (LABP).Methods: This retrospective study evaluated the provider-specific proportion of LABP patientsdischarged from an urban academic ED over a seven-month period with a prescription for opioids.LABP was strictly defined as (1) back pain chief complaint, (2) discharged from ED with nointerventions, and (3) predefined discharge diagnosis of back pain. We excluded providers if theyhad less than 25 LABP patients in the study period. The primary outcome was the physician-specificproportion of LABP patients discharged with an opioid analgesic prescription. We performed adescriptive analysis and then risk standardized prescribing proportion by adjusting for patient andclinical characteristics using hierarchical logistic regression.Results: During the seven-month study period, 23 EPs treated and discharged at least 25 LABPpatients and were included. Eight (34.8%) were female, and six (26.1%) were junior attendings (< 5years after residency graduation). There were 943 LABP patients included in the analysis. Providerspecificproportions ranged from 3.7% to 88.1% (mean 58.4% [SD +/- 22.2]), and we found a 22-foldvariation in prescribing proportions. There was a six-fold variation in the adjusted, risk-standardizedprescribing proportion with a range from 12.0% to 78.2% [mean 50.4% (SD +/-16.4)].Conclusion: We found large variability in opioid prescribing practices for LABP that persistedafter adjustment for patient and clinical characteristics. Our findings support the need to furtherstandardize and improve adherence to treatment guidelines and evidence suggesting alternatives toopioids.
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- 2017
36. Estimating the Cost of Care for Emergency Department Syncope Patients: Comparison of Three Models
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Probst, Marc, McConnell, John, Weiss, Robert, Laurie, Amber, Yagapen, Annick, Lin, Michelle, Caterino, Jeffrey, Shah, Manish, and Sun, Benjamin
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Syncope ,Healthcare costs ,Cost model ,Emergency Department - Abstract
Introduction: We sought to compare three hospital cost estimation models for patients undergoing evaluation for unexplained syncope with hospital cost data. Developing such a model would allow researchers to assess the value of novel clinical algorithms for syncope management.Methods: Complete health services data, including disposition, testing, and length of stay (LOS), were collected on 67 adult patients (age 60 years and older) who presented to the Emergency Department (ED) with syncope at a single hospital. Patients were excluded if a serious medical condition was identified. Three hospital cost estimation models were created to estimate facility costs: V1, unadjusted Medicare payments for observation and/or hospital admission, V2: modified Medicare payment, prorated by LOS in calendar days, and, V3: modified Medicare payment, prorated by LOS in hours. Total hospital costs included unadjusted Medicare payments for diagnostic testing and estimated facility costs. These estimates were plotted against actual cost data from the hospital finance department. Correlation and regression analyses were performed.Results: Of the three models, V3 consistently outperformed the others with regard to correlation and goodness of fit. The Pearson correlation coefficient for V3 was 0.88 (95% Confidence Interval 0.81, 0.92) with an R-square value of 0.77 and a linear regression coefficient of 0.87 (95% Confidence Interval 0.76, 0.99).Conclusion: Using basic health services data, it is possible to accurately estimate hospital costs for older adults undergoing a hospital-based evaluation for unexplained syncope. This methodology could help assess the potential economic impact of implementing novel clinical algorithms for ED syncope.
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- 2017
37. Impact of a multidisciplinary acute aortic dissection program: Improved outcomes with a comprehensive initial surgical repair strategy
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Manunga, Jesse, Smith, Jenna, Schmidt, Christian W., Titus, Jessica, Mudy, Karol, Pavlovec, Matthew P., Sun, Benjamin, Teng, Xiaoyi, Mirza, Aleem, Skeik, Nedaa, Sharma, Amit, and Harris, Kevin M.
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- 2021
- Full Text
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38. Changes in Clinical Management Following 14-Day Ambulatory ECG Monitoring Following Emergency Department Evaluation for Unexplained Syncope
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Moore, Andrew B., Gershon, Colin, Fiske, Christa, Sun, Benjamin, Nazer, Babek, Kea, Bory, Moore, Andrew B., Gershon, Colin, Fiske, Christa, Sun, Benjamin, Nazer, Babek, and Kea, Bory
- Published
- 2024
39. Left Ventricular Remodeling After Transcatheter Mitral Valve Replacement With Tendyne: New Insights From Computed Tomography
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Fukui, Miho, Sorajja, Paul, Gössl, Mario, Bae, Richard, Lesser, John R., Sun, Benjamin, Duncan, Alison, Muller, David, and Cavalcante, João L.
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- 2020
- Full Text
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40. Complete 2-Year Results Confirm Bayesian Analysis of the SURTAVI Trial
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Sorajja, Paul, Sun, Benjamin, Agarwal, Himanshu, Langdon, Thomas, den Heijer, Peter, Bentala, Mohamed, O’Hair, Daniel, Bajwa, Tanvir, Byrne, Timothy, Caskey, Michael, Paulus, Basil, Garrett, Edward, Jr., Stoler, Robert, Hebeler, Robert, Popma, Jeffrey J., Khabbaz, Kamal, Lim, David Scott, Bladergroen, Mark, Fail, Peter, Feinberg, Edgar, II, Rinaldi, Michael, Skipper, Eric, Chawla, Atul, Hockmuth, David, Makkar, Raj, Cheng, Wen, Kodali, Susheel, George, Isaac, Aji, Janah, Bowen, Frank, Schreiber, Theodore, Henry, Scott, Hengstenberg, Christian, Bleiziffer, Sabine, Harrison, J. Kevin, Hughes, Chad, Joye, James, Gaudiani, Vincent, Babaliaros, Vasilis, Thourani, Vinod, van Mieghem, Nicolas, Kappetein, A. Pieter, Dauerman, Harold, Schmoker, Joseph, Skelding, Kimberly, Casale, Alfred, Kovac, Jan, Spyt, Tomasz, Seshiah, Puvi, Smith, J. Michael, McKay, Raymond, Hagberg, Robert, Matthews, Ray, Starnes, Vaughn, O’Neill, William, Paone, Gaetano, Hernandez García, Jose Maria, Such, Miguel, Morís de la Tassa, Cesar, Llosa Cortina, Juan Carlos, Windecker, Stephan, Carrel, Thierry, Whisenant, Brian, Doty, John, Resar, Jon, Conte, John, Aharonian, Vicken, Pfeffer, Thomas, Rück, Andreas, Corbascio, Matthias, Blackman, Daniel, Kaul, Pankaj, Kliger, Chad, Brinster, Derek, Teefy, Patrick, Kiaii, Bob, Leya, Ferdinand, Bakhos, Mamdouh, Sandhu, Gurpreet, Pochettino, Alberto, Piazza, Nicolo, de Varennes, Benoit, van Boven, Ad, Boonstra, Piet, Waksman, Ron, Bafi, Ammar, Asgar, Anita, Cartier, Raymond, Kipperman, Robert, Brown, John, Lin, Lang, Rovin, Joshua, Sharma, Samin, Adams, David, Katz, Stanley, Hartman, Alan, Al-Jilaihawi, Hasanian, Williams, Mathew, Crestanello, Juan, Lilly, Scott, Ghani, Mohammad, Bodenhamer, Robert Mark, Rajagopal, Vivek, Kauten, James, Mumtaz, Mumbashir, Bachinsky, Williams, Nickenig, Georg, Welz, Armin, Søndergaard, Lars, Olsen, Peter Skov, Yakubov, Steven, Watson, Daniel, Chhatriwalla, Adnan, Allen, Keith, Teirstein, Paul, Tyner, Jeffrey, Mahoney, Paul, Newton, Joseph, Merhi, William, Keiser, John, Yeung, Alan, Miller, Craig, ten Berg, Jurriën, Heijmen, Robin, Petrossian, George, Robinson, Newell, Brecker, Stephen, Jahangiri, Marjan, Davis, Thomas, Batra, Sanjay, Hermiller, James, Heimansohn, David, Radhakrishnan, Sam, Fremes, Stephen, Maini, Brijeshwar, Bethea, Brian, Brown, David, Ryan, William, Reardon, Michael, Kleiman, Neal, Spies, Christian, Lau, Jeffrey, Herrmann, Howard, Bavaria, Joseph, Horlick, Eric, Feindel, Chris, Neumann, Franz-Josef, Beyersdorf, Friedhelm, Binder, Roland, Maisano, Francesco, Costa, Marco, Markowitz, Alan, Tadros, Peter, Zorn, George, III, de Marchena, Eduardo, Salerno, Tomas, Chetcuti, Stanley, Deeb, G. Michael, Labinz, Marino, Ruel, Marc, Sup Lee, Joon, Gleason, Thomas, Ling, Frederick, Knight, Peter, Robbins, Mark, Ball, Stephen, Giacomini, John, Burdon, Thomas, Applegate, Robert, Kon, Neal, Schwartz, Richard, Schubach, Scott, Forrest, John, Mangi, Abeel, Van Mieghem, Nicolas M., Yakubov, Steven J., Serruys, Patrick W., Mumtaz, Mubashir, Gada, Hemal, Kleiman, Neal S., Oh, Jae K., Kappetein, Arie Pieter, Chang, Yanping, Mugglin, Andrew S., and Reardon, Michael J.
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- 2020
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41. Reliability of Clinical Assessments in Older Adults With Syncope or Near Syncope
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Nishijima, Daniel K, Laurie, Amber L, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Patient Safety ,Cardiovascular ,Health Services ,Clinical Research ,Aged ,Aged ,80 and over ,Cross-Sectional Studies ,Emergency Service ,Hospital ,Female ,Hospitalization ,Humans ,Male ,Medical History Taking ,Middle Aged ,Observer Variation ,Physical Examination ,Reproducibility of Results ,Risk Factors ,Syncope ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesClinical prediction models for risk stratification of older adults with syncope or near syncope may improve resource utilization and management. Predictors considered for inclusion into such models must be reliable. Our primary objective was to evaluate the inter-rater agreement of historical, physical examination, and electrocardiogram (ECG) findings in older adults undergoing emergency department (ED) evaluation for syncope or near syncope. Our secondary objective was to assess the level of agreement between clinicians on the patient's overall risk for death or serious cardiac outcomes.MethodsWe conducted a cross-sectional study at 11 EDs in adults 60 years of age or older who presented with unexplained syncope or near syncope. We excluded patients with a presumptive cause of syncope (e.g., seizure) or if they were unable or unwilling to follow-up. Evaluations of the patient's past medical history and current medication use were completed by treating provider and trained research associate pairs. Evaluations of the patient's physical examination and ECG interpretation were completed by attending/resident, attending/advanced practice provider, or attending/attending pairs. All evaluations were blinded to the responses from the other rater. We calculated the percent agreement and kappa statistic for binary variables. Inter-rater agreement was considered acceptable if the kappa statistic was 0.6 or higher.ResultsWe obtained paired observations from 255 patients; mean (±SD) age was 73 (±9) years, 137 (54%) were male, and 204 (80%) were admitted to the hospital. Acceptable agreement was achieved in 18 of the 21 (86%) past medical history and current medication findings, none of the 10 physical examination variables, and three of the 13 (23%) ECG interpretation variables. There was moderate agreement (Spearman correlation coefficient, r = 0.40) between clinicians on the patient's probability of 30-day death or serious cardiac outcome, although as the probability increased, there was less agreement.ConclusionsAcceptable agreement between raters was more commonly achieved with historical rather than physical examination or ECG interpretation variables. Clinicians had moderate agreement in assessing the patient's overall risk for a serious outcome at 30 days. Future development of clinical prediction models in older adults with syncope should account for variability of assessments between raters and consider the use of objective clinical variables.
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- 2016
42. Emergency Department Cardiac Risk Stratification With High-Sensitivity vs Conventional Troponin HEART Pathway
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Yore, Mackensie, primary, Sharp, Adam, additional, Wu, Yi-Lin, additional, Kawatkar, Aniket, additional, Lee, Ming-Sum, additional, Ferencik, Maros, additional, Redberg, Rita, additional, Shen, Ernest, additional, Zheng, Chengyi, additional, and Sun, Benjamin, additional
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- 2023
- Full Text
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43. A fast and efficient colocalization algorithm for identifying shared genetic risk factors across multiple traits
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Foley, Christopher N., Staley, James R., Breen, Philip G., Sun, Benjamin B., Kirk, Paul D. W., Burgess, Stephen, and Howson, Joanna M. M.
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- 2021
- Full Text
- View/download PDF
44. National trends in resource utilization associated with ED visits for syncope
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Probst, Marc A, Kanzaria, Hemal K, Gbedemah, Misato, Richardson, Lynne D, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Health Services ,Clinical Research ,Emergency Care ,Adolescent ,Adult ,Aged ,Arrhythmias ,Cardiac ,Databases ,Factual ,Dehydration ,Emergency Service ,Hospital ,Female ,Hospitalization ,Humans ,Magnetic Resonance Imaging ,Male ,Middle Aged ,Syncope ,Tomography ,X-Ray Computed ,United States ,Young Adult ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
BackgroundOver the last 20 years, numerous research articles and clinical guidelines aimed at optimizing resource utilization for emergency department (ED) patients presenting with syncope have been published.HypothesisWe hypothesized that there would be temporal trends in syncope-related ED visits and associated trends in imaging, hospital admissions, and diagnostic frequencies.MethodsThe ED component of National Hospital Ambulatory Medical Care Survey was analyzed from 2001 through 2010, comprising more than 358000 visits (representing an estimated 1.18 billion visits nationally). We selected ED visits with a reason for visit of syncope or fainting and calculated nationally representative weighted estimates for prevalence of such visits and associated rates of advanced imaging utilization and admission. For admitted patients from 2005 to 2010, the most frequent hospital discharge diagnoses were tabulated.ResultsDuring the study period, there were more than 3500 actual ED visits (representing 11.9 million visits nationally) related to syncope, representing roughly 1% of all ED visits. Admission rates for syncope patients ranged from 27% to 35% and showed no significant downward trend (P = .1). Advanced imaging rates increased from about 21% to 45% and showed a significant upward trend (P < .001). For admitted patients, the most common hospital discharge diagnosis was the symptomatic diagnosis of "syncope and collapse" (36.4%).ConclusionsDespite substantial efforts by medical researchers and professional societies, resource utilization associated with ED visits for syncope appears to have actually increased. There have been no apparent improvements in diagnostic yield for admissions. Novel strategies may be needed to change practice patterns for such patients.
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- 2015
45. Emergency Physicians' Perceptions and Decision-making Processes Regarding Patients Presenting with Palpitations
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Probst, Marc A, Kanzaria, Hemal K, Hoffman, Jerome R, Mower, William R, Moheimani, Roya S, Sun, Benjamin C, and Quigley, Denise D
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Emergency Care ,Health Services ,Clinical Research ,7.3 Management and decision making ,Management of diseases and conditions ,Adult ,Aged ,Arrhythmias ,Cardiac ,Attitude of Health Personnel ,Clinical Decision-Making ,Emergency Medicine ,Female ,Humans ,Interviews as Topic ,Male ,Middle Aged ,Practice Patterns ,Physicians' ,Risk Assessment ,United States ,palpitations ,emergency medicine ,clinical decision-making ,interviews ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
BackgroundPalpitations are a common emergency department (ED) complaint, yet relatively little research exists on this topic from an emergency care perspective.ObjectivesWe sought to describe the perceptions and clinical decision-making processes of emergency physicians (EP) surrounding patients with palpitations.MethodsWe conducted 21 semistructured interviews with a convenience sample of EPs. We recruited participants from academic and community practice settings from four regions of the United States. The transcribed interviews were analyzed using a combination of structural coding and grounded theory approaches with ATLAS.ti, a qualitative data analysis software program (version 7; Atlas.ti Scientific Software Development GmbH, Berlin, Germany).ResultsEPs perceive palpitations to be a common but generally benign chief complaint. EPs' clinical approach to palpitations, with regards to testing, treatment, and ED management, can be classified as relating to one or more of the following themes: (1) risk stratification, (2) diagnostic categorization, (3) algorithmic management, and (4) case-specific gestalt. With regard to disposition decisions, four main themes emerged: (1) presence of a serious diagnosis, (2) perceived need for further cardiac testing/monitoring, (3) presence of key associated symptoms, (4) request of other physician or patient desire. The interrater reliability exercise yielded a Fleiss' kappa measure of 0.69, indicating substantial agreement between coders.ConclusionEPs perceive palpitations to be a common but generally benign chief complaint. EPs rely on one or more of four main clinical approaches to manage these patients. These findings could help guide future efforts at developing risk-stratification tools and clinical algorithms for patients with palpitations.
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- 2015
46. Novel Transcatheter Mitral Valve Prosthesis for Patients With Severe Mitral Annular Calcification
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Sorajja, Paul, Gössl, Mario, Babaliaros, Vasilis, Rizik, David, Conradi, Lenard, Bae, Richard, Burke, Robert F., Schäfer, Ulrich, Lisko, John C., Riley, Robert D., Guyton, Robert, Dumonteil, Nicolas, Berthoumieu, Pierre, Tchetche, Didier, Blanke, Philipp, Cavalcante, João L., and Sun, Benjamin
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- 2019
- Full Text
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47. Causes and Clinical Outcomes of Patients Who Are Ineligible for Transcatheter Mitral Valve Replacement
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Niikura, Hiroki, Gössl, Mario, Kshettry, Vibhu, Olson, Sara, Sun, Benjamin, Askew, Judah, Stanberry, Larissa, Garberich, Ross, Tang, Liang, Lesser, John, Bae, Richard, Harris, Kevin M., Bradley, Steven M., and Sorajja, Paul
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- 2019
- Full Text
- View/download PDF
48. Randomized Clinical Trial of an Emergency Department Observation Syncope Protocol Versus Routine Inpatient Admission
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Sun, Benjamin C, McCreath, Heather, Liang, Li-Jung, Bohan, Stephen, Baugh, Christopher, Ragsdale, Luna, Henderson, Sean O, Clark, Carol, Bastani, Aveh, Keeler, Emmett, An, Ruopeng, and Mangione, Carol M
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Health Services ,Clinical Research ,Emergency Care ,Patient Safety ,Clinical Trials and Supportive Activities ,Aged ,Clinical Protocols ,Emergency Service ,Hospital ,Female ,Hospital Costs ,Humans ,Length of Stay ,Male ,Middle Aged ,Patient Admission ,Patient Discharge ,Patient Outcome Assessment ,Patient Satisfaction ,Quality of Life ,Syncope ,Watchful Waiting ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Study objectiveOlder adults are frequently hospitalized from the emergency department (ED) after an episode of unexplained syncope. Current admission patterns are costly, with little evidence of benefit. We hypothesize that an ED observation syncope protocol will reduce resource use without adversely affecting patient-oriented outcomes.MethodsThis randomized trial at 5 EDs compared an ED observation syncope protocol to inpatient admission for intermediate-risk adults (≥50 years) presenting with syncope or near syncope. Primary outcomes included inpatient admission rate and length of stay. Secondary outcomes included 30-day and 6-month serious outcomes after hospital discharge, index and 30-day hospital costs, 30-day quality-of-life scores, and 30-day patient satisfaction.ResultsStudy staff randomized 124 patients. Observation resulted in a lower inpatient admission rate (15% versus 92%; 95% confidence interval [CI] difference -88% to -66%) and shorter hospital length of stay (29 versus 47 hours; 95% CI difference -28 to -8). Serious outcome rates after hospital discharge were similar for observation versus admission at 30 days (3% versus 0%; 95% CI difference -1% to 8%) and 6 months (8% versus 10%; 95% CI difference -13% to 9%). Index hospital costs in the observation group were $629 (95% CI difference -$1,376 to -$56) lower than in the admission group. There were no differences in 30-day quality-of-life scores or in patient satisfaction.ConclusionAn ED observation syncope protocol reduced the primary outcomes of admission rate and hospital length of stay. Analyses of secondary outcomes suggest reduction in index hospital costs, with no difference in safety events, quality of life, or patient satisfaction. Our findings suggest that an ED observation syncope protocol can be replicated and safely reduce resource use.
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- 2014
49. Mesenchymal precursor cells as adjunctive therapy in recipients of contemporary left ventricular assist devices.
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Ascheim, Deborah, Gelijns, Annetine, Goldstein, Daniel, Moye, Lemuel, Smedira, Nicholas, Lee, Sangjin, Klodell, Charles, Szady, Anita, Parides, Michael, Jeffries, Neal, Skerrett, Donna, Taylor, Doris, Rame, J, Milano, Carmelo, Rogers, Joseph, Lynch, Janine, Dewey, Todd, Eichhorn, Eric, Sun, Benjamin, Feldman, David, Simari, Robert, OGara, Patrick, Taddei-Peters, Wendy, Miller, Marissa, Naka, Yoshifumi, Bagiella, Emilia, Rose, Eric, and Woo, Y
- Subjects
heart failure ,left ventricular assist device ,randomized controlled trial ,stem cell ,Adult ,Aged ,Cell- and Tissue-Based Therapy ,Double-Blind Method ,Female ,Heart Failure ,Heart Neoplasms ,Heart-Assist Devices ,Humans ,Incidence ,Male ,Mesenchymal Stem Cell Transplantation ,Mesenchymal Stem Cells ,Middle Aged ,Myocarditis ,Treatment Outcome ,Ventricular Dysfunction ,Left - Abstract
BACKGROUND: Allogeneic mesenchymal precursor cells (MPCs) injected during left ventricular assist device (LVAD) implantation may contribute to myocardial recovery. This trial explores the safety and efficacy of this strategy. METHODS AND RESULTS: In this multicenter, double-blind, sham-procedure controlled trial, 30 patients were randomized (2:1) to intramyocardial injection of 25 million MPCs or medium during LVAD implantation. The primary safety end point was incidence of infectious myocarditis, myocardial rupture, neoplasm, hypersensitivity reaction, and immune sensitization (90 days after randomization). Key efficacy end points were functional status and ventricular function while temporarily weaned from LVAD support (90 days after randomization). Patients were followed up until transplant or 12 months after randomization, whichever came first. Mean age was 57.4 (±13.6) years, mean left ventricular ejection fraction was 18.1%, and 66.7% were destination therapy LVADs. No safety events were observed. Successful temporary LVAD weaning was achieved in 50% of MPC and 20% of control patients at 90 days (P=0.24); the posterior probability that MPCs increased the likelihood of successful weaning was 93%. At 90 days, 3 deaths (30%) occurred in control patients, and none occurred in MPC patients. Mean left ventricular ejection fraction after successful wean was 24.0% (MPC=10) and 22.5% (control=2; P=0.56). At 12 months, 30% of MPC patients and 40% of control patients were successfully temporarily weaned from LVAD support (P=0.69), and 6 deaths (30%) occurred in MPC patients. Donor-specific HLA sensitization developed in 2 MPC and 3 control patients and resolved by 12 months. CONCLUSIONS: In this preliminary trial, administration of MPCs appeared to be safe, and there was a potential signal of efficacy. Future studies will evaluate the potential for higher or additional doses to enhance the ability to wean LVAD recipients off support. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01442129.
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- 2014
50. Analysis of emergency department visits for palpitations (from the National Hospital Ambulatory Medical Care Survey).
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Probst, Marc A, Mower, William R, Kanzaria, Hemal K, Hoffman, Jerome R, Buch, Eric F, and Sun, Benjamin C
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Humans ,Tachycardia ,Patient Admission ,Health Care Surveys ,Incidence ,Retrospective Studies ,Follow-Up Studies ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Middle Aged ,Child ,Child ,Preschool ,Infant ,Infant ,Newborn ,Emergency Service ,Hospital ,United States ,Female ,Male ,Young Adult ,and over ,Preschool ,Newborn ,Emergency Service ,Hospital ,Cardiovascular System & Hematology ,Cardiorespiratory Medicine and Haematology - Abstract
Palpitations is a common complaint in patients who visit the emergency department (ED), with causes ranging from benign to life threatening. We analyzed the ED component of the National Hospital Ambulatory Medical Care Survey for 2001 through 2010 for visits with a chief complaint of palpitations and calculated nationally representative weighted estimates for prevalence, demographic characteristics, and admission rates. ED and hospital discharge diagnoses were tabulated and categorized, and recursive partitioning was used to identify factors associated with admission. An estimated 684,000 visits had a primary reason for visit of "palpitations" representing a national prevalence of 5.8 per 1,000 ED visits (0.58%, 95% confidence interval 0.52 to 0.64). Women and non-Hispanic whites were responsible for most visits. A cardiac diagnosis made up 34% of all ED diagnoses. The overall admission rate was 24.6% (95% confidence interval 21.2 to 28.1), with higher rates seen in the Midwest and Northeast compared with the West. Survey-weighted recursive partitioning revealed several factors associated with admission including age >50 years, male gender, cardiac ED diagnosis, tachycardia, hypertension, and Medicare insurance. In conclusion, palpitations are responsible for a significant minority of ED visits and are associated with a cardiac diagnosis roughly 1/3 of the time. This was associated with a relatively high admission rate, although significant regional variation in these rates exists.
- Published
- 2014
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