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1. Cluster analysis of COVID-19 recovery center patients at a clinic in Boston, MA 2021–2022: impact on strategies for access and personalized care

Author

Ann-Marcia C. Tukpah, Jhillika Patel, Beret Amundson, Miguel Linares, Meera Sury, Julie Sullivan, Tajmah Jocelyn, Brenda Kissane, Gerald Weinhouse, Nancy Lange-Vaidya, Daniela Lamas, Khalid Ismail, Chandan Pavuluri, Michael H. Cho, Elizabeth B. Gay, and Matthew Moll

Subjects
Informatics, Equity, Disparities, Community health, Quality of care, Public aspects of medicine, RA1-1270
Abstract

Abstract Background There are known disparities in COVID-19 resource utilization that may persist during the recovery period for some patients. We sought to define subpopulations of patients seeking COVID-19 recovery care in terms of symptom reporting and care utilization to better personalize their care and to identify ways to improve access to subspecialty care. Methods Prospective study of adult patients with prior COVID-19 infection seen in an ambulatory COVID-19 recovery center (CRC) in Boston, Massachusetts from April 2021 to April 2022. Hierarchical clustering with complete linkage to differentiate subpopulations was done with four sociodemographic variables: sex, race, language, and insurance status. Outcomes included ICU admission, utilization of supplementary care, self-report of symptoms. Results We included 1285 COVID-19 patients referred to the CRC with a mean age of 47 years, of whom 71% were female and 78% White. We identified 3 unique clusters of patients. Cluster 1 and 3 patients were more likely to have had intensive care unit (ICU) admissions; Cluster 2 were more likely to be White with commercial insurance and a low percentage of ICU admission; Cluster 3 were more likely to be Black/African American or Latino/a and have commercial insurance. Compared to Cluster 2, Cluster 1 patients were more likely to report symptoms (ORs ranging 2.4–3.75) but less likely to use support groups, psychoeducation, or care coordination (all p

Published
2023
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2. Payment Reform as a Means of Achieving Justice

Author

Scott L. Schissel, Emilia Thurber, Derek Soled, and Beret Amundson

Subjects
Pulmonary and Respiratory Medicine, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Payment reform, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Critical Care and Intensive Care Medicine, Nursing, medicine, Pulmonary rehabilitation, Justice (ethics), Cardiology and Cardiovascular Medicine, business, Reimbursement
Published
2021
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4. Distinct cellular immune properties in cerebrospinal fluid are associated with cognition in HIV-infected individuals initiating antiretroviral therapy

Author

Suprateek Kundu, Mark J. Mulligan, Alison Swaims-Kohlmeier, Drenna Waldrop-Valverde, Beret Amundson, Lillin Lai, Donald Franklin, Zidou Zheng, Jeffrey L. Lennox, Yong Xu, Scott Letendre, and Albert M. Anderson

Subjects
0301 basic medicine, Male, Pediatric AIDS, HIV Infections, 0302 clinical medicine, Cerebrospinal fluid, Cognition, Antiretroviral Therapy, Highly Active, Immunology and Allergy, Flow cytometry, Pediatric, Immunity, Cellular, medicine.diagnostic_test, Viral Load, Middle Aged, AIDS, medicine.anatomical_structure, Infectious Diseases, Mental Health, Neurology, 6.1 Pharmaceuticals, HIV/AIDS, Female, Infection, Adult, T cell, Immunology, Antiretroviral Therapy, Article, 03 medical and health sciences, Immune system, Acquired immunodeficiency syndrome (AIDS), Clinical Research, Behavioral and Social Science, medicine, Humans, Highly Active, Retrospective Studies, Neurology & Neurosurgery, business.industry, Monocyte, Immunity, Neurosciences, HIV, Evaluation of treatments and therapeutic interventions, medicine.disease, 030104 developmental biology, Neurology (clinical), Cellular, business, 030217 neurology & neurosurgery, CD8, Follow-Up Studies
Abstract

We examined the relationship between CSF immune cells and neurocognition and neuronal damage in HIV+ individuals before and after initiating antiretroviral therapy. Multivariate analysis at baseline indicated that greater CD4+ T cell abundance was associated with better cognition (p=.017), while higher CSF HIV RNA was associated with increased neuronal damage (p=.014). Following 24weeks of antiretroviral therapy, CD8+ T cells, HLA-DR expressing CD4+ and CD8+ T cells, B cells, NK cells, and non-classical monocyte percentage decreased in CSF. Female gender was negatively associated with cognitive performance over time, as was higher percentage of HLA-DR expressing CD8+ T cells at baseline.

Published
2020

5. Timing of Recognition for Perioperative Strokes Following Cardiac Surgery

Author

Fadi Nahab, Brent Keeling, Jose N. Binongo, Beret Amundson, Joseph T Hormes, Anna Katema, Gregory J. Esper, J. Kirk Edwards, Michael E. Halkos, Priyadharshi Rathakrishnan, and Yi Lasanajak

Subjects
Male, medicine.medical_specialty, Delayed Diagnosis, Time Factors, Databases, Factual, Disease, Risk Assessment, Delayed recognition, 03 medical and health sciences, Coronary artery bypass surgery, 0302 clinical medicine, Risk Factors, medicine.artery, Medicine, Thoracic aorta, Humans, cardiovascular diseases, Coronary Artery Bypass, Perioperative Period, Stroke, Perioperative stroke, Aged, Retrospective Studies, Heart Valve Prosthesis Implantation, business.industry, Rehabilitation, Perioperative, Middle Aged, medicine.disease, United States, Cardiac surgery, Surgery, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Introduction: More than half of reported perioperative strokes following cardiac surgery are identified beyond postoperative day one. The objective of our study was to determine preoperative and intraoperative factors that are associated with stroke following cardiac surgery and to identify factors that may contribute delayed recognition of perioperative stroke. Methods: Patients undergoing coronary artery bypass surgery or isolated valve surgery from January 2, 2015 to April 28, 2017 at an academic health system were identified from the Society of Thoracic Surgeons Registry. We determined preoperative and intraoperative factors associated with perioperative stroke. Two neurologists performed retrospective chart reviews on perioperative stroke patients to determine the last seen well time and the stroke cause. Results: During the study period, 2795 patients underwent coronary artery bypass surgery or isolated valve surgery (mean age 64 ± 11 years, 71% male, 72% Caucasian, 9% history of stroke), of which 43 (1.5%) had a perioperative stroke; 31 (72%) patients had an embolic mechanism of stroke based on neuroimaging. In multivariable analysis, perioperative strokes were independently associated with increasing age (OR 1.04, 95% 1.01-1.07), history of stroke (OR 2.73, 95% CI 1.47-5.06), and history of thoracic aorta disease (OR 3.36, 95% CI 1.16-9.71). Strokes were identified after postoperative day one in 32 (74%) patients of which 26 (81%) had a preoperative last seen well time. Conclusion: Given the high frequency of preoperative last seen well time in perioperative stroke patients who are identified after postoperative day one, delayed stroke recognition may contribute to the bimodal distribution in timing of perioperative stroke. Frequent neurological monitoring within 24 hours after CABG or isolated valve surgery should be considered for all patients undergoing cardiac surgery, particularly elderly patients and those with a history of stroke or thoracic aorta disease, to improve early stroke recognition.

Published
2020

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