You are here

College of Medicine

Permalink: https://diginole.lib.fsu.edu/islandora/object/fsu:college_of_medicine
Anemia at Discharge and Risk of Readmission in Elderly Patients
Anemia at Discharge and Risk of Readmission in Elderly Patients
Summary: Title: Anemia at Discharge and Risk of Readmission in Elderly Patients Authors: Yeshanew Teklie MD, Niraj Patel MD; Victoria Campdesuner DO; Kayla Marini DO; Yorlenis Rodriguez DO; Karen M. Hamad MD, FAAP, FACP; Mary E. Geary PhD, RN; and Wilhelmine Wiese-Rometsch MD, FACPAffiliation: Florida State University Internal Medicine Residency Program at Sarasota Memorial Hospital, 1700 South Tamiami Trail, Sarasota FL 34239, 941-917-7799Type of Project: Practice-based Quality ImprovementIntroduction: Anemia is defined by the World Health Organization (WHO) as a hemoglobin (Hb) concentration less than 12.0 g/dL for females and less than 13.0 g/dL for males. Objective of this quality improvement initiative was to test if anemia independently is associated with readmission in elderly patients discharged from the medicine service of a community teaching hospital. Methods: We conducted a retrospective cohort study declared exempt by our Institutional Review Board involving electronic medical record data from patients at least 65 years old hospitalized between September 2009 and June 2019 discharged not to hospice care. Severity of anemia classified by the WHO was applied for Hb concentrations obtained at hospital discharge for females as mild (11.0 – 11.9 g/dL), moderate (8.0 – 10.9 g/dL), severe (<8.0 g/dL); and males as mild (11.0 - 12.9 g/dL), moderate (8.0 - 10.9 g/dL), severe (<8.0 g/dL). Time to readmission after index hospitalization within 30d, 90d, and 180d with mild, moderate, severe, or no anemia was compared using Kaplan Meier survival curves with covariates (age; sex; multiple chronic conditions; length of stay; APR-DRG Severity of Illness and Risk of Mortality; and discharge destination) controlled using Cox Proportional Hazard modeling with relative impact assessed using Random Forest modeling. Readmission after 180d was considered a new index hospitalization. Continuous variables summarized as mean (SD) or median (interquartile range) were contrasted using Kruskal-Wallis ANOVA. Categorical variables summarized as proportions were compared using chi square or Fisher exact test. Statistical tests were two-tailed with p<.05 considered significant.Findings: Among 13,526 inpatients with 18,793 discharges median age of 78 (14) years was statistically similar by sex (49% females, 51% males) exhibiting an anemia distribution of no (31.0%), mild (20.5%), moderate (47.1%) and severe (1.4%). Race distributed as 89.9% white; 5.9% African American or Black; and 4.2% Other. Females differentiated distribution across anemia spectrum at no (95.7%) (p<0.001), mild (26.4%) (p<0.001), moderate (51.0%) and severe (43.5%). No, mild, moderate and severe anemia corrected for putative confounders impacted (p<0.001) respectively cumulative risk of readmission at 30 d (7.0%, 7.9%, 17.2%, 21.3%), 90 d (12.0%, 15.3%, 28.1%, 34.8%) and 180 d (16.4%, 20.7%, 34.4%, 42.6%).Conclusion: An essential patient-centric question is whether anemia in elderly inpatients affects poor outcomes and/or whether anemia is a surrogate marker for underlying overt and/or subclinical disease(s). Although present quality improvement initiative was not designed to unravel mechanisms of anemia, we controlled for putative severity of illness confounders while demonstrating readmission risk escalating with severity of anemia. Implications for Practice: Findings herald readmission risk associated with “no anemia” as defined by the World Health Organization. Tailored anemia care could offer clinical advantages to mitigate risk for readmission.Reference: WHO. Hemoglobin concentrations for the diagnosis of anemia. Accessed May 16, 2020 at https://www.who.int/vmnis/indicators/haemoglobin.pdf, Keywords: Discharge Anemia, Risk of Readmission, Elderly Anemia
Change In Five-factor Model Personality Traits During The Acute Phase Of The Coronavirus Pandemic
Change In Five-factor Model Personality Traits During The Acute Phase Of The Coronavirus Pandemic
The rapid spread of the coronavirus and the strategies to slow it have disrupted just about every aspect of our lives. Such disruption may be reflected in changes in psychological function. The present study used a pre-posttest design to test whether Five Factor Model personality traits changed with the coronavirus outbreak in the United States. Participants (N= 2,137) were tested in early February 2020 and again during the President's 15 Days to Slow the Spread guidelines. In contrast to the preregistered hypotheses, Neuroticism decreased across these six weeks, particularly the facets of Anxiety and Depression, and Conscientiousness did not change. Interestingly, there was some evidence that the rapid changes in the social context had changed the meaning of an item. Specifically, an item about going to work despite being sick was a good indicator of conscientiousness before COVID-19, but the interpretation of it changed with the pandemic. In sum, the unexpected small decline in Neuroticism suggests that, during the acute phase of the coronavirus outbreak, feelings of anxiety and distress may be attributed more to the pandemic than to one's personality., impact, age, life events, The publisher's version of record is availible at https://doi.org/10.1371/journal.pone.0237056
Practice Guideline
Practice Guideline
ObjectiveTo review pharmacologic and nonpharmacologic strategies for treating sleep disturbances in children and adolescents with autism spectrum disorder (ASD) and to develop recommendations for addressing sleep disturbance in this population.MethodsThe guideline panel followed the American Academy of Neurology 2011 guideline development process, as amended. The systematic review included studies through December 2017. Recommendations were based on evidence, related evidence, principles of care, and inferences.Major recommendations (Level B)For children and adolescents with ASD and sleep disturbance, clinicians should assess for medications and coexisting conditions that could contribute to the sleep disturbance and should address identified issues. Clinicians should counsel parents regarding strategies for improved sleep habits with behavioral strategies as a first-line treatment approach for sleep disturbance either alone or in combination with pharmacologic or nutraceutical approaches. Clinicians should offer melatonin if behavioral strategies have not been helpful and contributing coexisting conditions and use of concomitant medications have been addressed, starting with a low dose. Clinicians should recommend using pharmaceutical-grade melatonin if available. Clinicians should counsel children, adolescents, and parents regarding potential adverse effects of melatonin use and the lack of long-term safety data. Clinicians should counsel that there is currently no evidence to support the routine use of weighted blankets or specialized mattress technology for improving disrupted sleep. If asked about weighted blankets, clinicians should counsel that the trial reported no serious adverse events with blanket use and that blankets could be a reasonable nonpharmacologic approach for some individuals., scale, symptoms, safety, management, health, childhood, therapy, melatonin treatment, release melatonin, The publisher's version of record is availible at https://doi.org/10.1212/WNL.0000000000009033
Sex Differences in Effects of Ketamine on Behavior, Spine Density, and Synaptic Proteins in Socially Isolated Rats.
Sex Differences in Effects of Ketamine on Behavior, Spine Density, and Synaptic Proteins in Socially Isolated Rats.
The mechanistic underpinnings of sex differences in occurrence of depression and efficacy of antidepressant treatments are poorly understood. We examined the effects of isolation stress (IS) and the fast-acting antidepressant ketamine on anhedonia and depression-like behavior, spine density, and synaptic proteins in male and female rats. We used a chronic social IS paradigm to test the effects of ketamine (0, 2.5 mg/kg, and 5 mg/kg) on behavior and levels of synaptic proteins synapsin-1, postsynaptic density protein 95, and glutamate receptor 1 in male rats and female rats in diestrus. Medial prefrontal cortex spine density was also examined in male rats and female rats that received ketamine during either the diestrus or the proestrus phase of their estrous cycle. Male rats showed anhedonia and depression-like behavior after 8 weeks of IS, concomitant with decreases in spine density and levels of synapsin-1, postsynaptic density protein 95, and glutamate receptor 1 in the medial prefrontal cortex; these changes were reversed by a single injection of ketamine (5 mg/kg). After 11 weeks of IS, female rats showed depression-like behavior but no signs of anhedonia. Although both doses of ketamine rescued depression-like behavior in female rats, the decline observed in synaptic proteins and spine density in IS and in diestrus female rats could not be reversed by ketamine. Spine density was higher in female rats during proestrus than in diestrus. Our findings implicate a role for synaptic proteins synapsin-1, postsynaptic density protein 95, and glutamate receptor 1 and medial prefrontal cortex spine density in the antidepressant effects of ketamine in male rats subjected to IS but not in female rats subjected to IS, suggesting dissimilar underlying mechanisms for efficacy of ketamine in the two sexes., Keywords: Anhedonia, Depression, Ketamine, Sex difference, Social isolation, MPFC, Grant Number: R01 MH087583, R01 MH099085, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940294.
Zika Virus Infects Human Cortical Neural Progenitors and Attenuates Their Growth.
Zika Virus Infects Human Cortical Neural Progenitors and Attenuates Their Growth.
The suspected link between infection by Zika virus (ZIKV), a re-emerging flavivirus, and microcephaly is an urgent global health concern. The direct target cells of ZIKV in the developing human fetus are not clear. Here we show that a strain of the ZIKV, MR766, serially passaged in monkey and mosquito cells efficiently infects human neural progenitor cells (hNPCs) derived from induced pluripotent stem cells. Infected hNPCs further release infectious ZIKV particles. Importantly, ZIKV infection increases cell death and dysregulates cell-cycle progression, resulting in attenuated hNPC growth. Global gene expression analysis of infected hNPCs reveals transcriptional dysregulation, notably of cell-cycle-related pathways. Our results identify hNPCs as a direct ZIKV target. In addition, we establish a tractable experimental model system to investigate the impact and mechanism of ZIKV on human brain development and provide a platform to screen therapeutic compounds., Grant Number: R37 NS047344, R21 AI111250, R21 NS095348, R21 AI119530, R56 NS047344, R01 NS048271, R01 NS047344, R01 MH102690, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299540.