Publications by authors named "C Michael Gibson"

1,947 Publications

  • Page 1 of 1

Contemporary Experience of Posterior Retroperitoneoscopic Adrenalectomy in the US.

J Am Coll Surg 2021 Mar 9. Epub 2021 Mar 9.

Yale School of Medicine, New Haven, CT.

Background: As the incidence of adrenalectomy steadily increases, so do the utilization of minimally invasive approaches like the Posterior Retroperitoneoscopic Adrenalectomy (PRA). To date, the largest studies of PRA have been from abroad, and we sought to provide a contemporary American update on the outcomes following PRA.

Methods: A retrospective chart review was conducted on all PRAs performed at a single tertiary care institution between 2013 and 2020. Patient demographics, indication for surgery, operative details, and postoperative course were abstracted. Outcomes of interest included 30-day mortality, conversion to open or transabdominal approach, postoperative complication, and 30-day readmission.

Results: A total of 249 RPA were performed between 2013 and 2020. The population was 54.2% female with an average age of 54.1 (SD 14.1). Most (60.6%) lesions were left-sided, and the most common diagnosis was non-functioning adenoma (39.4%), followed by pheochromocytoma (21.3%) and aldosteronoma (16.6%). The average tumor size was 3.2 cm (SD 1.7) with a range from 0.5 to 9.4 cm. The average operative length was 110 minutes (Range 30-319 minutes). Overall, the complication rate was 6.4%. Nine (3.6%) patients had a minor postoperative complication (Clavien-Dindo I-III), while five patients (2.0%) had a major postoperative complication (Clavien-Dindo IV-V), including one mortality (0.4%). There were two conversions of approach (0.8%). The majority (58.2%) of patients were discharged on postoperative day one, and 92.0% were discharged by postoperative day three. The 30-day readmission rate was 1.6%.

Conclusion: Current practice demonstrates that RPA is an extremely safe approach, with a complication rate under 7% and mortality under 1%. Additionally, the vast majority of patients are able to return home in an expedient manner.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jamcollsurg.2021.02.018DOI Listing
March 2021

Persistent Globe Flattening in Astronauts following Long-Duration Spaceflight.

Neuroophthalmology 2021 3;45(1):29-35. Epub 2020 Sep 3.

Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.

Posterior globe flattening has been well-documented in astronauts both during and after long-duration space flight (LDSF) and has been observed as early as 10 days into a mission on the International Space Station. Globe flattening (GF) is thought to be caused by the disc centred anterior forces created by elevated volume and/or pressure within the optic nerve sheath (ONS). This might be the result of increased intracranial pressure, increased intraorbital ONS pressure from compartmentalisation or a combination of these mechanisms. We report posterior GF in three astronauts that has persisted for 7 years or more following their return from LDSFs suggesting that permanent scleral remodelling may have occurred.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/01658107.2020.1791189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946045PMC
September 2020

Author Correction: Inherited causes of clonal haematopoiesis in 97,691 whole genomes.

Authors:
Alexander G Bick Joshua S Weinstock Satish K Nandakumar Charles P Fulco Erik L Bao Seyedeh M Zekavat Mindy D Szeto Xiaotian Liao Matthew J Leventhal Joseph Nasser Kyle Chang Cecelia Laurie Bala Bharathi Burugula Christopher J Gibson Abhishek Niroula Amy E Lin Margaret A Taub Francois Aguet Kristin Ardlie Braxton D Mitchell Kathleen C Barnes Arden Moscati Myriam Fornage Susan Redline Bruce M Psaty Edwin K Silverman Scott T Weiss Nicholette D Palmer Ramachandran S Vasan Esteban G Burchard Sharon L R Kardia Jiang He Robert C Kaplan Nicholas L Smith Donna K Arnett David A Schwartz Adolfo Correa Mariza de Andrade Xiuqing Guo Barbara A Konkle Brian Custer Juan M Peralta Hongsheng Gui Deborah A Meyers Stephen T McGarvey Ida Yii-Der Chen M Benjamin Shoemaker Patricia A Peyser Jai G Broome Stephanie M Gogarten Fei Fei Wang Quenna Wong May E Montasser Michelle Daya Eimear E Kenny Kari E North Lenore J Launer Brian E Cade Joshua C Bis Michael H Cho Jessica Lasky-Su Donald W Bowden L Adrienne Cupples Angel C Y Mak Lewis C Becker Jennifer A Smith Tanika N Kelly Stella Aslibekyan Susan R Heckbert Hemant K Tiwari Ivana V Yang John A Heit Steven A Lubitz Jill M Johnsen Joanne E Curran Sally E Wenzel Daniel E Weeks Dabeeru C Rao Dawood Darbar Jee-Young Moon Russell P Tracy Erin J Buth Nicholas Rafaels Ruth J F Loos Peter Durda Yongmei Liu Lifang Hou Jiwon Lee Priyadarshini Kachroo Barry I Freedman Daniel Levy Lawrence F Bielak James E Hixson James S Floyd Eric A Whitsel Patrick T Ellinor Marguerite R Irvin Tasha E Fingerlin Laura M Raffield Sebastian M Armasu Marsha M Wheeler Ester C Sabino John Blangero L Keoki Williams Bruce D Levy Wayne Huey-Herng Sheu Dan M Roden Eric Boerwinkle JoAnn E Manson Rasika A Mathias Pinkal Desai Kent D Taylor Andrew D Johnson Paul L Auer Charles Kooperberg Cathy C Laurie Thomas W Blackwell Albert V Smith Hongyu Zhao Ethan Lange Leslie Lange Stephen S Rich Jerome I Rotter James G Wilson Paul Scheet Jacob O Kitzman Eric S Lander Jesse M Engreitz Benjamin L Ebert Alexander P Reiner Siddhartha Jaiswal Gonçalo Abecasis Vijay G Sankaran Sekar Kathiresan Pradeep Natarajan

Nature 2021 Mar;591(7851):E27

Broad Institute of MIT and Harvard, Cambridge, MA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41586-021-03280-1DOI Listing
March 2021

Prognosis of Claims- Versus Trial-Based Ischemic and Bleeding Events Beyond 1 Year After Coronary Stenting.

J Am Heart Assoc 2021 Mar 6;10(6):e018744. Epub 2021 Mar 6.

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA.

Background It is unknown whether clinical events identified with administrative claims have similar prognosis compared with trial-adjudicated events in cardiovascular clinical trials. We compared the prognostic significance of claims-based end points in context of trial-adjudicated end points in the DAPT (Dual Antiplatelet Therapy) study. Methods and Results We matched 1336 patients aged ≥65 years who received percutaneous coronary intervention in the DAPT study with the CathPCI registry linked to Medicare claims. We compared death at 21 months post-randomization using Cox proportional hazards models among patients with ischemic events (myocardial infarction or stroke) and bleeding events identified by: (1) both trial adjudication and claims; (2) trial adjudication only; and (3) claims only. A total of 47 patients (3.5%) had ischemic events identified by both trial adjudication and claims, 24 (1.8%) in trial adjudication only, 15 (1.1%) in claims only, and 1250 (93.6%) had no ischemic events, with annualized unadjusted mortality rates of 12.8, 5.5, 14.9, and 1.26 per 100 person-years, respectively. A total of 44 patients (3.3%) had bleeding events identified with both trial adjudication and claims, 13 (1.0%) in trial adjudication only, 65 (4.9%) in claims only, and 1214 (90.9%) had no bleeding events, with annualized unadjusted mortality rates of 11.0, 16.8, 10.7, and 0.95 per 100 person-years, respectively. Among patients with no trial-adjudicated events, patients with events in claims only had a high subsequent adjusted mortality risk (hazard ratio (HR) ischemic events: 31.5; 95% CI, 8.9‒111.9; HR bleeding events 23.9; 95% CI, 10.7‒53.2). Conclusions In addition to trial-adjudicated events, claims identified additional clinically meaningful ischemic and bleeding events that were prognostically significant for death.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.120.018744DOI Listing
March 2021

Pre-Hospital Antiplatelet Therapy for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: What We Know and What Lies Ahead.

Thromb Haemost 2021 Mar 7. Epub 2021 Mar 7.

Maastricht University Medical Centre+, Gastroenterology & Hepatology, Maastricht, Netherlands.

Early recanalization of the infarct-related artery to achieve myocardial reperfusion is the primary therapeutic goal in patients with ST-elevation myocardial infarction (STEMI). In order to decrease the duration of ischemia, continuous efforts have been made to improve pre-hospital treatment and to target the early period after symptom onset, when the platelet content of the fresh coronary thrombus is maximal and the thrombi are dynamic, and thus more susceptible to powerful antiplatelet agents. There have been substantial advances in antiplatelet therapy in the last three decades with several classes of oral and intravenous antiplatelet agents with different therapeutic targets, pharmacokinetics, and pharmacodynamic properties. New parenteral drugs achieve immediate inhibition of platelet aggregation and fast and easy methods of administration may create the opportunity to bridge the initial gap in platelet inhibition observed with oral P2Y12 inhibitors. Moreover, potential future management of STEMI could directly involve select patients in the process with self-administered antiplatelet agents designed to achieve rapid reperfusion. However the potential anti-ischemic benefits of potent antiplatelet agents will need to be balanced against their risk of increased bleeding. This manuscript presents a comprehensive and updated review of pre-hospital antiplatelet therapy among STEMI patients undergoing primary percutaneous intervention and explores new therapies under development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1414-5009DOI Listing
March 2021

Measurement of total liver blood flow in intact anesthetized rats using ultrasound imaging.

Pharmacol Res Perspect 2021 Apr;9(2):e00731

Departments of Pharmacokinetics, Pharmacodynamics and Drug Metabolism (CRG), Translational Biomarkers (AG, EM), Merck & Co., Inc., West Point, PA, USA.

This short report describes the measurement of total liver blood flow in commonly used laboratory rats using the relatively non-invasive approach of ultrasound imaging. A total of 29 rats (n = 26 Wistar-Han, n = 3 Sprague-Dawley) were imaged and both male and female rats were included. The mean (SD) total liver blood flow of all animals combined was 33.3 ± 7.8 mL/min, or 104.3 ± 17.1 mL/min/kg when normalized to observed body weight at the time of imaging. There was a trend for higher unnormalized total liver blood flow as body weight increased and the female rats had, in general, the lowest body weight and total liver blood flow of the animals studied. There were no major differences in total liver blood flow between the small number of Sprague-Dawley rats used in the study and the larger Wistar-Han group. Further research would be needed to accurately characterize any subtle differences in body weight between rats of different strains, sexes, and body weight.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/prp2.731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931129PMC
April 2021

Distinct genetic pathways define pre-malignant versus compensatory clonal hematopoiesis in Shwachman-Diamond syndrome.

Nat Commun 2021 02 26;12(1):1334. Epub 2021 Feb 26.

Department of Medical Oncology, Division of Hematological Malignancies Dana-Farber Cancer Institute, Boston, MA, USA.

To understand the mechanisms that mediate germline genetic leukemia predisposition, we studied the inherited ribosomopathy Shwachman-Diamond syndrome (SDS), a bone marrow failure disorder with high risk of myeloid malignancies at an early age. To define the mechanistic basis of clonal hematopoiesis in SDS, we investigate somatic mutations acquired by patients with SDS followed longitudinally. Here we report that multiple independent somatic hematopoietic clones arise early in life, most commonly harboring heterozygous mutations in EIF6 or TP53. We show that germline SBDS deficiency establishes a fitness constraint that drives selection of somatic clones via two distinct mechanisms with different clinical consequences. EIF6 inactivation mediates a compensatory pathway with limited leukemic potential by ameliorating the underlying SDS ribosome defect and enhancing clone fitness. TP53 mutations define a maladaptive pathway with enhanced leukemic potential by inactivating tumor suppressor checkpoints without correcting the ribosome defect. Subsequent development of leukemia was associated with acquisition of biallelic TP53 alterations. These results mechanistically link leukemia predisposition to germline genetic constraints on cellular fitness, and provide a rational framework for clinical surveillance strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-021-21588-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910481PMC
February 2021

Insulating Composites Made from Sulfur, Canola Oil, and Wool*.

ChemSusChem 2021 Feb 25. Epub 2021 Feb 25.

Institute for Nanoscale Science and Technology, College of Science and Engineering, Flinders University, Bedford Park, South Australia, 5042, Australia.

An insulating composite was made from the sustainable building blocks wool, sulfur, and canola oil. In the first stage of the synthesis, inverse vulcanization was used to make a polysulfide polymer from the canola oil triglyceride and sulfur. This polymerization benefits from complete atom economy. In the second stage, the powdered polymer was mixed with wool, coating the fibers through electrostatic attraction. The polymer and wool mixture were then compressed with mild heating to provoke S-S metathesis in the polymer, which locks the wool in the polymer matrix. The wool fibers imparted tensile strength, insulating properties, and reduced the flammability of the composite. All building blocks are sustainable or derived from waste and the composite is a promising lead on next-generation insulation for energy conservation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/cssc.202100187DOI Listing
February 2021

Unilateral intrusion in a medically complex patient using an orthodontic mini-implant: A case report.

J Orthod 2021 Feb 23:1465312521996376. Epub 2021 Feb 23.

Great Ormond Street Hospital, London, UK.

Orthognathic surgery offers a predictable treatment option for patients with skeletal discrepancies and corresponding dental malocclusions. In cases where surgery is not advised due to significant medical co-morbidity, the orthodontist must approach the treatment using different mechanical modalities. Orthodontic mini-implants can be a valuable adjunct in these cases. We describe a case where a palatal mini-implant was used during orthodontic treatment in a patient with a complex capillary malformation, which precluded surgical correction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1465312521996376DOI Listing
February 2021

Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis.

JACC Cardiovasc Interv 2021 Feb;14(4):444-456

Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Objectives: The aim of this study was to compare ticagrelor monotherapy with dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents.

Background: The role of abbreviated DAPT followed by an oral P2Y inhibitor after PCI remains uncertain.

Methods: Two randomized trials, including 14,628 patients undergoing PCI, comparing ticagrelor monotherapy with standard DAPT on centrally adjudicated endpoints were identified, and individual patient data were analyzed using 1-step fixed-effect models. The protocol was registered in PROSPERO (CRD42019143120). The primary outcomes were the composite of Bleeding Academic Research Consortium type 3 or 5 bleeding tested for superiority and, if met, the composite of all-cause death, myocardial infarction, or stroke at 1 year, tested for noninferiority against a margin of 1.25 on a hazard ratio (HR) scale.

Results: Bleeding Academic Research Consortium type 3 or 5 bleeding occurred in fewer patients with ticagrelor than DAPT (0.9% vs. 1.7%, respectively; HR: 0.56; 95% confidence interval [CI]: 0.41 to 0.75; p < 0.001). The composite of all-cause death, myocardial infarction, or stroke occurred in 231 patients (3.2%) with ticagrelor and in 254 patients (3.5%) with DAPT (HR: 0.92; 95% CI: 0.76 to 1.10; p < 0.001 for noninferiority). Ticagrelor was associated with lower risk for all-cause (HR: 0.71; 95% CI: 0.52 to 0.96; p = 0.027) and cardiovascular (HR: 0.68; 95% CI: 0.47 to 0.99; p = 0.044) mortality. Rates of myocardial infarction (2.01% vs. 2.05%; p = 0.88), stent thrombosis (0.29% vs. 0.38%; p = 0.32), and stroke (0.47% vs. 0.36%; p = 0.30) were similar.

Conclusions: Ticagrelor monotherapy was associated with a lower risk for major bleeding compared with standard DAPT, without a concomitant increase in ischemic events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcin.2020.11.046DOI Listing
February 2021

Identification and visualisation of microplastics / nanoplastics by Raman imaging (iii): algorithm to cross-check multi-images.

Water Res 2021 Apr 8;194:116913. Epub 2021 Feb 8.

Global Centre for Environmental Remediation (GCER), University of Newcastle, Callaghan NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), University of Newcastle, Callaghan NSW 2308, Australia.

We recently developed the Raman mapping image to visualise and identify microplastics / nanoplastics (Fang et al. 2020, Sobhani et al. 2020). However, when the Raman signal is low and weak, the mapping uncertainty from the individual Raman peak intensity increases and may lead to images with false positive or negative features. For real samples, even the Raman signal is high, a low signal-noise ratio still occurs and leads to the mapping uncertainty due to the high spectrum background when: the target plastic is dispersed within another material with interfering Raman peaks; materials are present that exhibit broad Raman peaks; or, materials are present that fluoresce when exposed to the excitation laser. In this study, in order to increase the mapping certainty, we advance the algorithm to combine and merge multi-images that have been simultaneously mapped at the different characteristic peaks from the Raman spectra, akin imaging via different mapping channels simultaneously. These multi-images are merged into one image via algorithms, including colour off-setting to collect signal with a higher ratio of signal-noise, logic-OR to pick up more signal, logic-AND to eliminate noise, and logic-SUBTRACT to remove image background. Specifically, two or more Raman images can act as "parent images", to merge and generate a "daughter image" via a selected algorithm, to a "granddaughter image" via a further selected algorithm, and to an "offspring image" etc. More interestingly, to validate this algorithm approach, we analyse microplastics / nanoplastics that might be generated by a laser printer in our office or home. Depending on the toner and the printer, we might print and generate millions of microplastics and nanoplastics when we print a single A4 document.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.watres.2021.116913DOI Listing
April 2021

Sex, Permanent Drug Discontinuation, and Study Retention in Clinical Trials: Insights From the TIMI trials.

Circulation 2021 Feb 15;143(7):685-695. Epub 2021 Feb 15.

TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (E.B., D.A.M., R.P.G., E.M.A., B.M.S., E.A.B., S.D.W., K.I., J.G., M.S.S., M.O.D.).

Background: Women are underrepresented across cardiovascular clinical trials. Whether women are more likely than men to prematurely discontinue study drug or withdraw consent once enrolled in a clinical trial is unknown.

Methods: Eleven phase 3/4 TIMI (Thrombolysis in Myocardial Infarction) trials were included (135 879 men and 51 812 women [28%]). The association between sex and premature study drug discontinuation and withdrawal of consent were examined by multivariable logistic regression after adjusting for potential confounders in each individual trial and combining the individual point estimates in random effects models.

Results: After adjusting for baseline differences, women had 22% higher odds of premature drug discontinuation (adjusted odds ratio [OR], 1.22 [95% CI, 1.16-1.28]; <0.001) compared with men. Qualitatively consistent results were observed for women versus men in the placebo arms (OR, 1.20 [95% CI, 1.13-1.27]) and active therapy arms (OR, 1.23 [95% CI, 1.17-1.30)]; there was some evidence for regional heterogeneity ( interaction <0.001). Of those who stopped study drug prematurely, a similar proportion of men and women in the active arm stopped because of an adverse event (36% for both; =0.60). Women were also more likely to withdraw consent compared with men (OR, 1.26 [95% CI, 1.17-1.36]; <0.001).

Conclusions: Women were more likely than men to prematurely discontinue study drug and withdraw consent across cardiovascular outcome trials. Premature study drug discontinuation was not explained by baseline differences by sex or a higher proportion of adverse events. Future trials should better capture reasons for drug discontinuation and withdrawal of consent to understand barriers to continued study drug use and clinical trial participation, particularly among women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.120.052339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894618PMC
February 2021

On-Site Prescription Dispensing Improves Antidepressant Adherence among Uninsured Depressed Patients.

Psychiatr Q 2021 Feb 15. Epub 2021 Feb 15.

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.

The successful treatment of depressive disorders critically depends on adherence to prescribed treatment regimens. Despite increasing rates of antidepressant medication prescription, adherence to the full treatment course remains poor. Rates of antidepressant non-adherence are higher for uninsured patients and members of some marginalized racial and ethnic communities due to factors such as inequities in healthcare and access to insurance. Among patients treated in a free, student-run and faculty-supervised clinic serving uninsured patients in a majority Hispanic community in East Harlem, adherence rates are lower than those observed in patients with private or public New York State health insurance coverage. A prior study of adherence in these patients revealed that difficulty in obtaining medications from an off-site hospital pharmacy was a leading factor that patients cited for non-adherence. To alleviate this barrier to obtaining prescriptions, we tested the effectiveness of on-site, in-clinic medication dispensing for improving antidepressant medication adherence rates among uninsured patients. We found that dispensing medications directly to patients in clinic was associated with increased visits at which patients self-reported proper adherence and increased overall adherence rates. Furthermore, we found evidence that higher rates of antidepressant medication adherence were associated with more favorable treatment outcomes. All patients interviewed reported increased satisfaction with on-site dispensing. Overall, this study provides promising evidence that on-site antidepressant dispensing in a resource-limited setting improves medication adherence rates and leads to more favorable treatment outcomes with enhanced patient satisfaction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11126-021-09885-zDOI Listing
February 2021

Disruption of the anterior thalamic head direction signal following reduction of the hippocampal theta rhythm.

Behav Neurosci 2020 Dec;134(6):577-594

Department of Psychology.

There is overlap between the structures containing head direction (HD) cells and those mediating the hippocampal theta rhythm, and both signals are thought to play an important role in spatial navigation. Previous research has shown that reversible inactivation of the medial septum attenuates hippocampal theta activity and disrupts path integration-based navigation. Although the HD signal reflects navigational performance, it is unclear whether theta rhythm contributes to the direction-specific activity of HD cells. We sought to determine whether HD cell activity is changed following reversible inactivation of the medial septum to eliminate theta rhythm. HD cells were recorded from the anterodorsal thalamus of female Long-Evans rats while they navigated in a cylindrical environment across standard, landmark rotation, and dark conditions. Following infusions of muscimol into the medial septum, recordings demonstrated a clear decrease in the power of hippocampal theta oscillations. In the landmark rotation experiment, intraseptal administration of muscimol produced HD cells with preferred directions that shifted unpredictably between sessions, suggesting that cue control was affected. Further, following septal inactivation many HD cells were unable to maintain a stable preferred firing direction within the recording sessions when the animals locomoted in the dark, suggesting that idiothetic processing was affected. These findings provide evidence that theta oscillations contribute to the directional stability of HD cells in anterodorsal thalamus. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/bne0000415DOI Listing
December 2020

Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A North American Perspective: 2021 Update.

Circulation 2021 Feb 8;143(6):583-596. Epub 2021 Feb 8.

Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., D.P.F.).

A growing number of patients undergoing percutaneous coronary intervention (PCI) with stent implantation also have atrial fibrillation. This poses challenges for their optimal antithrombotic management because patients with atrial fibrillation undergoing PCI require oral anticoagulation for the prevention of cardiac thromboembolism and dual antiplatelet therapy for the prevention of coronary thrombotic complications. The combination of oral anticoagulation and dual antiplatelet therapy substantially increases the risk of bleeding. Over the last decade, a series of North American Consensus Statements on the Management of Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention have been reported. Since the last update in 2018, several pivotal clinical trials in the field have been published. This document provides a focused updated of the 2018 recommendations. The group recommends that in patients with atrial fibrillation undergoing PCI, a non-vitamin K antagonist oral anticoagulant is the oral anticoagulation of choice. Dual antiplatelet therapy with aspirin and a P2Y inhibitor should be given to all patients during the peri-PCI period (during inpatient stay, until time of discharge, up to 1 week after PCI, at the discretion of the treating physician), after which the default strategy is to stop aspirin and continue treatment with a P2Y inhibitor, preferably clopidogrel, in combination with a non-vitamin K antagonist oral anticoagulant (ie, double therapy). In patients at increased thrombotic risk who have an acceptable risk of bleeding, it is reasonable to continue aspirin (ie, triple therapy) for up to 1 month. Double therapy should be given for 6 to 12 months with the actual duration depending on the ischemic and bleeding risk profile of the patient, after which patients should discontinue antiplatelet therapy and receive oral anticoagulation alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.120.050438DOI Listing
February 2021

Women Veterans' Experiences with Integrated, Biopsychosocial Pain Care: A Qualitative Study.

Pain Med 2021 Feb 6. Epub 2021 Feb 6.

San Francisco VA Health Care System, San Francisco, California.

Objectives: Biopsychosocial, integrated pain care models are increasingly implemented in the Veterans Health Administration to improve chronic pain care and reduce opioid-related risks, but little is known about how well these models address women veterans' needs.

Design: Qualitative, interview-based study.

Setting: San Francisco VA Health Care System Integrated Pain Team (IPT), an interdisciplinary team that provides short-term, personalized chronic pain care emphasizing functional goals and active self-management.

Subjects: Women with chronic pain who completed ≥3 IPT sessions.

Methods: Semistructured phone interviews focused on overall experience with IPT, perceived effectiveness of IPT care, pain care preferences, and suggested changes for improving gender-sensitive pain care. We used a rapid approach to qualitative thematic analysis to analyze interviews.

Results: Fourteen women veterans (mean age 51 years; range 33-67 years) completed interviews. Interviews revealed several factors impacting women veterans' experiences: 1) an overall preference for receiving both primary and IPT care in gender-specific settings, 2) varying levels of confidence that IPT could adequately address gender-specific pain issues, 3) barriers to participating in pain groups, and 4) barriers to IPT self-management recommendations due to caregiving responsibilities.

Conclusions: Women veterans reported varied experiences with IPT. Recommendations to improve gender-sensitive pain care include increased provider training; increased knowledge of and sensitivity to women's health concerns; and improved accommodations for prior trauma, family and work obligations, and geographic barriers. To better meet the needs of women veterans with chronic pain, integrated pain care models must be informed by an understanding of gender-specific needs, challenges, and preferences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/pm/pnaa481DOI Listing
February 2021

Overfeeding Extends the Period of Annual Cyclicity but Increases the Risk of Early Embryonic Death in Shetland Pony Mares.

Animals (Basel) 2021 Feb 1;11(2). Epub 2021 Feb 1.

Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 112, 3584 CM Utrecht, The Netherlands.

Obesity has been associated with altered reproductive activity in mares, and may negatively affect fertility. To examine the influence of long-term high-energy (HE) feeding on fertility, Shetland pony mares were fed a diet containing 200% of net energy (NE) requirements during a three-year study. The incidence of hemorrhagic anovulatory follicles (HAF) and annual duration of cyclicity were compared to those in control mares receiving a maintenance diet. Day-7 embryos were flushed and transferred between donor and recipient mares from both groups; the resulting conceptuses were collected 21 days after transfer to assess conceptus development. HE mares became obese, and embryos recovered from HE mares were more likely to succumb to early embryonic death. The period of annual cyclicity was extended in HE compared to control mares in all years. The incidence of HAFs did not consistently differ between HE and control mares. No differences in embryo morphometric parameters were apparent. In conclusion, consuming a HE diet extended the duration of cyclicity, and appeared to increase the likelihood of embryos undergoing early embryonic death following embryo transfer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ani11020361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912773PMC
February 2021

Definitions and Clinical Trial Design Principles for Coronary Artery Chronic Total Occlusion Therapies: CTO-ARC Consensus Recommendations.

Circulation 2021 Feb 1;143(5):479-500. Epub 2021 Feb 1.

The Cardiovascular Research Foundation, New York, NY (D.K., A.M., Z.A.A., J.W.M., G.W.S.).

Over the past 2 decades, chronic total occlusion (CTO) percutaneous coronary intervention has developed into its own subspecialty of interventional cardiology. Dedicated terminology, techniques, devices, courses, and training programs have enabled progressive advancements. However, only a few randomized trials have been performed to evaluate the safety and efficacy of CTO percutaneous coronary intervention. Moreover, several published observational studies have shown conflicting data. Part of the paucity of clinical data stems from the fact that prior studies have been suboptimally designed and performed. The absence of standardized end points and the discrepancy in definitions also prevent consistency and uniform interpretability of reported results in CTO intervention. To standardize the field, we therefore assembled a broad consortium comprising academicians, practicing physicians, researchers, medical society representatives, and regulators (US Food and Drug Administration) to develop methods, end points, biomarkers, parameters, data, materials, processes, procedures, evaluations, tools, and techniques for CTO interventions. This article summarizes the effort and is organized into 3 sections: key elements and procedural definitions, end point definitions, and clinical trial design principles. The Chronic Total Occlusion Academic Research Consortium is a first step toward improved comparability and interpretability of study results, supplying an increasingly growing body of CTO percutaneous coronary intervention evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.120.046754DOI Listing
February 2021

Oxidative Dissolution of Sulfide Minerals in Single and Mixed Sulfide Systems under Simulated Acid and Metalliferous Drainage Conditions.

Environ Sci Technol 2021 Feb 28;55(4):2369-2380. Epub 2021 Jan 28.

Blue Minerals Consultancy, Wattle Grove, Tasmania 7109, Australia.

Chalcopyrite, galena, and sphalerite commonly coexist with pyrite in sulfidic waste rocks. The aim of this work was to investigate their impact, potentially by galvanic interaction, on pyrite oxidation and acid generation rates under simulated acid and metalliferous drainage conditions. Kinetic leach column experiments using single-minerals and pyrite with one or two of the other sulfide minerals were carried out at realistic sulfide contents (total sulfide <5.2 wt % for mixed sulfide experiments), mimicking sulfidic waste rock conditions. Chalcopyrite was found to be most effective in limiting pyrite oxidation and acid generation with 77-95% reduction in pyrite oxidation over 72 weeks, delaying decrease in leachate pH. Sphalerite had the least impact with reduction of pyrite dissolution by 26% over 72 weeks, likely because of the large band gap and poor conductivity of sphalerite. Galena had a smaller impact than chalcopyrite on pyrite oxidation, despite their similar band gaps, possibly because of the greater extent of oxidation and the significantly reduced surface areas of galena (area reductions of >47% for galena <1.5% for chalcopyrite) over 72 weeks. The results are directly relevant to mine waste storage and confirm that the galvanic interaction plays a role in controlling acid generation in multisulfide waste even at low sulfide contents (several wt %) with small probabilities (≤0.23%) of direct contact between sulfide minerals in mixed sulfide experiments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.est.0c07136DOI Listing
February 2021

Workplace Sexual Harassment: Potential Long-term Associations with Psychological Function in Older Adults.

J Gen Intern Med 2021 Jan 19. Epub 2021 Jan 19.

Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11606-021-06591-1DOI Listing
January 2021

Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial.

JAMA 2021 01;325(3):254-264

D'Or Institute for Research and Education, Rio de Janeiro, Brazil.

Importance: It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19).

Objective: To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days.

Design, Setting, And Participants: A randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization (enrolled: April 9-June 26, 2020; final follow-up: July 26, 2020).

Interventions: Discontinuation (n = 334) or continuation (n = 325) of ACEIs or ARBs.

Main Outcomes And Measures: The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression.

Results: Among 659 patients, the median age was 55.1 years (interquartile range [IQR], 46.1-65.0 years), 14.7% were aged 70 years or older, 40.4% were women, and 100% completed the trial. The median time from symptom onset to hospital admission was 6 days (IQR, 4-9 days) and 27.2% of patients had an oxygen saturation of less than 94% of room air at baseline. In terms of clinical severity, 57.1% of patients were considered mild at hospital admission and 42.9% were considered moderate. There was no significant difference in the number of days alive and out of the hospital in patients in the discontinuation group (mean, 21.9 days [SD, 8 days]) vs patients in the continuation group (mean, 22.9 days [SD, 7.1 days]) and the mean ratio was 0.95 (95% CI, 0.90-1.01). There also was no statistically significant difference in death (2.7% for the discontinuation group vs 2.8% for the continuation group; odds ratio [OR], 0.97 [95% CI, 0.38-2.52]), cardiovascular death (0.6% vs 0.3%, respectively; OR, 1.95 [95% CI, 0.19-42.12]), or COVID-19 progression (38.3% vs 32.3%; OR, 1.30 [95% CI, 0.95-1.80]). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs 7.7% in the continuation group), shock requiring vasopressors (8.4% vs 7.1%, respectively), acute myocardial infarction (7.5% vs 4.6%), new or worsening heart failure (4.2% vs 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs 2.8%).

Conclusions And Relevance: Among patients hospitalized with mild to moderate COVID-19 and who were taking ACEIs or ARBs before hospital admission, there was no significant difference in the mean number of days alive and out of the hospital for those assigned to discontinue vs continue these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment.

Trial Registration: ClinicalTrials.gov Identifier: NCT04364893.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2020.25864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816106PMC
January 2021

Peripapillary Hyper-Reflective Ovoid Mass-Like Structures in Astronauts.

Ann Neurol 2021 Apr 28;89(4):849. Epub 2021 Jan 28.

Colonel, US Army (retired), Moab, UT.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ana.26027DOI Listing
April 2021

Effects of proprotein convertase subtilisin/kexin type-9 inhibitors on fatty liver.

World J Hepatol 2020 Dec;12(12):1258-1266

Internal Medicine, NCH Health Care System, Naples, FL 34102, United States.

Background: Many studies have investigated the progression of nonalcoholic fatty liver disease (NAFLD) and its predisposing risk factors, but the conclusions from these studies have been conflicting. More challenging is the fact that no effective treatment is currently available for NAFLD.

Aim: To determine the effects of proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors on fatty infiltration of the liver.

Methods: This retrospective, chart review-based study was conducted on patients, 18-year-old and above, who were currently on PCSK9 inhibitor drug therapy. Patients were excluded from the study according to missing pre- or post-treatment imaging or laboratory values, presence of cirrhosis or rhabdomyolysis, or development of acute liver injury during the PCSK9 inhibitor treatment period; the latter being due to false elevation of liver function markers, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Radiographic improvement was assessed by a single radiologist, who read both the pre- and post-treatment images to minimize reading bias. Fatty infiltration of the liver was also assessed by changes in ALT and AST, with pre- and post-treatment levels compared by paired -test (alpha criterion: 0.05).

Results: Of the 29 patients included in the study, 8 were male (27.6%) and 21 were female (72.4%). Essential hypertension was present in 25 (86.2%) of the patients, diabetes mellitus in 18 (62.1%) and obesity in 15 (51.7%). In all, patients were on PCSK9 inhibitors for a mean duration of 23.69 ± 11.18 mo until the most recent ALT and AST measures were obtained. Of the 11 patients who received the radiologic diagnosis of hepatic steatosis, 8 (72.73%) achieved complete radiologic resolution upon use of PCSK9 inhibitors (mean duration of 17.6 mo). On average, the ALT level (IU/L) decreased from 21.83 ± 11.89 at pretreatment to 17.69 ± 8.00 at post-treatment (2-tailed = 0.042) and AST level (IU/L) decreased from 22.48 ± 9.00 pretreatment to 20.59 ± 5.47 post-treatment (2-tailed = 0.201).

Conclusion: PCSK9 inhibitors can slow down or even completely resolve NAFLD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4254/wjh.v12.i12.1258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772734PMC
December 2020

Effects of proprotein convertase subtilisin/kexin type-9 inhibitors on fatty liver.

World J Hepatol 2020 Dec;12(12):1258-1266

Internal Medicine, NCH Health Care System, Naples, FL 34102, United States.

Background: Many studies have investigated the progression of nonalcoholic fatty liver disease (NAFLD) and its predisposing risk factors, but the conclusions from these studies have been conflicting. More challenging is the fact that no effective treatment is currently available for NAFLD.

Aim: To determine the effects of proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors on fatty infiltration of the liver.

Methods: This retrospective, chart review-based study was conducted on patients, 18-year-old and above, who were currently on PCSK9 inhibitor drug therapy. Patients were excluded from the study according to missing pre- or post-treatment imaging or laboratory values, presence of cirrhosis or rhabdomyolysis, or development of acute liver injury during the PCSK9 inhibitor treatment period; the latter being due to false elevation of liver function markers, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Radiographic improvement was assessed by a single radiologist, who read both the pre- and post-treatment images to minimize reading bias. Fatty infiltration of the liver was also assessed by changes in ALT and AST, with pre- and post-treatment levels compared by paired -test (alpha criterion: 0.05).

Results: Of the 29 patients included in the study, 8 were male (27.6%) and 21 were female (72.4%). Essential hypertension was present in 25 (86.2%) of the patients, diabetes mellitus in 18 (62.1%) and obesity in 15 (51.7%). In all, patients were on PCSK9 inhibitors for a mean duration of 23.69 ± 11.18 mo until the most recent ALT and AST measures were obtained. Of the 11 patients who received the radiologic diagnosis of hepatic steatosis, 8 (72.73%) achieved complete radiologic resolution upon use of PCSK9 inhibitors (mean duration of 17.6 mo). On average, the ALT level (IU/L) decreased from 21.83 ± 11.89 at pretreatment to 17.69 ± 8.00 at post-treatment (2-tailed = 0.042) and AST level (IU/L) decreased from 22.48 ± 9.00 pretreatment to 20.59 ± 5.47 post-treatment (2-tailed = 0.201).

Conclusion: PCSK9 inhibitors can slow down or even completely resolve NAFLD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4254/wjh.v12.i12.1258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772734PMC
December 2020

Comparison of two escalated enoxaparin dosing regimens for venous thromboembolism prophylaxis in obese hospitalized patients.

J Thromb Thrombolysis 2021 Jan 5. Epub 2021 Jan 5.

Medical City Fort Worth, 900 Eighth Ave, Fort Worth, TX, 76104, USA.

Standard fixed-dose enoxaparin dosing regimens may not provide adequate prophylaxis against venous thromboembolism among obese hospitalized patients. While several escalated doses have been shown to result in more frequent attainment of target anti-factor Xa levels than standard doses, few studies compare escalated doses to each other. In this prospective, multi-center trial, enoxaparin 0.5 mg/kg daily (weight-based dosing) and enoxaparin 40 mg twice daily were compared to determine if either dose resulted in more frequent attainment of anti-factor Xa levels within the goal range of 0.2-0.5 IU/mL. Eighty patients with a BMI ≥ 40 kg/m were enrolled. There was no difference in the percent of patients achieving goal anti-factor Xa levels (72.5% vs. 70.0%, respectively; p = 0.72). Patients were more likely to attain anti-factor Xa levels below goal range than above. No bleeding or thrombotic events occurred. Either weight-based or twice-daily escalated enoxaparin dosing regimens appear effective at achieving target anti-factor Xa levels among hospitalized patients, and no safety events were noted. Future studies are needed to determine the clinical significance of this result.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11239-020-02360-9DOI Listing
January 2021

Short telomere length predicts nonrelapse mortality after stem cell transplantation for myelodysplastic syndrome.

Blood 2020 12;136(26):3070-3081

Division of Hematological Malignancies, Department of Medical Oncology, and.

Allogeneic hematopoietic stem cell transplantation is the only potentially curative treatment for patients with myelodysplastic syndrome (MDS), but long-term survival is limited by the risk of transplant-related complications. Short telomere length, mediated by inherited or acquired factors, impairs cellular response to genotoxic and replicative stress and could identify patients at higher risk for toxicity after transplantation. We measured relative telomere length in pretransplant recipient blood samples in 1514 MDS patients and evaluated the association of telomere length with MDS disease characteristics and transplantation outcomes. Shorter telomere length was significantly associated with older age, male sex, somatic mutations that impair the DNA damage response, and more severe pretransplant cytopenias, but not with bone marrow blast count, MDS treatment history, or history of prior cancer therapy. Among 1267 patients ≥40 years old, telomere length in the shortest quartile was associated with inferior survival (P < .001) because of a high risk of nonrelapse mortality (NRM; P = .001) after adjusting for significant clinical and genetic variables. The adverse impact of shorter telomeres on NRM was independent of recipient comorbidities and was observed selectively among patients receiving more intensive conditioning, including myeloablative regimens and higher dose melphalan-based reduced-intensity regimens. The effect of shorter telomeres on NRM was prominent among patients who developed severe acute graft-versus-host disease, suggesting that short telomere length may limit regenerative potential of mucosal tissues after acute injury. MDS patients with shorter telomere length, who have inferior survival driven by excess toxicity, could be considered for strategies focused on minimizing toxic effects of transplantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1182/blood.2020005397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770569PMC
December 2020

Burnout or Fade Away; experiences of health professionals caring for patients with head and neck cancer.

Eur J Oncol Nurs 2021 Feb 24;50:101881. Epub 2020 Nov 24.

School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia.

Purpose: The oncology workforce has been found to have high risk of burnout; however, limited research has explored the experiences of health professionals working with head and neck cancer patients. The objective of this qualitative study was to explore the experiences of health professionals who work directly with patients diagnosed with head and neck cancers, with a focus on work-life balance, mental health and wellbeing.

Method: A total of 21 in-depth semi-structured interviews were conducted with health professionals including radiation oncologists, medical oncologists, nurses, and associated medical and allied health professionals. A qualitative research approach based on social constructionist theory was used. Thematic analysis was used to identify and code themes.

Results: Five main themes emerged: 1. Conscientiousness; 2. Empathy; 3. Challenges; 4. Coping; and 5. Burnout or Fade Away. Challenges included sub-themes of Time & Resource Constraints, Work-Life Imbalance, Patients with Complex Needs, and Lack of Self-Care.

Conclusion: It is vital to the sustainability of head and neck oncology services that this highly skilled workforce is retained. The development of interventions that will reduce the risk of burnout and improve retention and capacity of health professionals may include advanced communication skills training, trauma sensitivity training, self-compassion and stress management skills.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejon.2020.101881DOI Listing
February 2021

The multiplication of loaves and fishes approach: A Critic to Double anti-thrombotics or to Double number of ischemic events?

Eur Heart J Cardiovasc Pharmacother 2020 Dec 19. Epub 2020 Dec 19.

CardioCentro Ticino, Via Tesserete 48, Lugano, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjcvp/pvaa141DOI Listing
December 2020

Are motorcycles really "donorcycles"? Examining organ donation rates between unhelmeted and helmeted motorcyclists.

J Safety Res 2020 12 6;75:173-177. Epub 2020 Oct 6.

Trauma Research Institute, Division of Acute Care Surgery, Spectrum Health Hospital, Michigan State University College of Human Medicine, Grand Rapids, MI, United States.

Introduction: Motorcycles are colloquially referred to as "donorcycles" among medical staff. However, the actual impact of helmet laws and helmet use on organ donation is unknown. Michigan's 35-year-old universal helmet law (UHL) was repealed in April 2012 and replaced by a partial-helmet law. We hypothesized that there would be an increase in organ donation rates from unhelmeted motorcyclist fatalities.

Methods: Michigan's Gift of Life Michigan organ donation database was queried from April 2008 through May 2015 in conjunction with the Michigan Trauma Quality Improvement Program database from the same time period. All in-hospital motorcycle crash fatalities were examined.

Results: A three-fold increase was found in the rate of organ donation for unhelmeted motorcyclists compared to helmeted motorcyclists (p = 0.006). Motorcycle crash fatalities tended to be younger in age after the UHL repeal with an average age of 32.8 years versus 40.8, however, this finding was not statistically significant (p = 0.071). Additionally, there was no significant difference in organ donation rates pre-UHL repeal (2008-2012) versus post-repeal (2012-2015).

Conclusions: This is the first study to demonstrate an increased rate of organ donation among unhelmeted motorcyclist fatalities compared to helmeted rider fatalities. There was no significant increase in the rate of organ donation following the Michigan UHL repeal. However, we identified that some motorcycle crash fatalities were from illegally unhelmeted riders in the past, prior to the repeal. Practical Application: Unhelmeted motorcyclists are three times more likely than helmeted riders to become organ donors, possibly due to the well documented increase in severe traumatic brain injuries in this population. From a public health perspective, helmets should be required for all motorcyclists and efforts to advocate in favor of helmet legislation should be supported by trauma systems and health professionals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsr.2020.09.006DOI Listing
December 2020