Publications by authors named "K Bailey Freund"

821 Publications

Older Adult Willingness to Use Fully Autonomous Vehicle (FAV) Ride Sharing.

Geriatrics (Basel) 2021 Apr 29;6(2). Epub 2021 Apr 29.

ITNAmerica, 90 Bridge St, Suite 210, Westbrook, ME 04092, USA.

In the United States, older adults (age 65 and older) rely on private automobiles for transportation. For those who stop driving, access to alternative modes of transportation is important for health, wellbeing, mobility, and independence. This paper explores older adult willingness to use fully autonomous vehicle (FAV) ride sharing and the features or services of FAV ride sharing that would make them willing to take a ride. These data were gathered as part of a larger qualitative research study designed to explore the factors affecting older adult use of ride share services. For the larger study, we conducted 68 telephone interviews with older adults, and 10 in-person focus groups with 56 older adults, including individuals who both used and never used ride share services. We used a convenience sample recruited by study partners, including ride share and transportation services and a recruitment firm. The predominant thematic findings of the qualitative analysis included a desire for a proven safety record in terms of performance and technology, followed by dependability and accuracy of FAV ride sharing. Older adults' concerns about FAV ride sharing included safety concerns and preferences for social interaction with drivers. Ride share services that use FAVs in the future may need to tailor transportation offerings for older adults to increase their willingness to use FAVS to support their mobility and social needs.
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http://dx.doi.org/10.3390/geriatrics6020047DOI Listing
April 2021

Deploying the Physician Workforce During a Respiratory Pandemic: The Experience of an Academic Teaching Hospital During the COVID-19 Pandemic.

Qual Manag Health Care 2021 Apr 26. Epub 2021 Apr 26.

Tufts Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine (Drs Roberts, Kher, Garpestad, and Chweich), and Division of Geographic Medicine and Infectious Disease (Drs Boucher and Poutsiaka), Department of Medicine (Drs Mohanty, Davis, Kumar, Weingart and Freund), Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts (Drs Roberts, Kher, Garpestad, Chweich, Boucher, Poutsiaka, Weingart, and Freund); Department of Medicine, University of California, San Diego (Dr Kumar); and Rhode Island Hospital, Providence (Dr Weingart).

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http://dx.doi.org/10.1097/QMH.0000000000000321DOI Listing
April 2021

Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial.

JAMA 2021 03;325(10):942-951

Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio.

Importance: Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction worldwide. It remains unknown whether a ventral or dorsal surgical approach provides the best results.

Objective: To determine whether a ventral surgical approach compared with a dorsal surgical approach for treatment of cervical spondylotic myelopathy improves patient-reported physical functioning at 1 year.

Design, Setting, And Participants: Randomized clinical trial of patients aged 45 to 80 years with multilevel cervical spondylotic myelopathy enrolled at 15 large North American hospitals from April 1, 2014, to March 30, 2018; final follow-up was April 15, 2020.

Interventions: Patients were randomized to undergo ventral surgery (n = 63) or dorsal surgery (n = 100). Ventral surgery involved anterior cervical disk removal and instrumented fusion. Dorsal surgery involved laminectomy with instrumented fusion or open-door laminoplasty. Type of dorsal surgery (fusion or laminoplasty) was at surgeon's discretion.

Main Outcomes And Measures: The primary outcome was 1-year change in the Short Form 36 physical component summary (SF-36 PCS) score (range, 0 [worst] to 100 [best]; minimum clinically important difference = 5). Secondary outcomes included 1-year change in modified Japanese Orthopaedic Association scale score, complications, work status, sagittal vertical axis, health resource utilization, and 1- and 2-year changes in the Neck Disability Index and the EuroQol 5 Dimensions score.

Results: Among 163 patients who were randomized (mean age, 62 years; 80 [49%] women), 155 (95%) completed the trial at 1 year (80% at 2 years). All patients had surgery, but 5 patients did not receive their allocated surgery (ventral: n = 1; dorsal: n = 4). One-year SF-36 PCS mean improvement was not significantly different between ventral surgery (5.9 points) and dorsal surgery (6.2 points) (estimated mean difference, 0.3; 95% CI, -2.6 to 3.1; P = .86). Of 7 prespecified secondary outcomes, 6 showed no significant difference. Rates of complications in the ventral and dorsal surgery groups, respectively, were 48% vs 24% (difference, 24%; 95% CI, 8.7%-38.5%; P = .002) and included dysphagia (41% vs 0%), new neurological deficit (2% vs 9%), reoperations (6% vs 4%), and readmissions within 30 days (0% vs 7%).

Conclusions And Relevance: Among patients with cervical spondylotic myelopathy undergoing cervical spinal surgery, a ventral surgical approach did not significantly improve patient-reported physical functioning at 1 year compared with outcomes after a dorsal surgical approach.

Trial Registration: ClinicalTrials.gov Identifier: NCT02076113.
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http://dx.doi.org/10.1001/jama.2021.1233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944378PMC
March 2021

Multimodal imaging of a choroidal nevus with caverns in the setting of pachychoroid disease.

Retin Cases Brief Rep 2021 Feb 26. Epub 2021 Feb 26.

Doheny Eye Institute, Los Angeles, California, United States. Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States. Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy. Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA Vitreous Retina Macula Consultants of New York, New York, New York. Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY USA.

Purpose: To describe the multimodal imaging findings of extensive choroidal caverns within a choroidal nevus in an eye with pachychoroid spectrum disease.

Methods: A 69 year-old woman was referred with a known history of branch retinal vein occlusion (BRVO) in the right eye and choroidal nevus in the left eye. Fundus examination of both eyes (OU) revealed subretinal yellow deposits, suggestive of pachydrusen. Retinal venous collaterals were noted in the temporal macular of the right eye. A lightly pigmented choroidal lesion with nearly confluent overlying drusen and retinal pigment epithelial (RPE) alterations, consistent with chronic choroidal nevus, was noted in the macula of the left eye.

Results: Optical coherence tomography B-scans revealed thickened choroid (pachychoroid) with subfoveal choroidal thickness of 504 and 580 µm with large hyporeflective spaces suggestive of pachyvessels OU. In the region of the choroidal nevus, the choroidal vascular spaces appeared comparatively large and were classified as "caverns", measuring up to 480 µm in diameter. OCT angiography (OCTA) and indocyanine green angiography (ICGA) demonstrated absence of flow within the caverns. ICGA further illustrated choroidal vascular hyperpermeability with patchy hyperfluorescent areas OU. Widefield swept source OCT showed mild posterior scleral bowing, a feature occasionally documented with choroidal nevus, and highlighted greater hyporeflectivity and hypertransmission on OCT within the caverns compared to the non-cavernous choroidal vessels.

Conclusion: Choroidal caverns can occur within choroidal nevus in the setting of pachychoroid disease.
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http://dx.doi.org/10.1097/ICB.0000000000001138DOI Listing
February 2021

Correlation of Outer Retinal Tubulations and Choriocapillaris Flow Signal Deficits surrounding Geographic Atrophy.

Retina 2021 Feb 17. Epub 2021 Feb 17.

Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland. University of Zurich, Zürich, Switzerland Vitreous Retina Macula Consultants of New York, New York, NY, USA Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA.

Purpose: To evaluate and compare para- and perilesional choriocapillaris vascular impairment in eyes with geographic atrophy (GA) with and without outer retinal tubulations (ORT).

Methods: Using swept source optical coherence tomography angiography (OCTA), 6x6mm scans of eyes with GA with and without ORT were acquired. Choriocapillaris en face flow and structural images were binarized, prior to flow signal deficit (FD) analysis in the para-atrophy zone (a 500 µm wide band adjacent to the GA) and the peri-atrophy zone (a 500 µm wide band adjacent to the latter).

Results: Twenty-four eyes of 19 patients with ORT and 18 eyes of 15 patients without ORT were analyzed. With and without ORT, mean percental area of FD (%FD) was greater in para- than in peri-atrophy zone. The difference of %FD between para- and peri-atrophy zone (deltaFD) was lower in eyes with ORT (mean 1.8477%, 95% CI 0.8607 to 2.8346) than without ORT (mean 4.0018%, 95% CI 2.8622 to 5.1414).

Conclusion: In eyes with GA due to non-neovascular AMD, smaller reductions in FDs were found between the para- and peri-atrophy zone in eyes with ORT. In both cohorts, the para-atrophy zone had more FD than the peri-atrophy zone.
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http://dx.doi.org/10.1097/IAE.0000000000003135DOI Listing
February 2021