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"Block, Lawrence"
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A drop of the hard stuff : a Matthew Scudder novel
After a childhood friend is shot down while attempting to atone for past sins, Scudder is drawn into a murder investigation that threatens to upset his path toward recovery--and get him killed in the process.
Book
Extracting patient-level data from the electronic health record: Expanding opportunities for health system research
Epidemiological studies of interstitial lung disease (ILD) are limited by small numbers and tertiary care bias. Investigators have leveraged the widespread use of electronic health records (EHRs) to overcome these limitations, but struggle to extract patient-level, longitudinal clinical data needed to address many important research questions. We hypothesized that we could automate longitudinal ILD cohort development using the EHR of a large, community-based healthcare system.
We applied a previously validated algorithm to the EHR of a community-based healthcare system to identify ILD cases between 2012-2020. We then extracted disease-specific characteristics and outcomes using fully automated data-extraction algorithms and natural language processing of selected free-text.
We identified a community cohort of 5,399 ILD patients (prevalence = 118 per 100,000). Pulmonary function tests (71%) and serologies (54%) were commonly used in the diagnostic evaluation, whereas lung biopsy was rare (5%). IPF was the most common ILD diagnosis (n = 972, 18%). Prednisone was the most commonly prescribed medication (911, 17%). Nintedanib and pirfenidone were rarely prescribed (n = 305, 5%). ILD patients were high-utilizers of inpatient (40%/year hospitalized) and outpatient care (80%/year with pulmonary visit), with sustained utilization throughout the post-diagnosis study period.
We demonstrated the feasibility of robustly characterizing a variety of patient-level utilization and health services outcomes in a community-based EHR cohort. This represents a substantial methodological improvement by alleviating traditional constraints on the accuracy and clinical resolution of such ILD cohorts; we believe this approach will make community-based ILD research more efficient, effective, and scalable.
Journal Article
Asthma and COVID-19 Outcomes: A Prospective Study in a Large Health Care Delivery System
Introduction: Previous studies on the outcomes of asthma and COVID-19 have shown inconsistent results. This study aimed to elucidate the association between asthma and COVID-19 outcomes. Methods: We conducted a prospective study with a large health plan to compare the incidence of COVID-19 infection, hospitalization and ICU admission in a cohort of 41,282 patients with asthma and a 1:1 age-, sex-, and race-ethnicity-matched cohort without asthma across the following pandemic periods: pre-Delta (03/01/2020 to 05/31/2021), Delta (06/01/2021 to 12/31/2021), and Omicron (01/01/2022 to 08/13/2022). Demographic factors, comorbidities, COVID-19 test results, inpatient utilization, and COVID-19 vaccination status were collected from electronic health records. Results: Subjects with asthma were more likely than controls to undergo COVID-19 testing during the three pandemic periods and were less likely to test positive in the Omicron period (fully adjusted odds ratio=0.92; 95% CI=0.86-0.98; p=0.01). Relative to controls, patients with asthma had an increased risk of hospitalization for COVID-19 (fully adjusted hazard ratio=1.33; 95% CI=1.08-1.64; p=0.01) and borderline significant (p=0.05) higher rates of ICU admissions in the pre-delta period but not during the delta or Omicron periods. The increased risk of COVID-19 hospitalization associated with asthma was more pronounced in patients with severe asthma and in women compared with men. None of the associations were significantly modified by vaccination status. Conclusion: Asthma was associated with a lower risk of COVID-19 infection but only during the Omicron period. Asthma was an independent risk factor for hospitalization for COVID-19 in the pre-delta period and this association was stronger for severe asthma and in women. Keywords: asthma, COVID-19, severe asthma, cohort study
Journal Article
Borderline
\"On the border between El Paso, Texas, and Juarez, Mexico, five lives are about to collide--with fatal results. You'll meet Marty--the professional gambler who rolls the dice on a night with ... Meg--the bored divorcee who seeks excitement and finds ... Lily--the beautiful hitchhiker lured into a live sex show by ... Cassie--the redhead with her own private agenda ... and Weaver--the madman, the killer with a straight razor in his pocket, on the run from the police and determined to go down swinging!\"--Publisher's web site.
Book
Improved infrared spectroscopic method for the analysis of degree of N-deacetylation of chitosan
SummaryVarious infrared spectroscopic techniques for the analysis of degree of N-deacetylation of chitosan were evaluated for accuracy. A new method was proposed which involved development of a calibration curve using the absorbance intensities of the chitosan infrared spectrum at 1655 and 3450 cm−1. The degree of N-deacetylation of various chitosan samples was then determined by using the absorption ratios [A1655/A3450] in the equation of the calibration curve. This method yielded results which were superior to those of any of the previously reported infrared spectroscopic methods tested herein.
Journal Article
Sinner man
To escape punishment for a murder he didn't mean to commit, insurance man Don Barshter has to take on a new identity: Nathaniel Crowley, ferocious up-and-comer in the New York mob. But can he find safety in the skin of another man...a worse man...a sinner man...?
Book
A successful program preventing nonventilator hospital-acquired pneumonia in a large hospital system
To develop and evaluate a program to presvent hospital-acquired pneumonia (HAP).
Prospective, observational, surveillance program to identify HAP before and after 7 interventions. An order set automatically triggered in programmatically identified high-risk patients.
All 21 hospitals of an integrated healthcare system with 4.4 million members.
All hospitalized patients.
Interventions for high-risk patients included mobilization, upright feeding, swallowing evaluation, sedation restrictions, elevated head of bed, oral care and tube care.
HAP rates decreased between 2012 and 2018: from 5.92 to 1.79 per 1,000 admissions (P = .0031) and from 24.57 to 6.49 per 100,000 members (P = .0014). HAP mortality decreased from 1.05 to 0.34 per 1,000 admissions and from 4.37 to 1.24 per 100,000 members. Concomitant antibiotic utilization demonstrated reductions of broad-spectrum antibiotics. Antibiotic therapy per 100,000 members was measured as follows: carbapenem days (694 to 463; P = .0020), aminoglycoside days (154 to 61; P = .0165), vancomycin days (2,087 to 1,783; P = .002), and quinolone days (2,162 to 1,287; P < .0001). Only cephalosporin use increased, driven by ceftriaxone days (264 to 460; P = .0009). Benzodiazepine use decreased between 2014 to 2016: 10.4% to 8.8% of inpatient days. Mortality for patients with HAP was 18% in 2012% and 19% in 2016 (P = .439).
HAP rates, mortality, and broad-spectrum antibiotic use were all reduced significantly following these interventions, despite the absence of strong supportive literature for guidance. Most interventions augmented basic nursing care. None had risks of adverse consequences. These results support the need to examine practices to improve care despite limited literature and the need to further study these difficult areas of care.
Journal Article
Effectiveness of 2023–2024 seasonal influenza vaccine against influenza-associated emergency department and urgent care encounters among pregnant and non-pregnant women of reproductive age
Influenza vaccination is particularly important for pregnant women. Using a test-negative, case-control design, we estimated the effectiveness of 2023–2024 seasonal influenza vaccination against influenza-associated emergency department and urgent care (ED/UC) encounters among pregnant and non-pregnant women of reproductive age using data from seven healthcare systems. Eligible encounters were among individuals aged 18–49 years with documented female sex. Vaccine effectiveness (VE) was estimated by comparing the odds of vaccination among influenza-positive cases versus influenza-negative controls, adjusting for site, age, race/ethnicity, calendar time, and gestational age at encounter (in pregnant women). Among pregnant women (N = 3539), VE against influenza-associated ED/UC encounters was 46 % (95 % CI: 36–55) and did not differ by gestational age at vaccination. Among non-pregnant women (N = 57,709), VE against influenza-associated ED/UC encounters was 54 % (95 % CI: 51–56). Influenza vaccination during the 2023–2024 season was similarly effective in both pregnant and non-pregnant women and by timing of vaccine receipt during pregnancy.
Journal Article