Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/1/jgs16109-sup-0001-TableS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/2/jgs16109_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/3/jgs16109.pd

USE OF PERIPHERAL VASOPRESSORS IN EARLY SEPSIS-INDUCED HYPOTENSION ACROSS MICHIGAN HOSPITALS

INTRODUCTION: Recent data suggest it may be safe to administer vasopressors via peripheral IV (PIV), challenging convention that vasopressors must be delivered centrally. Surviving Sepsis Campaign 2021 guidelines suggest using peripheral vasopressors as a bridge to central access. However, little is known about vasopressor initiation in practice. METHODS: Cohort study of patients hospitalized with community-onset sepsis at 12 hospitals in the Hospital Medicine Safety Consortium (HMS) sepsis initiative. HMS is a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan. A random sample of adult sepsis hospitalizations between 11/2020-1/2022 were included. Data were abstracted by trained abstractors. We sought to determine how commonly vasopressors were initiated via PIV vs central access across hospitals. HMS-Sepsis is expanding to 69 hospitals. Here we present pilot data; full cohort analysis is in process. RESULTS: of 1,901 patients in the HMS-Sepsis registry at the time of pilot data analysis, 440 (23.1%) had hypotension (defined by mean arterial pressure\u3c 65mmHg, systolic blood pressure\u3c 90mmHg, and/or vasopressor initiation) within 3 hours of hospital arrival. of these, 160 (36.4%) received vasopressors within 6 hours of hospital arrival. Route of initial vasopressor was PIV in 122 (76.3%), central access in 30 (18.8%), midline catheter in 1 (0.6%), oral (ie, midodrine) in 5 (3.1%), and unknown in 2 (1.3%). Across all hospitals, 50.0% to 91.7% of vasopressor initiation was via PIV (median 83.3%). Among 122 patients with vasopressor initiation via PIV, 66 (54.1%) received a 2nd vasopressor, after a median of 2.8 hrs [IQR 1, 8] from 1st vasopressor. Route of 2nd vasopressor was PIV in 27 (40.9%) and central access in 30 (45.4%). Time from hypotension to vasopressor initiation did not differ between patients receiving initial vasopressor via PIV vs central access (median 1.9 vs 2.1 hrs, p=0.79). Likewise, IV fluids within 6 hrs (median 2.0 vs 2.1L, p=0.78), hospitalization length (median 7 vs 6 days, p=0.31), and inhospital mortality (33.6% vs 40.0%, p=0.51) were similar. CONCLUSIONS: In this 12-hospital cohort, vasopressors were most frequently initiated peripherally. Outcomes were similar between patients in whom vasopressors were initiated via peripheral vs central access

Whitney Comorbidity Index to monitor health status for adults with cerebral palsy: validation and thresholds to assist clinical decision making

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168367/1/dmcn14879_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168367/2/dmcn14879-sup-0006-FigS3.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168367/3/dmcn14879-sup-0005-FigS2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168367/4/dmcn14879.pd

Anticoagulant medication adherence for cancer‐associated thrombosis: A comparison of LMWH to DOACs

BackgroundLow molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) are used to treat cancer‐associated thrombosis (CAT). It is not clear if patients are less adherent to LMWH compared to DOACs.ObjectivesTo compare medication persistence and adherence between LMWH and DOACs.Patients/MethodsWe analyzed Optum’s de‐identified Clinformatics® Data Mart Database of privately insured adults with cancer diagnosed between January 2009 and October 2015 who were undergoing chemotherapy, immunotherapy, targeted or hormonal therapies; developed CAT; and were treated with an outpatient anticoagulant. The proportion of days covered (PDC) was calculated from the date of anticoagulant prescription until the anticoagulant was switched, stopped, or the study end. Medication adherence was defined as PDC ≥ 80%, ≥95%, and by comparing the mean PDC.ResultsTwo propensity‐matched groups of 1128 patients were identified. Patient persistence was higher with DOACs compared to LMWH (median 116 days versus 34 days). With adherence defined as PDC ≥ 80%, we found no significant difference (95.6% versus 94.6% adherence with DOACs versus LMWH, P = .33). The mean difference of PDC between the two groups was also similar. With medication adherence defined as PDC ≥ 95%, adherence was evident in 73% of DOAC users and 81% of patients on LMWH (P < .001). Prescription copayments were higher on average for LMWH compared to DOACs (mean $153.61 versus 40.67; standard deviation$306.74 versus $33.11).ConclusionPatients remain on DOACs longer than LMWH, but medication adherence is similar with LMWH.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166289/1/jth15153_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166289/2/jth15153.pd

The Association of Vasopressor Administration Through a Midline Catheter with Catheter-Related Complications

Little is known about the safety of infusing vasopressors through a midline catheter. To evaluate safety outcomes following vasopressor administration though a midline. We conducted a cohort study of adults admitted to 39 hospitals in Michigan (December 2017 - March 2022) who received vasopressors while either a midline or peripherally inserted central catheter (PICC) was in place. Patients receiving vasopressors through a midline were compared to those receiving vasopressors through a PICC and, separately, to those with midlines in place but who received vasopressors through a different catheter. We used descriptive statistics to characterize and compare cohort characteristics. Multivariable mixed effects logistic regression models were fit to determine the association between vasopressor administration through a midline with outcomes, primarily catheter-related complications (bloodstream infection, superficial thrombophlebitis, exit site infection, or catheter occlusion). Our cohort included 287 patients with midlines through which vasopressors were administered, 1660 with PICCs through which vasopressors were administered, and 884 patients with midlines who received vasopressors through a separate catheter. Age (median [interquartile range]: 68.7 [58.6-75.7], 66.6 [57.1-75.0], and 67.6 [58.7-75.8] years) and gender (percent female: 50.5%, 47.3%, and 43.8%) were similar in all groups. The frequency of catheter-related complications was lower in patients with midlines used for vasopressors than PICCs used for vasopressors (5.2% vs. 13.4%, p<0.001), but similar to midlines with vasopressor administration through a different device (5.2% vs. 6.3%, p=0.49). Following adjustment, administration of vasopressors through a midline was not associated with catheter-related complications compared to PICCs with vasopressors (adjusted odds ratios [aOR] 0.65 [95% confidence interval, 0.31-1.33], p=0.23), nor midlines with vasopressors elsewhere (aOR 0.85 [0.46-1.58], p=0.59). Midlines used for vasopressors were associated with greater risk of systemic thromboembolism (vs PICCs with vasopressors: (aOR 2.69 [1.31,5.49] , p=0.008; vs midlines with vasopressors elsewhere: aOR 2.42 [1.29,4.54], p=0.008) yet not thromboses restricted to the ipsilateral upper extremity (vs PICCs with vasopressors: aOR 2.35 [0.83,6.63], p=0.10; model did not converge for vs midlines with vasopressors elsewhere). We found no significant association of vasopressor administration though a midline with catheter-related complications. However, we identified an increased odds of systemic (but not ipsilateral upper extremity) venous thromboembolism warranting further evaluation