Percutaneous Coronary Intervention in Patients With a History of Gastrointestinal Bleeding (From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium)

Potent antithrombotic agents are routinely prescribed after percutaneous coronary intervention (PCI) to reduce ischemic complications. However, in patients who are at an increased bleeding risk, this may pose significant risks. We sought to evaluate the association between a history of gastrointestinal bleeding (GIB) and outcomes after PCI. We linked clinical registry data from PCIs performed at 48 Michigan hospitals between 1/2013 and 3/2018 to Medicare claims. We used 1:5 propensity score matching to adjust for patient characteristics. In-hospital outcomes included bleeding, transfusion, stroke or death. Post-discharge outcomes included 90-day all-cause readmission and long-term mortality. Of 30,206 patients, 1.1% had a history of GIB. Patients with a history of GIB were more likely to be older, female, and have more cardiovascular comorbidities. After matching, those with a history of GIB (n = 312) had increased post-procedural transfusions (15.7% vs 8.4%; p \u3c 0.001), bleeding (11.9% vs 5.2%; p \u3c 0.001), and major bleeding (2.8% vs 0.6%; p = 0.004). Ninety-day readmission rates were similar among those with and without a history of GIB (34.3% vs 31.3%; p = 0.318). There was no significant difference in post-discharge survival (1 year: 78% vs 80%; p = 0.217; 5 years: 54% vs 51%; p = 0.189). In conclusion, after adjusting for baseline characteristics, patients with a history of GIB had increased risk of post-PCI in-hospital bleeding complications. However, a history of GIB was not significantly associated with 90-day readmission or long-term survival

Patients’ Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

Background: In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods: We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results: Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion: Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources

Final Product of the Virtual Anatomy Atlas Project

Final prototype movie for the Virtual Anatomy Atlas project.The Virtual Anatomy Atlas will allow students to explore anatomy through photographic images with the dimension and clarity of finely dissected specimens. The team members will apply their fine photography and dissecting skills to capture a series of images of a human hand through five levels of dissection. The images will be "stitched" to produce a prototype QTVR movie. Students will be able to turn the specimen 360 degrees, and to peel back the layers of dissection one by one. In producing the prototype movie, the team will test methods for mounting, stabilizing and lighting the specimen; for removing it in order to perform the next level of dissection; and then for returning it to its original position for the next round of photographs. The team will also learn from the process how many individual images are necessary to create an appropriate level of realism.GROCS: GRant Opportunities [collaborative spaces], a Digital Media Commons program to fund student research on the use of rich media in collaborative learning.http://deepblue.lib.umich.edu/bitstream/2027.42/61373/1/_handTestObj_01.mo

Willingness to Stop Proton Pump Inhibitors in Patients with Gastroesophageal Reflux Disease: Results of a Patient Survey

http://deepblue.lib.umich.edu/bitstream/2027.42/175717/2/1-s2.0-S0016508518329974-main.pdfPublished versionDescription of 1-s2.0-S0016508518329974-main.pdf : Published versio

National Poll on Healthy Aging: Virtual Visits: Telehealth and Older Adults

https://deepblue.lib.umich.edu/bitstream/2027.42/151376/1/21_October-2019-Telehealth-Report-Qs_092019.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151376/4/NPHA_Telehealth-Report-FINAL-093019.pdfDescription of 21_October-2019-Telehealth-Report-Qs_092019.pdf : Poll QuestionsDescription of NPHA_Telehealth-Report-FINAL-093019.pdf : Poll Repor