Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152017/1/acr23777.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152017/2/acr23777_am.pd

Medicare beneficiary panel characteristics associated with high Part D biologic disease-modifying anti-rheumatic drug prescribing for older adults among rheumatologists.

ABSTRACT: The aim of this study was to investigate beneficiary panel characteristics associated with rheumatologists' prescribing of biologic DMARDs (bDMARDs) for older adults.In this retrospective observational study, we used Medicare Public Use Files (PUFs) to identify rheumatologists who met criteria for high-prescribing, defined as bDMARD prescription constituting ≥20% of their DMARD claims for beneficiaries ≥65 years of age. We first used descriptive analysis then multivariable regression model to test the association of high prescribing of bDMARDs with rheumatologists' panel size and beneficiary characteristics. In particular, we quantified the proportion of panel beneficiaries ≥75 years of age to assess how caring for an older panel correlate with prescribing of bDMARDs.We identified 3197 unique rheumatologists, of whom 405 (13%) met criteria for high prescribing of bDMARDs for Medicare beneficiaries ≥65 years of age. The high-prescribers provided care to 12% of study older adults, and yet accounted for 21% of bDMARD prescriptions for them. High prescribing of bDMARDs was associated with smaller panel size, and their beneficiaries were more likely to be non-black, ≥75 years of age, non-dual eligible, have diagnosis of CHF, however, less likely to have CKD.Rheumatologists differ in their prescribing of bDMARDs for older adults, and those caring for more beneficiaries ≥75 years of age are more likely to be high-prescribers. Older adults are more prone to the side-effects of bDMARDs and further investigation is warranted to understand drivers of differential prescribing behaviors to optimize use of these high-risk and high-cost medications.http://deepblue.lib.umich.edu/bitstream/2027.42/170715/2/Medicare beneficiary panel characteristics associated with high Part D biologic disease-modifying anti-rheumatic drug prescr.pdfPublished versio

Bilateral hydrothorax and cardiac tamponade after right subclavian vein catheterization -A case report-

Central venous catheterization is typically used for the anesthetic management of patients undergoing a major surgery or care of patients in Intensive Care Unit (ICU). The occurrence of complications associated with central venous catheterization such as pneumothorax or vascular injury have decreased, while delayed complications such as hydrothorax, hydromediastinum, or cardiac tamponade have risen recently. We report a case of complications of bilateral hydrothorax with cardiac tamponade by superior vena cava perforation due to continuous mechanical force of the looped central venous catheter tip against SVC wall after subclavian vein cannulation

Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More

The world population is aging, and the rheumatology workforce must be prepared to care for medically complex older adults. We can learn from our colleagues and experts in geriatrics about how to best manage multimorbidity, polypharmacy, geriatric syndromes, and shifting priorities of older adults in the context of delivering care for rheumatic and musculoskeletal diseases (RMDs). Polypharmacy, a common occurrence in an aging population with multimorbidity, affects half of older adults with RMDs and is associated with increased risk of morbidity and mortality. In addition, potentially inappropriate medications that should be avoided under most circumstances is common in the RMD population. In recent years, deprescribing, known as the process of tapering, stopping, discontinuing, or withdrawing drugs, has been introduced as an approach to improve appropriate medication use among older adults and the outcomes that are important to them. As the rheumatology patient population ages globally, it is imperative to understand the burden of polypharmacy and the potential of deprescribing to improve medication use in older adults with RMDs. We encourage the rheumatology community to implement geriatric principles, when possible, as we move toward becoming an age‐friendly health care specialty

Provider Specialty and the Use of Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among Older Adults in the 2005-2016 National Ambulatory Medical Care Survey

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172305/1/acr211406.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172305/2/acr211406_am.pd

Endoscopic Treatment of Intussusception due to Intestinal Tuberculosis

Traditionally, adult intussusception has required a bowel resection because of the malignancy risk. A patient with anorexia, weight loss, and abdominal pain visited our clinic. A physical exam and imaging study revealed no acute peritoneal signs. A colonoscopy for biopsy and bowel reduction was attempted. The tissue sample was consistent with intestinal tuberculosis. We report intestinal tuberculosis complicating intussusception which was treated without surgical intervention

Modeling success: How to work effectively with your biostatistician

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/174824/1/jgs17888_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/174824/2/jgs17888.pd

Perspective Chapter: Creation and Evolution of Intergeneric Hybrids between <em>Brassica rapa</em> and <em>Raphanus sativus</em>

Although research has been conducted on intergeneric hybridization between Brassica and Raphanus, much of it remains unpublished. We have acquired numerous Brassica rapa ssp. pekinensis (kimchi cabbage) and R. sativus var. major (“big root radish”) hybrids, originally classified as intergeneric hybrids and named “baechumu” in 1995. A cultivar was identified BB#12, (renamed BB#1 for registration) in baemoochae following stabilization via a microspore mutation in 2006. Numerous hybrids were created for various purposes; some were sterile when self-pollinated but fertile in crosses with other cultivars. Microspore mutation also produced, BB#12x is a novel intergeneric hybrid. A new stable plant variety, BB#5, was selected from numerous inbred lines and produced via microspore culture; it has a very late bolting time and is cultivated in spring. The cultivar purple BB#10 was developed by adding radish chromosomes to turnip, including one providing the purple color, and double-crossing with BB#12, CMS BB#12, and normal BB#12. Now that the hybrid between ssp. pekinensis and radish has produced mature seeds as a dominant property, intergeneric hybrid cultivars can be bred in the future