Publications by authors named "Michael Rothberg"
Article Synopsis
- - Chronic low back pain (CLBP) significantly affects individuals' physical and emotional health, leading to high healthcare costs and reduced productivity, yet there is a gap in adopting recommended nonpharmacologic treatments like yoga in practice.
- - The study aimed to assess the effectiveness of virtual yoga classes over a wait-list control in reducing CLBP intensity, improving back-related function, enhancing sleep quality, and decreasing pain medication use in adults aged 18 to 64.
- - Conducted as a 24-week randomized clinical trial with participants receiving 12 weeks of live streamed hatha yoga classes, the main outcomes focused on measuring pain intensity and disability after 12 weeks, with follow-up assessments at 24 weeks to gauge broader impacts.
Objective: The authors examined racial/ethnic and socioeconomic disparities in receiving treatment for alcohol use disorder (AUD).
Methods: A retrospective cohort study was conducted that included adults (≥18 years) with AUD from the All of Us Controlled Tier database v7. Outcomes were lifetime receipt of FDA-approved medications (disulfiram, acamprosate, and naltrexone), psychotherapy (individual, family, and group-based session), and combination treatment (medication and psychotherapy).
Acceptance of pharmacist-led stewardship recommendations for patients with community-acquired pneumonia.
Antimicrob Steward Healthc Epidemiol
October 2024
Background: Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and mortality in the US. Overuse of extended spectrum antibiotics (ESA) for CAP contributes to antimicrobial resistance. The 2019 Infectious Diseases Society of America/American Thoracic Society CAP guidelines emphasize de-escalation of ESA following negative cultures, early switch to oral (PO) antibiotics, and limited duration of therapy (DOT).
View Article and Find Full Text PDFBackground: Patients with bacteremia often have elevated white blood cell (WBC) and neutrophil counts, yet these alone are poor predictors of bacteremia. Data on the continuous relationship between WBC response and bacteremia are lacking.
Objective: This study aims to characterize the relationship of WBC count, neutrophil percentage, and absolute neutrophil count (ANC) to bacteremia using interval likelihood ratios (ILRs) derived from a large sample of hospitalized patients.
Introduction: In 2021, the USPSTF lowered the recommended age of colorectal cancer (CRC) screening initiation from 50 to 45 years. This study assessed clinician response to the updated guideline in a major health system.
Methods: This was a retrospective cohort study of average-risk, CRC screening-naïve adults aged 45-50 years with a primary care appointment between July 2018 and February 2023.
Article Synopsis
- A study was conducted on individuals aged 70 and older to assess the frequency and burden of atrial fibrillation (AF) using a 14-day electrocardiograph monitor.
- Out of 5,684 participants, 4.4% were found to have AF, with the majority having paroxysmal AF of low burden; the median time spent in AF was only about 75 minutes.
- The research highlighted that while most AF cases had low burden, a significant portion had extended episodes, raising potential concerns for increased stroke risk and suggesting the need for targeted AF screening approaches.
Importance: Limited data are available on long-term weight loss achieved with semaglutide or liraglutide for type 2 diabetes (T2D) or obesity in clinical practice.
Objective: To document weight loss achieved with injectable forms of semaglutide or liraglutide and identify factors associated with weight reduction of 10% or greater at 1 year.
Design, Setting, And Participants: This retrospective cohort study used electronic health records from a large, integrated health system in Ohio and Florida.
Article Synopsis
- The study aimed to define a specific probability threshold for determining which medical inpatients are at high risk for venous thromboembolism (VTE) and should receive prophylaxis, acknowledging that current guidelines lack a clear risk definition.
- By analyzing data from over 41,000 patients across Cleveland Clinic hospitals, researchers compared five different methods to establish this threshold, finding that most methods suggested a high-risk cutoff around 0.5%. This compared to observed prophylaxis rates by physicians that ranged significantly higher.
- The results indicated that while an optimal threshold for VTE prophylaxis might be around 0.5%, clinical practice showed a much higher rate of prophylaxis, highlighting a potential gap between
Background: Atrial fibrillation (AF) often remains undiagnosed, and it independently raises the risk of ischemic stroke, which is largely reversible by oral anticoagulation. Although randomized trials using longer term screening approaches increase identification of AF, no studies have established that AF screening lowers stroke rates.
Objectives: To address this knowledge gap, the GUARD-AF (Reducing Stroke by Screening for Undiagnosed Atrial Fibrillation in Elderly Individuals) trial screened participants in primary care practices using a 14-day continuous electrocardiographic monitor to determine whether screening for AF coupled with physician/patient decision-making to use oral anticoagulation reduces stroke and provides a net clinical benefit compared with usual care.
Article Synopsis
- The study aimed to identify the incidence and risk factors for upper extremity deep vein thrombosis (UEDVT), a condition linked to complications like pulmonary embolism, and to evaluate the effectiveness of preventative medication.
- Out of nearly 195,000 patients analyzed, only 496 developed UEDVT within 14 days, with specific risk factors such as the presence of central catheters significantly increasing the likelihood.
- The findings suggest that while UEDVT is uncommon, certain patients are at higher risk and should be considered for preventive treatment to reduce the chances of developing this condition.
Article Synopsis
- The 2019 guidelines suggest doctors should only use strong antibiotics for certain pneumonia cases if there are specific local risk factors.
- A study looked at how many patients in hospitals were given these strong antibiotics over a few years, and found big differences in use based on the hospitals' local rules.
- The research showed that using local risk factors led to fewer patients getting those strong antibiotics, and there’s a need for clearer guidelines on when to use them.
Background And Objective: Inpatient subspecialty consultation is often medically necessary but in some cases may represent overuse. While pediatric consultation patterns have been described using observational data, qualitative methods may generate knowledge about contextual determinants of consultation behavior. Our objective was to understand how pediatric hospitalists make decisions about subspecialty consultation.
View Article and Find Full Text PDFThis retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with multiple myeloma diagnosed between January 2017-December 2021. Electronic health records data captured time from diagnosis to initial prescription fill for oral antimyeloma medications and initiation of facility administered or oral antimyeloma treatment. We identified 720 patients with a mean age at diagnosis of 67 years ±11; 55% were male, 77% White, 22% Black, 1% other races, covered by private insurance (36%), traditional Medicare (29%), Medicare Advantage (25%), and Medicaid (8.
View Article and Find Full Text PDFBackground: Little is known about antibiotic prescribing for respiratory tract infections (RTIs) in virtual versus in-person urgent care within the same health system.
Methods: This is a retrospective study using electronic health record data from Cleveland Clinic Health System. We identified RTI patients via ICD-10 codes and assessed whether the visit resulted in an antibiotic.
Background: Guidelines recommend pharmacologic VTE prophylaxis for acutely ill medical patients at acceptable bleeding risk, but only the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) model has been validated for bleeding risk assessment.
Objectives: We developed and internally validated a risk assessment model (RAM) to predict major in-hospital bleeding using risk factors at admission and compared our model with IMPROVE.
Methods: We selected patients admitted to medical services at 10 hospitals in the Cleveland Clinic Health System from 2017 to 2020.
Objective: To examine the renoprotective effects of metabolic surgery in patients with established chronic kidney disease (CKD).
Background: The impact of metabolic surgery compared with glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with established CKD has not been fully characterized.
Methods: Patients with obesity (body mass index ≥30 kg/m 2 ), type 2 diabetes, and baseline estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.
Background: Patients admitted with pneumonia and heart failure (HF) have increased mortality and cost compared to those without HF, but it is not known whether outcomes differ between systolic and diastolic HF. Management of concomitant pneumonia and HF is complicated because HF treatments can worsen complications of pneumonia.
Methods: This is a retrospective cohort study from the Premier Database among patients admitted with pneumonia between 2010-2015.
Objectives: Do-not-resuscitate DNR) orders are used to express patient preferences for cardiopulmonary resuscitation. This study examined whether early DNR orders are associated with differences in treatments and outcomes among patients hospitalized with pneumonia.
Methods: This is a retrospective cohort study of 768,015 adult patients hospitalized with pneumonia from 2010 to 2015 in 646 US hospitals.
Aim: To examine whether racial and ethnic disparities in uncontrolled type 2 diabetes mellitus (T2DM) persist among those taking medication and after accounting for other demographic, socioeconomic, and health indicators.
Methods: Adults aged ≥20 years with T2DM using prescription diabetes medication were among participants assessed in a retrospective cohort study of the National Health and Nutrition Examination Survey 2007-2018. We estimated weighted sequential multivariable logistic regression models to predict odds of uncontrolled T2DM (HbA1c ≥ 8%) from racial and ethnic identity, adjusting for demographic, socioeconomic, and health indicators.
Purpose: Little is known about the role of social determinants of health (SDOH) in the utilization of novel treatments among patients with newly diagnosed multiple myeloma (NDMM).
Methods: This retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with NDMM between January 1, 2017, and December 31, 2021. Electronic health records data captured treatment with (1) triplet or quadruplet regimen and (2) lenalidomide during the first year after NDMM, and (3) stem-cell transplant (SCT) through December 31, 2022.
Article Synopsis
- * After implementing the RAM, appropriate prophylaxis for high-risk patients increased from 43.1% to 48.8%, though overall prophylaxis use decreased from 73.5% to 65.2%.
- * The analysis showed that while the RAM improved appropriate prophylaxis rates, it didn't significantly affect venous thromboembolism rates in high-risk patients or increase instances of major bleeding or heparin-induced thrombocytopenia.
Aim: To characterize factors associated with the receipt of anti-obesity medication (AOM) prescription and fill.
Materials And Methods: This retrospective cohort study used electronic health records from 1 January 2015 to 30 June 2023, in a large health system in Ohio and Florida. Adults with a body mass index ≥30 kg/m who attended ≥1 weight-management programme or had an initial AOM prescription between 1 July 2015 and 31 December 2022, were included.
Objective: Type 2 Diabetes (T2D) is a major cause of morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) are highly effective but underutilized. Our objective was to assess racial/ethnic and other sociodemographic disparities in GLP-1RA/SGLT2i use among US adults with T2D.
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