Papers by Andrei Brateanu
C103. CRITICAL CARE: THE LONG WALK - ELUCIDATING OUTCOMES: DEATH, FUNCTIONAL STATUS AND COGNITION, 2019
QJM: An International Journal of Medicine, Dec 24, 2013
Clinical Journal of The American Society of Nephrology, Jun 1, 2012
Background and objectives Cardiovascular disease is the most common cause of death in CKD. This s... more Background and objectives Cardiovascular disease is the most common cause of death in CKD. This study evaluated whether electrocardiogram (ECG) abnormalities are predictors of cardiovascular death in CKD. Design, setting, participants, & measurements The Cardiovascular Health Study limited database (1989-2005) was used to identify a cohort with CKD at baseline (estimated GFR , 60 mL/min per 1.73 m 2). The patients were categorized as having major, minor, or no ECG abnormalities. Rates of adjudicated cardiovascular events and mortality were compared among the groups using proportional hazards regression models. Results A total of 1192 participants had CKD at baseline; mean age 6 SD was 74.766.2 years. Of these patients, 452 (38.8%) had major, 346 (29.7%) had minor, and 367 (31.5%) had no ECG abnormalities. Participants with estimated GFR , 60 mL/min per 1.73 m 2 were more likely to have ECG abnormalities at baseline (adjusted prevalence odds ratio, 1.23 [95% confidence interval (CI), 1.06-1.43]) than those with GFR $ 60 mL/min per 1.73 m 2. During mean follow-up of 10.363.8 years, 814 (68.3%) participants died. Compared with participants without ECG abnormalities, participants with major abnormalities had the highest risk for cardiovascular events and death; adjusted hazard ratios were 2.15 (95% CI, 1.56-2.98) and 2.27 (95% CI, 1.56-3.30), respectively. For minor ECG abnormalities, hazard ratios were 1.24 (95% CI, 0.91-1.70) and 1.48 (95% CI, 1.00-2.18), respectively. Conclusions In patients with CKD, major ECG abnormalities are frequently present and predict a significantly higher risk for death and adverse cardiovascular outcomes.
Frontiers in Physiology, Apr 26, 2017
Background: Atherosclerotic carotid intima-media thickness (IMT) may be associated with alteratio... more Background: Atherosclerotic carotid intima-media thickness (IMT) may be associated with alterations in the sensitivity of carotid baroreceptors. The aim of this study was to investigate the association between carotid IMT and the autonomic modulation of heart rate variability (HRV). Methods: A total of 101 subjects were enrolled in this prospective observational study. The carotid IMT was determined by duplex ultrasonography. The cardiac autonomic function was determined through HRV measures during the Deep Breathing Test. Linear regression models, adjusted for demographics, comorbidities, body mass index, waist-hip-ratio, and left ventricular ejection fraction were used to evaluate the association between HRV parameters and carotid IMT. Results: Participants had a mean age of 60.4 ± 13.4 years and an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk score (using the Pooled Cohort Equations) of 16.4 ± 17. The mean carotid media thickness was highest (0.90 ± 0.19 mm) in the first quartile of the standard deviation of all RR intervals (SDNN) (19.7 ± 5.1 ms) and progressively declined in each subsequent quartile to 0.82 ± 0.21 mm, 0.81 ± 0.16 mm, and 0.68 ± 0.19 in quartiles 2 (36.5 ± 5.9 ms), 3 (57.7 ± 6.2 ms) and 4 (100.9 ± 22.2 ms), respectively. In multivariable adjusted models, there was a statistical significant association between SDNN and carotid IMT (OR −0.002; 95%CI −0.003 to −0.001, p = 0.005). The same significant association was found between carotid IMT and other measures of HRV, including coefficient of variation of RR intervals (CV) and dispersion of points along the line of identity (SD2). Conclusions: In a cohort of individuals at increased cardiovascular risk, carotid IMT as a marker of subclinical atherosclerosis was associated with alterations of HRV indicating an impaired cardiac autonomic control, independently of other cardiovascular risk factors.
Journal of Clinical Pharmacy and Therapeutics, 2012
Hyperglycaemia in trauma patients admitted to the intensive care unit (ICU) is associated with in... more Hyperglycaemia in trauma patients admitted to the intensive care unit (ICU) is associated with increased morbidity and mortality. Our pilot study is a prospective randomized controlled trial comparing the impact of two glucose control regimens on outcomes in non-diabetic trauma patients admitted with hyperglycaemia to the ICU. Trauma patients with blood glucose levels (BGLs) ≥7·8 mm within the first 48 h of the hospital admission were randomized to receive intermittent SQ or continuous IV insulin to maintain BGLs between 4·4 and 6·1 mm. We excluded diabetics on the basis of history, or a glycosylated haemoglobin ≥6% on admission. We compared the effect of SQ vs. IV insulin therapy on the ICU length of stay (ILOS). A total of 58 patients were included in the study. The SQ and IV groups were comparable in terms of age, gender, injury severity, revised trauma, Glasgow coma scores and type of trauma (blunt vs. penetrating). There was no significant difference between the two treatment groups in the ILOS (3 vs. 2 days, P = 0·084), hospital length of stay (8 vs. 6, P = 0·09), ventilator support days (6 vs. 3, P = 0·98), requirement for blood transfusion (P = 0·66), rates of infections (P = 0·70), acute kidney injury (P = 0·99) and mortality (P = 0·61). There was no difference between SQ and IV insulin therapy in the ILOS in non-diabetic trauma patients.
Journal of the American College of Cardiology, Mar 1, 2023
Hypertension, 2015
Introduction: Uncontrolled blood pressure (BP) due to non-adherence to medical therapy or inadequ... more Introduction: Uncontrolled blood pressure (BP) due to non-adherence to medical therapy or inadequate medical therapy in African American (AA) patients with congestive heart failure (CHF) increases the risk of CHF exacerbation. Use of telemonitoring (TM) to monitor BP in low-income AA patients with CHF has not been studied. Aim: To identify patients with uncontrolled BP in low-income AA patients with CHF using a TM device. Methods: We conducted a prospective study of 15 patients with CHF (Ejection Fraction <45%) randomly selected from a Cleveland Clinic outpatient clinic serving a low income AA population. Patients were trained to use a tablet monitor & a BP machine at their home to record their BP everyday for a period of 28 days. Using a secure internet connection patients BP measurement was transmitted to a password protected website where it was studied daily by a nurse to identify abnormal parameters (BP equal to or greater than 140/90 mm of Hg). The nurse contacted patients ...
Current Medical Research and Opinion, 2021
Abstract Background Acute kidney injury (AKI) is common among hospitalized patients with communit... more Abstract Background Acute kidney injury (AKI) is common among hospitalized patients with community-acquired pneumonia (CAP). We aimed to estimate and compare the risk of AKI for various antibiotic combinations in adults hospitalized for CAP. Methods We conducted a retrospective cohort study of the Premier Healthcare Database containing all admissions for 660 US hospitals from 2010 to 2015. We included adults aged ≥18 years hospitalized with CAP and considered 6 different antibiotic combinations based on continuous use in the first 3 hospital days. The primary outcome was incident AKI, defined by ICD-9 codes 584.5-584-9. We evaluated associations of AKI with in-hospital mortality and length-of-stay. We excluded patients who were admitted directly to the intensive care unit, had AKI codes present on admission or had dialysis in the first 2 days. We used generalized linear mixed models with the hospital as a random effect and covariate adjustment for patient demographics, comorbidities, other treatments on day 0/1, and hospital characteristics. Results The total sample included 449,535 patients, 3.15% of whom developed AKI. All other regimens but fluoroquinolones exhibited higher AKI odds than 3rd generation cephalosporin with or without macrolide. The combination of piperacillin/tazobactam and vancomycin with or without other antibiotics was associated with the highest AKI odds (OR = 1.89; 95% CI: 1.73–2.06). Patients with incident AKI had an increased odds of hospital mortality (OR = 6.37; 95% CI: 6.07–6.69) and longer length-of-stay (mean multiplier = 1.84; 95% CI: 1.82, 1.86). Conclusion Compared to 3rd generation cephalosporin with or without macrolide, piperacillin/tazobactam, vancomycin, and their combination were associated with higher odds of developing AKI, which in turn were associated with worse clinical outcomes.
CHEST Journal, 2007
PURPOSE: Patients treated with corticosteroids are often found to have an increase in total white... more PURPOSE: Patients treated with corticosteroids are often found to have an increase in total white blood cell (WBC) count. The study was conducted to evaluate quantitative changes in total WBC, neutrophil, lymphocyte and eosinophil count following steroid administration in patients with asthma or COPD exacerbation. METHODS: We retrospectively reviewed 100 cases admitted with diagnosis of COPD or asthma exacerbation between January 2002 and September 2005. Inclusion criteria: age 18 and older, steroids administered on admission (daily for atleast first 3 days), normal WBC count on admission and WBC count with differential count checked daily during first 3 hospitalized days. Exclusion criteria: patients with malignancy, autoimmune disease, HIV infection, fever on admission,chest X-ray suggestive of infectious process on admission and those who have been on chronic oral steroid treatment. Total WBC, neutrophil, lymphocyte and eosinophil counts during first 3 days following admission were recorded and compared by Bonferoni t-test. RESULTS: The mean leukocyte count increased from 8.5 × 103(day1) to 9.7 × 103(day2), and to 14.4 × 103(day 3) (P< 0.0001). The mean neutrophil count increased from 5.3 × 103(day1) to 8.4 × 103(day2) and to 11.9 ×103(day3) (p < 0.0001). The mean lymphocyte count decreased from 2.1 × 103(day1) to 1.0 × 103(day2) (p< 0.0001), followed by an increase from 1.0 × 103(day2) to 1.7 × 103(day3) (p< 0.0005). The mean eosinophil count decreased from 0.5 × 103(day1) to 0.2 × 103(day2) and to 0.05 × 103(day3) (p< 0.0001). CONCLUSION: The pattern of steroid induced changes in the total WBC, neutrophil, lymphocyte and eosinophil count is predictable during the first 3 days of initiation of treatment in absebce of active infection at the time of admission. The described changes can be used in evaluating complications, such as infections or non-responsiveness to treatment. CLINICAL IMPLICATIONS: Awareness of a predictive response on total WBC and differential count following steroid administration can help to differentiate it from infection. Such approach can avoid unnecessary use of antibiotics.
American Journal of Kidney Diseases, 2010
Vascular access has a central role as the lifeline for hemodialysis (HD) patients. An arterioveno... more Vascular access has a central role as the lifeline for hemodialysis (HD) patients. An arteriovenous fistula (AVF) is recommended as the access of first choice by many different HD guideline committees. However, despite these recommendations, there remains much variation in vascular access use among dialysis units. We conducted a cohort study of HD vascular access types in 80 patients and their rates of change from one type to another over a 12 month period. The mean rates of vascular access use were: AVF, 44%; grafts [AVG], 5%; while central venous catheter (CVC) use was 51%. The rates of access change from days 0 to 360 is shown in the figure.
Journal of Graduate Medical Education
Background In medical education, self-administered questionnaires are used to gather information ... more Background In medical education, self-administered questionnaires are used to gather information for needs assessments, innovation projects, program evaluations, and research studies. Despite the importance of survey methodology, response rates have declined for years, especially for physicians. Objective This study explored residents' experiences with survey participation and perceptions of survey design and implementation. Methods In 2019, residents at a large Midwestern academic medical center were recruited via email to participate in mixed specialty focus groups (FGs). Narrative comments were recorded, transcribed, and then analyzed via conventional content analysis, utilizing cognitive sociology as a conceptual framework. Themes and subthemes were generated iteratively. Results Postgraduate year 1–4 residents (n = 33) from internal medicine, surgery, and neurology participated in 7 FGs (3–7 participants/group) from April–May 2019. Eight themes were generated during content...
Current Pharmaceutical Design, 2007
ABSTRACT Hypertension is the most common medical condition encountered in and complicating pregna... more ABSTRACT Hypertension is the most common medical condition encountered in and complicating pregnancy, with significant implications on maternal and perinatal morbidity and mortality. It is also one of the areas of clinical practice that has been studied extensively, yet less well understood. The hypertensive disorders of pregnancy are a spectrum of conditions that are classified into 4 categories based upon recommendations of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. This article provides an overview of the pathophysiology and current pharmacologic management of hypertension in pregnancy.
Clinical Journal of the American Society of Nephrology, 2012
Background and objectives Cardiovascular disease is the most common cause of death in CKD. This s... more Background and objectives Cardiovascular disease is the most common cause of death in CKD. This study evaluated whether electrocardiogram (ECG) abnormalities are predictors of cardiovascular death in CKD. Design, setting, participants, & measurements The Cardiovascular Health Study limited database (1989-2005) was used to identify a cohort with CKD at baseline (estimated GFR , 60 mL/min per 1.73 m 2). The patients were categorized as having major, minor, or no ECG abnormalities. Rates of adjudicated cardiovascular events and mortality were compared among the groups using proportional hazards regression models. Results A total of 1192 participants had CKD at baseline; mean age 6 SD was 74.766.2 years. Of these patients, 452 (38.8%) had major, 346 (29.7%) had minor, and 367 (31.5%) had no ECG abnormalities. Participants with estimated GFR , 60 mL/min per 1.73 m 2 were more likely to have ECG abnormalities at baseline (adjusted prevalence odds ratio, 1.23 [95% confidence interval (CI), 1.06-1.43]) than those with GFR $ 60 mL/min per 1.73 m 2. During mean follow-up of 10.363.8 years, 814 (68.3%) participants died. Compared with participants without ECG abnormalities, participants with major abnormalities had the highest risk for cardiovascular events and death; adjusted hazard ratios were 2.15 (95% CI, 1.56-2.98) and 2.27 (95% CI, 1.56-3.30), respectively. For minor ECG abnormalities, hazard ratios were 1.24 (95% CI, 0.91-1.70) and 1.48 (95% CI, 1.00-2.18), respectively. Conclusions In patients with CKD, major ECG abnormalities are frequently present and predict a significantly higher risk for death and adverse cardiovascular outcomes.
Journal of the American College of Cardiology, 2015
Background: Factors associated with subsequent proximal deep vein thrombosis (PDVT) and/or pulmon... more Background: Factors associated with subsequent proximal deep vein thrombosis (PDVT) and/or pulmonary embolism (PE) after an isolated distal deep vein thrombosis (DDVT) are not well studied. We developed a model predicting the probability of developing PDVT and/or PE within 1 year after an isolated episode of DDVT.
American Journal of Kidney Diseases, 2010
American Journal of Health-System Pharmacy
Purpose Studies have supported the use of packaging interventions such as pillboxes or blister pa... more Purpose Studies have supported the use of packaging interventions such as pillboxes or blister packs to improve medication adherence but have not evaluated the efficacy of these interventions in a population of low socioeconomic status. The aim of this study was to assess the effect of home-delivered pill packs on medication adherence in a low-income Black American population with Medicaid insurance. Methods This study was an open-label, randomized, controlled trial. The patient population studied included 80 patients followed by primary care physicians at the Cleveland Clinic. Patients were randomized to a study group who received delivery of their multidrug medical therapy, defined as a minimum of 4 medications daily, in prepackaged blisters or a control group who obtained their prescriptions from their routine pharmacy. Results The primary analysis compared the mean percentage of missed pills between the 2 groups using t-test analysis. The percentage of missed pills in the study ...
IntroductionTelemedicine is an important element of healthcare. However, until the COVID-19 pande... more IntroductionTelemedicine is an important element of healthcare. However, until the COVID-19 pandemic, training in telemedicine was not a substantial element of most residency programs. Social distancing measures changed this. The Cleveland Clinic Internal Medicine Residency Program (IMRP) is one of the largest programs in the United States, which made the task of developing and adopting an effective, expedited telemedicine curriculum challenging. Our goal was to implement a system for teaching telemedicine care skills and supervising the care provided by residents during virtual visits.MethodsThis study was started in April 2020. We developed and implemented a resident-led curriculum and training program for providing telemedicine care in less than five weeks. This entailed creating a formal training program for residents, creating a resource guide for the different video communication tools, and training preceptors to safely supervise care in this new paradigm. We also created an a...
Teaching and Learning in Medicine
The American Journal of the Medical Sciences
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Papers by Andrei Brateanu