Internal Medicine Commons^™

A Mixed Methods Study Of Inpatients’ Experiences, Priorities, And Health-Related Quality Of Life During High- Flow Nasal Cannula Therapy, Cintamani H. Ellsworth, Rebecca S. Bartlett

Journal of Patient-Centered Research and Reviews

Purpose: High-flow nasal cannula (HFNC) is an oxygen delivery method with numerous benefits for severely ill patients. There is a paucity of research focused on the perspectives of patients receiving HFNC oxygen therapy. This study aimed to engage with patients to gain a clearer understanding of their experiences, priorities, and health-related quality of life.

Methods: A cross-sectional, mixed methods study was completed with 10 adult inpatients who had received HFNC oxygen therapy during their hospital admission. Semi-structured interviews and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale were used to identify participant perceptions of their physical and …

Responding To Medetomidine In Philadelphia: Narrative Summary Of The Public Health Response To A New Psychoactive Substance, Tareva Warrick-Stone, Serge-Emile Simpson, Phil Durney, Dennis Goodstein, Catherine Abrams, Raymond Bobb, Kory London, Daniel Teixeira Da Silva

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Despite the emergence of medetomidine as the dominant adulterant in Philadelphia's illicit opioid supply, coordinated public health responses are limited or non-existent in the literature. Thus, we summarize a recent Summit in Philadelphia of outpatient and inpatient service providers who specialize in the care of persons who use drugs to discuss medetomidine response readiness and building ongoing community readiness for potential destabilizing drug supply changes.

PURPOSE: Describe a public health intervention that distributed information about practices across health care settings and mobilized key informants to identify and address barriers to treatment.

METHODS: Descriptive summary of the in-person Summit organized …

A Global Prospective Harmonization Framework For Suicidality, Anhedonia, And Obsessive-Compulsive Symptoms In Psychiatric Genetic Studies: A Cross-Continental Study Within The Ancestral Population Network, Ana Diaz-Zuluaga, Jacey Anderberg, Ana Ramirez-Diaz, Andrea Marques, Catherine Rast, Daniel Bustamante, Deborah Jonker, Johanna Valencia-Echeverry, Stella Gichuru, Lukoye Atwoli

Internal Medicine, East Africa

This study aims to prospectively collect harmonized, quantitative, and dimensional psychiatric phenotypes (suicidality, anhedonia, and obsessive-compulsive symptoms) and information on discrimination, stigma, and unfair treatment in up to 27,500 individuals across diverse ancestries and clinical populations for genetic analysis within the NIMH Ancestral Population Network (APN). Five APN projects are participating in the current study (PUMAS-Paisa, PUMAS-NeuroGAP, KOMOGEN-D, LATINO, and SAX-II), spanning recruitment over 15 countries across the Americas, Africa, and Asia. Participants are being enrolled via the recruitment protocols specific to each participating project. The harmonized clinical battery includes the Columbia-Suicide Severity Scale, Snaith-Hamilton Pleasure Scale, and Florida Obsessive-Compulsive …

Social Correlates Of Trauma And Posttraumatic Stress Disorder: The Importance Of Context, Lukoye Atwoli, Linnet Ongeri

Internal Medicine, East Africa

Understanding trauma and posttraumatic stress disorder (PTSD) requires a contextual perspective that considers historical legacies, social environments, and cultural realities. This paper draws on empirical evidence from Kenya and Uganda to demonstrate the limitations of applying trauma frameworks developed in high-income countries to African contexts. Findings from the Orphaned and Separated Children’s Assessment Related to Their Health and Well-Being (OSCAR) study challenge assumptions about care environments. The study reveals higher PTSD rates among orphans in family-based settings compared to institutional care, and highlights the protective roles of religion and social support. The Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis) study provides …

Assessing The Association Between Musculoskeletal Injury And Mental Health In Rugby Players-A Cross-Sectional Study, Mordicai Atinga, Jasmit Shah, Sarah Karanja, Mark Lumbasi, Miriam Ndungu, Sarah Kiburi, James Ondiege, Njalalle Baraza

Internal Medicine, East Africa

Background: Musculoskeletal injuries are common among athletes and can negatively affect both physical and psychological wellbeing. Beyond physical disability, injuries have been linked to poor mental health, loss of athletic identity, and increased substance use. In low- and middle-income countries (LMICs), where awareness and management of mental health remain limited, the psychological burden of sports injuries may be underrecognized. Rugby, a physically demanding contact sport, has one of the highest rates of injury, but little is known about how such injuries influence mental health and related outcomes in African contexts. This study explored the relationship between musculoskeletal injuries and health …

“Medical Cannabis”: Advising Patients While Navigating Medical Ethics And Limited Evidence, Anna-Maria South, Shanna L. Babalonis, Laura C. Fanucchi, Michelle R. Lofwall

Internal Medicine Faculty Publications

Cannabis is increasingly legalized in more areas of the USA and marketed under the misnomer “medical cannabis.” Yet, there are no official dosing guidelines or approved medical uses for plant cannabis by the Food and Drug Administration. Due to significant federal barriers, research on efficacy, safety, and adverse effects of cannabis is limited. Patients are interested in cannabis as potential treatment of medical issues and/or symptoms and clinicians should include a discussion of the risks of cannabis consumption. However, many risks are not yet known, and clinicians might be unaware of the emerging literature. This perspective summarizes the potential harms …

Family Mental Health – A Case Report, Vikrant Arora, Medha Kosireddy, Mathumitha Ananth, Kishor M. Manohar Rao

Digital Journal of Clinical Medicine

Psychiatric illness in India is estimated to be 15% as per National Mental Health Survey 2015-16.  Mental health challenges within families, especially depression, anxiety disorders that are not common and when unaddressed exert cascading effects on all members, disrupting emotional cohesion, relational functioning, and socioeconomic stability. There are few case reports on entire family presenting to psychiatry department.

With informed consent a city-based middle-class family of non-consanguineous origin, where the 40-year-old female, presented with intractable limb pains and health anxiety, she had multiple consultation in last few months and her 48-year-old husband also had with episodic pains, irritability and her …

A Community-Informed Survey Identifying Research Priorities For Sex Chromosome Aneuploidies, Matthew Fein

Summer Research Program Abstracts

No abstract provided.

Orthostatic Hypotension In Older Adults And Its Economic Impact On The Healthcare System: A Systematic Literature Review, Olushola E. Ilogho, Jennifer Broyles, Viet Le, Denise Rizzolo

Lynchburg Journal of Medical Science

ABSTRACT

Orthostatic Hypotension (OH) has been shown to lead to poor quality of life, falls, and death. Literature suggests that falls from OH may be preventable, therefore opportunities to reduce its associated cost to the healthcare system exist. This literature review aims to evaluate the importance of diagnosing and treating OH in older adult patients. OH is the drop in blood pressure upon changing to an upright position. This acute hemodynamic drop in blood pressure causes hypoperfusion in the brain, leading to dizziness, syncope, and falls. An extensive literature search for publications in PubMed and Cumulative Index in Nursing and …

Faktor-Faktor Yang Berhubungan Dengan Gejala Depresi Pada Pasien Insomnia Usia Lanjut Di Rawat Jalan, Amalia Nur Pratiwi, Edy Rizal Wahyudi, Profitasari Kusumaningrum, Hamzah Shatri, Ikhwan Rinaldi, Rino Alvani Gani, Ika Prasetya Wijaya, Adityo Susilo, Kaka Renaldi

Jurnal Penyakit Dalam Indonesia

Introduction. The elderly population is increasing globally, including in Indonesia, where 10.7% of the population in 2020 were elderly. Insomnia is a common health issue among older adults and has been identified as a predictor of depression. This study aims to identify factors associated with depressive symptoms in elderly outpatients with insomnia.

Methods. This cross-sectional study was conducted in 2024 on patients aged ≥60 years at the outpatient unit of Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, using consecutive sampling to select participants. Elderly patients were screened using the Pittsburgh sleep quality index (PSQI), and those with a score …

Small Steps For A Big Change: A Longitudinal Project To Enhance Well-Being Of Internal Medicine Residents, Vandana Nagpal, Benjamin Tanenbaum, Christine Runyan

Journal of Wellness

Introduction: Residency training is demanding and often leads to burnout. In 2017, Internal Medicine (IM) residents at our institution reported a poor collective residency experience. In response, we launched a longitudinal wellness program in 2018, featuring multi-pronged interventions to improve residents' well-being. The program, still active today, has undergone iterative modifications with ongoing input from residents.

Approach: The resident-led Wellness Committee was established in 2018, and the following no to low-cost initiatives were implemented sequentially: quarterly group sessions with an institutional health psychologist, bi-annual self-checks, peer buddy support for incoming first-year residents, weekly 5-minute reflection sessions, and volunteer dog visits. …

Autoimmune Encephalitis Presenting As Pseudodementia (Case Report), Renita Ng, Christie Richardson

Rowan-Virtua Research Day

Patients with autoimmune encephalitis frequently present with psychiatric symptoms including psychosis, behavioral changes, and affective disorders. Because of this, misdiagnosis of a primary psychiatric disorder in a case of autoimmune encephalitis is not uncommon. We present a case of autoimmune encephalitis in a 72 year old who was initially thought to have psuedodementia or catatonia due to variable collateral who later on LP was found to have markers and responded to steroid treatment. This case highlights the importance of maintaining a broad differential with patients who present with psychiatric alterations and to consider other causes of behavioral change.

Maternal Dysbiosis Produces Long-Lasting Behavioral Changes In Offspring, Jacob Hudobenko, Claudia M Di Gesù, Patrick R Mooz, Joseph Petrosino, Nagireddy Putluri, Bhanu P Ganesh, Kristen Rebeles, Frank W Blixt, Venugopal R Venna, Louise D Mccullough

Faculty, Staff and Student Publications

Advanced maternal age (AMA) is defined as a pregnancy in a woman older than 35 years of age. AMA increases the risk for both maternal and neonatal complications, including miscarriage and stillbirth. AMA has also been linked to neurodevelopmental and neuropsychiatric disorders in the offspring. Recent studies have found that age-associated compositional shifts in the gut microbiota contribute to altered microbial metabolism and enhanced inflammation in the host. We investigated the specific contribution of the maternal microbiome on pregnancy outcomes and offspring behavior by recolonizing young female mice with aged female microbiome prior to pregnancy. We discovered that pre-pregnancy colonization …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Lifestyle Effects On An Unusual Presentation Of Syncope: A Case Report, Rishma Gattu, Nisarg Shah, Ramya Ravulapalli, Vania Rodriguez, Gary Merlino

HCA-NSU MD Research Day

Introduction: This case study explores a unique presentation of syncope with a multifactorial etiology and discusses the impact of lifestyle behaviors on syncope exacerbation. Scant literature exists on behavioral modifications affecting cardiogenic responses. Case Presentation: We present a 53 year old Hispanic male with a past history of palpitations and chronic marijuana use coming to the emergency department (ED) with three episodes of sudden loss of consciousness that occurred after starting his job as a night shift worker, which led to severe chronic sleep deprivation. These episodes lacked prodromal (chest pain, shortness of breath, palpitations, diaphoresis) and postictal (drowsiness, nausea, …

Forecasting The Effects Of Smoking Prevalence Scenarios On Years Of Life Lost And Life Expectancy From 2022 To 2050: A Systematic Analysis For The Global Burden Of Disease Study 2021, Gbd 2021 Tobacco Forecasting Collaborators

Faculty, Staff and Students Publications

BACKGROUND: Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies.

METHODS: In this analysis, we use …

Assessing The State Of Obesity Care: Quality, Access, Guidelines, And Standards, Lee M Kaplan, Caroline M Apovian, Jamy D Ard, David B Allison, Louis J Aronne, Rachel L Batterham, Luca Busetto, Dror Dicker, Deborah B Horn, Aaron S Kelly, Jeffrey I Mechanick, Jonathan Q Purnell, Ximena Ramos-Salas, Assessing The State Of Obesity Care Writing Group

Faculty, Staff and Student Publications

BACKGROUND: An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence.

AIMS: The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity.

METHODS: The panel was held in Leesburg, Virginia in September 2019.

RESULTS: The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice …

Cognitive Behavioral Therapy Factors Related To Outcomes In Depression Among Youth With Hiv, Betsy D Kennard, Larry K Brown, Kristin Baltrusaitis, Miriam Chernoff, Graham J Emslie, Jessica Jones, Sarah Buisson, Jaime Deville, Megan Wilkins, Amber Bunch, Chivon Mcmullen Jackson, Christy Beneri, David E Shapiro

Faculty, Staff and Students Publications

PURPOSE: This is a secondary analysis of a multi-site, cluster (site) randomized trial of the efficacy of a combined Health and Wellness Cognitive Behavior Therapy (H&W CBT) and medication management approach for depression in youth with HIV (YWH) compared to standard care. In this study, we explored the association between H&W CBT factors and depression outcomes after 24 weeks of treatment to discover treatment elements associated with symptom reduction.

METHODS: Participants (12-24 years of age) were YWH in the United States (US) diagnosed with moderate to severe depression [Quick Inventory of Depressive Symptomatology (QIDS), Clinician-Rated score ≥ 11]. Thirteen US …

Aging- And Alcohol-Associated Spatial Transcriptomic Signature In Mouse Acute Pancreatitis Reveals Heterogeneity Of Inflammation And Potential Pathogenic Factors, Rachel R Tindall, Yuntao Yang, Isabella Hernandez, Amy Qin, Jiajing Li, Yinjie Zhang, Thomas H Gomez, Mamoun Younes, Qiang Shen, Jennifer M Bailey-Lundberg, Zhongming Zhao, Daniel Kraushaar, Patricia Castro, Yanna Cao, W Jim Zheng, Tien C Ko

Faculty, Staff and Student Publications

The rapidly aging population is consuming more alcohol, leading to increased alcohol-associated acute pancreatitis (AAP) with high mortality. However, the mechanisms remain undefined, and currently there are no effective therapies available. This study aims to elucidate aging- and alcohol-associated spatial transcriptomic signature by establishing an aging AAP mouse model and applying Visium spatial transcriptomics for understanding of the mechanisms in the context of the pancreatic tissue. Upon alcohol diet feeding and caerulein treatment, aging mice (18 months) developed significantly more severe AAP with 5.0-fold increase of injury score and 2.4-fold increase of amylase compared to young mice (3 months). Via …

Clinical And Genomic Profile Of Primary Cranial Neurolymphomatosis, Emily B Wolf, Robin Imperial, Liuyan Jiang, Amit K Agarwal, Han W Tun

Faculty, Staff and Student Publications

Primary cranial neurolymphomatosis (PCNL) is a rare subtype of primary CNS lymphoma (PCNSL) in which infiltrative lymphomatous involvement is confined to cranial nerves. Here, we report a case of PCNL with successful genomic profiling. A 57-year-old male had a lengthy prediagnostic phase spanning approximately 30 months, characterized by multiple episodes of cranial neuropathies managed by steroids. At the time of diagnosis, the patient had right-sided cranial neuropathies involving cranial nerves (CN) V, VI, and VII. Pathological findings of the right cavernous lesion biopsy were consistent with large B-cell lymphoma-infiltrating nerve fibers. The clinical course was aggressive and refractory, characterized by …

Digital Twin Mathematical Models Suggest Individualized Hemorrhagic Shock Resuscitation Strategies, Jeremy W Cannon, Danielle S Gruen, Ruben Zamora, Noah Brostoff, Kelly Hurst, John H Harn, Fayten El-Dehaibi, Zhi Geng, Rami Namas, Jason L Sperry, John B Holcomb, Bryan A Cotton, Jason J Nam, Samantha Underwood, Martin A Schreiber, Kevin K Chung, Andriy I Batchinsky, Leopoldo C Cancio, Andrew J Benjamin, Erin E Fox, Steven C Chang, Andrew P Cap, Yoram Vodovotz

Faculty, Staff and Student Publications

BACKGROUND: Optimizing resuscitation to reduce inflammation and organ dysfunction following human trauma-associated hemorrhagic shock is a major clinical hurdle. This is limited by the short duration of pre-clinical studies and the sparsity of early data in the clinical setting.

METHODS: We sought to bridge this gap by linking preclinical data in a porcine model with clinical data from patients from the Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) study via a three-compartment ordinary differential equation model of inflammation and coagulation.

RESULTS: The mathematical model accurately predicts physiologic, inflammatory, and laboratory measures in both the porcine model and patients, as well …

Development Of An Antioxidant-Rich Sugar-Free Plantain Candy And Assessment Of Its Shelf Life In A Flexible Laminate, Poulami Sarkar, Paramita Bhattacharjee, Bidhan Das

Faculty, Staff and Student Publications

RESEARCH BACKGROUND: Candy is a popular confection worldwide, and it would be beneficial to society if it were converted into a source of antioxidant molecules to eliminate its adverse health effects. The amount of antioxidants available even in fruit candies is questionable due to the high thermal processing losses they undergo and the presence of various food additives. Plantains (

EXPERIMENTAL APPROACH: To accomplish the first objective, lyophilized plantain powder, sorbitol and mannitol were used as base materials with minimal additives under minimal processing conditions to reduce processing loss. Sensory, proximate, physicochemical and phytochemical properties, including the antioxidant synergy among …

Trends In Shortages Of Lead Chelators From 2001 To 2022, James D Whitledge, Pelayia Soto, Kieran M Glowacki, Diane P Calello, Erin R Fox, Maryann Mazer-Amirshahi

Faculty, Staff and Student Publications

OBJECTIVE: The study aims to describe drug shortages affecting lead chelators in the United States from 2001 through 2022.

METHODS: Drug shortage data were retrieved from the University of Utah Drug Information Service from January 1, 2001, through December 31, 2022. Shortages of first- and second-line lead chelators were analyzed. Drug class, formulation, administration route, shortage reason, shortage duration, generic status, single-source status, and presence of temporally overlapping shortages were examined. Total shortage months, percentages of study period on shortage, and median shortage durations were calculated.

RESULTS: Thirteen lead chelator shortages were reported during the study period. Median duration was …

Challenges And Implications For Substance Use And Mental Healthcare Among Under-Resourced Women In The Covid-19 Era, Maria C Mejia, Alicia Kowalchuk, Sandra J Gonzalez, Muktha Nair, Lisa Webb, Nadine Scamp

Faculty, Staff and Students Publications

BACKGROUND: The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes toward it, and its impact on substance use and treatment access.

METHODS: A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive …

Factors Associated With Intention To Implement Sbi And Sud Treatment: A Survey Of Primary Care Clinicians In Texas Enrolled In An Online Course, Alicia Kowalchuk, Tiffany G Ostovar-Kermani, Kylie Schaper, Larissa Grigoryan, Jacqueline M Hirth, Maria Carmenza Mejia, Kiara K Spooner, Roger J Zoorob

Faculty, Staff and Students Publications

BACKGROUND: Substance use disorder (SUD) presents a range of public health challenges and consequences. Despite the prevention potential of screening and brief intervention (SBI) in the primary care setting, implementation is low. The purpose of this study was to assess associations of primary care clinicians' knowledge of SBI and SUD treatment, subjective norms, and perceived behavioral control with intention to incorporate SBI and SUD treatment into regular clinical practice.

METHODS: This online survey was administered to primary care clinicians who practice in Texas between March 1, 2021, and February 5, 2023. Survey questions were mapped to factors in the Theory …

Life-Space Mobility And Cognitive Function: The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Emiri Matsuda, Michael Crowe, Virginia J. Howard, Cynthia J. Brown, Madeline R. Sterling, Emily B. Levitan

School of Medicine Faculty Publications

No abstract provided.

Chronic Schizophrenia Presenting With Psychogenic Polydipsia Masking Stage Iv Uterine Adenocarcinoma, Dakota B. Pastore, Kamayel Jaludi, Angelo Sica

Rowan-Virtua Research Day

Background: Psychogenic polydipsia (PPD) is a condition of excessive water intake and seeking behavior with a 6-20% prevalence among patients with psychiatric illnesses, commonly Schizophrenia. It remains unknown how often concomitant disease can mask other, more serious conditions in psychiatric patients.

Case Description: The patient is a 58-year-old Hispanic, white female with chronic schizophrenia complicated by multiple hospitalizations for hyponatremia secondary to PPD. The patient initially presented to the emergency department (ED) in 2016 with abdominal pain, was treated symptomatically and discharged. From 2020 to 2023, the patient was readmitted seven more times, with two suspected aspirin overdoses, an Ambien …

A Matter Of Time: How Musical Training Affects Time Perception, Jahanvi Mittal, Khushi Kaur Juneja, Saumya Saumya, Anuj Shukla

Faculty, Staff and Student Publications

Musical training has been linked to changes in early attentional and perceptual processing. Thus, such an altered attentional and perceptual processing has enabled musicians to judge the duration differently than non-musicians. Although these claims seem intriguing, there are many questions that are not addressed yet, for example, how would the performance of musically-trained differ from that of untrained on visual and auditory temporal judgments? Is there any advantage to musically-trained person in temporal processing? To understand these questions, we thus conducted a series of Auditory and Visual Temporal Bisection Tasks on 32 musically-trained and 32 musically-untrained participants. We hypothesized that …

Emerging Variants Develop Total Escape From Potent Monoclonal Antibodies Induced By Ba4/5 Infection, Chang Liu, Raksha Das, Aiste Dijokaite-Guraliuc, Daming Zhou, Alexander J Mentzer, Piyada Supasa, Muneeswaran Selvaraj, Helen M E Duyvesteyn, Thomas G Ritter, Nigel Temperton, Paul Klenerman, Susanna J Dunachie, Neil G Paterson, Mark A Williams, David R Hall, Elizabeth E Fry, Juthathip Mongkolsapaya, Jingshan Ren, David I Stuart, Gavin R Screaton

Faculty, Staff and Student Publications

The rapid evolution of SARS-CoV-2 is driven in part by a need to evade the antibody response in the face of high levels of immunity. Here, we isolate spike (S) binding monoclonal antibodies (mAbs) from vaccinees who suffered vaccine break-through infections with Omicron sub lineages BA.4 or BA.5. Twenty eight potent antibodies are isolated and characterised functionally, and in some cases structurally. Since the emergence of BA.4/5, SARS-CoV-2 has continued to accrue mutations in the S protein, to understand this we characterize neutralization of a large panel of variants and demonstrate a steady attrition of neutralization by the panel of …

Effect Of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis On Medication Satisfaction And Out-Of-Pocket Costs: A Secondary Analysis Of A Randomized Clinical Trial, Nathan N O'Hara, Katherine P Frey, Deborah M Stein, Joseph F Levy, Gerard P Slobogean, Renan Castillo, Reza Firoozabadi, Madhav A Karunakar, Joshua L Gary, William T Obremskey, Rachel B Seymour, Joseph Cuschieri, C Daniel Mullins, Robert V O'Toole, Metrc

Faculty, Staff and Student Publications

BACKGROUND: Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin.

METHODS: This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) …