Bio


Nidhi Rohatgi, MD, MS, FACP is a Clinical Associate Professor of Medicine and Chief, Surgical Co-management, Division of Hospital Medicine at the Stanford University School of Medicine. She primarily manages medical co-morbidities and medical complications in neurosurgical patients in the hospital setting. She is involved in clinical education and clinical research in Perioperative Medicine, and has been the research lead for the Surgical Co-management group since 2012.

Clinical Focus


  • Perioperative Medicine
  • Internal Medicine
  • Clinical Research
  • Clinical Protocols

Academic Appointments


  • Clinical Associate Professor, Medicine
  • Clinical Associate Professor (By courtesy), Neurosurgery

Administrative Appointments


  • Chief, Surgical Co-management Section, Division of Hospital Medicine, Stanford University School of Medicine (2019 - Present)
  • Member, Executive Council, Society of Hospital Medicine: Perioperative Special Interest Group (2019 - Present)
  • Medical Director, Patient Health Education, Engagement and Promotion, Stanford Health Care (2018 - Present)
  • Clinical Associate Professor of Medicine, Stanford University School of Medicine (2017 - Present)
  • Co-Chair, Medication Safety Committee, Stanford Health Care (2017 - Present)
  • Co-Medical Director, Clinical Advice Service, Stanford Health Care (2015 - 2018)
  • Clinical Assistant Professor of Medicine/Neurosurgery Hospitalist, Stanford University School of Medicine (2013 - 2017)
  • Research Lead, Surgical Co-management group, Stanford University School of Medicine (2012 - Present)
  • Clinical Instructor of Medicine/Neurosurgery Hospitalist, Stanford University School of Medicine (2012 - 2013)
  • Co-Medical Director of Hospitalist Group/General Hospitalist, Sutter Health (2012 - 2012)
  • Co-Management Hospitalist for Medical and Surgical Oncology, Sutter Health (2011 - 2012)
  • Clinical Assistant Professor/Hospitalist, Critical Care Medicine, University of Pittsburgh Medical Center (2009 - 2011)
  • Clinical Instructor/Hospitalist, Critical Care Medicine, University of Pittsburgh Medical Center (2009 - 2009)
  • Graduate Research Assistant, Pulmonary Medicine, University of Texas M.D. Anderson Cancer Center, Houston (2005 - 2006)
  • Research Fellow, Infectious Diseases, University of Texas M.D. Anderson Cancer Center, Houston (2005 - 2005)
  • Graduate Teaching Assistant, Intermediate Biostatistics, School of Public Health, University of Texas Health Science Center, Houston (2004 - 2005)

Honors & Awards


  • Division Teaching Award, Stanford University School of Medicine (2018-2019)
  • Top Hospitalist, American College of Physicians (2018-2019)
  • Malinda S. Mitchell Quality Award for delirium prevention and management protocol in non-ICU, Stanford Health Care (2016)
  • Malinda S. Mitchell Quality Award for development of Perioperative Medicine Program (Co-Recipient), Stanford Hospital and Clinics (2013)

Boards, Advisory Committees, Professional Organizations


  • Member, Research Committee, Society of Hospital Medicine (2019 - Present)
  • Member, Hospital Quality and Patient Safety Committee, Society of Hospital Medicine (2018 - Present)
  • Member, Quality, Patient Safety, and Clinical Effectiveness Committee, Stanford Health Care (2017 - Present)
  • Member, Medication Safety Committee, Stanford Hospital and Clinics (2015 - Present)
  • Member, World Health Organization External Advisory Committee, Stanford University Medical Center (2014 - 2014)
  • Founder/Member, SHC Delirium Task Force (non-ICU), Stanford Hospital and Clinics (2013 - Present)
  • Member, American College of Physicians (2013 - 2017)
  • Collaborator, Neurosurgery Pain Management Task Force, Stanford University School of Medicine (2013 - 2013)
  • Member, Sepsis Committee, Sutter Health (2012 - 2012)
  • Member, Society of Hospital Medicine (2011 - Present)
  • Member, Risk Management and Patient Safety Committee, Sutter Health (2011 - 2012)
  • Physician Champion and Subject Matter Expert for Electronic Health Records (EPIC), Sutter Health (2011 - 2012)
  • Member, Readmission Initiative Committee, University of Pittsburgh Medical Center (2010 - 2011)
  • Member, Venous Thromboembolism Committee, University of Pittsburgh Medical Center (2010 - 2011)
  • Member, Ethics Committee, Case Western University/St. Vincent Medical Center (2007 - 2009)
  • Member, Pharmacy and Therapeutics Committee, Case Western University/St. Vincent Medical Center (2007 - 2009)

Professional Education


  • Residency: St Vincent Charity Hospital (2009) OH
  • Master of Science, University of Texas Health Science Center at Houston, Epidemiology and Biostatistics (2006)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2009)
  • Medical Education: Maulana Azad Medical College (2002) India

Community and International Work


  • National Health, Rural/Urban India

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Current Research and Scholarly Interests


- Quality improvement in Perioperative Medicine
- Standardizing patient care for safer/effective management

Clinical Trials


  • Adaptive COVID-19 Treatment Trial (ACTT) Recruiting

    This study is an adaptive, randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of novel therapeutic agents in hospitalized adults diagnosed with COVID-19. The study is a multicenter trial that will be conducted in up to approximately 100 sites globally. The study will compare different investigational therapeutic agents to a control arm. There will be interim monitoring to introduce new arms and allow early stopping for futility, efficacy, or safety. If one therapy proves to be efficacious, then this treatment may become the control arm for comparison(s) with new experimental treatment(s). Any such change would be accompanied by an updated sample size. Because background standards of supportive care may evolve/improve over time as more is learned about successful management of COVID-19, comparisons of safety and efficacy will be based on data from concurrently randomized subjects. An independent Data and Safety Monitoring Board (DSMB) will actively monitor interim data to make recommendations about early study closure or changes to study arms. To evaluate the clinical efficacy, as assessed by time to recovery, of different investigational therapeutics as compared to the control arm.

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  • Adaptive COVID-19 Treatment Trial 2 (ACTT-II) Recruiting

    ACTT-II will evaluate the combination of baricitinib and remdesivir compared to remdesivir alone. Subjects will be assessed daily while hospitalized. If the subjects are discharged from the hospital, they will have a study visit at Days 15, 22, and 29. For discharged subjects, it is preferred that the Day 15 and 29 visits are in person to obtain safety laboratory tests and oropharyngeal (OP) swab and blood (serum only) samples for secondary research as well as clinical outcome data. However, infection control or other restrictions may limit the ability of the subject to return to the clinic. In this case, these visits may be conducted by phone, and only clinical data will be obtained. The Day 22 visit does not have laboratory tests or collection of samples and is conducted by phone. The primary outcome is time to recovery by Day 29.

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  • A Study to Evaluate the Safety and Efficacy of Tocilizumab in Patients With Severe COVID-19 Pneumonia Not Recruiting

    This study will evaluate the efficacy, safety, pharmacodynamics, and pharmacokinetics of tocilizumab (TCZ) compared with a matching placebo in combination with standard of care (SOC) in hospitalized patients with severe COVID-19 pneumonia.

    Stanford is currently not accepting patients for this trial.

    View full details

Projects


  • MD-RN Collaborative Delirium Management Protocol, Stanford Hospital and Clinics (2013 - Present)

    Location

    Stanford

  • Studying the Impact of Surgical Co-Management on Quality and Costs of Patient Care, Stanford University School of Medicine (2012 - Present)

    Location

    Stanford

All Publications


  • Clinical Progress Note: Myocardial Injury After Noncardiac Surgery. Journal of hospital medicine Cohn, S. L., Rohatgi, N., Patel, P., Whinney, C. 2020

    View details for DOI 10.12788/jhm.3448

    View details for PubMedID 32584248

  • Remdesivir for the Treatment of Covid-19 - Preliminary Report. The New England journal of medicine Beigel, J. H., Tomashek, K. M., Dodd, L. E., Mehta, A. K., Zingman, B. S., Kalil, A. C., Hohmann, E., Chu, H. Y., Luetkemeyer, A., Kline, S., Lopez de Castilla, D., Finberg, R. W., Dierberg, K., Tapson, V., Hsieh, L., Patterson, T. F., Paredes, R., Sweeney, D. A., Short, W. R., Touloumi, G., Lye, D. C., Ohmagari, N., Oh, M. D., Ruiz-Palacios, G. M., Benfield, T., Fätkenheuer, G., Kortepeter, M. G., Atmar, R. L., Creech, C. B., Lundgren, J., Babiker, A. G., Pett, S., Neaton, J. D., Burgess, T. H., Bonnett, T., Green, M., Makowski, M., Osinusi, A., Nayak, S., Lane, H. C. 2020

    Abstract

    Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), none have yet been shown to be efficacious.We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 with evidence of lower respiratory tract involvement. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only.A total of 1063 patients underwent randomization. The data and safety monitoring board recommended early unblinding of the results on the basis of findings from an analysis that showed shortened time to recovery in the remdesivir group. Preliminary results from the 1059 patients (538 assigned to remdesivir and 521 to placebo) with data available after randomization indicated that those who received remdesivir had a median recovery time of 11 days (95% confidence interval [CI], 9 to 12), as compared with 15 days (95% CI, 13 to 19) in those who received placebo (rate ratio for recovery, 1.32; 95% CI, 1.12 to 1.55; P<0.001). The Kaplan-Meier estimates of mortality by 14 days were 7.1% with remdesivir and 11.9% with placebo (hazard ratio for death, 0.70; 95% CI, 0.47 to 1.04). Serious adverse events were reported for 114 of the 541 patients in the remdesivir group who underwent randomization (21.1%) and 141 of the 522 patients in the placebo group who underwent randomization (27.0%).Remdesivir was superior to placebo in shortening the time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; ACCT-1 ClinicalTrials.gov number, NCT04280705.).

    View details for DOI 10.1056/NEJMoa2007764

    View details for PubMedID 32445440

    View details for PubMedCentralID PMC7262788

  • Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years Journal of Hospital Medicine Rohatgi, N., Weng, Y., Ahuja, N. 2020

    View details for DOI 10.12788/jhm.3363

  • Osteoarthritis risk is reduced after treatment with ticagrelor compared to clopidogrel: a propensity score matching analysis. Arthritis & rheumatology (Hoboken, N.J.) Baker, M. C., Weng, Y., William, R. H., Ahuja, N., Rohatgi, N. 2020

    Abstract

    Osteoarthritis (OA) is a common cause of joint pain and disability, and effective treatments are lacking. Extracellular adenosine has anti-inflammatory effects and can prevent and treat OA in animal models. Ticagrelor and clopidogrel are both used in patients with coronary artery disease, but only ticagrelor increases extracellular adenosine. The aim of this study was to determine whether treatment with ticagrelor was associated with a lower risk of OA.We conducted a 1:2 propensity score matching analysis using the Optum Clinformatics™ Data Mart from 2011 to 2017. We included patients who received either ticagrelor or clopidogrel for at least 90 days and excluded those with a prior diagnosis of OA or inflammatory arthritis. OA was identified using International Classification of Diseases codes. The primary outcome was the time to diagnosis of OA after treatment with ticagrelor versus clopidogrel.Our propensity score matched cohort consisted of 7,007 ticagrelor-treated patients and 14,014 clopidogrel-treated patients, with a median number of days on treatment of 287 and 284 respectively. For both groups, the mean age was 64 years, and 73% of the patients were male. Multivariate Cox-regression analysis estimated a hazard ratio of 0.71 (95% CI 0.64-0.79, p<0.001) for developing OA after treatment with ticagrelor compared to clopidogrel.Treatment with ticagrelor was associated with a 29% lower risk of developing OA compared to clopidogrel over five years of follow-up. We hypothesize that the reduction in OA seen in patients who received ticagrelor may in part be due to increased extracellular adenosine.

    View details for DOI 10.1002/art.41412

    View details for PubMedID 32564514

  • Co-Management by Hospitalists: Why it makes clinical and fiscal sense. The American journal of medicine Rohatgi, N., Schulman, K., Ahuja, N. 2019

    View details for DOI 10.1016/j.amjmed.2019.07.053

    View details for PubMedID 31449770

  • Initiative for prevention and early identification of delirium in medical-surgical units: Lessons learnt in the past five years. The American journal of medicine Rohatgi, N., Weng, Y., Bentley, J., Lansberg, M. G., Shepard, J., Mazur, D., Ahuja, N., Hopkins, J. 2019

    Abstract

    BACKGROUND: Delirium is an acute change in mental status affecting 10-64% of hospitalized patients, and may be preventable in 30-40% cases. In October 2013, a task force for delirium prevention and early identification in medical-surgical units was formed at our hospital. We studied if our standardized protocol prevented delirium among high-risk patients.METHODS: We studied 105,455 patient encounters between November 2013 and January 2018. Since November 2013, there has been ongoing education to decrease deliriogenic medications use. Since 2014, nurses screen all patients for presence or absence of delirium using confusion assessment method (CAM). Since 2015, nurses additionally screen all patients for risk of delirium. In 2015, a physician order set for delirium was created. Non-pharmacological measures are implemented for high-risk or CAM positive patients.RESULTS: 98.8% of patient encounters had CAM screening, and 99.6% had delirium risk screening. Since 2013, odds of opiate use decreased by 5.0% per year (P<0.001), and odds of benzodiazepines use decreased by 8.0% per year (P<0.001). There was no change in anticholinergics use. In the adjusted analysis, since 2015, odds of delirium decreased by 25.3% per year among high-risk patients (N=21,465; P<0.001). Among high-risk patients or those diagnosed with delirium (N=22,121), estimated LOS decreased by 0.13days per year (P<0.001), odds of inpatient mortality decreased by 16.0% per year (P=0.011), and odds of discharge to nursing home decreased by 17.1% per year (P<0.001).CONCLUSION: With high clinician engagement and simplified workflows, our delirium initiative has shown sustained results.

    View details for DOI 10.1016/j.amjmed.2019.05.035

    View details for PubMedID 31228413

  • Perioperative Risk Calculators and the Art of Medicine. JAMA internal medicine Rohatgi, N. 2019

    View details for DOI 10.1001/jamainternmed.2019.4914

    View details for PubMedID 31633737

  • Surgical Comanagement by Hospitalists Improves Patient Outcomes: A Propensity Score Analysis. Annals of surgery Rohatgi, N., Loftus, P., Grujic, O., Cullen, M., Hopkins, J., Ahuja, N. 2016; 264 (2): 275-282

    Abstract

    The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution.Prior studies may have underestimated the impact of SCM due to methodological shortcomings.This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695). Patients were admitted between January 2009 to July 2012 (pre-SCM) and September 2012 to September 2013 (post-SCM) to Orthopedic or Neurosurgery at our institution. Using propensity score methods, linear regression, and a difference-in-difference approach, we estimated changes in outcomes between pre and post periods, while adjusting for confounding patient characteristics.The SCM intervention was associated with a significant differential decrease in the proportion of patients with at least 1 medical complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.74-0.96; P = 0.008), the proportion of patients with length of stay at least 5 days (OR 0.75; 95% CI, 0.67-0.84; P < 0.001), 30-day readmission rate for medical cause (OR 0.67; 95% CI, 0.52-0.81; P < 0.001), and the proportion of patients with at least 2 medical consultants (OR 0.55; 95% CI, 0.49-0.63; P < 0.001). There was no significant change in patient satisfaction (OR 1.08; 95% CI, 0.87-1.33; P = 0.507). We estimated average savings of $2642 to $4303 per patient in the post-SCM group. The overall provider satisfaction with SCM was 88.3%.The SCM intervention reduces medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care.

    View details for DOI 10.1097/SLA.0000000000001629

    View details for PubMedID 26764873

  • Determinants of Cost Variation in Total Hip and Knee Arthroplasty: Implications for Alternative Payment Models. The Journal of the American Academy of Orthopaedic Surgeons Rudy, M. D., Bentley, J., Ahuja, N., Rohatgi, N. 2019

    Abstract

    Alternative payment models have been proposed to deliver high-quality, cost-effective care. Under these models, payments may be shared between the hospital and the post-acute care services. Post-acute care services may account for one-third of the episode costs for total hip or knee arthroplasty (THA/TKA). Because hospitals or episode initiators bear notable financial risks in these payment models with minimal risk adjustment for complexity, it has been suggested these models may lead to prospective selection of healthier and younger patients. Studies evaluating the effect of patient demographics, medical complexity, and surgical characteristics on the cost of index hospitalization have been limited. We aimed to (1) quantify the impact of patient demographics, medical complexity, and surgical characteristics (type of anesthesia and operating time) on variation in direct cost of index hospitalization and (2) examine the association of these characteristics with discharge with home health services or to rehabilitation facility.Retrospective study of 3,542 patients admitted to our hospital for elective THA/TKA between 2012 and 2017. Multivariable generalized estimating equations were used for analysis.Patient demographics and medical complexity accounted for 6.2% (THA) and 5.6% (TKA) of variation in direct cost of index hospitalization. Surgical characteristics accounted for 37.1% (THA) and 35.3% (TKA) of the cost variation. One thousand one hundred eighty-three (53.4%) patients were discharged with home health services, and 1,237 (29.4%) were discharged to rehabilitation facility. Patient demographics and higher medical complexity were markedly associated with discharge with home health services or to rehabilitation facility after THA/TKA.Patient demographics and medical complexity had minimal impact on variation in direct cost of index hospitalization for elective THA/TKA compared with surgical characteristics but were markedly associated with discharge with home health services or to rehabilitation facility. Having additional risk adjustment in these payment models could mitigate concerns about access to care for higher risk, higher cost patients.

    View details for DOI 10.5435/JAAOS-D-18-00718

    View details for PubMedID 31192883

  • Comparison of Outcomes for Adult Inpatients With Sickle Cell Disease Cared for by Hospitalists Versus Hematologists. American journal of medical quality : the official journal of the American College of Medical Quality Slade, J., Rohatgi, N., Weng, Y., Hom, J., Ahuja, N. 2019: 1062860619892060

    View details for DOI 10.1177/1062860619892060

    View details for PubMedID 31856577

  • Surgical Comanagement by Hospitalists in Colorectal Surgery. Journal of the American College of Surgeons Rohatgi, N., Wei, P. H., Grujic, O., Ahuja, N. 2018

    Abstract

    BACKGROUND: Patients with increasing age and medical complexity are undergoing colorectal surgery. Medical complications are not uncommon, and may contribute to higher mortality. We implemented a surgical co-management (SCM) model in July 2014 at our institution where same two SCM hospitalists were dedicated to Colorectal surgery year round. Each patient was screened daily by a SCM hospitalist for prevention and management of medical complications. Prior to SCM, hospitalists were typically consulted after medical complications had occurred.STUDY DESIGN: Pre-post study at an academic medical center with 938 patients in the pre-SCM group (July 2012 to June 2014), and 1,062 patients in the post-SCM group (July 2014 to May 2016). We evaluated if SCM by hospitalists improved outcomes of patients in Colorectal surgery.RESULTS: There was no significant difference in medical complications, patient satisfaction, or 30-day readmission rate to our institution for medical cause with the SCM intervention. This intervention was associated with a significant decrease in the proportion of patients transferred to intensive care unit after rapid response team calls (RR, 0.25 [95% CI, 0.05 to 0.84], P = 0.039), proportion of patients with LOS ≥5 days (RR, 0.73 [95% CI, 0.64 to 0.83], P <0.001), use of medical consultants (RR, 0.75 [95% CI, 0.63 to 0.89], P = 0.001), and the median direct cost of care by 10.3% (P = 0.0002).CONCLUSIONS: SCM intervention was associated with a decrease in transfers to intensive care unit after rapid response team call, LOS, medical consultants, and the cost of care.

    View details for PubMedID 30030136

  • Nurse Telephonic Triage Service for After-hour Patient Calls in Neurosurgery. Annals of surgery Escobedo-Wu, E. L., Dhebar, F., Harsh, G., Steinberg, G., Vyas, A., Katznelson, L., Ho, A. L., Pendharkar, A. V., Sussman, E. S., Rohatgi, N. 2018; 267 (4): e67–e68

    Abstract

    OBJECTIVE: The aim of this study was to report the utilization and experience of the nurse telephonic triage service for after-hour patient calls in Neurosurgery.BACKGROUND: It is challenging for patients to reach their clinicians after-hours in a timely manner. This may result in worse health outcomes for the patients, or inappropriate utilization of emergency rooms and urgent care facilities. Physicians continue to remain overwhelmed with frequent after-hours calls in addition to other clinical responsibilities while on-call.METHODS: In August 2015, our institution launched the Clinical Advice Service (CAS) to provide a patient-centric, nurse-run telephone triage service for after-hour calls from Neurosurgery patients. Clinical protocols were created for use by CAS staff by Neurosurgery clinicians.RESULTS: Between July 2016 and June 2017, CAS has accepted 1021 after-hours calls from Neurosurgery patients. A total of 71.4% of these calls were clinical, and the remaining nonclinical (directions, appointments, general information). CAS escalated 37.3% of the calls to the on-call Neurosurgery physician; 4.8% Neurosurgery patients were triaged to the emergency room by CAS.CONCLUSION: CAS has been able to provide well-coordinated care to Neurosurgery patients while reducing physician workload.

    View details for PubMedID 29064895

  • Factors Associated With Delayed Discharge on General Medicine Service at an Academic Medical Center. Journal for healthcare quality : official publication of the National Association for Healthcare Quality Rohatgi, N., Kane, M., Winget, M., Haji-Sheikhi, F., Ahuja, N. 2018

    Abstract

    Lack of collaboration between care teams and patients/families has been associated with delayed discharge from the hospital. In this study, we determine whether patients' awareness of the estimated date of discharge (EDD) was associated with a decrease in delayed discharge, and determine the factors associated with a delayed discharge. A total of 221 patients admitted to the General Medicine service between July and September 2014 were included in the study. Estimated date of discharge was identified within 36 hours of admission. The bedside nurse communicated this EDD to the patient/family. Patients were interviewed to identify whether they were aware of their EDD. Bedside nurses were interviewed to identify barriers to discharge. In our study, 49.8% of the patients had a delayed discharge. Patients who were aware of their EDD were less likely to have a delayed discharge (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.1-0.6], p < .001). Patients who were discharged on Saturday or Sunday (OR, 4.8 [95% CI, 1.7-14.6], p < .001) and patients who were waiting for physicians' consult (OR, 4.5 [95% CI, 1.6-14.4], p = .007) were more likely to have a delayed discharge. Early identification of the EDD and communicating it with the care team and the patient/family, mobilizing resources for safe weekend discharges, and creating efficient process for consultations might decrease delayed discharges.

    View details for DOI 10.1097/JHQ.0000000000000126

    View details for PubMedID 29315151

  • Lean-Based Redesign of Multidisciplinary Rounds on General Medicine Service. Journal of hospital medicine Kane, M., Rohatgi, N., Heidenreich, P., Thakur, A., Winget, M., Shum, K., Hereford, J., Shieh, L., Lew, T., Horn, J., Chi, J., Weinacker, A., Seay-Morrison, T., Ahuja, N. 2018

    Abstract

    Multidisciplinary rounds (MDR) facilitate timely communication amongst the care team and with patients. We used Lean techniques to redesign MDR on the teaching general medicine service.To examine if our Lean-based new model of MDR was associated with change in the primary outcome of length of stay (LOS) and secondary outcomes of discharges before noon, documentation of estimated discharge date (EDD), and patient satisfaction.This is a pre-post study. The preperiod (in which the old model of MDR was followed) comprised 4000 patients discharged between September 1, 2013, and October 22, 2014. The postperiod (in which the new model of MDR was followed) comprised 2085 patients between October 23, 2014, and April 30, 2015.Lean-based redesign of MDR.LOS, discharges before noon, EDD, and patient satisfaction.There was no change in the mean LOS. Discharges before noon increased from 6.9% to 10.7% (P < .001). Recording of EDD increased from 31.4% to 41.3% (P < .001). There was no change in patient satisfaction.Lean-based redesign of MDR was associated with an increase in discharges before noon and in recording of EDD.

    View details for PubMedID 29394300

  • Eptifibatide overdose INTERNATIONAL JOURNAL OF CARDIOLOGY Parakh, S., Naik, N., Rohatgi, N., Bhat, U., Parakh, K. 2009; 131 (3): 430-432

    Abstract

    Eptifibatide is a glycoprotein (GP) IIb/IIIa inhibitor used globally, but there is little information on overdose. We report a case of eptifibatide overdose with no consequence to the patient.We searched for eptifibatide overdose on PubMed, British National Formulary, Thomson Micromedex, EudraPharm, Toxbase, and the Medicines and Healthcare products Regulatory Agency and Food and Drug Administration websites.In clinical trials, overdose occurred in 17 cases with no adverse events including bleeding. In case reports, prolonged infusions of eptifibatide were associated with gastrointestinal bleeding and thrombocytopenia. In animal studies, eptifibatide was not lethal but induced dyspnea, ptosis, cerebellar dysfunction, hypotonia and petechial hemorrhages. Eptifibatide side effects including chest pain, bradycardia, angioedema and hypotension may occur in patients with overdose. Alveolar hemorrhage should be suspected in patients with hemoptysis, dyspnea or new infiltrates on chest X-ray. Management of overdose requires discontinuation of eptifibatide, monitoring for bleeding and waiting for clearance (primarily renal). Normalization of hemostasis occurs rapidly and coronary bypass surgery performed within 2 hours of eptifibatide discontinuation did not have excess bleeding. Eptifibatide clearance is delayed in renal failure and in one report hemodialysis normalized hemostasis. Platelet transfusion is appropriate in cases of acute thrombocytopenia, a side effect of eptifibatide. If the platelet count is normal, transfusion of platelets does not help as drug molecules overwhelmingly outnumber GP IIb/IIIa receptors. Desmopressin reversed platelet dysfunction caused by eptifibatide in healthy volunteers but is untested in patients.Available data suggest that eptifibatide overdose is rare and can be managed conservatively.

    View details for DOI 10.1016/j.ijcard.2007.07.132

    View details for Web of Science ID 000262328700029

    View details for PubMedID 18023892

  • Fatal cytomegalovirus pneumonia in patients with haematological malignancies: an autopsy-based case-control study CLINICAL MICROBIOLOGY AND INFECTION Torres, H. A., Aguilera, E., Safdar, A., Rohatgi, N., Raad, I. I., SEPULVEDA, C., Luna, M., Kontoyiannis, D. P., Chemaly, R. F. 2008; 14 (12): 1160-1166

    Abstract

    Cytomegalovirus (CMV) pneumonia is a life-threatening infection in patients with haematological malignancies (HMs) or in haematopoietic stem cell transplant (HSCT) recipients. To assess the incidence and risk factors for developing fatal CMV pneumonia in these patients, a case-control study based on 999 autopsies was performed at The University of Texas M. D. Anderson Cancer Center, Houston, Texas (January 1990 to December 2004). Twenty-five cases (patients who died with CMV pneumonia) were matched with 34 controls (patients who died without CMV pneumonia) by type of HM or HSCT, year of autopsy, age and gender. The incidence of CMV pneumonia declined between January 1990 to June /1997 and July 1997 to December 2004 (CMV pneumonia rates were 22/620 and 3/379 autopsies, respectively; p 0.006). Logistic regression analysis identified complete remission and sustained lymphopenia as independent predictors of CMV pneumonia (all p <0.05). The incidence of fatal CMV pneumonia has decreased over the last 15 years, which might reflect earlier diagnosis or the use of pre-emptive therapy or more effective preventive strategies. Complete remission of an HM does not preclude the development of CMV pneumonia among patients with prolonged lymphopenia.

    View details for DOI 10.1111/j.1469-0691.2008.02106.x

    View details for Web of Science ID 000261627200009

    View details for PubMedID 19046167

  • Chemotherapy and survival for patients with multiple myeloma - Findings from a large nationwide and population-based cohort AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS Rohatgi, N., Du, X. L., Coker, A. L., Moye, L. A., Wang, M., Fang, S. 2007; 30 (5): 540-548

    Abstract

    To assess the patterns of chemotherapy use for patients with multiple myeloma and to determine if chemotherapy is effective in prolonging survival outside the clinical trial settings.We studied a nationwide and population-based retrospective cohort of 4902 patients > or =65 years of age with stage II or III multiple myeloma from 1992 to 1999, identified from the Surveillance, Epidemiology, and End-Results-Medicare data. Multivariate logistic regression was used to estimate the odds ratio of receiving chemotherapy and Cox proportional hazard model was used to estimate the hazard ratio of mortality associated with chemotherapy.Of 4902 patients with stage II or III multiple myeloma, 52.0% received chemotherapy during the course of the disease. The receipt of chemotherapy decreased significantly with age from 65.7% in the 65- to 69-year age group to 34.3% in those > or =80 years. Blacks (47.6%) were less likely to receive chemotherapy than whites (52.8%). Use of chemotherapy decreased significantly with comorbidity scores and increased over time. Risk of all-cause mortality was significantly reduced in patients who received chemotherapy compared with those who did not (adjusted hazard ratio = 0.65; 95% confidence interval = 0.61-0.69). A similar pattern as observed for myeloma-specific mortality (0.61; 0.56-0.67). Survival benefit increased with increasing cycles of chemotherapy (P < 0.001 for trend) and was significant across different age groups, gender, ethnic groups, and comorbidity scores.Chemotherapy was significantly associated with increased survival in patients with multiple myeloma outside the clinical trial settings. This survival benefit was significant across different groups by age, gender, race, and comorbidity. A substantial number of patients with multiple myeloma did not receive chemotherapy.

    View details for DOI 10.1097/COC.0b013e3180592a30

    View details for Web of Science ID 000250023100014

    View details for PubMedID 17921717

  • Characteristics and outcome of respiratory syncytial virus infection in patients with leukemia HAEMATOLOGICA-THE HEMATOLOGY JOURNAL Torres, H. A., Aguilera, E. A., Mattiuzzi, G. N., Cabanillas, M. E., Rohatgi, N., Sepulveda, C. A., Kantarjian, H. M., Jiang, Y., Safdar, A., Raad, I. I., Chemaly, R. F. 2007; 92 (9): 1216-1223

    Abstract

    Little is known about respiratory syncytial virus (RSV) infection in patients with leukemia. The aim of this study was to determine the characteristics, and the outcome of RSV infection with or without therapy with aerosolized ribavirin in leukemia patients.We reviewed the records of 52 leukemia patients with RSV infection seen at our institution between October 2000 and March 2005.The median age of the patients was 47 years (range, 1-83 years). Most patients were male (65%) and had acute leukemia (65%); 46% had received salvage chemotherapy and 62% corticosteroids before RSV infection. Compared to the 25 patients with upper respiratory tract infection (URI), the 27 patients with pneumonia had a higher median APACHE II score at the time of the first assessment at the hospital for respiratory symptoms (11 vs 16), and a higher rate of corticosteroid treatment in the month preceding the infection (48% vs 74%) (all p < or =0.05). Twenty-four (46%) patients received aerosolized ribavirin. Patients who presented with URI and were treated with ribavirin were less likely than non-treated patients to develop pneumonia (68% vs 96%, p<0.01) and possibly die of pneumonia (6% vs 36%, p=0.1). Multiple logistic regression analysis identified high APACHE II score and lack of ribavirin treatment as independent predictors of progression to pneumonia (p=0.01). Five patients (10%) died within 30 days of RSV infection; all had pneumonia.RSV infection is associated with significant morbidity and mortality in leukemia patients; treatment with aerosolized ribavirin at the stage of URI may prevent pneumonia in some subsets of patients.

    View details for DOI 10.3324/haematol.11300

    View details for Web of Science ID 000249402100010

    View details for PubMedID 17666367

  • Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients - A retrospective study at a major cancer center MEDICINE Chemaly, R. F., Ghosh, S., Bodey, G. P., Rohatgi, N., Safdar, A., Keating, M. J., Champlin, R. E., Aguilera, E. A., Tarrand, J. J., Raad, I. I. 2006; 85 (5): 278-287

    Abstract

    Community respiratory viruses (CRVs) have been recognized as a potential cause of pneumonia and death among hematopoietic stem cell transplantation (HSCT) recipients and patients with hematologic malignancies. We reviewed the Microbiology Laboratory records dated from July 1, 2000, to June 30, 2002, to identify patients who had respiratory specimens positive for influenza, parainfluenza, respiratory syncytial virus, or picornavirus. We identified 343 infections among patients with underlying hematologic malignancies and HSCT. We collected data on type of disease, age, sex, type of infection, neutrophil and lymphocyte counts, therapy, and outcome. Influenza, parainfluenza, and respiratory syncytial virus accounted for most cases and were approximately equal in frequency. Most infections occurred predominantly among recipients of allogeneic transplants. Infection progressed to pneumonia in 119 patients (35%) and occurred with similar frequency for the 3 viruses. Patients at greatest risk for developing pneumonia included those with leukemia, those aged more than 65 years, and those with severe neutropenia or lymphopenia. Lack of respiratory syncytial virus-directed antiviral therapy (p=0.025) and age (p=0.042) were associated with development of respiratory syncytial virus pneumonia, and an absolute lymphocyte count

    View details for DOI 10.1097/01.md.0000232560.22098.4e

    View details for Web of Science ID 000240661300003

    View details for PubMedID 16974212