Nidhi Rohatgi, MD MS

All Publications

• The promises and limitations of artificial intelligence for quality improvement, patient safety, and research in hospital medicine. Journal of hospital medicine Ma, S. P., Rohatgi, N., Chen, J. H. 2024

  View details for DOI 10.1002/jhm.13404

  View details for PubMedID 38751246

• Adapted large language models can outperform medical experts in clinical text summarization. Nature medicine Van Veen, D., Van Uden, C., Blankemeier, L., Delbrouck, J. B., Aali, A., Bluethgen, C., Pareek, A., Polacin, M., Reis, E. P., Seehofnerová, A., Rohatgi, N., Hosamani, P., Collins, W., Ahuja, N., Langlotz, C. P., Hom, J., Gatidis, S., Pauly, J., Chaudhari, A. S. 2024

  Abstract

  Analyzing vast textual data and summarizing key information from electronic health records imposes a substantial burden on how clinicians allocate their time. Although large language models (LLMs) have shown promise in natural language processing (NLP) tasks, their effectiveness on a diverse range of clinical summarization tasks remains unproven. Here we applied adaptation methods to eight LLMs, spanning four distinct clinical summarization tasks: radiology reports, patient questions, progress notes and doctor-patient dialogue. Quantitative assessments with syntactic, semantic and conceptual NLP metrics reveal trade-offs between models and adaptation methods. A clinical reader study with 10 physicians evaluated summary completeness, correctness and conciseness; in most cases, summaries from our best-adapted LLMs were deemed either equivalent (45%) or superior (36%) compared with summaries from medical experts. The ensuing safety analysis highlights challenges faced by both LLMs and medical experts, as we connect errors to potential medical harm and categorize types of fabricated information. Our research provides evidence of LLMs outperforming medical experts in clinical text summarization across multiple tasks. This suggests that integrating LLMs into clinical workflows could alleviate documentation burden, allowing clinicians to focus more on patient care.

  View details for DOI 10.1038/s41591-024-02855-5

  View details for PubMedID 38413730

  View details for PubMedCentralID 5593724

• Building and Sustaining Co-Management Programs in Hospital Medicine: A Technical Report and Operational Guide Rohatgi, N., Vora, H., Atchley Jr. , W., Álvarez de-Arcaya, A., Choksey, U., Daniel, R., Gupta, K., Lalli, J., Morris, J., Mullikin, S., Ngan, W., Pombra, J., Rahman, S., Rappaport, D. I., Sahai, S., Vuong, K., Zhao, R., Pfeifer, K. Society of Hospital Medicine. 2024

  Abstract

  Hospitalists are increasingly involved in the care of patients from surgical and medical subspecialty services. The Building and Sustaining Co-Management Programs in Hospital Medicine: A Technical Report and Operational Guide is designed for hospital medicine leaders who have co-management programs or are considering starting one. This program guide outlines key considerations for creating, leading, or participating in a hospitalist co-management model.

• Perioperative considerations for patients with severe aortic stenosis undergoing elective noncardiac surgery. The American journal of medicine Rohatgi, N., Smilowitz, N. R., Reejhsinghani, R. 2023

  View details for DOI 10.1016/j.amjmed.2023.05.017

  View details for PubMedID 37369272

• State of research in adult Hospital Medicine: Updated results of a national survey and longitudinal analysis of national data. Journal of hospital medicine Pappas, M. A., Jenkins, A. M., Horstman, M. J., Rohatgi, N., Press, V. G., Prochaska, M. T., Michtalik, H. J., Sigmund, A., Pavon, J. M., Bhandari, S., Gupta, V., Taylor, S. P., Society of Hospital Medicine Research Committee 2023

  Abstract

  We sought to understand the current state of research in adult Hospital Medicine by repeating a 2018 survey of leaders in Hospital Medicine with changes to improve the response rate of surveyed programs. We also analyzed the public sources of federal research funding and MEDLINE-indexed publications from 2010 through 2019 among members of the Society of Hospital Medicine (SHM). Of the 102 contacted leaders of Hospital Medicine groups across the country, 49 responded, for a total response rate of 48%. Among the 3397 faculty members represented in responding programs, 72 (2%) of faculty were identified as conducting research for more than 50% of their time. Respondents noted difficulties at every stage of the research development pipeline, from a lack of mentors to running a fellowship program to a lack of applicants seeking further research training. Improvements to our research training pipeline will be essential to the long-term improvement of our profession.

  View details for DOI 10.1002/jhm.13096

  View details for PubMedID 37020348

• 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

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

• JMIR Perioperative Medicine: A Global Journal for Publishing Interdisciplinary Innovations, Research, and Perspectives. JMIR perioperative medicine Rohatgi, N. 2023; 6: e54344

  Abstract

  JMIR Perioperative Medicine supports the dissemination of technological and data science-driven innovative research conducted by interdisciplinary teams in perioperative medicine. We invite contributions on a broad range of topics from clinicians, scientists, and allied health professionals from across the globe.

  View details for DOI 10.2196/54344

  View details for PubMedID 37988142

• Clinical Text Summarization: Adapting Large Language Models Can Outperform Human Experts. Research square Veen, D. V., Uden, C. V., Blankemeier, L., Delbrouck, J. B., Aali, A., Bluethgen, C., Pareek, A., Polacin, M., Reis, E. P., Seehofnerova, A., Rohatgi, N., Hosamani, P., Collins, W., Ahuja, N., Langlotz, C., Hom, J., Gatidis, S., Pauly, J., Chaudhari, A. 2023

  Abstract

  Sifting through vast textual data and summarizing key information from electronic health records (EHR) imposes a substantial burden on how clinicians allocate their time. Although large language models (LLMs) have shown immense promise in natural language processing (NLP) tasks, their efficacy on a diverse range of clinical summarization tasks has not yet been rigorously demonstrated. In this work, we apply domain adaptation methods to eight LLMs, spanning six datasets and four distinct clinical summarization tasks: radiology reports, patient questions, progress notes, and doctor-patient dialogue. Our thorough quantitative assessment reveals trade-offs between models and adaptation methods in addition to instances where recent advances in LLMs may not improve results. Further, in a clinical reader study with ten physicians, we show that summaries from our best-adapted LLMs are preferable to human summaries in terms of completeness and correctness. Our ensuing qualitative analysis highlights challenges faced by both LLMs and human experts. Lastly, we correlate traditional quantitative NLP metrics with reader study scores to enhance our understanding of how these metrics align with physician preferences. Our research marks the first evidence of LLMs outperforming human experts in clinical text summarization across multiple tasks. This implies that integrating LLMs into clinical workflows could alleviate documentation burden, empowering clinicians to focus more on personalized patient care and the inherently human aspects of medicine.

  View details for DOI 10.21203/rs.3.rs-3483777/v1

  View details for PubMedID 37961377

  View details for PubMedCentralID PMC10635391

• Characteristics associated with diagnostic yield of imaging for deep venous thrombosis and pulmonary embolism in the emergency department, hospital, and office settings: An Optum Clinformatics claims database study (2015-2019). Thrombosis research Rohatgi, N., Dahlen, A., Berube, C., Weng, Y., Wintermark, M., Ahuja, N. 2023; 224: 4-12

  Abstract

  Different patient characteristics influence the decision to order diagnostic imaging for deep venous thrombosis (DVT) and pulmonary embolism (PE) in different settings (emergency department (ED), hospital, and office). Diagnostic yield is defined as the proportion of tests that report positive results. We hypothesize different patient characteristics are associated with higher or lower diagnostic yield of imaging for DVT and PE in different settings.We used Optum Clinformatics™ national claims database (2015-2019) to assess the diagnostic yield of imaging for DVT and PE in three settings: (a) ED discharge, (b) Hospitalized, and (c) Office. We studied the patient characteristics associated with diagnostic yield using logistic regression.Diagnostic imaging for DVT and PE was performed in 1,502,417 and 710,263 visits, respectively. Diagnostic yield for DVT and PE was 9.8 ± 0.1 % and 12.7 ± 0.1 %, respectively in the overall cohort. In the ED discharge, hospitalized, and office settings, diagnostic yield for DVT was 10.4 ± 0.1 %, 16.9 ± 0.1 %, and 6.5 ± 0.1 %, respectively, and that for PE 6.4 ± 0.1 %, 18.7 ± 0.1 %, and 8.8 ± 0.2 %, respectively. Of the patients who underwent imaging for DVT, higher diagnostic yield was more likely with thrombophilia, central venous access, and cancer. Of the patients who underwent imaging for PE, higher diagnostic yield was most likely with thrombophilia, respiratory failure, and heart failure or acute myocardial infarction.In each setting, different patient characteristics influence the diagnostic yield of imaging for DVT and PE and can inform clinical practice. Judicious use of imaging for DVT and PE could reduce costs and avoid exposure to radiation and contrast.

  View details for DOI 10.1016/j.thromres.2023.02.004

  View details for PubMedID 36774701

• Clinical text summarization: Adapting large language models can outperform human experts arXiv van Veen, D., van Uden, C., Blankemeier, L., Delbrouck, J., Aali, A., Bluethgen, C., Pareek, A., Polacin, M., Reis, E. P., Seehofnerov, A., Rohatgi, N., Hosamani, P., Collins, W., Ahuja, N., Langlotz, C. P., Hom, J., Gatidis, S., Pauly, J., Chaudhari, A. S. 2023

  View details for DOI 10.48550/arXiv.2309.07430

• Utilization of a National Writing Challenge to Promote Scholarly Work: A Pilot Study Cureus Keniston, A., Frank, M., McBeth, L., Barkoudah, E., Pavon, J., Rohatgi, N., Vaughn, V., Bhandari, S., Burden, M. 2023; 14 (2): e21935

  View details for DOI 10.7759/cureus.21935

• Association between Obesity and Length of COVID-19 Hospitalization: Unexpected Insights from the American Heart Association National COVID-19 Registry. Journal of obesity & metabolic syndrome Collins, W. J., Chang, A. Y., Weng, Y., Dahlen, A., O'Brien, C. G., Hom, J., Ahuja, N., Rodriguez, F., Rohatgi, N. 2022

  Abstract

  Background: Observational analyses have noted an association between obesity and poor clinical outcome from Coronavirus Disease 2019 (COVID-19). The mechanism for this finding remains unclear.Methods: We analyzed data from 22,915 COVID-19 patients hospitalized in non-intensive care units using the American Heart Association National COVID Registry of adult COVID-19 admissions from March 2020 to April 2021. A multivariable Poisson model adjusted for age, sex, medical history, admission respiratory status, hospitalization characteristics, and select laboratory findings was used to calculate length of stay (LOS) as a function of body mass index (BMI) category. Additionally, 5,327 patients admitted to intensive care units were similarly analyzed for comparison.Results: Relative to normal BMI subjects, overweight, class I obese, and class II obese patients had approximately half-day reductions in LOS (-0.469 days, P<0.01; -0.480 days, P<0.01; -0.578 days, P<0.01, respectively).Conclusion: The model identified a dose-dependent, inverse relationship between BMI category and LOS for COVID-19, which was not seen when the model was applied to critically ill patients.

  View details for DOI 10.7570/jomes22042

  View details for PubMedID 36058896

• Management of antiplatelet therapy in patients with coronary stents undergoing noncardiac surgery. The American journal of medicine Rohatgi, N., Zehnder, J. L., Smilowitz, N. R. 2022

  View details for DOI 10.1016/j.amjmed.2022.05.014

  View details for PubMedID 35636479

• Venous thromboembolism (VTE) prevention and diagnosis in COVID-19: Practice patterns and outcomes at 33 hospitals PLoS One Hospital Medicine Reengineering Network (HOMERuN) Authors, .. 2022; 17 (5): e0266944

  Abstract

  Early reports of increased thrombosis risk with SARS-CoV-2 infection led to changes in venous thromboembolism (VTE) management. Real-world data on the prevalence, efficacy and harms of these changes informs best practices.Define practice patterns and clinical outcomes related to VTE diagnosis, prevention, and management in hospitalized patients with coronavirus disease-19 (COVID-19) using a multi-hospital US sample.In this retrospective cross-sectional study of 1121 patients admitted to 33 hospitals, exposure was dose of anticoagulant prescribed for VTE prophylaxis (standard, intensified, therapeutic), and primary outcome was VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]); secondary outcomes were PE, DVT, arterial thromboembolism (ATE), and bleeding events. Multivariable logistic regression models accounting for clustering by site and adjusted for risk factors were used to estimate odds ratios (ORs). Inverse probability weighting was used to account for confounding by indication.1121 patients (mean age 60 ± 18, 47% female) admitted with COVID-19 between February 2, 2020 and December 31, 2020 to 33 US hospitals were included. Pharmacologic VTE prophylaxis was prescribed in 86%. Forty-seven patients (4.2%) had PE, 51 (4.6%) had DVT, and 23 (2.1%) had ATE. Forty-six patients (4.1%) had major bleeding and 46 (4.1%) had clinically relevant non-major bleeding. Compared to standard prophylaxis, adjusted odds of VTE were 0.67 (95% CI 0.21-2.1) with no prophylaxis, 1.0 (95% CI 0.06-17) with intensified, and 3.0 (95% CI 0.89-10) with therapeutic. Adjusted odds of bleeding with no prophylaxis were 5.6 (95% CI 3.0-11) and 5.3 (95% CI 3.0-10) with therapeutic (no events on intensified dosing).Therapeutic anticoagulation was associated with a 3-fold increased odds of VTE and 5-fold increased odds of bleeding. While higher bleeding rates with high-intensity prophylaxis were likely due to full-dose anticoagulation, we conclude that high thrombosis rates were due to clinical concern for thrombosis before formal diagnosis.

  View details for DOI 10.1371/journal.pone.0266944

  View details for PubMedCentralID PMC9071149

• Tocilizumab in patients hospitalised with COVID-19 pneumonia: Efficacy, safety, viral clearance, and antibody response from a randomised controlled trial (COVACTA). EClinicalMedicine Rosas, I. O., Brau, N., Waters, M., Go, R. C., Malhotra, A., Hunter, B. D., Bhagani, S., Skiest, D., Savic, S., Douglas, I. S., Garcia-Diaz, J., Aziz, M. S., Cooper, N., Youngstein, T., Sorbo, L. D., Zerda, D. J., Ustianowski, A., Gracian, A. C., Blyth, K. G., Carratala, J., Francois, B., Benfield, T., Haslem, D., Bonfanti, P., van der Leest, C. H., Rohatgi, N., Wiese, L., Luyt, C. E., Bauer, R. N., Cai, F., Lee, I. T., Matharu, B., Metcalf, L., Wildum, S., Graham, E., Tsai, L., Bao, M. 2022; 47: 101409

  Abstract

  Background: In COVACTA, a randomised, placebo-controlled trial in patients hospitalised with coronavirus disease-19 (COVID-19), tocilizumab did not improve 28-day mortality, but shortened hospital and intensive care unit stay. Longer-term effects of tocilizumab in patients with COVID-19 are unknown. Therefore, the efficacy and safety of tocilizumab in COVID-19 beyond day 28 and its impact on Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) clearance and antibody response in COVACTA were investigated.Methods: Adults in Europe and North America hospitalised with COVID-19 (N=452) between April 3, 2020 and May 28, 2020 were randomly assigned (2:1) to double-blind intravenous tocilizumab or placebo and assessed for efficacy and safety through day 60. Assessments included mortality, time to hospital discharge, SARS-CoV-2 viral load in nasopharyngeal swab and serum samples, and neutralising anti-SARS-CoV-2 antibodies in serum. ClinicalTrials.gov registration: NCT04320615.Findings: By day 60, 24·5% (72/294) of patients in the tocilizumab arm and 25·0% (36/144) in the placebo arm died (weighted difference -0·5% [95% CI -9·1 to 8·0]), and 67·0% (197/294) in the tocilizumab arm and 63·9% (92/144) in the placebo arm were discharged from the hospital. Serious infections occurred in 24·1% (71/295) of patients in the tocilizumab arm and 29·4% (42/143) in the placebo arm. Median time to negative reverse transcriptase-quantitative polymerase chain reaction result in nasopharyngeal/oropharyngeal samples was 15·0 days (95% CI 14·0 to 21·0) in the tocilizumab arm and 21·0 days (95% CI 14·0 to 28·0) in the placebo arm. All tested patients had positive test results for neutralising anti-SARS-CoV-2 antibodies at day 60.Interpretation: There was no mortality benefit with tocilizumab through day 60. Tocilizumab did not impair viral clearance or host immune response, and no new safety signals were observed. Future investigations may explore potential biomarkers to optimize patient selection for tocilizumab treatment and combination therapy with other treatments.Funding: F. Hoffmann-La Roche Ltd and the US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority, under OT number HHSO100201800036C.

  View details for DOI 10.1016/j.eclinm.2022.101409

  View details for PubMedID 35475258

• Perioperative Cardiovascular Considerations Prior to Elective Noncardiac Surgery in Patients With a History of COVID-19. JAMA surgery Rohatgi, N., Smilowitz, N. R., Reejhsinghani, R. 1800

  View details for DOI 10.1001/jamasurg.2021.6953

  View details for PubMedID 35019990

• Postoperative atrial fibrillation Rohatgi, N., et al Online CME educational module for the National Society of Hospital Medicine Learning Portal created in collaboration with faculty from multiple institutions. 2022
• Which Patient Should Have a Preoperative Cardiac Evaluation (Stress Test)? Evidence-Based Practice of Anesthesiology Rohatgi, N., Cohn, S. Elsevier. 2022; 4: 12-22

  View details for DOI 10.1016/B978-0-323-77846-6.00003-3

• Prognostic and Predictive Biomarkers in Patients With Coronavirus Disease 2019 Treated With Tocilizumab in a Randomized Controlled Trial. Critical care medicine Tom, J., Bao, M., Tsai, L., Qamra, A., Summers, D., Carrasco-Triguero, M., McBride, J., Rosenberger, C. M., Lin, C. J., Stubbings, W., Blyth, K. G., Carratala, J., Francois, B., Benfield, T., Haslem, D., Bonfanti, P., van der Leest, C. H., Rohatgi, N., Wiese, L., Luyt, C. E., Kheradmand, F., Rosas, I. O., Cai, F. 2021

  Abstract

  OBJECTIVES: To explore candidate prognostic and predictive biomarkers identified in retrospective observational studies (interleukin-6, C-reactive protein, lactate dehydrogenase, ferritin, lymphocytes, monocytes, neutrophils, D-dimer, and platelets) in patients with coronavirus disease 2019 pneumonia after treatment with tocilizumab, an anti-interleukin-6 receptor antibody, using data from the COVACTA trial in patients hospitalized with severe coronavirus disease 2019 pneumonia.DESIGN: Exploratory analysis from a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial.SETTING: Hospitals in North America and Europe.PATIENTS: Adults hospitalized with severe coronavirus disease 2019 pneumonia receiving standard care.INTERVENTION: Randomly assigned 2:1 to IV tocilizumab 8mg/kg or placebo.MEASUREMENTS AND MAIN RESULTS: Candidate biomarkers were measured in 295 patients in the tocilizumab arm and 142 patients in the placebo arm. Efficacy outcomes assessed were clinical status on a seven-category ordinal scale (1, discharge; 7, death), mortality, time to hospital discharge, and mechanical ventilation (if not receiving it at randomization) through day 28. Prognostic and predictive biomarkers were evaluated continuously with proportional odds, binomial or Fine-Gray models, and additional sensitivity analyses. Modeling in the placebo arm showed all candidate biomarkers except lactate dehydrogenase and D-dimer were strongly prognostic for day 28 clinical outcomes of mortality, mechanical ventilation, clinical status, and time to hospital discharge. Modeling in the tocilizumab arm showed a predictive value of ferritin for day 28 clinical outcomes of mortality (predictive interaction, p = 0.03), mechanical ventilation (predictive interaction, p = 0.01), and clinical status (predictive interaction, p = 0.02) compared with placebo.CONCLUSIONS: Multiple biomarkers prognostic for clinical outcomes were confirmed in COVACTA. Ferritin was identified as a predictive biomarker for the effects of tocilizumab in the COVACTA patient population; high ferritin levels were associated with better clinical outcomes for tocilizumab compared with placebo at day 28.

  View details for DOI 10.1097/CCM.0000000000005229

  View details for PubMedID 34612846

• Comparison of Adverse Events Among Home- vs Facility-Administered Biologic Infusions, 2007-2017. JAMA network open Baker, M. C., Weng, Y., Fairchild, R., Ahuja, N., Rohatgi, N. 2021; 4 (6): e2110268

  Abstract

  Importance: Infusion reactions occur in 7% to 20% of patients receiving biologics. Home infusions are convenient and incur lower costs but may be associated with more adverse events; the safety of receiving biologic infusions for immune-mediated diseases at home remains unclear.Objective: To assess whether patients receiving home biologic infusions have increased adverse events requiring emergency department (ED) or hospital admission compared with patients receiving facility infusions.Design, Setting, and Participants: This retrospective cohort study used administrative claims data from a large national insurer for adult patients who received biologic infusions for immune-mediated disease between January 2007 and December 2017. Patients with hematologic malignant neoplasms or bone marrow transplantation were excluded. Data were analyzed from August 2019 to October 2020.Main Outcomes and Measures: ED or hospital admission on the same or next day after administration of a biologic infusion at home vs at a facility; secondary outcomes included discontinuation of the biologic after an ED or hospital admission and postinfusion mortality.Results: Of a total of 57 220 patients (mean [SD] age, 50.1 [14.8] years; 512 314 [68.1%] women) who received 752 150 biologic infusions (34 078 home infusions [4.5%] to 3954 patients and 718 072 facility infusions [95.5%] to 54 770 patients), patients who received home infusions were younger (mean [SD] age, 43.2 [13.2] vs 51.3 [14.8] years), more likely to be men (14 031 [41.2%] vs 225 668 [31.4%]), and had a lower Charlson comorbidity score compared with patients who received facility infusions (mean [SD] score, 0.5 [1.0] vs 1.1 [1.3]). Home infusions were associated with 25% increased odds of ED or hospital admission on the same or next day after the infusion (odds ratio [OR], 1.25; 95% CI, 1.09-1.44; P=.002) and 28% increased odds of discontinuation of the biologic after the ED or hospital admission (OR, 1.28; 95% CI, 1.08-1.51; P=.005). There was no difference in postinfusion mortality between home or facility infusions. The rates of adverse events were highest with home infusions of tocilizumab (48 of 481 infusions [10.0%]), vedolizumab (150 of 2681 infusions [5.6%]), and infliximab (1085 of 20 653 infusions [5.3%]), although the number of tocilizumab and vedolizumab infusions was low.Conclusions and Relevance: In this study, biologic infusions administered at home, compared with those administered at a facility, were associated with increased adverse events requiring escalation of care. Because the number of home infusions has increased and is expected to continue to rise, the safety implications of administering biologic infusions at home needs to be further assessed.

  View details for DOI 10.1001/jamanetworkopen.2021.10268

  View details for PubMedID 34081140

• Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews Rohatgi, N. n., Weng, Y. n., Kittle, J. n., Ahuja, N. n. 2021; 5 (3)

  Abstract

  Rotating medical consultants, hospitalists or geriatricians, are involved in the care of patients with hip fracture, often after medical complications have already occurred. In August 2012, we implemented a unique surgical comanagement (SCM) model in which the same Internal Medicine hospitalists are dedicated year-round to the orthopaedic surgery service. We examine whether this SCM model was associated with a decrease in medical complications, length of stay, and inpatient mortality in patients with hip fracture admitted at our institution, compared with the previous model.We included 2,252 admissions to the orthopaedic surgery service with a hip fracture between 2009 and 2018 (757 pre-SCM and 1495 post-SCM). We adjusted for age, Charlson comorbidity score, and operating time in all regression analyses.Mean Charlson comorbidity score (1.6 versus 1.2) and median case mix index (2.1 versus 1.9) were higher in the post-SCM group. A 32% decrease was observed in the odds of having ≥1 medical complication(s) (odds ratio, 0.68 [95% confidence interval, 0.50 to 0.91], P = 0.009) post-SCM. No change was observed in length of stay or inpatient mortality despite an increase in medical complexity post-SCM.Having dedicated orthopaedic hospitalists may contribute to fewer medical complications in patients with hip fracture.

  View details for DOI 10.5435/JAAOSGlobal-D-20-00231

  View details for PubMedID 33720101

• Postoperative atrial fibrillation Decision Making in Perioperative Medicine: Clinical Pearls Rohatgi, N., Wang, P. J. McGraw Hill / Medical. 2021; 1: 283-286
• Seizure Disorder, Parkinson’s Disease, and Myasthenia Gravis Decision Making in Perioperative Medicine: Clinical Pearls Rohatgi, N. McGraw Hill / Medical. 2021; 1: 209-218
• Cerebrovascular Disease Decision Making in Perioperative Medicine: Clinical Pearls Rohatgi, N. McGraw Hill / Medical. 2021; 1: 203-208
• Arrhythmias, Conduction System Disorders, and Cardiovascular Implant Electronic Devices Decision Making in Perioperative Medicine: Clinical Pearls Rohatgi, N., Wang, P. J. McGraw Hill / Medical. 2021; 1: 111-120
• Protecting India against COVID-19 through vaccines: Answers to frequently asked questions Rohatgi, N., Subramanian, A. Blog on Medium. 2021
• Managing COVID-19 in India: Breaking through the myths and caring at home Rohatgi, N., Subramanian, A. Blog on Medium. 2021
• A study to evaluate the safety and efficacy of tocilizumab in patients with severe COVID-19 pneumonia The New England Journal of Medicine COVACTA, I. 2021

  View details for DOI 10.1056/NEJMoa2028700

• Efficacy of interferon beta-1a plus remdesivir compared to remdesivir alone in hospitalised adults with COVID-19: a phase 3 double-bind, randomised, placebo-controlled trial (Adaptive COVID-19 Treatment Trial (ACTT-3)) The Lancet Respiratory Medicine Study team, M. 2021

  View details for DOI 10.1016/S2213-2600(21)00384-2

• Factors Associated with Hospital-Acquired Delirium in Patients 18–65 Years Old J GEN INTERN MED Rohatgi, N., Weng, Y., Ahuja, N., Lansberg, M. G. 2021

  View details for DOI 10.1007/s11606-020-06378-w

• Characteristics of Younger and Older Adults with Hospital-Acquired Delirium: a Claims Data Study Spanning 14 years J GEN INTERN MED Rohatgi, N., Weng, Y., Ahuja, N., Lansberg, M. G. 2021

  View details for DOI 10.1007/s11606-020-06379-9

• Cardiac risk assessment calculators: utility and limitations. International anesthesiology clinics Rohatgi, N., Cohn, S. L. 2020

  View details for DOI 10.1097/AIA.0000000000000309

  View details for PubMedID 33231943

• Perioperative Stroke Risk Reduction in Patients With Patent Foramen Ovale. JAMA neurology Rohatgi, N., Smilowitz, N. R., Lansberg, M. G. 2020

  View details for DOI 10.1001/jamaneurol.2020.2619

  View details for PubMedID 32744603

• 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 - Final Report (Adaptive COVID-19 Treatment Trial (ACTT-1)) The New England Journal of Medicine Study Team, M. 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 PubMedCentralID PMC7262788

• 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. n., William, R. H., Ahuja, N. n., Rohatgi, N. 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

• Transitions of care out of the hospital Rohatgi, N., et al Online CME educational module for the National Society of Hospital Medicine Learning Portal created in collaboration with faculty from multiple institutions. 2020
• Prognostic and predictive biomarkers in patients with COVID-19 treated with tocilizumab in a randomised controlled trial medRxiv 2020 Tom, J., Bao, M., Tsai, L., Qamra, A., Summers, D., Carrasco-Triguero, M., McBride, J., Rosenberger, C. M., Lin, C. J., Stubbings, W., Blyth, K. G., Carratalà, J., François, B., Benfield, T., Haslem, D., Bonfanti, P., van der Leest, C. H., Rohatgi, N., Wiese, L., Luyt, C. E., Kheradmand, F., Rosas, I. O., Cai, F. 2020

  View details for DOI 10.1101/2020.12.23.20247379

• Baricitinib plus Remdesivir for Hospitalized Adults with COVID-19 (Adaptive COVID-19 Treatment Trial (ACTT-2)) The New England Journal of Medicine Study Team, M. 2020

  View details for DOI 10.1056/NEJMoa2031994

• 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

• 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. n., Ahuja, N. n., Rohatgi, N. 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

• Postoperative atrial fibrillation Rohatgi, N., et al Online CME educational module for the National Society of Hospital Medicine Learning Portal created in collaboration with faculty from multiple institutions. 2019
• Teamwork in Quality Improvement Rohatgi, N., et al Online CME educational module for the National Society of Hospital Medicine Learning Portal created in collaboration with faculty from multiple institutions. 2019
• 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. n., Rohatgi, N. n., Weng, Y. n., Hom, J. n., Ahuja, N. 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

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

• 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. n., Kane, M. n., Winget, M. n., Haji-Sheikhi, F. n., Ahuja, N. 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

• 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

• Effect of sociodemographic factors on receipt of optimal therapy and survival in older patients with distant multiple myeloma: A population-based retrospective analysis using Surveillance, Epidemiology, and End-Results (SEER) - Medicare data Rohatgi, N. Master's Thesis. 2006