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Scholarly Works (2 results)

  • Article
  • Peer Reviewed
UC San Francisco Previously Published Works (2013)

Background

Effective and easy to implement interventions to improve adherence to antiretroviral therapy are needed.

Objective

To compare site nurse-initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy to the study site's standard of care.

Methods

A randomized controlled trial of site nurse-initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy. Subjects were randomized to receive site nurse-initiated telephone calls (intervention) or no additional calls to the site's standard of care (control). Subjects received calls 1 to 3 days after initiating antiretrovirals, on weeks 1, 2, 3, 6, 10, 14, 18, 22, and 26, and every 8 weeks thereafter. Self-reported adherence was captured during study visits.

Results

A total of 333 subjects starting antiretrovirals as part of ACTG 384 were co-enrolled into ACTG 5031. Subjects were followed for up to 160 weeks and were contacted for 74% of scheduled calls. There was no significant difference in proportion of patients with ≯95% mean total adherence (87.9% and 91.2%; P = .34) and mean self-reported total adherence (97.9% and 98.4%) in the intervention and control groups, respectively, or in symptom distress and clinical endpoints.

Conclusions

In the context of a clinical trial where self-reported adherence was exceptionally high, the site nurse-initiated telephone calls did not further improve self-reported adherence, symptom distress, or clinical outcomes.
    Cover page: Site Nurse–Initiated Adherence and Symptom Support Telephone Calls for HIV-Positive Individuals Starting Antiretroviral Therapy, ACTG 5031: Substudy of ACTG 384
    • Article
    • Peer Reviewed
    Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 18, Issue 4 (2017)

    Introduction: Our goal was to develop and validate an index to predict in-hospital mortality in olderadults after non-traumatic emergency department (ED) intubations.

    Methods: We used Vizient administrative data from hospitalizations of 22,374 adults >75 years whounderwent non-traumatic ED intubation from 2008-2015 at nearly 300 U.S. hospitals to develop andvalidate an index to predict in-hospital mortality. We randomly selected one half of participants for thedevelopment cohort and one half for the validation cohort. Considering 25 potential predictors, wedeveloped a multivariable logistic regression model using least absolute shrinkage and selection operatormethod to determine factors associated with in-hospital mortality. We calculated risk scores using pointsderived from the final model’s beta coefficients. To evaluate calibration and discrimination of the finalmodel, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis andcompared mortality by risk groups in the development and validation cohorts.

    Results: Death during the index hospitalization occurred in 40% of cases. The final model included sixvariables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer,age, admission diagnosis of sepsis, and admission diagnosis of stroke/ intracranial hemorrhage. Thosewith low-risk scores (<6) had 31% risk of in-hospital mortality while those with high-risk scores (>10) had58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p=0.09), andthe c-statistic was 0.62 in the validation cohort.

    Conclusion: The model may be useful in identifying older adults at high risk of death after ED intubation.

      Cover page: Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department IntubationsCreative Commons 'BY' version 4.0 license
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