Beaumont Health

About: Beaumont Health is a nonprofit organization based out in Royal Oak, Michigan, United States. It is known for research contribution in the topics: Medicine & Population. The organization has 1483 authors who have published 1448 publications receiving 15407 citations. The organization is also known as: William Beaumont Health System & Beaumont Hospitals.

Predictors for 30-Day and 90-Day Hospital Readmission Among Patients With Opioid Use Disorder.

Abstract: OBJECTIVES To identify the incidence, characteristics, and predictors for 30 and 90-day readmission among acutely hospitalized patients with opioid use disorder (OUD). METHODS This retrospective, cohort study evaluated consecutive adults with OUD admitted to an academic medical center over a 5-year period (10/1/11 to 9/30/16). Multivariable logistic regression was used to determine independent predictors for 30 and 90-day readmissions based on pertinent admission, hospital, and discharge variables collected via chart review and found to be different (with a P < 0.10) on univariate analysis. RESULTS Among the 470 adults (mean age 43.1 ± 12.8 years, past heroin use 77.9%; admission opioid agonist therapy use [buprenorphine 22.6%; methadone 27.0%]; medical [vs surgical] admission 75.3%, floor [vs ICU] admission 93.0%, in-hospital mortality 0.9%), 85 (18.2%) and 151 (32.1%) were readmitted within 30 and 90 days, respectively. Among the 90-day readmitted patients, median time to first readmission was 26 days. Buprenorphine use (vs no use) at index hospital admission was independently associated with reduced 30-day (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.24-0.93) and 90-day (OR 0.57, 95% CI 0.34-0.96) readmission; prior heroin (vs prescription opioid) use was associated with reduced 90-day readmission (OR 0.59, 95% CI 0.37-0.94) and length of hospital stay was associated with both greater 30-day (OR 1.02, 95% CI 1.01-1.05) and 90-day (OR 1.04, 95% CI 1.01-1.06) readmission rates. CONCLUSIONS Among patients with OUD taking buprenorphine at the time of hospital admission, 30-day and 90-day hospital readmission was reduced by 53% and 43%, respectively.

Toxicity After Central versus Peripheral Lung Stereotactic Body Radiation Therapy: A Propensity Score Matched-Pair Analysis

Abstract: Purpose To compare toxicity after stereotactic body radiation therapy (SBRT) for "central" tumors—within 2 cm of the proximal bronchial tree or with planning tumor volume (PTV) touching mediastinum—versus noncentral ("peripheral") lung tumors. Methods and Materials From November 2005 to January 2011, 229 tumors (110 central, 119 peripheral; T1-3N0M0 non–small-cell lung cancer and limited lung metastases) in 196 consecutive patients followed prospectively at a single institution received moderate-dose SBRT (48-60 Gy in 4-5 fractions [biologic effective dose=100-132 Gy, α/β=10]) using 4-dimensional planning, online image-guided radiation therapy, and institutional dose constraints. Clinical adverse events (AEs) were graded prospectively at clinical and radiographic follow-up using Common Terminology Criteria for Adverse Events version 3.0. Pulmonary function test (PFT) decline was graded as 2 (25%-49.9% decline), 3 (50.0%-74.9% decline), or 4 (≥75.0% decline). Central/peripheral location was assessed retrospectively on planning CT scans. Groups were compared after propensity score matching. Characteristics were compared with χ 2 and 2-tailed t tests, adverse events with χ 2 test-for-trend, and cumulative incidence using competing risks analysis (Gray's test). Results With 79 central and 79 peripheral tumors matched, no differences in AEs were observed after 17 months median follow-up. Two-year cumulative incidences of grade ≥2 pain, musculoskeletal, pulmonary, and skin AEs were 14%, 5%, 6%, and 10% (central) versus 19%, 10%, 10%, and 3% (peripheral), respectively ( P =.31, .38, .70, and .09). Grade ≥2 cardiovascular, gastrointestinal, and central nervous system AEs were rare ( P =.79), grade ≥2 PFT decline (36% vs 34%, P =.94), grade ≥3 clinical AEs (3% vs 7%, P =.48), and grade ≥3 PFT decline (0 vs 10%, P =.11) were similar for central versus peripheral tumors, respectively. Pooled 2-year incidences of grades 4 and 5 AEs were Conclusion Moderate-dose SBRT with these techniques yields a similarly safe toxicity profile for both central and peripheral lung tumors.

Progressive Radiation Dose Reduction from Coronary Computed Tomography Angiography in a Statewide Collaborative Quality Improvement Program: Results from the Advanced Cardiovascular Imaging Consortium (ACIC) Chinnaiyan et al: Radiation Dose Reduction from Coronary CTA

Abstract: Background—A best-practice intervention previously demonstrated significant dose reduction over 1 year. We sought to evaluate if this reduction would be incremental and sustained by promoting new scanner technology in the context of an ongoing quality improvement program over a 3-year period in a statewide registry of coronary CT angiography (CTA). Methods and Results—In this prospective, controlled, nonrandomized study involving 11,901 patients at 15 Michigan centers participating in the Advanced Cardiovascular Imaging Consortium (ACIC), radiation doses and image quality were compared between the following periods: control (May June 2008)] vs. follow-up I (July 2008 – June 2009), and follow-up I vs. follow-up II (July 2009 – April 2011)]. Intervention during these study periods included continuous education, feedback and mandatory participation in this initiative. The median radiation dose remained unchanged from control to follow-up I: dose-length product (DLP) of 697 (IQR 407, 1163) to 675 (IQR 418, 1146) mGy*cm (p=0.93). With the introduction of newer technology in follow-up I period, there was incremental 31% decrease during follow-up II to median DLP of 468 (IQR 292, 811) mGy*cm (P<0.0001). No significant change was noted in the percentage of diagnostic quality scans from follow-up I (92%) to follow-up II (92.7%). Conclusions—Although ongoing application of a best-practice algorithm was associated with sustaining previously achieved targets, use of newer scanner technology resulted in incremental radiation dose reduction in a statewide coronary CTA registry without image quality degradation. Clinical Trial Registration—URL: www.clinicaltrials.gov. Unique identifier: NCT00640068.

Immunotherapy and radiation in glioblastoma.

Abstract: Radiation therapy plays a central role in the management of glioblastoma. Although primarily thought of as modality to provide local tumor control through DNA damage, the capacity of ionizing radiation to modulate tumor immune response has long been recognized. The recent emergence of clinically active immunotherapies offers exciting potential for harnessing the immune modulatory effects or radiation through combinatorial strategies designed to enhance clinical outcomes. In this Review, we provide background describing the unique immune environment within the central nervous system, how ionizing radiation may modulate the tumor immune response, preclinical and clinical data testing the combination of radiation and immune modulating agents, and highlight some of the current challenges in extending these findings clinically.