Rush University Medical Center

About: Rush University Medical Center is a healthcare organization based out in Chicago, Illinois, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 13915 authors who have published 29027 publications receiving 1379216 citations. The organization is also known as: Rush Presbyterian St. Luke's Medical Center.

Prescribing Amiodarone: An Evidence-Based Review of Clinical Indications

Abstract: ContextAlthough amiodarone is approved by the US Food and Drug Administration only for refractory ventricular arrhythmias, it is one of the most frequently prescribed antiarrhythmic medications in the United States.ObjectiveTo evaluate and synthesize evidence regarding optimal use of amiodarone for various arrhythmias.Evidence AcquisitionSystematic search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other studies with clinical pertinence. The search was limited to human-participant, English-language reports published between 1970 and 2007. Amiodarone was searched using the terms adverse effects, atrial fibrillation, atrial flutter, congestive heart failure, electrical storm, hypertrophic cardiomyopathy, implantable cardioverter-defibrillator, surgery, ventricular arrhythmia, ventricular fibrillation, and Wolff-Parkinson-White. Bibliographies of identified articles and guidelines from official societies were reviewed for additional references. Ninety-two identified studies met inclusion criteria and were included in the review.Evidence SynthesisAmiodarone may have clinical value in patients with left ventricular dysfunction and heart failure as first-line treatment for atrial fibrillation, though other agents are available. Amiodarone is useful in acute management of sustained ventricular tachyarrythmias, regardless of hemodynamic stability. The only role for prophylactic amiodarone is in the perioperative period of cardiac surgery. Amiodarone may be effective as an adjunct to implantable cardioverter-defibrillator therapy to reduce number of shocks. However, amiodarone has a number of serious adverse effects, including corneal microdeposits (>90%), optic neuropathy/neuritis (≤1%-2%), blue-gray skin discoloration (4%-9%), photosensitivity (25%-75%), hypothyroidism (6%), hyperthyroidism (0.9%-2%), pulmonary toxicity (1%-17%), peripheral neuropathy (0.3% annually), and hepatotoxicity (elevated enzyme levels, 15%-30%; hepatitis and cirrhosis, <3% [0.6% annually]).ConclusionAmiodarone should be used with close follow-up in patients who are likely to derive the most benefit, namely those with atrial fibrillation and left ventricular dysfunction, those with acute sustained ventricular arrhythmias, those about to undergo cardiac surgery, and those with implantable cardioverter-defibrillators and symptomatic shocks.

Trends in the cost of illness for asthma in the United States, 1985-1994.

Abstract: Background: During the past decade, there have been notable changes in asthma prevalence, morbidity, and mortality. In this same time period, there have also been important national efforts to increase asthma awareness and improve asthma care. Objective: The purpose of this study was to examine the changes in US cost of illness for asthma during the 10-year period from 1985-1994. Methods: The study was a two-period (1985 and 1994), cross-sectional, cost-of-illness analysis. Cost estimates were based on US population and health care survey data available from the National Center for Health Statistics. Results: The total US costs of asthma for 1994 were $10.7 billion. On the basis of 1985 estimates adjusted to 1994 dollars, total asthma costs increased by 54.1% and direct medical expenditures increased by 20.4% during the 10-year period. In 1985, hospital inpatient care represented the largest component cost of direct medical expenditures (44.6%). Hospital inpatient costs decreased to 29.5% of direct medical expenditures in 1994, primarily because of shorter lengths of stay, as opposed to a decrease in the total number of admissions. In 1994, medications represented the largest component cost of direct medical expenditures (40.1%, up from 30.0% in 1985). The largest component increase in indirect costs was due to loss of work. On the basis of adjusted dollars, estimated costs per affected person with asthma declined by 3.4% (decrease of 15.5% for children and an increase of 2.9% for persons 18 years and older) during this time period. Conclusion: Although the US costs of asthma increased during the 1985-1994 time period, estimated costs per person with asthma demonstrated a modest decline. These findings may represent a combination of reductions in hospital lengths of stay and increasing prevalence of persons with low consumption of asthma-related health care resources. In examining the component costs, it is unclear whether these changes can be attributed to the many local, regional, and national efforts aimed at controlling untoward asthma outcomes during the 1985-1994 time period. (J Allergy Clin Immunol 2000;106:493-9.)

Cognitive function over time in the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT): results of a randomized, controlled trial of naproxen and celecoxib.

Abstract: Author(s): ADAPT Research Group; Martin, Barbara K; Szekely, Christine; Brandt, Jason; Piantadosi, Steven; Breitner, John CS; Craft, Suzanne; Evans, Denis; Green, Robert; Mullan, Michael | Abstract: BackgroundObservational studies have shown reduced risk of Alzheimer dementia in users of nonsteroidal anti-inflammatory drugs.ObjectiveTo evaluate the effects of naproxen sodium and celecoxib on cognitive function in older adults.DesignRandomized, double-masked chemoprevention trial.SettingSix US memory clinics.ParticipantsMen and women aged 70 years and older with a family history of Alzheimer disease; 2117 of 2528 enrolled had follow-up cognitive assessment.InterventionsCelecoxib (200 mg twice daily), naproxen sodium (220 mg twice daily), or placebo, randomly allocated in a ratio of 1:1:1.5, respectively.Main outcome measuresSeven tests of cognitive function and a global summary score measured annually.ResultsLongitudinal analyses showed lower global summary scores over time for naproxen compared with placebo (- 0.05 SDs; P = .02) and lower scores on the Modified Mini-Mental State Examination over time for both treatment groups compared with placebo (- 0.33 points for celecoxib [P = .04] and - 0.36 points for naproxen [P = .02]). Restriction of analyses to measures collected from persons without dementia attenuated the treatment group differences. Analyses limited to measures obtained while participants were being issued study drugs produced results similar to the intention-to-treat analyses.ConclusionsUse of naproxen or celecoxib did not improve cognitive function. There was weak evidence for a detrimental effect of naproxen.

Discs degenerate before facets.

Abstract: The purpose of this study was to determine the relationship between facet joint osteoarthritis and disc degeneration in subjects in whom both MRI and CT scans had been obtained. The MRI scans were used to determine disc degeneration, the CT scans to determine facet joint osteoarthritis. It was hypot