Browsing by Author "Rosenstein, Donald L."

Now showing 1 - 4 of 4
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    A randomized double-blind placebo-controlled trial of intravenous thiamine for prevention of delirium following allogeneic hematopoietic stem cell transplantation
    (Elsevier, 2021) Nakamura, Zev M.; Deal, Allison M.; Park, Eliza M.; Quillen, Laura J.; Chien, Stephanie A.; Stanton, Kate E.; McCabe, Sean D.; Heiling, Hillary M.; Wood, William A.; Shea, Thomas C.; Rosenstein, Donald L.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Objective: To determine if high dose intravenous (IV) thiamine can prevent delirium during hospitalization following allogeneic HSCT. Secondarily, we evaluated the effects of high dose IV thiamine on thiamine levels and explored risk factors for delirium. Methods: Randomized, double-blind, placebo-controlled trial in patients undergoing allogeneic HSCT at a U.S. academic medical center between October 2017 and March 2020. 64 participants were randomized 1:1 to thiamine 200 mg IV three times daily for 7 days or placebo. We used the Delirium Rating Scale to assess for delirium. Delirium incidence was compared between groups using the chi-square test. Group differences in time to onset and duration of delirium were compared using the Kaplan-Meier method. Fisher's Exact and Wilcoxon Rank Sum tests were used to examine associations between pre-transplantation variables and delirium. Results: 61 participants were analyzed. Delirium incidence (25% vs. 21%, Chi-square (df = 1) = 0.12, p = 0.73), time to onset, duration, and severity were not different between study arms. Immediately following the intervention, thiamine levels were higher in the thiamine arm (275 vs. 73 nmol/L, t-test (df = 57) = 13.63, p < 0.0001), but not predictive of delirium. Variables associated with delirium in our sample included disease severity, corticosteroid exposure, infection, and pre-transplantation markers of nutrition. Conclusion: High dose IV thiamine did not prevent delirium in patients receiving allogeneic HSCT. Given the multiple contributors to delirium in this population, further research regarding the efficacy of multicomponent interventions may be needed.
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    Against Medical Advice Discharge: A Narrative Review and Recommendations for a Systematic Approach
    (Elsevier, 2021-06) Holmes, Emily G.; Cooley, Benjamin S.; Fleisch, Sheryl B.; Rosenstein, Donald L.; Psychiatry, School of Medicine
    Approximately 1%-2% of hospitalizations in the United States result in an against medical advice discharge. Still, the practice of discharging patients against medical advice is highly subjective and variable. Discharges against medical advice are associated with physician distress, patient stigma, and adverse outcomes, including increased morbidity and mortality. This review summarizes discharge against medical advice research, proposes a definition for against medical advice discharge, and recommends a standard approach to a patient's request for discharge against medical advice.
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    Navigating Personal Health Crises, Imposter Syndrome, Sexual Harassment, Clinical Mistakes, and Leadership Challenges: Lessons for Work-Life Wellness in Academic Medicine: Part 3 of 3
    (University of Kansas Libraries, 2023-06-20) Barach, Paul; Ahmed, Rami; Agarwal, Gaurava; Olson, Kristine; Welch, Julie; Chernoby, Kimberly; Hein, Christine L.; Anand, Tanya; Joseph, Bellal; Rosenstein, Donald L.; Sotto-Santiago, Sylk; Hartsock, Jane; Holmes, Emily; Schroeder, Kristen; Hartwell, Jennifer L.; Medicine, School of Medicine
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    Parenting through grief: A cross-sectional study of recently bereaved adults with minor children
    (Sage, 2021) Park, Eliza M.; Deal, Allison M.; Yopp, Justin M.; Chien, Stephanie A.; McCabe, Sean; Hirsch, Ariella; Bowers, Savannah M.; Edwards, Teresa; Rosenstein, Donald L.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Background: Grieving adults raising parentally-bereaved minor children experience persistently elevated symptoms of depression and grief. However, the factors associated with their mental health outcomes are not well understood. Aim: To investigate the psychosocial and demographic characteristics associated with grief distress and depressive symptom severity in bereaved adults with minor children. Design: Cross-sectional, web-based survey. Setting/participants: Eight hundred forty-five bereaved adults raising minor (age <18 years) children who had experienced the death of a co-parent. Primary outcomes were grief distress (Prolonged Grief Disorder-13), depressive symptoms (Patient-Reported Outcomes Measurement Information System-Depression), and widowed parenting self-efficacy (WPSES). Results: Mean grief scores were 33.5; mean depression scores were 58.3. Among the 690 individuals more than 6 months bereaved, 132 (19.3%) met criteria for prolonged grief disorder. In adjusted models, participants reporting higher grief scores were more recently bereaved, identified as mothers, non-Caucasian, had lower education and income, and had not anticipated their co-parent's death. The statistical modeling results for depression scores were similar to grief scores except that depression was not associated with anticipation of co-parent death. Parents reporting lower WPSES scores had higher grief and depression scores. Retrospective assessments of more intense parenting worries at the time of co-parent death were also associated with higher grief and depression scores. Conclusions: For bereaved adults with minor children, unanticipated co-parent death was linked with higher grief distress but not symptoms of depression. Addressing parenting concerns may represent a common pathway for improving the mental health of parentally-bereaved families.