Papers by Madonna Michael
Journal of Xiangya medicine, Oct 1, 2018
Effective and safe perioperative immunosuppressive management for patients with rheumatic disease... more Effective and safe perioperative immunosuppressive management for patients with rheumatic diseases is often challenging and complex. Immunosuppressive agents result in decreased immunity, thus increasing the risk of infection, and its anti-inflammatory effect hinders the tissue healing process. The difficulty of the clinical decision-making regarding the safe management of these agents in the perioperative period arises from the need to conciliate several outcomes: ensure adequate clinical control of the underlying rheumatic disease activity, while also aiming to mitigate the risk of perioperative complications, mostly minimizing the risk of impairment of the postoperative tissue healing as well as the risk of postoperative infection. In this review article, we will highlight the peri-operative immunosuppressive management and doses suggested for patients with rheumatic diseases.
Creation of a Novel Prospectively Based Inflammatory Bowel Disease Readmission Index
The American Journal of Gastroenterology, Oct 1, 2016
Cleveland Clinic Journal of Medicine, 2016
A 31-year-old woman presents to the offi ce with a chief complaint of right midabdominal pain tha... more A 31-year-old woman presents to the offi ce with a chief complaint of right midabdominal pain that began 1 day ago. She says she did not seek medical attention earlier because she had to be at work that morning and she thought the pain would resolve on its own. She reports no fever, headache, anorexia, nausea, vomiting, malaise, loss of weight, melena, or changes in bowel habits. She describes the pain as sharp, localized to the right side, and radiating to the vulva upon sitting up. She denies any association of pain with current dietary habits or bowel function. She has no recollection of precipitating or alleviating factors, including the use of analgesics to reduce the pain. On further discussion, she mentions that 1 year ago she began experiencing chronic abdominal pain, which she says is sometimes exacerbated by coughing, by standing for extended periods of time, and during menses, and is alleviated upon lying down. She has regular menstrual periods, and her last one ended 7 days ago. Her surgical history includes two uncomplicated cesarean deliveries. She does not use tobacco, alcohol, or illicit substances. She is not aware of any allergies to drugs or foods. She appears to be in no acute distress and has been sitting quietly thus far. She seems to have positioned her hand on her abdomen over the corresponding area of pain. On physical examination, vital signs are within normal limits, and she is alert and oriented to person, place, and time. Her sclerae are anicteric, and the pupils are equal, round, and reactive to light. Cardiovascular and pulmonary examinations are also within normal limits. Examination of the abdomen elicits tenderness and guarding along the lateral border of the rectus abdominis muscle on the right side at the level of umbilicus, with no rebound tenderness or rigidity. The liver and spleen are not enlarged, and no abdominal mass is detected. No skin rash, joint swelling, or peripheral edema is noted. A neurologic examination is normal.
Journal of the American Heart Association, Sep 6, 2022
Fourth, the point estimates based on the CVRI were different between the derivation and validatio... more Fourth, the point estimates based on the CVRI were different between the derivation and validation datasets but what is more important and practical for patients and physicians is the range of risk rather than just an absolute number. The CVRI was able to stratify risk as low, intermediate, and high in both the derivation and validation cohorts. This was the main message that was highlighted in the paper. Fifth, the use of post-operative cardiac biomarkers is controversial. Although in large datasets, these biomarkers have been shown to predict risk, their value in the individual patient who is asymptomatic and with no clinical or electrocardiographic markers of ischemia is unknown and many times might confuse the treating physicians rather than guide them. This is why the guidelines do not recommend routine post-operative screening with cardiac biomarkers. The CVRI is a new, simple, and powerful index for pre-operative cardiovascular evaluation. Future research will define its place and role in the cardiovascular assessment of patients undergoing noncardiac surgery.
Incidence and Prognostic Implications of Readmissions Caused by Thrombotic Events After a Heart Failure Hospitalization
Journal of the American Heart Association
Background Readmission occurs in 1 out of 3 patients with heart failure (HF). We aimed to study t... more Background Readmission occurs in 1 out of 3 patients with heart failure (HF). We aimed to study the incidence and prognostic implications of rehospitalizations because of arterial thromboembolism events (ATEs) and venous thromboembolism events (VTEs) after discharge in patients with HF. Methods and Results We identified Medicare beneficiaries who were admitted with a primary diagnosis of HF from 2014 to 2019, with a hospital stay ranging between 3 and10 days, followed by discharge to home. We calculated incidence of ATEs (myocardial infarction, ischemic stroke, or systemic embolism) and VTEs (deep venous thrombosis and pulmonary embolism) up to 90 days after discharge. Out of 2 953 299 patients admitted with HF during the study period, a total of 585 353 patients met the inclusion criteria, and 36.6% were readmitted within 90 days of discharge. The incidence of readmission due ATEs, VTEs, HF, and all other reasons was 3.4%, 0.5%, 13.2%, and 19.5%, respectively. Incidence of thromboe...
Journal of the American College of Cardiology, 2019
Fourth, the point estimates based on the CVRI were different between the derivation and validatio... more Fourth, the point estimates based on the CVRI were different between the derivation and validation datasets but what is more important and practical for patients and physicians is the range of risk rather than just an absolute number. The CVRI was able to stratify risk as low, intermediate, and high in both the derivation and validation cohorts. This was the main message that was highlighted in the paper. Fifth, the use of post-operative cardiac biomarkers is controversial. Although in large datasets, these biomarkers have been shown to predict risk, their value in the individual patient who is asymptomatic and with no clinical or electrocardiographic markers of ischemia is unknown and many times might confuse the treating physicians rather than guide them. This is why the guidelines do not recommend routine post-operative screening with cardiac biomarkers. The CVRI is a new, simple, and powerful index for pre-operative cardiovascular evaluation. Future research will define its place and role in the cardiovascular assessment of patients undergoing noncardiac surgery.
Cleveland Clinic journal of medicine, 2016
A 31-year-old woman presents to the offi ce with a chief complaint of right midabdominal pain tha... more A 31-year-old woman presents to the offi ce with a chief complaint of right midabdominal pain that began 1 day ago. She says she did not seek medical attention earlier because she had to be at work that morning and she thought the pain would resolve on its own. She reports no fever, headache, anorexia, nausea, vomiting, malaise, loss of weight, melena, or changes in bowel habits. She describes the pain as sharp, localized to the right side, and radiating to the vulva upon sitting up. She denies any association of pain with current dietary habits or bowel function. She has no recollection of precipitating or alleviating factors, including the use of analgesics to reduce the pain. On further discussion, she mentions that 1 year ago she began experiencing chronic abdominal pain, which she says is sometimes exacerbated by coughing, by standing for extended periods of time, and during menses, and is alleviated upon lying down. She has regular menstrual periods, and her last one ended 7 days ago. Her surgical history includes two uncomplicated cesarean deliveries. She does not use tobacco, alcohol, or illicit substances. She is not aware of any allergies to drugs or foods. She appears to be in no acute distress and has been sitting quietly thus far. She seems to have positioned her hand on her abdomen over the corresponding area of pain. On physical examination, vital signs are within normal limits, and she is alert and oriented to person, place, and time. Her sclerae are anicteric, and the pupils are equal, round, and reactive to light. Cardiovascular and pulmonary examinations are also within normal limits. Examination of the abdomen elicits tenderness and guarding along the lateral border of the rectus abdominis muscle on the right side at the level of umbilicus, with no rebound tenderness or rigidity. The liver and spleen are not enlarged, and no abdominal mass is detected. No skin rash, joint swelling, or peripheral edema is noted. A neurologic examination is normal.
Epidemiology of psoriatic arthritis
Oxford University Press eBooks, Aug 1, 2018
The epidemiological studies of psoriatic arthritis (PsA) is quite challenging as our understandin... more The epidemiological studies of psoriatic arthritis (PsA) is quite challenging as our understanding of the disease is evolving. A wide range of incidence and prevalence is reported among different countries suggesting genetic and environmental factors influencing the epidemiology of PsA. Other contributing factors accounting for the wide range and variation of PsA epidemiology include age and gender variations, ethnicity, lack of precise case definition, and small sample size. A high level of suspicion in patients with pre-existing psoriasis, and collaborative efforts shared between primary care physicians (PCP), dermatologist, and rheumatologist, will enhance early detection and management of PsA, subsequently improving overall patient outcomes, and quality of life.
Cureus
Introduction Communication between healthcare providers and patients is a key component associate... more Introduction Communication between healthcare providers and patients is a key component associated with the quality of healthcare and patient satisfaction. Often, simple communication skills may be insufficient to sustain a successful provider-patient relationship. The aim of this project was to assess and improve patient and nurse satisfaction with physicians via improvement in physician-patient and physician-nurse communication to a level greater than 90%.
Epidemiology of psoriatic arthritis
Oxford Medicine Online
The epidemiological studies of psoriatic arthritis (PsA) is quite challenging as our understandin... more The epidemiological studies of psoriatic arthritis (PsA) is quite challenging as our understanding of the disease is evolving. A wide range of incidence and prevalence is reported among different countries suggesting genetic and environmental factors influencing the epidemiology of PsA. Other contributing factors accounting for the wide range and variation of PsA epidemiology include age and gender variations, ethnicity, lack of precise case definition, and small sample size. A high level of suspicion in patients with pre-existing psoriasis, and collaborative efforts shared between primary care physicians (PCP), dermatologist, and rheumatologist, will enhance early detection and management of PsA, subsequently improving overall patient outcomes, and quality of life.
Creation of a Novel Prospectively Based Inflammatory Bowel Disease Readmission Index
American Journal of Gastroenterology
Journal of Xiangya Medicine
Effective and safe perioperative immunosuppressive management for patients with rheumatic disease... more Effective and safe perioperative immunosuppressive management for patients with rheumatic diseases is often challenging and complex. Immunosuppressive agents result in decreased immunity, thus increasing the risk of infection, and its anti-inflammatory effect hinders the tissue healing process. The difficulty of the clinical decision-making regarding the safe management of these agents in the perioperative period arises from the need to conciliate several outcomes: ensure adequate clinical control of the underlying rheumatic disease activity, while also aiming to mitigate the risk of perioperative complications, mostly minimizing the risk of impairment of the postoperative tissue healing as well as the risk of postoperative infection. In this review article, we will highlight the peri-operative immunosuppressive management and doses suggested for patients with rheumatic diseases.
Not all abdominal pain is gastrointestinal
Cleveland Clinic journal of medicine, 2016
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Papers by Madonna Michael