Browsing by Author "Olotu, Busuyi Sunday"
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Item Provision and utilization of Complementary and Alternative Medicine (CAM) in Texas hospices(2012-05) Olotu, Busuyi Sunday; Brown, Carolyn M., Ph. D.; Lawson, Kenneth A.; Barner, Jamie C.The purpose of this study was to describe the extent and nature of CAM services that are provided and used in Texas hospices. The study investigated the significance of hospice setting characteristics such as age, geographic location, agency type, profit orientation, Medicare certification, and number of patients served as they relate to the likelihood of offering CAM, using a robust methodological and analytical strategy. Data was collected via self-administered mail surveys to 369 hospice directors in the state of Texas. A total usable response rate of 35.7% was obtained after an initial and one follow-up mail-out. A majority (N = 62, 56.4%) of hospices provided at least one type of CAM to their clients; however, a sizeable proportion of patients did not utilize the provided CAMs. The most frequently offered CAMs included massage, music, relaxation, spiritual healing and pet therapies with females and non-Hispanic whites being the most frequent users of these CAM services. Among CAM providers, short length of stay and funding were the primary obstacles to CAM provision, with most hospices relying on a combination of general hospice funds and volunteers to sustain the delivery of CAM services. The odds of offering CAM in ‘not-for-profit’ hospices were approximately four times higher than in ‘for-profit’ hospices (OR = 3.77, p = 0.022), while the odds of offering CAM increased by 13% for every 100 patients served by hospices (OR = 1.131, p = 0.015). Other hospice setting characteristics were not significantly related to CAM provision. In conclusion, a majority of hospices offered CAM services to their clients, although many patients are not utilizing these services. This observation might be connected with the fact that most CAM services are currently not being reimbursed through the Medicare Hospice Benefit, a government program that a majority of hospices depend upon for the coverage of substantial portions of their end-of-life services. Nevertheless, our study showed that CAM provision is related to the number of patients served and profit orientation status, but is not related to other measured characteristics of hospices.Item Use of statins and the development of incident diabetes mellitus : a retrospective cohort study(2015-05) Olotu, Busuyi Sunday; Shepherd, Marvin D.; Lawson, Kenneth A; Wilson, James P; Richards, Kristin M; Novak, SuzanneStatins are pharmaceutical agents used in lowering blood cholesterols levels. Several landmark statin trials have demonstrated the beneficial effects of statins in both primary and secondary prevention of cardiovascular disease. Although statins are generally safe and well tolerated, several studies have suggested that statins are associated with a moderate increase in risk of new-onset diabetes. These observations prompted the FDA to revise statin labels to now include a warning of an increased risk of incident diabetes mellitus as a result of increases in glycosylated hemoglobin (A1C) and fasting plasma glucose (FPG). However, few studies have used US-based data to investigate this statin-associated increased risk of diabetes. Thus, the purpose of this study was to evaluate whether statin use was associated with an increased risk of new-onset diabetes. In addition, this study evaluated whether diabetes risk was increased when patients received intensive statin doses. This study was a retrospective cohort analysis that utilized data from the Thomson Reuters MarketScan® Commercial Claims Database for the period of 2003 - 2004. The study population included new statin users who were aged 20 - 63 years at index and who do not have a history of diabetes. Among the study population (N=116,224), 6.5% (or N=7,593) had incident diabetes. Compared to no statin use, statin use was significantly associated with increased risk of incident diabetes (HR=2.752; 99% C.I.=2.535 - 2.987; p<0.0001). In addition, each statin type (i.e., atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin) was associated with about a two-fold increase in risk of diabetes. Diabetes risk was highest among lovastatin users and lowest among rosuvastatin users. Furthermore, diabetes risk was higher among intensive-dose statin users compared to moderate-dose statin users (HR=1.540; 99% C.I.=1.393 – 1.704; p<0.0001). Because of the proven benefits of statins in both primary and secondary prevention of cardiovascular disease, and because the potential for diabetogenicity differs among statins, health care professionals should individualize statin therapy by identifying patients who would benefit from less diabetogenic statin types. This could help optimize treatment by providing the highest benefit achievable while reducing the number of patients developing diabetes under statin therapy.