Medicine and Health Sciences Commons^™

Effects Of Cost Sharing On Seeking Care For Serious And Minor Symptoms. Results Of A Randomized Controlled Trial, Martin Shapiro, John Ware, Cathy Sherbourne

Martin Shapiro

To estimate the effect of cost sharing on seeking care for serious and minor symptoms, we analyzed data for 3539 persons aged 17 to 61 from the Rand Health Insurance Experiment. Participants were randomly assigned to a free-care group or to insurance plans requiring them to pay part of the costs (cost-sharing group). Annual surveys were administered to determine if participants had serious and minor symptoms during the preceding month and whether they saw a physician. Serious symptoms were judged by a panel of physicians to warrant care in most instances; minor symptoms were judged neither to be severe nor …

Evaluation Of Animal Model Research, Kenneth J. Shapiro

Kenneth J. Shapiro, PhD

It is argued that a concept of evaluation of animal models that is broader and more useful than validation is available. Productive generativity refers to the degree to which a model furthers understanding and leads to more-effective treatment interventions. Results of the application of this novel evaluative frame to several animal models of eating disorders show that this animal-based research has not been productive. The question of the relation between clinic and animal laboratory is discussed.

Critical Assessment Of Outcomes In Acute Aortic Dissection (Type A) At A Community Hospital: A 10 Year Review, Tim S. Misselbeck Md, James K. Wu Md, Stephen Deturk Ba, Michael F. Szwerc Md, Sanjay M. Mehta Md, Theodore G. Phillips Md, Gary W. Szydlowski Md, Raymond L. Singer Md

Raymond L Singer MD

No abstract provided.

Conventional Isolated Aortic Valve Replacement In Octogenarians: A 10-Year Single Center Experience, James K. Wu Md, Justin D. Roberts Do, Gregory S. Troutman Bs, Michael J. Weiss Mph, Sanjay M. Mehta Md, Theodore G. Phillips Md, Michael F. Szwerc Md, Gary W. Szydlowski Md, Tim S. Misselbeck Md, Raymond L. Singer Md

Raymond L Singer MD

No abstract provided.

Alterations In Gene Array Patterns In Dendritic Cells From Aged Humans, Jia-Ning Cao, Anshu Agrawal, Edward Sharman, Zhenyu Jia, Sudhir Gupta

Zhenyu Jia

Dendritic cells (DCs) are major antigen-presenting cells that play a key role in initiating and regulating innate and adaptive immune responses. DCs are critical mediators of tolerance and immunity. The functional properties of DCs decline with age. The purpose of this study was to define the age-associated molecular changes in DCs by gene array analysis using Affymatrix GeneChips. The expression levels of a total of 260 genes (1.8%) were significantly different (144 down-regulated and 116 upregulated) in monocyte-derived DCs (MoDCs) from aged compared to young human donors. Of the 260 differentially expressed genes, 24% were down-regulated by more than 3-fold, …

Transcultural Self-Efficacy Perceptions Of Baccalaureate Nursing Students, Margaret Halter, Faye Grund, Mark Fridline, Sharon See, Lisa Young, Carol Reece

Mark Fridline PhD

Addressing the health care needs of a 21st-century nation that is experiencing increased diversity and disparity will require new models of educating future providers. The cultural competence and confidence model was the guiding framework in a study evaluating the influence of cultural educational offerings on the transcultural self-efficacy (TSE) perceptions in baccalaureate nursing students. The Transcultural Self-Efficacy Tool was used to measure perceived TSE in a pretest (N = 260), posttest (N = 236) study over an academic year. Significant changes were demonstrated in overall self-efficacy and on the cognitive, practical, and affective subscales. A classification and regression …

Rapid Door-To-Balloon Time (≤ 30 Minutes) In The Treatment Of Acute St-Elevation Myocardial Infarction (Stemi) Is Associated With Reduced Length Of Hospital Stay And Improved Clinical Outcomes, Yassir Nawaz Md, Ataul Qureshi Md, Navin K. Subrayappa Md, Orlando E. Rivera Rn, Bruce Feldman Do, Nainesh C. Patel Md

Bruce A. Feldman DO

No abstract provided.

Football Betting And The Efficient Market Hypothesis, Ravija Badarinathi, Ladd Kochman

Ladd Kochman

Three betting rules which had been nonrandomly profitable in both their initial application to the 1969-74 National Football League seasons and their replication during the years of 1975-81 were applied to all NFL games played between September 1984 and January 1994. One rule proved to be nonrandom and profitable for a third consecutive trial--a feat suggesting that bettors may be able to "beat the bookie" and, more broadly, that prices in competitive markets may not discount all available information in swift fashion.

Neoadjuvant Or Adjuvant Therapy For Resectable Esophageal Cancer: A Systematic Review And Meta-Analysis, Richard Malthaner, Rebecca Wong, R. Rumble, Lisa Zuraw

Richard A. Malthaner

Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. The large and growing number of patients affected, the high mortality rates, the worldwide geographic variation in practice, and the large body of good quality research warrants a systematic review with meta-analysis.

Methods: A systematic review and meta-analysis investigating the impact of neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer to inform evidence-based practice was produced.MEDLINE, CANCERLIT, Cochrane Library, EMBASE, and abstracts from the American Society of Clinical Oncology and the …

Neoadjuvant Or Adjuvant Therapy For Resectable Esophageal Cancer: A Clinical Practice Guideline, Richard Malthaner, Rebecca Wong, R. Rumble, Lisa Zuraw

Richard A. Malthaner

Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A clinical practice guideline was developed based on a systematic review investigating neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer. Methods: A systematic review with meta-analysis was developed and clinical recommendations were drafted. External review of the practice guideline report by practitioners in Ontario, Canada was obtained through a mailed survey, and incorporated. Final approval of the practice guideline was obtained from the Practice Guidelines Coordinating Committee. Results: The systematic review …

Cyclosporin Versus Tacrolimus For Liver Transplanted Patients, Elizabeth Haddad, Vivian Mcalister, Elizabeth Renouf, Richard Malthaner, Mette Kjaer, Lise Gluud

Richard A. Malthaner

A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring>tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients …

Neoadjuvant Or Adjuvant Therapy For Resectable Esophageal Cancer: A Systematic Review And Meta-Analysis, Richard Malthaner, Rebecca Wong, R. Rumble, Lisa Zuraw

Richard A. Malthaner

Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. The large and growing number of patients affected, the high mortality rates, the worldwide geographic variation in practice, and the large body of good quality research warrants a systematic review with meta-analysis.

Methods: A systematic review and meta-analysis investigating the impact of neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer to inform evidence-based practice was produced.MEDLINE, CANCERLIT, Cochrane Library, EMBASE, and abstracts from the American Society of Clinical Oncology and the …

Neoadjuvant Or Adjuvant Therapy For Resectable Esophageal Cancer: A Clinical Practice Guideline, Richard Malthaner, Rebecca Wong, R. Rumble, Lisa Zuraw

Richard A. Malthaner

Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A clinical practice guideline was developed based on a systematic review investigating neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer.

Methods: A systematic review with meta-analysis was developed and clinical recommendations were drafted. External review of the practice guideline report by practitioners in Ontario, Canada was obtained through a mailed survey, and incorporated. Final approval of the practice guideline was obtained from the Practice Guidelines Coordinating Committee.

Results: The systematic review …

Cyclosporin Versus Tacrolimus For Liver Transplanted Patients, Elizabeth Haddad, Vivian Mcalister, Elizabeth Renouf, Richard Malthaner, Mette Kjaer, Lise Gluud

Richard A. Malthaner

A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring>tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients …

Estimated Probability Of Becoming A Case Of Drug Dependence In Relation To Duration Of Drug-Taking Experience: A Function Approach, Olga A. Vsevolozhskaya, James C. Anthony

Olga A. Vsevolozhskaya

Measured as elapsed time from first use to dependence syndrome onset, the estimated 'induction interval' for cocaine clearly is short relative to the cannabis interval, but little is known about risk of becoming dependent when use persists. Published estimates for this facet of drug dependence epidemiology are from life histories elicited years after first use. To improve estimation, we turn to new data from nationally representative samples of newly incident drug users identified via probability sampling and confidential computer-assisted self-interviews for the National Surveys on Drug Use and Health, 2004-2013. Standardized modules assess first and most recent use, and dependence …

Expectations For Methodology And Translation Of Animal Research: A Survey Of Health Care Workers, Ari Joffe, Meredith Bara, Natalie Anton, Nathan Nobis

Nathan M. Nobis, PhD

Background: Health care workers (HCW) often perform, promote, and advocate use of public funds for animal research (AR); therefore, an awareness of the empirical costs and benefits of animal research is an important issue for HCW. We aim to determine what health-care-workers consider should be acceptable standards of AR methodology and translation rate to humans. Methods: After development and validation, an e-mail survey was sent to all pediatricians and pediatric intensive care unit nurses and respiratory-therapists (RTs) affiliated with a Canadian University. We presented questions about demographics, methodology of AR, and expectations from AR. Responses of pediatricians and nurses/RTs were …

Leukoaraiosis Predicts Poor 90-Day Outcome After Acute Large Cerebral Artery Occlusion, Nils Henninger, Eugene Lin, Stephen Baker, Ajay Wakhloo, Deepak Takhtani, Majaz Moonis

Nils Henninger

BACKGROUND: To date limited information regarding outcome-modifying factors in patients with acute intracranial large artery occlusion (ILAO) in the anterior circulation is available. Leukoaraiosis (LA) is a common finding among patients with ischemic stroke and has been associated with poor post-stroke outcomes but its association with ILAO remains poorly characterized. This study sought to clarify the contribution of baseline LA and other common risk factors to 90-day outcome (modified Rankin Scale, mRS) after stroke due to acute anterior circulation ILAO. METHODS: We retrospectively analyzed 1,153 consecutive patients with imaging-confirmed ischemic stroke during a 4-year period (2007-2010) at a single academic …

The Effect Of Shortening Door To Balloon Time (<90 Minutes) In Stemi Patients Transferred From Outside Hospitals, Ataul Qureshi Md, Yassir Nawaz Md, Navin K. Subrayappa Md, Orlando E. Rivera Rn, Nainesh C. Patel Md

Nainesh C Patel MD

No abstract provided.

Rapid Door To Balloon Time In The Treatment Of Acute St- Elevation Myocardial Infarction Meaningfully Reduces Overall Hospital Stay, Amit N. Nanavati Md, Nainesh Patel Md, Bruce Feldman Do, J Patrick Kleaveland Md, Orlando E. Rivera Rn, David A. Cox Md

Nainesh C Patel MD

No abstract provided.

Post-Resuscitation Care Practices Following Cardiac Arrest At Six Regional Interventional Cardiology Centers In The United States 2007-2011, David B. Seder Md, Nainesh Patel Md, J Mcpherson, P Mcmullen, K B. Kern, B Unger, J Browning, Sudip Nanda Md, Facp, M Hacobian, M B. Kelley, N Nielsen, M Mooney

Nainesh C Patel, MD

No abstract provided.

Rapid Door-To-Balloon Time (≤ 30 Minutes) In The Treatment Of Acute St-Elevation Myocardial Infarction (Stemi) Is Associated With Reduced Length Of Hospital Stay And Improved Clinical Outcomes, Yassir Nawaz Md, Ataul Qureshi Md, Navin K. Subrayappa Md, Orlando E. Rivera Rn, Bruce Feldman Do, Nainesh C. Patel Md

Nainesh C Patel MD

No abstract provided.

Neurological And Cardiovascular Outcomes After Cardiac Arrest At Six Regional Interventional Cardiology Centers In The United States 2007-2011, David Seder, Nainesh Patel, J Mcpherson, P Mcmullen, K Kern, B Unger, J Browning, Sudip Nanda, M Hacobian, M Kelley, N Nielsen, M Mooney

Nainesh C Patel MD

No abstract provided.

Geriatric Experience Following Cardiac Arrest At Six Interventional Cardiology Centers In The United States 2007-2011, David Seder, Nainesh Patel, John Mcpherson, Paul Mcmullen, Karl Kern, Barbara Unger, J Browning, Sudip Nanda, Melkon Hacobian, Michael Kelley, Niklas Nielsen, Michael Mooney

Nainesh C Patel MD

No abstract provided.

Teaching Of Biostatistics And Epidemiology In Medical Schools: How Do We Fare Compared With Developed Countries, Vijay Tiwari, Kuldeep Kumar, Sherin Raj

Kuldeep Kumar

Background Biostatistics is taught in almost all medical schools at the undergraduate and the postgraduate levels as a core course and is a prerequisite to epidemiology, public health and evidence-based medicine. However, it has to be taught in a different way in medical schools as compared with how it is taught to the students studying MSc (Biostatistics) or in the Statistics Department in universities. Objectives (1) To review the experience of teaching biostatistics in medical schools in India and compares the same with abroad (2) How best the curriculum can be designed as per the need of the medical students …

Gender Differences In Perceptions And Self-Reported Driving Behaviors Among Teenagers. (Poster), Gavin C. Barr Jr. Md, Kathleen E. Kane Md, Robert D. Barraco Md, Timarie Rayburg Do, Lauren Dugan Do, Chadd K. Kraus Do, Mph, Marna R. Greenberg Do, Mph, Facep, Valerie Rupp Rn, Bsn, Kimberly Hamilton, Bryan G. Kane Md

Robert D Barraco MD, MPH

No abstract provided.

Addressing Distress And Pain In Animal Research: The Veterinary, Research, Societal, Regulatory And Ethical Contexts For Moving Forward, Kathleen Conlee, Martin Stephens, Andrew N. Rowan

Andrew N. Rowan, DPhil

While most people recognize that biomedical scientists are searching for knowledge that will improve the health of humans and animals, the image of someone deliberately causing harm to an animal in order to produce data that may lead to some future benefit has always prompted an uncomfortable reaction outside the laboratory. However, proponents of animal research have usually justified the practice by reference to greater benefits (new knowledge and medical treatments) over lesser costs (in animal suffering and death). Given that one of the costs of animal research is the suffering experienced by the animals, the goal of eliminating distress …

The Minimization Of Research Animal Distress And Pain: Conclusions And Recommendations, Kathleen Conlee, Martin Stephens, Andrew N. Rowan

Andrew N. Rowan, DPhil

While the attention given to preventing, assessing, and alleviating pain in research animals has increased noticeably in recent decades, much remains to be done both in terms of implementing best practices and conducting studies to answer outstanding questions. In contrast, the attention to distress (particularly non-pain induced distress) has shown no comparable increase. There are many reasons for this discrepancy, including the conceptual untidiness of the distress concept, the paucity of pharmacological treatments for distress, and perceived lack of regulatory emphasis on distress. These are challenges that need to be addressed and overcome. This book is intended to help meet …

Challenges And Best Practices In Real-Time Prediction Of Infectious Disease: A Case Study Of Dengue In Thailand, Nicholas Reich, Stephen Lauer, Krzysztof Sakrejda, Sopon Iamsirithaworn, Soawapak Hinjoy, Paphanij Suangtho, Suthanun Suthachana, Hannah Clapham, Henrik Salje, Derek Cummings, Justin Lessler

Nicholas G Reich

Epidemics of communicable diseases place a huge burden on public health infrastructures across the world. Producing accurate and actionable forecasts of infectious disease incidence at short and long time scales will improve public health response to outbreaks. However, scientists and public health officials face many obstacles in trying to create accurate and actionable real-time forecasts of infectious disease incidence. Dengue is a mosquito-borne virus that annually infects over 400 million people worldwide. We developed a real-time forecasting model for dengue hemorrhagic fever in the 77 provinces of Thailand. We created an operational and computational infrastructure that generated multi-step predictions of …

Estimating Controlled Direct Effects Of Restrictive Feeding Practices In The `Early Dieting In Girls' Study, Yeying Zhu, Debashis Ghosh, Donna L. Coffman, Jennifer S. Williams

Debashis Ghosh

In this article, we examine the causal effect of parental restrictive feeding practices on children’s weight status. An important mediator we are interested in is children’s self-regulation status. Traditional mediation analysis (Baron and Kenny, 1986) applies a structural equation modelling (SEM) approach and decomposes the intent-to-treat (ITT) effect into direct and indirect effects. More recent approaches interpret the mediation effects based on the potential outcomes framework. In practice, there often exist confounders that jointly influence the mediator and the outcome. Inverse probability weighting based on propensity scores are used to adjust for confounding and reduce the dimensionality of confounders simultaneously. …

Case Studies In Evaluating Time Series Prediction Models Using The Relative Mean Absolute Error, Nicholas G. Reich, Justin Lessler, Krzysztof Sakrejda, Stephen A. Lauer, Sopon Iamsirithaworn, Derek A T Cummings

Nicholas G Reich

Statistical prediction models inform decision-making processes in many real-world settings. Prior to using predictions in practice, one must rigorously test and validate candidate models to ensure that the proposed predictions have sufficient accuracy to be used in practice. In this paper, we present a framework for evaluating time series predictions that emphasizes computational simplicity and an intuitive interpretation using the relative mean absolute error metric. For a single time series, this metric enables comparisons of candidate model predictions against naive reference models, a method that can provide useful and standardized performance benchmarks. Additionally, in applications with multiple time series, this …