Medicine and Health Sciences Commons^™

A Retrospective Look At The Predictions And Recommendations From The 2009 Amia Policy Meeting: Did We See Ehr-Related Clinician Burnout Coming?, Justin B Starren, William M Tierney, Marc S Williams, Paul Tang, Charlene Weir, Ross Koppel, Philip Payne, George Hripcsak, Don E Detmer

2020-Current year OA Pubs

Clinicians often attribute much of their burnout experience to use of the electronic health record, the adoption of which was greatly accelerated by the Health Information Technology for Economic and Clinical Health Act of 2009. That same year, AMIA's Policy Meeting focused on possible unintended consequences associated with rapid implementation of electronic health records, generating 17 potential consequences and 15 recommendations to address them. At the 2020 annual meeting of the American College of Medical Informatics (ACMI), ACMI fellows participated in a modified Delphi process to assess the accuracy of the 2009 predictions and the response to the recommendations. Among …

Real-World Outcomes Of Patients With Locally Advanced Or Metastatic Epithelioid Sarcoma, Mrinal M Gounder, Brian A Van Tine, Et Al.

2020-Current year OA Pubs

BACKGROUND: Limited data are available on the real-world effectiveness and safety of systemic therapies for advanced (surgically unresectable and/or metastatic) epithelioid sarcoma (ES).

METHODS: A retrospective medical records review was conducted in patients with advanced ES who were initiating first-line or ≥2 lines of systemic therapy (2000-2017) at 5 US cancer centers. The real-world overall response rate (rwORR), the duration of response (rwDOR), the disease control rate (rwDCR) (defined as stable disease for ≥32 weeks or any duration of response), and progression-free survival (rwPFS) were assessed by radiology reports. Overall survival (OS), rwDOR, and rwPFS were estimated from the time …

The Clinical Course Of Coronavirus Disease 2019 In A Us Hospital System: A Multistate Analysis, Aaloke Mody, Patrick G Lyons, Cristina Vazquez Guillamet, Andrew Michelson, Sean Yu, Angella Sandra Namwase, Pratik Sinha, William G Powderly, Keith Woeltje, Elvin H Geng

2020-Current year OA Pubs

There are limited data on longitudinal outcomes for coronavirus disease 2019 (COVID-19) hospitalizations that account for transitions between clinical states over time. Using electronic health record data from a hospital network in the St. Louis, Missouri, region, we performed multistate analyses to examine longitudinal transitions and outcomes among hospitalized adults with laboratory-confirmed COVID-19 with respect to 15 mutually exclusive clinical states. Between March 15 and July 25, 2020, a total of 1,577 patients in the network were hospitalized with COVID-19 (49.9% male; median age, 63 years (interquartile range, 50-75); 58.8% Black). Overall, 34.1% (95% confidence interval (CI): 26.4, 41.8) had …

Effect Of Aspirin On Cancer Incidence And Mortality In Older Adults, John J Mcneil, Yin Cao, Et Al.

2020-Current year OA Pubs

BACKGROUND: ASPirin in Reducing Events in the Elderly, a randomized, double-blind, placebo-controlled trial of daily low-dose aspirin (100 mg) in older adults, showed an increase in all-cause mortality, primarily due to cancer. In contrast, prior randomized controlled trials, mainly involving younger individuals, demonstrated a delayed cancer benefit with aspirin. We now report a detailed analysis of cancer incidence and mortality.

METHODS: 19 114 Australian and US community-dwelling participants aged 70 years and older (US minorities 65 years and older) without cardiovascular disease, dementia, or physical disability were randomly assigned and followed for a median of 4.7 years. Fatal and nonfatal …

The National Covid Cohort Collaborative (N3c): Rationale, Design, Infrastructure, And Deployment, Melissa A Haendel, Philip R O Payne, Et Al.

2020-Current year OA Pubs

OBJECTIVE: Coronavirus disease 2019 (COVID-19) poses societal challenges that require expeditious data and knowledge sharing. Though organizational clinical data are abundant, these are largely inaccessible to outside researchers. Statistical, machine learning, and causal analyses are most successful with large-scale data beyond what is available in any given organization. Here, we introduce the National COVID Cohort Collaborative (N3C), an open science community focused on analyzing patient-level data from many centers.

MATERIALS AND METHODS: The Clinical and Translational Science Award Program and scientific community created N3C to overcome technical, regulatory, policy, and governance barriers to sharing and harmonizing individual-level clinical data. We …

The Second Ninds/Nibib Consensus Meeting To Define Neuropathological Criteria For The Diagnosis Of Chronic Traumatic Encephalopathy, Kevin F Bieniek, Nigel J Cairns, Et Al.

2020-Current year OA Pubs

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with exposure to head trauma. In 2015, a panel of neuropathologists funded by the NINDS/NIBIB defined preliminary consensus neuropathological criteria for CTE, including the pathognomonic lesion of CTE as "an accumulation of abnormal hyperphosphorylated tau (p-tau) in neurons and astroglia distributed around small blood vessels at the depths of cortical sulci and in an irregular pattern," based on review of 25 tauopathy cases. In 2016, the consensus panel met again to review and refine the preliminary criteria, with consideration around the minimum threshold for diagnosis and the reproducibility of a proposed …

Whole Health Options And Pain Education (Whope): A Pragmatic Trial Comparing Whole Health Team Vs Primary Care Group Education To Promote Nonpharmacological Strategies To Improve Pain, Functioning, And Quality Of Life In Veterans-Rationale, Methods, And Implementation, Karen H Seal, Kavitha Reddy, Et Al.

2020-Current year OA Pubs

BACKGROUND: The Whole Health model of the U.S. Department of Veterans Affairs (VA) emphasizes holistic self-care and multimodal approaches to improve pain, functioning, and quality of life. wHOPE (Whole Health Options and Pain Education) seeks to be the first multisite pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care.

DESIGN: wHOPE is a pragmatic randomized controlled trial comparing a Whole Health Team (WHT) approach to Primary Care Group Education (PC-GE); both will be compared to Usual VA Primary Care (UPC). The WHT consists of a medical provider, a complementary and integrative health (CIH) provider, …

Strategies For Effective Dissemination Of Research To United States Policymakers: A Systematic Review, Laura Ellen Ashcraft, Deirdre A Quinn, Ross C Brownson

2020-Current year OA Pubs

BACKGROUND: Research has the potential to influence US social policy; however, existing research in this area lacks a coherent message. The Model for Dissemination of Research provides a framework through which to synthesize lessons learned from research to date on the process of translating research to US policymakers.

METHODS: The peer-reviewed and grey literature was systematically reviewed to understand common strategies for disseminating social policy research to policymakers in the United States. We searched Academic Search Premier, PolicyFile, SocINDEX, Social Work Abstracts, and Web of Science from January 1980 through December 2019. Articles were independently reviewed and thematically analyzed by …

Assessment Of Postoperative Nausea And Vomiting After Bariatric Surgery Using A Validated Questionnaire, Bradley S Kushner, Dawn Freeman, Jayme Sparkman, Arghavan Salles, J Christopher Eagon, Shaina R Eckhouse

2020-Current year OA Pubs

BACKGROUND: Postoperative nausea and vomiting (PONV) is known to occur after bariatric surgery, with over two thirds of patients affected. However, variability exists in how to objectively measure PONV.

OBJECTIVES: The goals of the present study were to use a validated, patient-centered scoring tool, the Rhodes Index of Nausea, Vomiting, and Retching to measure the severity of PONV after bariatric surgery, to directly compare PONV between patients who underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), and to identify risk factors for the development of PONV after bariatric surgery.

SETTING: Barnes-Jewish Hospital/Washington University School of Medicine, St. …

Boarding Of Critically Ill Patients In The Emergency Department, Nicholas M Mohr, Brian T Wessman, Benjamin Bassin, Marie-Carmelle Elie-Turenne, Timothy Ellender, Lillian L Emlet, Zachary Ginsberg, Kyle Gunnerson, Kevin M Jones, Bridgette Kram, Evie Marcolini, Susanna Rudy

2020-Current year OA Pubs

OBJECTIVES: Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, …

Associations Between Breast Cancer Subtype And Neighborhood Socioeconomic And Racial Composition Among Black And White Women, Erin Linnenbringer, Arline T Geronimus, Kia L Davis, John Bound, Libby Ellis, Scarlett L Gomez

2020-Current year OA Pubs

PURPOSE: Studies of Black-White differences in breast cancer subtype often emphasize potential ancestry-associated genetic or lifestyle risk factors without fully considering how the social or economic implications of race in the U.S. may influence risk. We assess whether neighborhood racial composition and/or socioeconomic status are associated with odds of triple-negative breast cancer (TNBC) diagnosis relative to the less-aggressive hormone receptor-positive/HER2-negative subtype (HR+ /HER-), and whether the observed relationships vary across women's race and age groups.

METHODS: We use multilevel generalized estimating equation models to evaluate odds of TNBC vs. HR+ /HER2- subtypes in a population-based cohort of 7291 Black and …

Toward Improving Practices For Submission Of Diagnostic Tissue Blocks For National Cancer Institute Clinical Trials, Hala Makhlouf, Mark A Watson, Heather A Lankes, Carol Weil, Maura Dickler, Michael Birrer, Christopher Moskaluk, Nilsa C Ramirez, Nader Okby, Edgar Alonsozana, Mark Barnes, Edward B Goldman, Rebecca Enos, Irina Lubensky

2020-Current year OA Pubs

OBJECTIVES: The National Cancer Institute (NCI) National Clinical Trials Network performs phase II and III clinical trials, which increasingly rely on the submission of diagnostic formalin-fixed, paraffin-embedded tissue blocks for biomarker assessment. Simultaneously, advances in precision oncology require that clinical centers maintain diagnostic specimens for ancillary, standard-of-care diagnostics. This has caused tissue blocks to become a limited resource for advancing the NCI clinical trial enterprise and the practice of modern molecular pathology.

METHODS: The NCI convened a 1-day workshop of multidisciplined experts to discuss barriers and strategic solutions to facilitate diagnostic block submission for clinical trial science, from the perspective …