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Advancing Population Health: New Models And The Role Of Research. An Overview Of The 22nd Annual Health Care Systems Research Network Conference, Robert T. Greenlee, Lois E. Lamerato, Sarah M. Greene 2016 Marshfield Clinic Research Foundation

Advancing Population Health: New Models And The Role Of Research. An Overview Of The 22nd Annual Health Care Systems Research Network Conference, Robert T. Greenlee, Lois E. Lamerato, Sarah M. Greene

Journal of Patient-Centered Research and Reviews

The Health Care Systems Research Network (HCSRN; formerly HMO Research Network) held its annual conference in Atlanta, Georgia, in April 2016. A consortium of research organizations affiliated with 20 large health care delivery systems, the HCSRN met for the 22nd consecutive year to report on scientific achievements, develop and share skills and best practices, and promote new research collaborations. The 2016 conference, with a theme of “Advancing Population Health: New Models and the Role of Research,” was co-hosted on behalf of HCSRN by Marshfield Clinic Research Foundation and Henry Ford Health System’s Public Health Sciences Department. The 350 ...


Using Machine Learning And Natural Language Processing Algorithms To Automate The Evaluation Of Clinical Decision Support In Electronic Medical Record Systems, Donald A. Szlosek, Jonathan M. Ferretti 2016 University of Southern Maine

Using Machine Learning And Natural Language Processing Algorithms To Automate The Evaluation Of Clinical Decision Support In Electronic Medical Record Systems, Donald A. Szlosek, Jonathan M. Ferretti

eGEMs (Generating Evidence & Methods to improve patient outcomes)

Introduction: As the number of clinical decision support systems incorporated into electronic medical records increases, so does the need to evaluate their effectiveness. The use of medical record review and similar manual methods for evaluating decision rules is laborious and inefficient. Here we use machine learning and natural language processing (NLP) algorithms to accurately evaluate a clinical decision support rule through an electronic medical record system and compare it against manual evaluation.

Methods: Modeled after the electronic medical record system EPIC at Maine Medical Center, we developed a dummy dataset containing physician notes in free text for 3621 artificial patients ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Tiffany A. Moore Simas

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Jeroan J. Allison

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Nancy Byatt

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Multiple Chronic Conditions And Psychosocial Limitations In A Contemporary Cohort Of Patients Hospitalized With An Acute Coronary Syndrome, Mayra Tisminetsky, Jerry H. Gurwitz, David D. McManus, Jane S. Saczynski, Molly E. Waring, Nathaniel Erskine, Milena D. Anatchkova, David C. Parish, Darleen M. Lessard, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Multiple Chronic Conditions And Psychosocial Limitations In A Contemporary Cohort Of Patients Hospitalized With An Acute Coronary Syndrome, Mayra Tisminetsky, Jerry H. Gurwitz, David D. Mcmanus, Jane S. Saczynski, Molly E. Waring, Nathaniel Erskine, Milena D. Anatchkova, David C. Parish, Darleen M. Lessard, Catarina I. Kiefe, Robert J. Goldberg

Molly E. Waring

Background: As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome (ACS).

Methods: We studied 2,174 patients discharged from the hospital after an ACS at 6 medical centers in Massachusetts and Georgia between April, 2011 and May, 2013. Hospital medical records yielded clinical information including presence of 8 cardiac-related and 8 non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments ...


Accumulation Of Metabolic Cardiovascular Risk Factors In Black And White Young Adults Over 20 Years, Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, David C. Goff, Donald Lloyd-Jones 2016 Harvard Medical School

Accumulation Of Metabolic Cardiovascular Risk Factors In Black And White Young Adults Over 20 Years, Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, David C. Goff, Donald Lloyd-Jones

Catarina I. Kiefe

BACKGROUND: Cross-sectional clustering of metabolic risk factors for cardiovascular disease in middle-aged adults is well described, but less is known regarding the order in which risk factors develop through young adulthood and their relation to subclinical atherosclerosis.

METHOD AND RESULTS: A total of 3178 black and white women and men in the Coronary Artery Risk Development in Young Adults study were assessed to identify the order in which cardiovascular disease risk factors including diabetes, hypertension, dyslipidemia (low high-density lipoprotein cholesterol or high triglyceride levels), hypercholesterolemia (high total or low-density lipoprotein cholesterol), and obesity develop. Observed patterns of risk factor development ...


Age And Sex Differences In Long-Term Outcomes Following Implantable Cardioverter-Defibrillator Placement In Contemporary Clinical Practice: Findings From The Cardiovascular Research Network, Frederick A. Masoudi, Jerry H. Gurwitz, Robert J. Goldberg 2016 University of Colorado

Age And Sex Differences In Long-Term Outcomes Following Implantable Cardioverter-Defibrillator Placement In Contemporary Clinical Practice: Findings From The Cardiovascular Research Network, Frederick A. Masoudi, Jerry H. Gurwitz, Robert J. Goldberg

Robert J. Goldberg

BACKGROUND: Patient sex and age may influence rates of death after receiving an implantable cardioverter-defibrillator for primary prevention. Differences in outcomes other than mortality and whether these differences vary by heart failure symptoms, etiology, and left ventricular ejection fraction are not well characterized.

METHODS AND RESULTS: We studied 2954 patients with left ventricular ejection fraction < /=0.35 undergoing first-time implantable cardioverter-defibrillator for primary prevention within the Cardiovascular Research Network; 769 patients (26%) were women, and 2827 (62%) were aged > 65 years. In a median follow-up of 2.4 years, outcome rates per 1000 patient-years were 109 for death, 438 for hospitalization, and 111 for heart failure hospitalizations. Procedure-related complications occurred in 8.36%. In multivariable models, women had significantly lower risks of death (hazard ...


Culturally Adaptive Storytelling Method To Improve Hypertension Control In Vietnam - "We Talk About Our Hypertension": Study Protocol For A Feasibility Cluster-Randomized Controlled Trial, Jeroan J. Allison, Hoa L. Nguyen, Duc A. Ha, German A. Pihan, Ha N. Ly, Hanh T. Tran, Ngoc T. Phan, Nguyen C. Vu, Minjin Kim, Robert J. Goldberg 2016 University of Massachusetts Medical School

Culturally Adaptive Storytelling Method To Improve Hypertension Control In Vietnam - "We Talk About Our Hypertension": Study Protocol For A Feasibility Cluster-Randomized Controlled Trial, Jeroan J. Allison, Hoa L. Nguyen, Duc A. Ha, German A. Pihan, Ha N. Ly, Hanh T. Tran, Ngoc T. Phan, Nguyen C. Vu, Minjin Kim, Robert J. Goldberg

Jeroan J. Allison

BACKGROUND: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. At present, the major risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam; inasmuch, the burden of CVD will continue to increase in this country unless effective prevention and control measures are put in place. A national survey in 2008 found that the prevalence of hypertension (HTN) was approximately 25 % among Vietnamese adults and it increased with advancing age. Therefore, novel, large-scale, and sustainable interventions for public health education to promote engagement in the process of detecting and ...


Can Physician Champions Improve Kangaroo Care? Trends Over 5 Years In Rural Western India, Apurv Soni, Amee Amin, Dipen V. Patel, Nisha Fahey, Ajay G. Phatak, Jeroan Allison, Somashekhar M. Nimbalkar 2016 University of Massachusetts Medical School

Can Physician Champions Improve Kangaroo Care? Trends Over 5 Years In Rural Western India, Apurv Soni, Amee Amin, Dipen V. Patel, Nisha Fahey, Ajay G. Phatak, Jeroan Allison, Somashekhar M. Nimbalkar

Jeroan J. Allison

Introduction: In 2013, approximately 2.8 million children worldwide died within the neonatal period. India is at the epicenter of this tragedy, accounting for one-third of all neonatal mortalities. Prematurity and/or with low birth weight are the leading cause of neonatal mortality and India has the highest number of neonates born preterm and weighing less than 2,500 grams worldwide. It is estimated that Kangaroo Care can avert up to 48% of all neonatal deaths among premature babies by 2025. However, the promise of Kangaroo Care as a low-cost, safe, and efficacious intervention to reduce neonatal mortality in India ...


The Rivas Cohort Study: Design And Baseline Characteristics Of A Nicaraguan Cohort, Madeline Fiore, Amos Lichtman, Keriann Nobil, Louis Fiore 2016 University of Massachusetts Medical School

The Rivas Cohort Study: Design And Baseline Characteristics Of A Nicaraguan Cohort, Madeline Fiore, Amos Lichtman, Keriann Nobil, Louis Fiore

Open Access Articles

BACKGROUND: A lack of advanced healthcare information systems and validated scientific cohorts in Nicaragua makes it difficult to estimate disease prevalences and other public health statistics. Although there is concern of an "epidemic" of chronic kidney disease (CKD) in this country, statistics regarding its magnitude are derived from only a small number of non-representative studies. Budgetary constraints and the logistical problems of maintaining a study cohort make longitudinal studies difficult. The Rivas Cohort was created to measure disease burden of CKD and other public health priorities in the Department of Rivas, Nicaragua. Using primarily volunteer research students and technologic innovation ...


Implementation And Reporting Of Causal Mediation Analysis In 2015: A Systematic Review In Epidemiological Studies, Shao-Hsien Liu, Christine M. Ulbricht, Stavroula A. Chrysanthopoulou, Kate L. Lapane 2016 University of Massachusetts Medical School

Implementation And Reporting Of Causal Mediation Analysis In 2015: A Systematic Review In Epidemiological Studies, Shao-Hsien Liu, Christine M. Ulbricht, Stavroula A. Chrysanthopoulou, Kate L. Lapane

Open Access Articles

BACKGROUND: Causal mediation analysis is often used to understand the impact of variables along the causal pathway of an occurrence relation. How well studies apply and report the elements of causal mediation analysis remains unknown.

METHODS: We systematically reviewed epidemiological studies published in 2015 that employed causal mediation analysis to estimate direct and indirect effects of observed associations between an exposure on an outcome. We identified potential epidemiological studies through conducting a citation search within Web of Science and a keyword search within PubMed. Two reviewers independently screened studies for eligibility. For eligible studies, one reviewer performed data extraction, and ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

UMass Center for Clinical and Translational Science Supported Publications

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Catheter Ablation For Atrial Fibrillation: Predicting Recurrence, Kendra Thomas 2016 The University of Western Ontario

Catheter Ablation For Atrial Fibrillation: Predicting Recurrence, Kendra Thomas

Electronic Thesis and Dissertation Repository

Background

Catheter ablation has emerged as treatment for atrial fibrillation (AF). Health care-related variables have not been explored as predictors of first ablation outcome. Determining factors associated with arrhythmia recurrence may help select patients likely to benefit. The objective was to identify variables associated with recurrence following AF ablation.

Methods

Retrospective cohort design of 314 AF patients who had undergone first ablation. Follow-up visits occurred at 3, 6 and 12 months. Variables and the outcome of recurrence were modeled with Cox proportional hazards analysis.

Results/Conclusions

After mean follow-up of 239+/-125 days, 110/314 patients (35.0%) experienced recurrence ...


Survival Rates In Trauma Patients Following Health Care Reform In Massachusetts, Turner Osler, Laurent G. Glance, Wenjun Li, Jeffery S. Buzas, David W. Hosmer 2016 University of Vermont Medical Center

Survival Rates In Trauma Patients Following Health Care Reform In Massachusetts, Turner Osler, Laurent G. Glance, Wenjun Li, Jeffery S. Buzas, David W. Hosmer

Wenjun Li

IMPORTANCE: Massachusetts introduced health care reform (HCR) in 2006, expecting to expand health insurance coverage and improve outcomes. Because traumatic injury is a common acute condition with important health, disability, and economic consequences, examination of the effect of HCR on patients hospitalized following injury may help inform the national HCR debate. OBJECTIVE: To examine the effect of Massachusetts HCR on survival rates of injured patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 1,520,599 patients hospitalized following traumatic injury in Massachusetts or New York during the 10 years (2002-2011) surrounding Massachusetts HCR using data from the State Inpatient ...


A 35-Year Perspective (1975 To 2009) Into The Long-Term Prognosis And Hospital Management Of Patients Discharged From The Hospital After A First Acute Myocardial Infarction, Han-Yang Chen, Joel Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Jerry H. Gurwitz, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

A 35-Year Perspective (1975 To 2009) Into The Long-Term Prognosis And Hospital Management Of Patients Discharged From The Hospital After A First Acute Myocardial Infarction, Han-Yang Chen, Joel Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Jerry H. Gurwitz, Catarina I. Kiefe, Robert J. Goldberg

Robert J. Goldberg

There are limited population-based data available describing trends in the long-term prognosis of patients discharged from the hospital after an initial acute myocardial infarction (AMI). Our objectives were to describe multidecade trends in post-discharge mortality and their association with hospital management practices in patients discharged from all medical centers in Central Massachusetts after a first AMI. Residents of the Worcester, Massachusetts, metropolitan area discharged from all hospitals in Central Massachusetts after a first AMI from 1975 to 2009 comprised the study population (n = 8,728). Multivariable-adjusted logistic regression analyses were used to examine the association between year of hospitalization and ...


The Impact Of Changing Guidelines On Prostate Cancer Screening In A Population-Based Setting, 2000-2014, Daniel M. Frendl, Mara M. Epstein, Hassan Fouayzi, Richard Krajenta, Benjamin A. Rybicki, Mitchell H. Sokoloff 2016 University of Massachusetts Medical School

The Impact Of Changing Guidelines On Prostate Cancer Screening In A Population-Based Setting, 2000-2014, Daniel M. Frendl, Mara M. Epstein, Hassan Fouayzi, Richard Krajenta, Benjamin A. Rybicki, Mitchell H. Sokoloff

UMass Center for Clinical and Translational Science Research Retreat

Introduction: This study evaluates the potential impact of the publication of conflicting prostate cancer (PCa) screening trial results in 2009 and changes to the US Preventive Services Task Force (USPSTF) guidelines to recommend against screening in 2012 on temporal trends in PSA testing at two participating sites in the NCI-funded Cancer Research Network.

Methods: Study participants were men aged 40-80 without a history of PCa who sought care at Fallon Health (Worcester, MA) or Henry Ford Health System (Detroit, MI) between 2000-2014. We used health claims and electronic health record data to identify men who underwent PSA testing per calendar ...


Total Hip Arthroplasty And Mental Health Status, Uyen-Sa D.T. Nguyen, Thomas Perneger, Patricia D. Franklin, Christophe Barea, Pierre Hoffmeyer, Anne Lubbeke 2016 University of Massachusettts Medical School

Total Hip Arthroplasty And Mental Health Status, Uyen-Sa D.T. Nguyen, Thomas Perneger, Patricia D. Franklin, Christophe Barea, Pierre Hoffmeyer, Anne Lubbeke

UMass Center for Clinical and Translational Science Research Retreat

Purpose. Total hip arthroplasty (THA) effectively restores function and alleviates pain in patients with end-stage hip osteoarthritis. Pain affects mood through its effect on disability and fatigue. Few studies have examined mental health as a consequence of pain or function after THA. We assessed change in mental health 1-year post-surgery, and examined whether change in pain and function predict change in mental health.

Methods. We used data from a prospective THA registry that began in 1996 at a large public Geneva University hospital. We included surgeries performed 2010 and 2012-2014, with demographic information, body mass index (BMI), co-morbidities, baseline and ...


Racial/Ethnic Disparities In Meeting 5-2-1-0 Recommendations Among Adolescents In The United States, Christina Haughton, Stephenie C. Lemon 2016 University of Massachusetts Medical School

Racial/Ethnic Disparities In Meeting 5-2-1-0 Recommendations Among Adolescents In The United States, Christina Haughton, Stephenie C. Lemon

UMass Center for Clinical and Translational Science Research Retreat

BACKGROUND: Obesity prevention has become a major focus of public health efforts in the United States. The Federal Government set forth national nutrition and physical activity recommendations to prevent obesity and promote well-being among children. A succinct message developed through a program in Maine “Let’s Go! 5-2-1-0” summarizes these obesity prevention behaviors including ≥5 fruit and vegetables, ≤2 hours of screen time, ≥1 hour of physical activity, and 0 sugar sweetened beverages daily. The study evaluates racial/ethnic disparities among adolescents meeting the 5-2-1-0 targets in a nationally representative sample.

METHODS: The 2011-2012 NHANES dataset was used to conduct ...


Sedentary Behavior And Cardiovascular Disease Risk Factors Among Latino Adults, Valerie J. Silfee, Stephenie C. Lemon, Vilma Lora, Milagros C. Rosal 2016 University of Massachusetts Medical School

Sedentary Behavior And Cardiovascular Disease Risk Factors Among Latino Adults, Valerie J. Silfee, Stephenie C. Lemon, Vilma Lora, Milagros C. Rosal

UMass Center for Clinical and Translational Science Research Retreat

Background: Compared to other racial/ethnic subgroups in the U.S., Latinos experience increased rates of cardiovascular disease (CVD) and CVD risk factors such as hypertension, inactivity, and diabetes. Sedentary behavior has also been defined as an additional risk factor for CVD, independent of physical activity participation. However, while sedentary behavior has been associated with increased risk for CVD among primarily White samples, previous studies in Latinos have shown mixed results.

Purpose: To explore the relationships between sedentary behavior and CVD risk factors, including BMI, waist circumference, blood pressure, physical activity, dyslipidemia, and diabetes, among a sample of Latino adults ...


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