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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 ...


Predictive Value Of The Functional Movement Screen As It Relates To Anterior Cruciate Ligament Injury, Daniel A. Herring, Kyle D. Cherry, Hannah L. Stedge 2016 Cedarville University

Predictive Value Of The Functional Movement Screen As It Relates To Anterior Cruciate Ligament Injury, Daniel A. Herring, Kyle D. Cherry, Hannah L. Stedge

Hannah L. Stedge, M.S.

Introduction: Anterior cruciate ligament injuries occur over 200,000 times annually in the United States alone (Brophy, et al. 2009). This injury strains the healthcare system and affects the players, teams, parents, and the organization they are a part of. There have been, however, clinically researched risk factors that predispose athletes to ACL injury (Gignac, et al. 2015; Laible, et al. 2014). As a result, there is a clinical need for an effective screening tool to identify those athletes at risk for ACL injury. The Functional Movement Screen has been shown to be an effective screening tool for detecting athletes ...


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 ...


Angina Characteristics As Predictors Of Trajectories Of Quality Of Life Following Acute Coronary Syndrome In The Transitions, Risks And Actions In Coronary Events-Center For Outcomes Research And Education Cohort (Trace-Core), Lisa Nobel, Jennifer Tjia, Jane S. Saczynski, Molly E. Waring, Milena D. Anatchkova, Arlene Ash, Catarina I. Kiefe, Jeroan Allison 2016 University of Massachusettts Medical School

Angina Characteristics As Predictors Of Trajectories Of Quality Of Life Following Acute Coronary Syndrome In The Transitions, Risks And Actions In Coronary Events-Center For Outcomes Research And Education Cohort (Trace-Core), Lisa Nobel, Jennifer Tjia, Jane S. Saczynski, Molly E. Waring, Milena D. Anatchkova, Arlene Ash, Catarina I. Kiefe, Jeroan Allison

UMass Center for Clinical and Translational Science Research Retreat

BACKGROUND: To describe longitudinal trajectories of health-related quality of life (HRQoL) after hospitalization with an acute coronary syndrome (ACS), their associations with baseline angina characteristics, and associations with anxiety, depression, and cognitive impairment.

METHODS: TRACE-CORE participants (N=1,613) completed the SF-36 during hospitalization for ACS and 1, 3, & 6 months post-discharge. Latent growth curves identified trajectories of physical and mental components of HRQOL (MCS and PCS) and sequential multiple logistic regression estimated associations between trajectories and angina characteristics.

RESULTS: Participants (N=1613) had mean age 63.3 (SD 11.4) years, 33.0% female, and 78.2% non-Hispanic white. We identified 2 MCS trajectories: AVERAGE and IMPAIRED HRQoL. The majority of participants (81.0%) had AVERAGE MCS at baseline (mean MCS 53.6) and slight improvement in scores over time. A minority (19.0%) had IMPAIRED HRQoL at baseline (mean MCS 36.7) and slight improvement in scores over time. We identified 2 similar PCS trajectories with similar patterns of scores over time: AVERAGE (71.1%) and IMPAIRED (28.9%) HRQoL at baseline. Adjusting for demographics & comorbidities, patients with less severe baseline angina were more likely to have AVERAGE MCS (odds ratio [OR]/10 unit change in severity 1.1) and PCS (OR 1.1) trajectories, and similarly for less frequent angina (MCS OR 1.2; PCS OR 1.3). The associations of MCS trajectory with severity and frequency lost significance after adjusting for psychosocial factors, whereas the PCS associations remained significant [All p < 0.05 unless noted].

CONCLUSIONS: About 1/3 of patients exhibited impaired 6-month HRQoL trajectories, which can be predicted by angina characteristics. Psychosocial factors may explain the ...


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

UMass Center for Clinical and Translational Science Research Retreat

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 ...


Impact Of Multimorbidity On Clinical Outcomes In Older Adults With Cardiovascular Disease, Mayra Tisminetsky, Robert J. Goldberg, Jerry H. Gurwitz 2016 University of Massachusetts Medical School

Impact Of Multimorbidity On Clinical Outcomes In Older Adults With Cardiovascular Disease, Mayra Tisminetsky, Robert J. Goldberg, Jerry H. Gurwitz

UMass Center for Clinical and Translational Science Research Retreat

Objective: To synthesize the current literature on the magnitude and impact of multiple chronic conditions on clinical outcomes, including total in-hospital and post discharge mortality and hospitalizations, in older patients with cardiovascular disease (CVD).

Methods: A systematic review was conducted. Four electronic databases and article bibliographies were searched for publications from 2005 to 2015 which assessed the impact of multimorbidity on clinical outcomes in the elderly with CVD. Identified studies were screened using pre-defined criteria for eligibility.

Results: Fifteen studies met our inclusion criteria. Multimorbidity was assessed by simple counting of morbidities and by the Charlson and Elixhauser indices. Case-fatality ...


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

UMass Center for Clinical and Translational Science Research Retreat

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 ...


Role Of Tsh And Excess Heart Age In Predicting Atrial Fibrillation Recurrence Post-Ablation, Aditya Vaze, Adedotun Ogunsua, Jakub Pach, David D. McManus 2016 University of Massachusetts Medical School

Role Of Tsh And Excess Heart Age In Predicting Atrial Fibrillation Recurrence Post-Ablation, Aditya Vaze, Adedotun Ogunsua, Jakub Pach, David D. Mcmanus

UMass Center for Clinical and Translational Science Research Retreat

Background: The association between atrial fibrillation (AF) and thyroid disease as defined by thyroid stimulating hormone (TSH) is established in literature. However, the relationship between TSH and recurrence of AF post ablation has not been established.

Methods: We studied 207 patients (60.54±9.39yrs, 35.7% female) with persistent or paroxysmal AF who underwent either Cryo or RFA ablation between April 2011 and Jan 2015 at our center. Patients were stratified into hypothyroid (TSH > >4.5 U/mL), euthyroid (TSH 0.5-4.5 U/mL) and hyperthyroid (TSH < 0.5 U/mL) based on pre procedure testing. Heart age was computed based on Framingham risk factors. Excess heart age was defined as the difference between actual age and heart age. Logistic regression and cox-proportional hazards model were implemented using R statistical software (v3.2.0).

Results: There was a statistically significant lower rate of AF recurrence ...


Keynote Address: The Future Of Cardiovascular Epidemiology: Current Trends?, Vasan S. Ramachandran 2016 Boston University School of Medicine

Keynote Address: The Future Of Cardiovascular Epidemiology: Current Trends?, Vasan S. Ramachandran

UMass Center for Clinical and Translational Science Research Retreat

This is the Research Retreat's Keynote presentation by Vasan S. Ramachandran, MD, who is Principal Investigator and Co-Director, Echocardiography/Vascular Laboratory, Framingham Heart Study. Dr. Ramachandran is also Chief, Section of Preventive Medicine and Epidemiology and Professor of Medicine, Boston University School of Medicine. Dr. Ramachandran discusses the future of cardiovascular epidemiology, including the roles of: cHealth (community), sHealth (social), mHealth (mobile), eHealth (electronic), and gHealth (genomic).


Decade-Long Trends (1999-2009) In The Characteristics, Management, And Hospital Outcomes Of Patients Hospitalized With Acute Myocardial Infarction With Prior Diabetes And Chronic Kidney Disease, Mayra Tisminetzky, David D. McManus, Alon Dor, Ruben Miozzo, Jorge L. Yarzebski, Joel M. Gore, Robert J. Goldberg 2016 University of Massachusetts Medical School

Decade-Long Trends (1999-2009) In The Characteristics, Management, And Hospital Outcomes Of Patients Hospitalized With Acute Myocardial Infarction With Prior Diabetes And Chronic Kidney Disease, Mayra Tisminetzky, David D. Mcmanus, Alon Dor, Ruben Miozzo, Jorge L. Yarzebski, Joel M. Gore, Robert J. Goldberg

Robert J. Goldberg

BACKGROUND: Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999-2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities.

METHODS: We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all ...


Decade-Long Trends (1999-2009) In The Characteristics, Management, And Hospital Outcomes Of Patients Hospitalized With Acute Myocardial Infarction With Prior Diabetes And Chronic Kidney Disease, Mayra Tisminetzky, David D. McManus, Alon Dor, Ruben Miozzo, Jorge L. Yarzebski, Joel M. Gore, Robert J. Goldberg 2016 University of Massachusetts Medical School

Decade-Long Trends (1999-2009) In The Characteristics, Management, And Hospital Outcomes Of Patients Hospitalized With Acute Myocardial Infarction With Prior Diabetes And Chronic Kidney Disease, Mayra Tisminetzky, David D. Mcmanus, Alon Dor, Ruben Miozzo, Jorge L. Yarzebski, Joel M. Gore, Robert J. Goldberg

Jorge L. Yarzebski

BACKGROUND: Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999-2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities.

METHODS: We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all ...


Decade-Long Trends (1999-2009) In The Characteristics, Management, And Hospital Outcomes Of Patients Hospitalized With Acute Myocardial Infarction With Prior Diabetes And Chronic Kidney Disease, Mayra Tisminetzky, David D. McManus, Alon Dor, Ruben Miozzo, Jorge L. Yarzebski, Joel M. Gore, Robert J. Goldberg 2016 University of Massachusetts Medical School

Decade-Long Trends (1999-2009) In The Characteristics, Management, And Hospital Outcomes Of Patients Hospitalized With Acute Myocardial Infarction With Prior Diabetes And Chronic Kidney Disease, Mayra Tisminetzky, David D. Mcmanus, Alon Dor, Ruben Miozzo, Jorge L. Yarzebski, Joel M. Gore, Robert J. Goldberg

David D. McManus

BACKGROUND: Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999-2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities.

METHODS: We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all ...


"What's App?" Utilizing Evidence Based Medicine Apps In The Clinical Setting, Kathryn C. O'Donovan 2016 Butler University

"What's App?" Utilizing Evidence Based Medicine Apps In The Clinical Setting, Kathryn C. O'Donovan

BU Well

The medical community has utilized evidence-based medicine, or EBM, in practice for decades, and healthcare personnel are used to the idea of utilizing research and statistics to determine the treatment of patients. However, as technology advances, the use of electronics and EBM apps has increased in the clinical setting. While there are advantages to clinicians having resources at their fingertips as they talk with patients, there are also hurdles that could harm or offend patients. So as healthcare inevitably becomes more and more electronic, can providers strike the balance needed to effectively use EBM apps in practice to provide optimum ...


Cohort Profile: The Nicotine Dependence In Teens (Ndit) Study, Jennifer O'Loughlin, Joseph R. DiFranza, Robert J. Wellman 2016 University of Montreal

Cohort Profile: The Nicotine Dependence In Teens (Ndit) Study, Jennifer O'Loughlin, Joseph R. Difranza, Robert J. Wellman

Robert J. Wellman

The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999-2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007-08 and ...


Geographic Distribution Of Maternal Group B Streptococcus Colonization And Infant Death During Birth Hospitalization: Eastern Wisconsin, Jessica J. F. Kram, Dennis J. Baumgardner, Kiley B. Vander Wyst, Melissa A. Lemke 2016 Aurora Health Care

Geographic Distribution Of Maternal Group B Streptococcus Colonization And Infant Death During Birth Hospitalization: Eastern Wisconsin, Jessica J. F. Kram, Dennis J. Baumgardner, Kiley B. Vander Wyst, Melissa A. Lemke

Dennis J. Baumgardner. MD

Purpose

Maternal group B Streptococcus (GBS) can be transmitted from a colonized mother to newborn during vaginal delivery and may or may not contribute to infant death. This study aimed to explore the geographic distribution and risk factors of maternal GBS colonization and infant death during birth hospitalization.

Methods

We retrospectively studied mothers with live birth(s) in a large eastern Wisconsin hospital system from 2007 through 2013. Associations between maternal and neonatal variables, GBS colonization and infant death were examined using chi-squared, Mann-Whitney U and t-tests. Multivariable logistic regression models also were developed.

Results

Study population (N = 99,305 ...


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