Digital Commons Network^™

Hpv Vaccine Reminders At The Point Of Service: Efficacy And Missed Opportunities. A Claims Based Study Within One Health Plan, B. Dale Magee, Katherine G. Leung, Tiffany A. Moore Simas

B. Dale Magee

Introduction: Our objective is to assess HPV vaccine series completion rates, whether on-screen Point of Service reminders (POS) make a difference, and missed opportunities for reminders to have an effect. Methods: Retrospective, claims-based study of females aged 9-26 receiving an initial dose of HPV vaccine during 2 periods: before (period 1) and after (period 2) implementation of a POS reminder system in 1(“Change Group”) of 2 physician groups using EHRs for both periods. Completion rates, and missed opportunities during eligible periods were calculated for those with continuous enrollment in the health plan investigated. Results: Completion rates within 1 year of …

Identifying Disparities In Colorectal Cancer Screening Rates In Milwaukee-Based Academic And Nonacademic Clinics, Jasmine Wiley, Jonathan J. Blaza, Will Lehmann, Deborah Simpson, Jeffrey A. Stearns, Shelby L. Pischke, Tracy L. Greiten

Aurora Family Medicine Residents

Background: The Institute for Healthcare Improvement’s Triple Aim focuses on improving the patient’s experience of care, improving population health and reducing the per capita cost of health care. Health care systems and providers continuously seek to improve quality of care through understanding what percentage of their patients are achieving quality-of-care standards for various indicators, including immunizations, tobacco cessation, asthma and cancer screening. As health care moves toward reimbursing for value-based care, deepening our understanding of patient population characteristics within each of these conditions is vital to continuous quality improvement.

Purpose: To determine if there are race/ethnicity/age/preferred language (REAL) disparities in …

Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg

Catarina I. Kiefe

OBJECTIVES: The purpose of this study was to examine decade-long trends (2001-2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI).

METHODS: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED) …

Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg

Jorge L. Yarzebski

OBJECTIVES: The purpose of this study was to examine decade-long trends (2001-2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI). METHODS: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED) …

A Delphi Process To Address Medication Appropriateness For Older Persons With Multiple Chronic Conditions, Terri R. Fried, Kristina Niehoff, Jennifer Tjia, Nancy Redeker, Mary K. Goldstein

Jennifer Tjia

BACKGROUND: Frameworks exist to evaluate the appropriateness of medication regimens for older patients with multiple medical conditions (MCCs). Less is known about how to translate the concepts of the frameworks into specific strategies to identify and remediate inappropriate regimens.

METHODS: Modified Delphi method involving iterative rounds of input from panel members. Panelists (n = 9) represented the disciplines of nursing, medicine and pharmacy. Included among the physicians were two geriatricians, one general internist, one family practitioner, one cardiologist and two nephrologists. They participated in 3 rounds of web-based anonymous surveys.

RESULTS: The panel reached consensus on a set of markers …

Deriving An Indoor Environmental Index For Portuguese Office Buildings, João F. Gomes

João F Gomes

No abstract provided.

It’S Not A Small World After All: Regulating Obesity Globally, Eloisa Rodriguez-Dod

Eloisa C Rodríguez-Dod

The rate of obesity and overweight among the world population has increased dramatically over the past several years in both adults and children. Childhood obesity is a critical health care concern. There have been well-publicized efforts to regulate children‘s obesity both in the U.S. and abroad through such measures as mandated nutritional school lunch programs. This article focuses, however, on a less examined area of regulation—the recent worldwide efforts to curb obesity among adults. The regulations discussed in this article include measures proposed or adopted by either administrative agencies or legislative bodies, whether on a local or national level. The …

Correlates Of Hiv Acquisition In A Cohort Of Black Men Who Have Sex With Men In The United States: Hiv Prevention Trials Network (Hptn) 061, Beryl A. Koblin, Kenneth H. Mayer, Susan H. Eshleman, Lei Wang, Sharon B. Mannheimer, Carlos Del Rio, Steve Shoptaw, Manya Magnus, Susan Buchbinder, Leo Wilton, Ting-Yuan Liu, Vanessa Cummings, Estelle Piwowar-Manning, Sheldon D. Fields, Sam Griffith, Vanessa Elharrar, Darrell Wheeler

Leo Wilton

Background

Black men who have sex with men (MSM) in the United States (US) are affected by HIV at disproportionate rates compared to MSM of other race/ethnicities. Current HIV incidence estimates in this group are needed to appropriately target prevention efforts.

Methods

From July 2009 to October 2010, Black MSM reporting unprotected anal intercourse with a man in the past six months were enrolled and followed for one year in six US cities for a feasibility study of a multi-component intervention to reduce HIV infection. HIV incidence based on HIV seroconversion was calculated as number of events/100 person-years. Multivariate proportional …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Carolyn A. Curtis, MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

The Relative Value Of Measures Of Omega-3 Index, Perceived Stress, Cortisol And Sleep Time In Identifying Depression Among A Cohort Of Australian Adolescents, Ross Grant, Ayse Bilgin, Jade Guest, Margaret J. Morris, Manohar Garg, Robyn Pearce

Robyn Pearce

Objective: To assess the relative prognostic value of 11 variables including, omega-3, perceived stress, cortisol and sleep duration, in predicting adolescent depression. Design, Setting and Participants: A cross-sectional study of 444 healthy adolescents aged 16-18 years, from 10 schools within the Northern Sydney and Central Coast regions of New South Wales, Australia. Participants provided blood and saliva samples and completed questionnaires. Statistical classification methods were used to model the relationships between the predictors and depression. Main Outcome Measures: relative predictive value of each variable in correctly classifying depression. Results: 6% of boys and 9% of girls were categorised as experiencing …

Exercise-Related Transient Abdominal Pain, Darren Morton, Robin Callister

Darren Morton

Exercise-related transient abdominal pain (ETAP), commonly referred to as “stitch”, is an ailment well known in many sporting activities. It is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. Approximately 70% of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition. ETAP is a well-localized pain that is most common in the lateral aspects of the mid abdomen along the costal border, although it may occur in any …

Salmonellosis Outbreak Linked To The Consumption Of Fried Ice-Cream, Lillian Kent, J Gregory, M Patel

Lillian Kent

On 8 April 2011, the Communicable Disease Prevention and Control Unit (CDPCU) of the Victorian Department of Health was advised that three adolescents from the same family had been admitted to a metropolitan hospital for treatment of dehydration secondary to diarrhoea. Other symptoms included fever and vomiting. Initial enquires suggested that the adolescents may have become infected after eating fried eggs for breakfast at their aunt’s home over three consecutive days, or dinner at a Chinese restaurant. Six days later two more notifications of salmonellosis were received by CDPCU; both cases had eaten at the same Chinese restaurant. Also on …

Impact Of Electronic Health Records On Patient Outcomes, Lilian Ndifon, Jude E. Edwards, Leila Halawi

Leila A. Halawi

With the passing of the HITECH Act, EHRs have come into prominence and sharper focus, due to efforts by the government to push for a national adoption of EHRs into our healthcare system. This push for a national adoption of EHRs is based on the premise that it will help improve the quality delivery of health care services and reduce costs. However, this push for a “national adoption” has experienced mixed results. This study was designed to assess the impact of EHRs post-2009, the year of the HITECH Act, to review some of the key contributing factors to this mixed …

Profiling Work Health And Safety Incidents And Injuries In Australian Army Personnel: An Investigation Of Injuries And Other Incidents Suffered By Army Reserve Personnel, Rob Marc Orr, Rodney Pope, Ben Schram, Dylan Macdonald, Wayne Hing

Ben Schram

The Army reserve soldier is an integral part of overall Army capability and functioning. Although only becoming full-time when participating in training exercises or when called on for operations, these personnel are generally expected to perform at a level commensurate with full-time soldiers of the same rank and trade. Due to their transitions between civilian and military employments, they are typically exposed to less chronic military physical conditioning than their full-time counterparts. This reduced chronic conditioning, but requirement to perform the same tasks at the same level as full-time soldiers, may leave the reserve soldier at a higher risk of …

Tobacco-Free Healthcare Policy Assessment Tool And Scoring Guide, Heidi Mennenga, Linda Burdette, Jennifer Kerkvliet, Jenna Cowan, Nancy Swenson

Linda Burdette

The Tobacco-Free Healthcare Assessment Tool is a standardized method to assess the comprehensiveness of tobacco-free or smoke-free policies in healthcare settings. Each policy is scored in the following four areas: Policy Communication, Environment, Enforcement, and Cessation Services. A fifth non-rated section includes two additional items related to emerging trends in tobacco control.

Profiling Work Health And Safety Incidents And Injuries In Australian Army Personnel: An Investigation Of Injuries And Other Incidents Suffered By Army Reserve Personnel, Rob Marc Orr, Rodney Pope, Ben Schram, Dylan Macdonald, Wayne Hing

Wayne Hing

The Army reserve soldier is an integral part of overall Army capability and functioning. Although only becoming full-time when participating in training exercises or when called on for operations, these personnel are generally expected to perform at a level commensurate with full-time soldiers of the same rank and trade. Due to their transitions between civilian and military employments, they are typically exposed to less chronic military physical conditioning than their full-time counterparts. This reduced chronic conditioning, but requirement to perform the same tasks at the same level as full-time soldiers, may leave the reserve soldier at a higher risk of …

Cjcheck Stage 1: Development And Testing Of A Checklist For Reporting Community Juries - Delphi Process And Analysis Of Studies Published In 1996-2015, Rae Thomas, Rebecca Sims, Chris Degeling, Jackie M Street, Stacy M Carter, Lucie Rychetnik, Jennifer A Whitty, Andrew Wilson, Paul Ward, Paul Glasziou

Paul Glasziou

BACKGROUND: Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer-reviewed literature is unknown. Adequate reporting of methodology enables others to judge process quality, compare outcomes, facilitate critical reflection and potentially repeat a process. We aimed to identify important elements for reporting CJs, to develop an initial checklist and to review published health and health policy CJs to examine reporting standards. DESIGN: Using the literature and expertise from CJ researchers and policy …

Cjcheck Stage 1: Development And Testing Of A Checklist For Reporting Community Juries - Delphi Process And Analysis Of Studies Published In 1996-2015, Rae Thomas, Rebecca Sims, Chris Degeling, Jackie M Street, Stacy M Carter, Lucie Rychetnik, Jennifer A Whitty, Andrew Wilson, Paul Ward, Paul Glasziou

Rae Thomas

BACKGROUND: Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer-reviewed literature is unknown. Adequate reporting of methodology enables others to judge process quality, compare outcomes, facilitate critical reflection and potentially repeat a process. We aimed to identify important elements for reporting CJs, to develop an initial checklist and to review published health and health policy CJs to examine reporting standards. DESIGN: Using the literature and expertise from CJ researchers and policy …

Aca Implementation In Metro Louisville: Outreach And Enrollment, Susan Buchino, Liza Creel

Susan Buchino

Training For Tactical Operations In Tropical Environments: Challenges, Risks, & Strategies For Risk Management, Rodney Pope, Rob Orr, Anthony Walker, Shane D. Irving, Ralph P. Jones, Richard J. Gorey, Scott D. Gayton, Joseph Knapik

Rob Marc Orr

Tactical operators, encompassing military, law enforcement, fire and other emergency personnel, can be found in all climatic zones. These tactical operators may be deployed at short notice to tropical environments, often with limited time to acclimatise if based in more temperate zones. They are then expected to undertake arduous tactical tasks, often repeatedly and for extended periods in the tropical area. These demands combine with harsh environments, personal protective equipment (PPE), tactical loads, threats to life, and responsibility for the safety and survival of others to place immense physical and mental stresses on tactical operators. Managing the resulting risks is …

Decade Long Trends (2001-2011) In Duration Of Pre-Hospital Delay Among Elderly Patients Hospitalized For An Acute Myocardial Infarction, Raghavendra Makam, Nathaniel Erskine, Jorge L. Yarzebski, Darleen M. Lessard, Jason Lau, Jeroan J. Allison, Joel M. Gore, Jerry H. Gurwitz, David D. Mcmanus, Robert J. Goldberg

Jorge L. Yarzebski

BACKGROUND: Early intervention with medical and/or coronary revascularization treatment approaches remains the cornerstone of the management of patients hospitalized with acute myocardial infarction (AMI). However, several patient groups, especially the elderly, are known to delay seeking prompt medical care after onset of AMI-associated symptoms. Current trends, and factors associated with prolonged prehospital delay among elderly patients hospitalized with AMI, are incompletely understood.

METHODS AND RESULTS: Data from a population-based study of patients hospitalized at all 11 medical centers in central Massachusetts with a confirmed AMI on a biennial basis between 2001 and 2011 were analyzed. Information about duration of prehospital …

The Future Of Teratology Research Is In Vitro, Jarrod Bailey, Andrew Knight, Jonathan Balcombe

Jarrod Bailey, PhD

Birth defects induced by maternal exposure to exogenous agents during pregnancy are preventable, if the agents themselves can be identified and avoided. Billions of dollars and manhours have been dedicated to animal-based discovery and characterisation methods over decades. We show here, via a comprehensive systematic review and analysis of this data, that these methods constitute questionable science and pose a hazard to humans. Mean positive and negative predictivities barely exceed 50%; discordance among the species used is substantial; reliable extrapolation from animal data to humans is impossible, and virtually all known human teratogens have so far been identified in spite …

Animal Carcinogenicity Studies: Implications For The Reach System, Andrew Knight, Jarrod Bailey, Jonathan Balcombe

Jarrod Bailey, PhD

The 2001 European Commission proposal for the Registration, Evaluation and Authorisation of Chemicals (REACH) aims to improve public and environmental health by assessing the toxicity of, and restricting exposure to, potentially toxic chemicals. The greatest benefits are expected to accrue from decreased cancer incidences. Hence the accurate identification of chemical carcinogens must be a top priority for the REACH system. Due to a paucity of human clinical data, the identification of potential human carcinogens has conventionally relied on animal tests. However, our survey of the US Environmental Protection Agency’s (EPA’s) toxic chemicals database revealed that, for a majority of the …

Animal Carcinogenicity Studies: 1. Poor Human Predictivity, Andrew Knight, Jarrod Bailey, Jonathan Balcombe

Jarrod Bailey, PhD

The regulation of human exposure to potentially carcinogenic chemicals constitutes society’s most important use of animal carcinogenicity data. Environmental contaminants of greatest concern within the USA are listed in the Environmental Protection Agency’s (EPA’s) Integrated Risk Information System (IRIS) chemicals database. However, of the 160 IRIS chemicals lacking even limited human exposure data but possessing animal data that had received a human carcinogenicity assessment by 1 January 2004, we found that in most cases (58.1%; 93/160), the EPA considered animal carcinogenicity data inadequate to support a classification of probable human carcinogen or non-carcinogen. For the 128 chemicals with human or …

Generalizing Evidence From Randomized Trials Using Inverse Probability Of Sampling Weights, Ashley L. Buchanan, Michael G. Hudgens, Stephen R. Cole, Katie R. Mollan, Paul E. Sax, Eric S. Daar, Adaora A. Adimora, Joseph J. Eron, Michael J. Mugavero

Ashley Buchanan

Barriers And Facilitators To Deaf Trauma Survivors’ Help-Seeking Behavior: Lessons For Behavioral Clinical Trials Research: A Master’S Thesis, Melissa L. Anderson

Melissa L. Anderson

Deaf individuals experience significant obstacles to participating in behavioral health research when careful consideration is not given to accessibility in the design of study methodology. To inform such considerations, we conducted a secondary analysis of a mixed-methods study that explored 16 Deaf trauma survivors’ help-seeking experiences. Our objective was to identify key findings and qualitative themes from consumers' own words that can be applied to the design of behavioral clinical trials methodology. In many ways, the themes that emerged are what we would expect of any research participant, Deaf or hearing – a need for communication access, empathy, respect, strict …

Project Breakfast: Rationale, Design, And Recruitment And Enrollment Methods Of A Randomized Controlled Trial To Improve Access To The School Breakfast Program In Rural High Schools, Marilyn S. Nanney, Amy Shanafelt, Qi Wang, Robert Leduc, Mary Hearst, Martha Y. Kubik, Ellen Dodds, Katherine Grannon, Lisa Harnack

Mary Hearst

No abstract provided.

A Functional Movement Screen Profile Of An Australian State Police Force: A Retrospective Cohort Study, Robin Marc Orr, Rodney Pope, Michael Stierli, Ben Hinton

Rodney P Pope

Background Police officers are required to perform dynamic movements in unpredictable environments, the results of which can lead to injury. Early identification of poor movement patterns of a police population, and potential sub groups within this population, may provide opportunities to treat and minimise injury risks. The aim of this study was to profile the functional movement capabilities of an Australian state police force and potential sub groups through a retrospective cohort study. Methods Retrospective data from an Australian State Police Force were provided for analysis (♂ n = 1155, mean (±SD) age = 31.34 ± 8.41 years: ♀ n …

A Comparison Of Fitness Scores Between Injured And Uninjured Police Cadets., J. Jay Dawes, Robin Orr, Rodney Pope, Craig Elder

Rodney P Pope

Purpose: The purpose of this investigation was to determine whether there were significant mean score differences on selected fitness tests between cadets who sustained an injury while attending a 27-week state patrol training academy and their uninjured counterparts. Methods: Archival data for eighty-one cadets from two 27-week state patrol training cohorts were utilized for this analysis. This data was collected as part of the agency’s normal training academy fitness assessment prior to commencement of training. The data included self-reported age (yrs); height (in) and weight (lbs); and push-up, sit-up, vertical jump and 20 meter multi-stage fitness test (20m-MSFT) scores. Injury …

A Comparison Of Fitness Scores Between Injured And Uninjured Police Cadets., J. Jay Dawes, Robin Orr, Rodney Pope, Craig Elder

Rob Marc Orr

Purpose: The purpose of this investigation was to determine whether there were significant mean score differences on selected fitness tests between cadets who sustained an injury while attending a 27-week state patrol training academy and their uninjured counterparts. Methods: Archival data for eighty-one cadets from two 27-week state patrol training cohorts were utilized for this analysis. This data was collected as part of the agency’s normal training academy fitness assessment prior to commencement of training. The data included self-reported age (yrs); height (in) and weight (lbs); and push-up, sit-up, vertical jump and 20 meter multi-stage fitness test (20m-MSFT) scores. Injury …