Digital Commons Network^™

Association Between Socioeconomic Factors, Race, And Use Of A Specialty Memory Clinic, Abigail Lewis, Aditi Gupta, Inez Oh, Suzanne E. Schindler, Nupur Ghoshal, Zachary Abrams, Randi Foraker, Barbara Joy Snider, John C. Morris, Joyce Balls-Berry, Mahendra Gupta, Philip R. O. Payne, Albert M. Lai

2020-Current year OA Pubs

BACKGROUND AND OBJECTIVES: The capacity of specialty memory clinics in the United States is very limited. If lower socioeconomic status or minoritized racial group is associated with reduced use of memory clinics, this could exacerbate health care disparities, especially if more effective treatments of Alzheimer disease become available. We aimed to understand how use of a memory clinic is associated with neighborhood-level measures of socioeconomic factors and the intersectionality of race.

METHODS: We conducted an observational cross-sectional study using electronic health record data to compare the neighborhood advantage of patients seen at the Washington University Memory Diagnostic Center with the …

Race Differences In Pain And Pain-Related Risk Factors Among Former Professional American-Style Football Players., Robert R. Edwards, Can Ozan Tan, Inana Dairi, Alicia J. Whittington, Julius Dewayne Thomas, Claudia M. Campbell, Edgar Ross, Herman A. Taylor, Marc Weisskopf, Aaron L. Baggish, Ross Zafonte, Rachel Grashow

Faculty Articles

The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of …

Review Of Toxocariasis At A Children's Hospital Prompting Need For Public Health Interventions, Karina M Robinson, Megan N Carey, Sarah J Smith, Brendan Sullivan, Alisa R Nelson, Sarah M Gunter, Jill E Weatherhead

Faculty, Staff and Students Publications

BACKGROUND: Toxocariasis, caused the by dog and cat roundworm, is one of the most common zoonotic helminth infections in the United States and can lead to severe lifelong morbidity in children. Although historical seroprevalence studies have identified a high frequency of toxocariasis regionally in the United States, there are few studies linking epidemiology and clinical disease in children. The study objective was to examine the contemporary epidemiology of pediatric toxocariasis within an endemic US region.

METHODS: We conducted an epidemiologic study analyzing children diagnosed with toxocariasis presenting to a tertiary pediatric hospital in Texas from 2010 to 2021. We examined …

The Pre-Adaptation Of A Stroke-Specific Self-Management Program Among Older Adults, Monique R Pappadis, Rachel R Deer, Chih-Ying Li, Ickpyo Hong, Annalisa Na, Sara Nowakowski, Hashem M Shaltoni, Suresh K Bhavnani

Faculty, Staff and Students Publications

Objectives:

Managing multimorbidity as aging stroke patients is complex; standard self-management programs necessitate adaptations. We used visual analytics to examine complex relationships among aging stroke survivors’ comorbidities. These findings informed pre-adaptation of a component of the Chronic Disease Self-Management Program.

Methods:

Secondary analysis of 2013–2014 Medicare claims with stroke as an index condition, hospital readmission within 90 days (n=42,938), and 72 comorbidities. Visual analytics identified patient subgroups and co-occurring comorbidities. Guided by the framework for reporting adaptations and modifications to evidence-based interventions (FRAME), an interdisciplinary team developed vignettes that highlighted multimorbidity to customize the self-management program.

Results:

There were five …

The 2017 American College Of Cardiology/American Heart Association Hypertension Guideline And Blood Pressure In Older Adults, Kathryn Foti, Stephen P Juraschek, John W Mcevoy, Vijay Nambi, Mercedes R Carnethon, Erin D Michos, Sadiya S Khan

Faculty, Staff and Students Publications

Introduction: The 2017 American College of Cardiology/American Heart Association blood pressure guideline redefined hypertension and lowered the blood pressure treatment target. Empirical data on the guideline's impact are needed.

Methods: Data were analyzed from Atherosclerosis Risk in Communities study participants who attended baseline pre-guideline (2016-2017) and post-guideline (2018-2019) visits with baseline systolic blood pressure between 120 and 159 mmHg. Participants were grouped according to baseline systolic blood pressure by change in classification under the new guideline as follows: not reclassified (120-129 mmHg), reclassified to Stage 1 hypertension (130-139 mmHg), and reclassified to Stage 2 hypertension (140-159 mmHg). Means and 95% …

Sts/Aats-Endorsed Rebuttal To 2023 Acc/Aha Chronic Coronary Disease Guideline: A Missed Opportunity To Present Accurate And Comprehensive Revascularization Recommendations, Leonard N Girardi, Robert Guyton, Dawn Hui, Rosemary F Kelly, Thomas E Macgillivray, S Christopher Malaisrie, Marc R Moon, Joseph F Sabik, Peter K Smith, Lars G Svensson, Wilson Y Szeto

Faculty, Staff and Students Publications

No abstract provided.

Longitudinal Associations Between Cognitive Functioning And Depressive Symptoms Among Couples In The Mexican Health And Aging Study

Faculty, Staff and Student Publications

OBJECTIVE: To examine the bidirectional associations between older adult spouses' cognitive functioning and depressive symptoms over time and replicate previous findings from the United States (US) in Mexico.

DESIGN: Longitudinal, dyadic path analysis with the actor-partner interdependence model.

SETTING: Data were from the three most recent interview waves (2012, 2015, and 2018) of the Mexican Health and Aging Study (MHAS), a longitudinal national study of adults aged 50+ years in Mexico.

PARTICIPANTS: Husbands and wives from 905 community-dwelling married couples (N = 1,810).

MEASUREMENTS: The MHAS cognitive battery measured cognitive function. Depressive symptoms were assessed using a modified nine-item Center …

Serum Metabolomic Markers Of Dairy Consumption: Results From The Atherosclerosis Risk In Communities Study And The Bogalusa Heart Study, Lydia Bazzano, Varun S Rao, Kaitlin S Potts, Tanika N Kelly, Kari E Wong, Lyn M Steffen, Bing Yu, Eugene P Rhee, Casey M Rebholz

Faculty, Staff and Student Publications

BACKGROUND: Dairy consumption is related to chronic disease risk; however, the measurement of dairy consumption has largely relied upon self-report. Untargeted metabolomics allows for the identification of objective markers of dietary intake.

OBJECTIVES: We aimed to identify associations between dietary dairy intake (total dairy, low-fat dairy, and high-fat dairy) and serum metabolites in 2 independent study populations of United States adults.

METHODS: Dietary intake was assessed with food frequency questionnaires. Multivariable linear regression models were used to estimate cross-sectional associations between dietary intake of dairy and 360 serum metabolites analyzed in 2 subgroups of the Atherosclerosis Risk in Communities study …

Soaps And Shampoos: Proposals To Reform Regulation In The United States Personal Care Market To Decrease Deforestation From Palm Oil Imports, Kelsey Weston

Environmental and Earth Law Journal (EELJ)

Palm oil is the world's most highly sought-after vegetable oil due to its multifaceted uses and cheap cost of production. However, producing this versatile oil comes at a high cost to one of the largest biodiversity on the planet. Over the last two centuries, Indonesia and Malaysia have become the main producers and exporters of palm oil but they are also home to the largest number of mammal species in the world that have seen a staggering decline in populations. Furthermore, palm oil production has caused excessive release of greenhouse gases, increased disruption of forestland, and economic poverty for smallholders …

Mapping The Delineation Of Practice To The Amia Foundational Domains For Applied Health Informatics, Annette L Valenta, Damian Borbolla, Gloria Deckard, Laverne Manos

Faculty, Staff and Student Publications

OBJECTIVE: This article reports on the alignment between the foundational domains and the delineation of practice (DoP) for health informatics, both developed by the American Medical Informatics Association (AMIA). Whereas the foundational domains guide graduate-level curriculum development and accreditation assessment, providing an educational pathway to the minimum competencies needed as a health informatician, the DoP defines the domains, tasks, knowledge, and skills that a professional needs to competently perform in the discipline of health informatics. The purpose of this article is to determine whether the foundational domains need modification to better reflect applied practice.

MATERIALS AND METHODS: Using an iterative …

Adding Pharmacist-Led Home Blood Pressure Telemonitoring To Usual Care For Blood Pressure Control: A Systematic Review And Meta-Analysis, Nischit Baral, Annabelle Santos Volgman, Amith Seri, Vijaya Chelikani, Sakiru Isa, Sri L P Javvadi, Timir K Paul, Joshua D Mitchell

2020-Current year OA Pubs

Health systems have been quickly adopting telemedicine throughout the United States, especially since the onset of the COVID-19 pandemic. However, there are limited data on whether adding pharmacist-led home blood pressure (BP) telemonitoring to office-based usual care improves BP. We searched PubMed/MEDLINE and Embase for randomized controlled trials from January 2000 until April 2022, comparing studies on pharmacist-led home BP telemonitoring with usual care. Six randomized controlled trials, including 1,550 participants, satisfied the inclusion criteria. There were 774 participants in the pharmacist-led telemonitoring group and 776 in the usual care group. The addition of pharmacist-led telemonitoring to usual care was …

Notes From The Field: Online Weight Loss Supplements Labeled As Tejocote (Crataegus Mexicana) Root, Substituted With Yellow Oleander (Cascabela Thevetia) - United States, 2022, Noah Berland, James Kababick, Cynthia Santos, Diane P Calello

Faculty, Staff and Student Publications

No abstract provided.

Predictors Of Pharmacy Students' Attitudes About The Therapeutic Use Of Psilocybin, Nm Mahmudul Alam Bhuiya, Robin J. Jacobs, Karina Wang, Yiqun Sun, Brenda Nava, Luke Sampiere, Akhila Yerubandi, Joshua Caballero

HPD Articles

Background Psilocybin has been studied for its potential therapeutic benefits, particularly for the treatment of psychiatric disorders such as anxiety, depression, and obsessive-compulsive disorder. While more research is needed as psilocybin-assisted therapy becomes more prevalent, future pharmacists will probably be involved at some level. At present, pharmacists receive minimal training on psilocybin, and little is known about their attitudes toward its use for medical purposes. Findings from recent clinical studies have attempted to establish the safety and medical efficacy of psilocybin, leading to an increased interest in therapeutic psilocybin use in the United States. This study aimed to assess if …

Gnsi Decision Brief: What Keeps The Us In The Middle East?, Arman Mahmoudian, Tad Schnaufer Ii

GNSI Decision Briefs

In early August the United States sent “More than 3,000 Marines and Sailors [to the Middle East] in a deployment meant to deter Iran from seizing and harassing merchant ships near the Strait of Hormuz.” The decision likely caught many off guard, considering that just two years prior, the US had finalized its troop withdrawal from Afghanistan. Yet, this isn't the first instance of the United States oscillating in its engagement with the Middle East. Historically, a range of factors have consistently drawn America into the region. The US had minimal involvement in the Middle East until the compounding interests …

Trochanteric Bolt Failure In A Modular Femoral Revision System, Daniel Acevedo, Justin E Trapana, David Constantinescu, Jaime Alberto Carvajal Alba

HPD Articles

With the incidence of primary total hip arthroplasty continuing to rise in the United States, the innovation behind improving current total hip arthroplasty systems inevitably grows with it-each new design potentially ushering in new flaws. We report a case of screw failure with the Arcos Modular Femoral Revision System-Trochanteric Bolt and Claw Technique in a 74-year-old male patient. The patient presented to the investigator's clinic for their 20-month follow-up evaluation of their complex right hip revision. Radiographs revealed failure of the screw attaching the claw plate to the stem resulting in dislodgement and relocation of the screw within the intra-articular …

Mental Health Challenges Among Physicians In The United States, Kase Haas

Ballard Brief

Physicians in the United States experience elevated mental health challenges compared to the general population of the US and other professional groups. Owing to the significant demands placed on their time, emotional resilience, and effectiveness, many physicians in the United States encounter mental health challenges that surpass the national average by approximately 1.5 times. Because of these challenges, physicians hesitate to seek help due to licensure complications, stigmatization, and a culture of perfectionism and independence. As a result, physicians are more likely to develop habits of substance abuse, especially alcohol. Rates of alcohol abuse are about 3 times higher among …

Implantable Penile Prosthesis For Erectile Dysfunction: Insurance Coverage In The United States, Denise Asafu-Adjei, Natalie C Edwards, Krista D Nitschelm, Mital Patel, Samir K Bhattacharyya

Faculty, Staff and Students Publications

Introduction: A manufacturer's benefit verification database was evaluated to ascertain United States health plan insurance coverage for implantable penile prostheses for erectile dysfunction.

Methods: All-payer and employer-sponsored health plan benefit verification databases were queried to determine implantable penile prosthesis approval status. For the all-payer analysis, data by payer were available and presented for 2019-2021 to assess approval status varied by payer and over time. For the employer-sponsored health plan analysis, data by payer were available from 2018-2021.

Results: Benefit verification records for the all-payer database were available for 3,167 patients in 2019, 3,016 in 2020, and 2,837 in 2021. Insurance …

Incidence Of And Factors Associated With Recurrent Firearm Injury Among Patients Presenting To St. Louis Trauma Centers, 2010 To 2019 : A Cohort Study, Daphne Lew, Rachel Ancona, Joshua M Landman, Marguerite Spruce, Phillip Marotta, David B Liss, Michael A Mancini, Douglas Schuerer, Megan E Ranney, Randi E Foraker

Faculty, Staff and Students Publications

Background: Firearm injuries are a public health crisis in the United States.

Objective: To examine the incidence and factors associated with recurrent firearm injuries and death among patients presenting with an acute (index), nonfatal firearm injury.

Design: Multicenter, observational, cohort study.

Setting: Four adult and pediatric level I trauma hospitals in St. Louis, Missouri, 2010 to 2019.

Participants: Consecutive adult and pediatric patients (n = 9553) presenting to a participating hospital with a nonfatal acute firearm injury.

Measurements: Data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and death were collected from the St. Louis Region-Wide …

Public Reporting For Coronary Artery Bypass Graft Surgery: The Quest For The Optimal Scorecard, Michael Halkos, Danny Chu, Bradley S Taylor, John Puskas, Deepak L Bhatt, Marco Zenati, John Stulak, Todd Rosengart, Husam H Balkhy, Eugene H Blackstone, Lars G Svensson, Faisal G Bakaeen, Ozgun Erten, Tara Karamlou, Edward G Soltesz, A Marc Gillinov, Anthony Warmuth, Eric E Roselli, Nicholas G Smedira

Faculty, Staff and Students Publications

Objective: A number of publicly available rating algorithms are used to assess hospital performance in coronary artery bypass grafting (CABG). However, concerns remain that these algorithms fail to correlate with each other and inadequately capture the case complexity of individual center practices.

Methods: Composite star ratings for isolated CABG from the Society of Thoracic Surgeons public reporting database were extracted for 2018-2019. U.S. News & World Report Best Hospitals was used to extract CABG ratings as well as overall cardiology and heart surgery ranking, and the Centers for Medicare & Medicaid Services Hospital Compare was used to extract CABG volume …

Nurse Leader Perceptions Of Data In The Veterans Health Administration: A Qualitative Evaluation, Melissa K Knox, Sylvia J Hysong, Lynette E Dorsey, Patrick N O'Mahen, Laura A Petersen

Faculty, Staff and Students Publications

Healthcare systems and nursing leaders aim to make evidence-based nurse staffing decisions. Understanding how nurses use and perceive available data to support safe staffing can strengthen learning healthcare systems and support evidence-based practice, particularly given emerging data availability and specific nursing challenges in data usability. However, current literature offers sparse insight into the nature of data use and challenges in the inpatient nurse staffing management context. We aimed to investigate how nurse leaders experience using data to guide their inpatient staffing management decisions in the Veterans Health Administration, the largest integrated healthcare system in the United States. We conducted semistructured …

Beginning To Address An Implementation Gap In Asthma: Clinicians' Views Of Prescribing Reliever Budesonide-Formoterol Inhalers And Smart In The United States, James G Krings, Tejas C Sekhar, Vanessa Chen, Kathryn V Blake, Kaharu Sumino, Aimee S James, Amber K Clover, Eric J Lenze, Ross C Brownson, Mario Castro

2020-Current year OA Pubs

BACKGROUND: The Global Initiative for Asthma and National Asthma Education and Prevention Program recently made paradigm-shifting recommendations regarding inhaler management in asthma. The Global Initiative for Asthma now recommends that combination inhaled corticosteroid (ICS)-formoterol inhalers replace short-acting β-agonists as the preferred reliever therapy at all steps of asthma management. Although the most recent guidelines of the National Asthma Education and Prevention Program did not review reliever ICS-formoterol usage in mild asthma, they similarly recommended single maintenance and reliever therapy (SMART) at steps 3 and 4 of asthma management. Despite these recommendations, many clinicians-particularly in the United States-are not prescribing new …

Mpla Case: How Do You Lead As A Lead Physicist?, Patricia Sansourekidou, Leonard Kim, Lee Xu, Mary Gronberg, Cassandra Stambaugh

Faculty, Staff and Student Publications

This work of fiction is part of a case study series developed by the Medical Physics Leadership Academy (MPLA). It is intended to facilitate the discussion of the managerial and leadership challenges faced by a clinical medical physicist. In this case, a physicist David used to work in a clinic where he thrived and felt like a leader, despite not having the title. After a job change, he is now officially the "Lead Physicist" at a hospital newly affiliated with a large academic healthcare system. He believes he will be equally successful. Yet he struggles to bring about changes and …

Current Curricular Trends After The Covid-19 Pandemic: A National Survey Of Psychiatry Residency Programs, Hanjing Emily Wu

Faculty, Staff and Student Publications

OBJECTIVES: During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hybrid programs) have adopted different learning modalities to preserve a high quality of educational training. There is minimal data on specific program adaptations, related change perspectives, and program type stratification. This study sought to examine trends in curriculum changes in accredited psychiatry residency programs in the United States.

METHODS: Program directors of accredited general psychiatry programs in the United States were surveyed to assess both general program details and changes in educational content, delivery, and perspectives with regard to program curricula.

RESULTS: A total of 63 program directors out …

Outcomes Of Transcatheter Aortic Valve Replacement In Patients With Cardiogenic Shock, Anju Bhardwaj, Richard Smalling, Abhijeet Dhoble

Faculty, Staff and Student Publications

AIMS: The safety and efficacy of transcatheter aortic valve replacement (TAVR) with contemporary balloon expandable transcatheter valves in patients with cardiogenic shock (CS) remain largely unknown. In this study, the TAVRs performed for CS between June 2015 and September 2022 using SAPIEN 3 and SAPIEN 3 Ultra bioprosthesis from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were analysed.

METHODS AND RESULTS: CS was defined as: (i) coding of CS within 24 h on Transcatheter Valve Therapy Registry form; and/or (ii) pre-procedural use of inotropes or mechanical circulatory support devices and/or (iii) cardiac arrest within 24 …

Current Curricular Trends After The Covid-19 Pandemic: A National Survey Of Psychiatry Residency Programs, Jeff Wang Jin, Kacy Smith, Amanda Helminiak, Vineeth John, Hanjing Emily Wu

Faculty, Staff and Student Publications

Objectives: During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hybrid programs) have adopted different learning modalities to preserve a high quality of educational training. There is minimal data on specific program adaptations, related change perspectives, and program type stratification. This study sought to examine trends in curriculum changes in accredited psychiatry residency programs in the United States.

Methods: Program directors of accredited general psychiatry programs in the United States were surveyed to assess both general program details and changes in educational content, delivery, and perspectives with regard to program curricula.

Results: A total of 63 program directors out …

Interstitial Lung Abnormalities After Hospitalization For Covid-19 In Patients With Cancer: A Prospective Cohort Study, Bela Patel, Lara Bashoura, Roberto Adachi, Scott E Evans, Burton Dickey, Carol Wu, Girish S Shroff, Joanna-Grace Manzano, Bruno Granwehr, Shannon Holloway, Kodwo Dickson, Alyssa Mohammed, Mayoora Muthu, Hui Song, Caroline Chung, Jia Wu, Lyndon Lee, Ying Jiang, Fareed Khawaja, Ajay Sheshadri

Faculty, Staff and Student Publications

INTRODUCTION: Survivors of SARS-CoV-2 pneumonia often develop persistent respiratory symptom and interstitial lung abnormalities (ILAs) after infection. Risk factors for ILA development and duration of ILA persistence after SARS-CoV-2 infection are not well described in immunocompromised hosts, such as cancer patients.

METHODS: We conducted a prospective cohort study of 95 patients at a major cancer center and 45 patients at a tertiary referral center. We collected clinical and radiographic data during the index hospitalization for COVID-19 pneumonia and measured pneumonia severity using a semi-quantitative radiographic score, the Radiologic Severity Index (RSI). Patients were evaluated in post-COVID-19 clinics at 3 and …

An Update On The Healthy Soldier Effect In U.S. Veterans

Faculty, Staff and Students Publications

Introduction: The healthy soldier effect (HSE) describes a phenomenon of enduring health and lower mortality among veterans due in part to initial screening procedures and health care access. Although early data were supportive of a broad HSE among former military members, more recent investigations have suggested a possible attenuation of the effect with older age. The present study aimed to provide an update of the HSE using an expansive Veterans Health Administration (VHA)-wide sample with a particular focus on age and sex effects.

Materials and methods: Mortality data for veterans within the VHA were obtained from the VHA Support Service …

Reducing Oral Health Disparities: Effectiveness Of Preventive Dental Care On Treatment Use, Expenditures And Determinants Of Service Utilization, Rashmi Lamsal

Theses & Dissertations

Given the importance of oral health in maintaining the general health and well-being of an individual, this dissertation includes three independent studies examining dental care utilization and expenditures among adults in the U.S. The first study examines the effectiveness of preventive dental visits on treatment utilization and expenditures among adults aged 18 and above. The second study focuses on the impact of paid sick leave on different types of dental services utilization among working adults aged 18-64. Finally, the last paper compares the differences in dental care utilization and related expenditure between foreign-born and US-born adults with diabetes. The paper …

Inclusive Education Is Power: Revising Sexual Health Education For People With Disabilities, Carly M. Tsuruda

Master's Projects and Capstones

For people with disabilities in the United States, comprehensive sexual health education is not always available. There are a number of reasons for the lack of comprehensive sexual health education, including excessive censorship and curriculum that is not representative of people with disabilities. Sexual health education and disability are both topics that have several preconceived notions attached to them, yet there is a dearth in resources that could provide accurate information to those both with and without disabilities. These preconceived notions that have been associated with these identity labels lead to negative health outcomes for people with disabilities such as …

Prevalence Of Symptoms ≤12 Months After Acute Illness, By Covid-19 Testing Status Among Adults — United States, December 2020–March 2023, Dana Morse, Pamela Logan, Kristin Rising, Mandy J Hill, Lauren E Wisk, Wafah Salah, Ahamed H Idris, Ryan M Huebinger, Erica S Spatz, Robert M Rodriguez, Robin E Klabbers, Kristyn Gatling, Ralph C Wang, Joann G Elmore, Samuel A Mcdonald, Kari A Stephens, Robert A Weinstein, Arjun K Venkatesh, Sharon Saydah, Innovative Support For Patients With Sars-Cov-2 Infections Registry (Inspire) Group

Faculty, Staff and Student Publications

To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration-approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months. Prevalence of any symptom decreased substantially between baseline …