Medicine and Health Sciences Commons^™

"It's A Mess Sometimes": Patient Perspectives On Provider Responses To Healthcare Costs, And How Informatics Interventions Can Help Support Cost-Sensitive Care Decisions., Olivia K Richards, Bradley E Iott, Tammy Toscos, Jessica Pater, Shauna Wagner, Tiffany C Veinot

Health Services and Informatics Research

OBJECTIVE: We investigated patient experiences with medication- and test-related cost conversations with healthcare providers to identify their preferences for future informatics tools to facilitate cost-sensitive care decisions.

MATERIALS AND METHODS: We conducted 18 semistructured interviews with diverse patients (ages 24-81) in a Midwestern health system in the United States. We identified themes through 2 rounds of qualitative coding.

RESULTS: Patients believed their providers could help reduce medication-related costs but did not see how providers could influence test-related costs. Patients viewed cost conversations about medications as beneficial when providers could adjust medical recommendations or provide resources. However, cost conversations did not …

Consensual Sexting Among College Students: The Interplay Of Coercion And Intimate Partner Aggression In Perceived Consequences Of Sexting., Tara L Cornelius, Kathryn M Bell, Tylor Kistler, Michelle Drouin

Health Services and Informatics Research

Recent empirical data suggests that the majority of adolescents and emerging adults utilize digital technology to engage with texting and social media on a daily basis, with many using these mediums to engage in sexting (sending sexual texts, pictures, or videos via digital mediums). While research in the last decade has disproportionately focused on the potential risk factors and negative consequences associated with sexting, the data are limited by failing to differentiate consensual from non-consensual sexting and account for potential influences of intimate partner aggression (IPA) and sexting coercion in these contexts. In the current study, we assessed the positive …

Adolescent Interventions To Manage Self-Regulation In Type 1 Diabetes (Aims-T1d): Randomized Control Trial Study Protocol., Alison L Miller, Sharon L Lo, Dana K. Albright Phd, Joyce M Lee, Christine M Hunter, Katherine W Bauer, Rosalind King, Katy M Clark, Kiren Chaudhry, Niko Kaciroti, Benjamin Katz, Emily M Fredericks

Health Services and Informatics Research

BACKGROUND: Self-regulation (SR), or the capacity to control one's thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity …

Evaluation Of Prescribing Patterns Of Long-Acting Injectable Antipsychotics Within A Community Health System., Jared Netley Pharmd, Mpa, Bcps, Jamie Gaul Pharmd, Bcps, Chelsea L Ferguson Pharmd

Parkview Pharmacy Department

PURPOSE/BACKGROUND: Long-acting injectable antipsychotics (LAIAs) are used in the management of schizophrenia, bipolar disorder, and related psychiatric conditions. The efficacy of LAIAs has been established in randomized controlled trials; however, usage of LAIAs outside of randomized controlled trials may not correlate to naturalistic prescribing habits. The purpose of this analysis was to evaluate the prescribing patterns of LAIAs within our health system and identify any inconsistencies between medications' published labeling information and clinical practice.

METHODS/PROCEDURES: All patients who received a LAIA at the time of the analysis were included for review. Areas of inconsistency between the prescribed LAIA and each …

Selection Biases In Technology-Based Intervention Research: Patients' Technology Use Relates To Both Demographic And Health-Related Inequities., Tammy Toscos Phd, Michelle Drouin, Jessica Pater, Mindy Flanagan, Rachel Pfafman, Michael Mirro Md, Facc, Fhrs, Faha

Health Services and Informatics Research

OBJECTIVE: Researchers conduct studies with selection biases, which may limit generalizability and outcomes of intervention research. In this methodological reflection, we examined demographic and health characteristics of implantable cardioverter defibrillator patients who were excluded from an informatics intervention due to lack of access to a computer and/or the internet.

MATERIALS AND METHODS: Using information gathered from surveys and electronic health records, we compared the intervention group to excluded patients on demographic factors, computer skills, patient activation, and medical history.

RESULTS: Excluded patients were older, less educated, less engaged and activated in their health, and had worse health (ie, more medical …

Cross-Day Influences Between Couple Closeness And Coparenting Support Among New Parents., Yunying Le, Steffany J Fredman, Brandon T. Mcdaniel Phd, Jean-Philippe Laurenceau, Mark E Feinberg

Health Services and Informatics Research

The couple and coparenting relationships are demonstrated to be prospectively and bidirectionally associated over months to years during the early parenting years. However, little is known about these associations at the daily level within the first year of parenthood, when coparenting first emerges. The goal of the current study was to examine the association between couples' daily feelings of relationship closeness and coparenting support in first-time parents and determine directionality of these effects using a dyadic daily diary design. At 10 months postpartum, heterosexual couples (

Bivalirudin Anticoagulation Dosing Protocol For Extracorporeal Membrane Oxygenation: A Retrospective Review., Jared W. Netley Pharmd, Mpa , Bcps, James Roy Pharmd, Joseph Greenlee Iii Md, Shaun Hart Np, Michael Todt Pharmd, Bryan Statz Pharmd

Parkview Pharmacy Department

Anticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis. Clinical characteristics and changes in activated partial thromboplastin time (aPTT) were evaluated from medical records to determine the efficacy …

Technoference: Longitudinal Associations Between Parent Technology Use, Parenting Stress, And Child Behavior Problems., Brandon T. Mcdaniel Phd, Jenny S Radesky

Health Services and Informatics Research

BACKGROUND AND OBJECTIVES: Heavy parent digital technology use has been associated with suboptimal parent-child interactions and internalizing/externalizing child behavior, but directionality of associations is unclear. This study aims to investigate longitudinal bidirectional associations between parent technology use and child behavior, and understand whether this is mediated by parenting stress.

METHODS: Participants included 183 couples with a young child (age 0-5 years, mean = 3.0 years) who completed surveys at baseline, 1, 3 and 6 months. Cross-lagged structural equation models of parent technology interference during parent-child activities, parenting stress, and child externalizing and internalizing behavior were tested.

RESULTS: Controlling for potential …

Technoference: Parent Distraction With Technology And Associations With Child Behavior Problems., Brandon T. Mcdaniel Phd, Jenny S Radesky

Health Services and Informatics Research

Heavy parent digital technology use has been associated with suboptimal parent-child interactions, but no studies examine associations with child behavior. This study investigates whether parental problematic technology use is associated with technology-based interruptions in parent-child interactions, termed "technoference," and whether technoference is associated with child behavior problems. Parent reports from 170 U.S. families (child age = 3.04 years) and actor-partner interdependence modeling showed that maternal and paternal problematic digital technology use predicted greater technoference in mother-child and father-child interactions; then, maternal technoference predicted both mothers' and fathers' reports of child externalizing and internalizing behaviors. Results suggest that technological interruptions are …

Sexting Among Married Couples: Who Is Doing It, And Are They More Satisfied?, Brandon T. Mcdaniel Phd, Michelle Drouin

Health Services and Informatics Research

This study examined the prevalence and correlates of sexting (i.e., sending sexual messages via mobile phones) within a sample of married/cohabiting couples (180 wives and 175 husbands). Married adults do sext each other, but it is much less common than within young adult relationships, and consists mainly of sexy or intimate talk (29% reported engaging in sexy talk with partners) rather than sexually explicit photos or videos (12% reported sending nude or nearly-nude photos). Sending sexy talk messages was positively related to relationship satisfaction only among those with high levels of avoidance, and sending sexually explicit pictures was related to …

Impact Of Morbid Obesity On Outcome Of Laparoscopic Splenectomy., Edward P Dominguez, Yong U Choi, Bradford G Scott, Alan M. Yahanda Md, Facs, Edward A Graviss, John F Sweeney

PCI Publications and Projects

BACKGROUND: Because of the obesity epidemic, surgeons are operating on morbidly obese patients in increasing numbers. The aim of this study was to evaluate the impact of morbid obesity on the outcome of laparoscopic splenectomy.

METHODS: The study group consisted of 120 consecutive patients who underwent laparoscopic splenectomy for benign and malignant disease from March 1996 to May 2005. These patients were retrospectively divided into three groups. Group 1 had a body mass index (BMI) < 30. Group 2 patients had a BMI > or = 30 and < 40 and were considered obese. Group 3 had a BMI > or = 40 and were considered morbidly obese. Data including surgical approach (laparoscopic vs. hand-assisted), operative time, conversion rate, estimated blood …

Mitotic Rate And Younger Age Are Predictors Of Sentinel Lymph Node Positivity: Lessons Learned From The Generation Of A Probabilistic Model., Vernon K Sondak, Jeremy M G Taylor, Michael S Sabel, Yue Wang, Lori Lowe, Amelia C Grover, Alfred E Chang, Alan M. Yahanda Md, Facs, James Moon, Timothy M Johnson

PCI Publications and Projects

BACKGROUND: Sentinel lymph node (SLN) biopsy allows surgeons to identify patients with subclinical nodal involvement who may benefit from lymphadenectomy and, possibly, adjuvant therapy. Several factors have been variably, and sometimes discordantly, reported to have predictive value for SLN metastasis to best select which patients require SLN biopsy.

METHODS: We reviewed 419 patients who underwent SLN biopsy for melanoma from a prospectively collected melanoma database. To derive a probabilistic model for the occurrence of a positive SLN, a multivariate logistic model was fit by using a stepwise variable selection method. The accuracy of each model was evaluated by using receiver …

Is Mammography Useful In Screening For Local Recurrences In Patients With Tram Flap Breast Reconstruction After Mastectomy For Multifocal Dcis?, A P Salas, M A Helvie, E G Wilkins, H A Oberman, P W Possert, Alan M. Yahanda Md, Facs, A E Chang

PCI Publications and Projects

BACKGROUND: Skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction is being used more often for the treatment of breast cancer. Mammography is not used routinely to evaluate TRAM flaps in women who have undergone mastectomy. We have identified the potential value of its use in selected patients.

METHODS AND RESULTS: We report on four women who manifested local recurrences in TRAM flaps after initial treatment for ductal carcinoma in situ (DCIS) or DCIS with microinvasion undergoing skin-sparing mastectomy and immediate reconstruction. All four patients presented with extensive, high-grade, multifocal DCIS that precluded breast conservation. Three of four …

Extraskeletal Mesenchymal Chondrosarcoma Of The Rectus Sheath., D B Johnson, W Breidahl, J S Newman, K Devaney, Alan M. Yahanda Md, Facs

PCI Publications and Projects

Mesenchymal chondrosarcomas (MSCs) are a rare form of chondrosarcoma which usually arise in bone. Extraskeletal chondrosarcomas constitute a minority (14-25%) of MSCs. We describe the imaging features of an extraskeletal mesenchymal chondrosarcoma that arose from the rectus abdominus muscle.

Computed Tomography In Staging Of Patients With Melanoma Metastatic To The Regional Nodes., T M Johnson, D J Fader, A E Chang, Alan M. Yahanda Md, Facs, J W Smith, K R Hamlet, V K Sondak

PCI Publications and Projects

BACKGROUND: This study addresses the yield and clinical impact of computed tomography (CT) imaging in otherwise asymptomatic patients with stage III melanoma metastatic to the regional nodes.

METHODS: The database from the University of Michigan Mutlidisciplinary Melanoma Clinic was reviewed and identified 127 asymptomatic patients with stage III melanoma (regional nodal disease) who received CT scans of the head, chest, abdomen, and/or pelvis. Scans were confirmed as true positive, false positive, and normal.

RESULTS: Four hundred twenty-six head and body CT scans were performed at the time of presentation of stage III disease. Twenty patients had a true-positive CT scan …