Clinical Epidemiology Commons^™

Improving Patient Care Outcomes To Reduce Recurrent Admissions Of Patients With Chronic Obstructive Pulmonary Disease, Lisa Maria Friedrich

Seton Hall University DNP Final Projects

Purpose:Transitional care is time-limited, with the goal of ensuring safety and health continuity for at-risk patients with chronic obstructive pulmonary disease (COPD) as they move from one setting to the next. An acute care episode of COPD ranges from relatively healthy adults to adults with multiple chronic conditions or those in the end-of-life phase. The primary quality concern of an urgent need to improve health care is in response to the gaps of sufficient experience to manage patients with COPD, leading to hospital readmissions. Implementation of standards of care for the improvement of health-related quality of life (HRQL) of COPD …

Antibiotic Resistance And The White House Forum On Antibiotic Stewardship, Mary Lou Manning Phd, Crnp, Cic, Faan

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Hispanic Ethnicity Is Associated With Increased Hospital Charges After Radical Cystectomy In The United States, Mark D. Tyson, Erik P. Castle

Journal of Health Disparities Research and Practice

Objective: To examine the impact of race and ethnicity on financial charges associated with radical cystectomy (RC).

Data Sources/Study Setting: The Nationwide Inpatient Sample was used to identify patients who underwent RC for bladder cancer between 1998 and 2010.

Study Design: The primary outcome was total hospital charges adjusted for inflation. Multivariate analysis was performed using a generalized linear model on the logarithmically transformed outcome variable (total hospital charges) after adjusting for age, sex, race, Elixhauser comorbidities, surgical approach, year, primary payer, hospital and surgeon annual RC volume, hospital characteristics, and postoperative complications.

Principle findings: A total of 14,873 patients …

A Machine Learning Approach To Post-Market Surveillance Of Medical Devices, Jonathan Bates, Shu-Xia Li, Craig Parzynski, Ronald Coifman, Harlan Krumholz, Joseph Ross

Yale Day of Data

Post-market surveillance is a collection of processes and activities used by product manufacturers and regulators, such as the U.S. Food and Drug Administration (FDA) to monitor the safety and effectiveness of medical devices once they are available for use “on the market”. These activities are designed to generate information to identify poorly performing devices and other safety problems, accurately characterize real-world device performance and clinical outcomes, and facilitate the development of new devices, or new uses for existing devices. Typically, a device is monitored by comparing adverse events in the exposed population to a matched unexposed population. This research considers …

Preparedness Of Hospitals In The Republic Of Ireland For An Influenza Pandemic, An Infection Control Perspective, Mary Reidy, Fiona Ryan, Dervla Hogan, Seán Lacey, Claire Buckley

Department of Mathematics Publications

When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective.

Economic Evaluation Of Fungal Meningitis Outbreak Response In New River Valley: Local Health Department Perspective, Kaja M. Abbas, Nargesalsadat Dorratoltaj, Margaret L. O’Dell, Paige Bordwine, Thomas M. Kerkering, Kerry J. Redican

Frontiers in Public Health Services and Systems Research

Background: The multi-state fungal meningitis outbreak started in September 2012 in Tennessee. The cause of the outbreak was injection of contaminated lots of methylprednisolone acetate used in epidural spinal injections. Roanoke and New River Valley were the epicenter of this outbreak in Virginia, with two clinical centers having administered the contaminated injections to their patients. New River Health District, in coordination with hospitals, and state and federal agencies, deployed its resources to control the local impact of the outbreak.

Purpose: The objective of this study was to conduct an economic evaluation of the fungal meningitis outbreak response in New River …

Adolescent Exercise In Association With Mortality From All Causes, Cardiovascular Disease, And Cancer Among Middle-Aged And Older Chinese Women, Sarah J. Nechuta, Xiao Ou Shu, Gong Yang, Hui Cai, Yu-Tang Gao, Hong-Lan Li, Yong-Bing Xiang, Wei Zheng

Peer Reviewed Articles

Background: Little is known regarding the role of early-life exercise, a potentially modifiable factor, in long-term adult morbidity and mortality. We utilized the Shanghai Women's Health Study (SWHS) to investigate adolescent exercise in association with cancer, cardiovascular disease (CVD), and all-cause mortality among middle-aged and older women.

Methods: The SWHS is a prospective cohort of 74,941 Chinese women ages 40 to 70 years recruited from 1996 to 2000. In-person interviews at enrollment assessed adolescent and adult exercise history, medical and reproductive history, and other lifestyle and socioeconomic (SES) factors. Mortality follow-up occurs via annual linkage to the Shanghai Vital Statistics …

A Combination Sms And Transportation Reimbursement Intervention To Improve Hiv Care Following Abnormal Cd4 Test Results In Rural Uganda: A Prospective Observational Cohort Study, Mark J. Siedner, Data Santorino, Alexander J. Lankowski, Michael Kanyesigye, Mwebesa B. Bwana, Jessica E. Haberer, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Up to 50 % of HIV-infected persons in sub-Saharan Africa are lost from care between HIV diagnosis and antiretroviral therapy (ART) initiation. Structural barriers, including cost of transportation to clinic and poor communication systems, are major contributors.

Methods: We conducted a prospective, pragmatic, before-and-after clinical trial to evaluate a combination mobile health and transportation reimbursement intervention to improve care at a publicly operated HIV clinic in Uganda. Patients undergoing CD4 count testing were enrolled, and clinicians selected a result threshold that would prompt early return for ART initiation or further care. Participants enrolled in the pre-intervention period (January – …

Know Your Status: Alleviating Stigma From The Hiv Positive Community Of San Luis Obispo California, Mario Alberto Viveros Espinoza

Ethnic Studies

The purpose of this project is to alleviate stigma from the HIV community in San Luis Obispo, CA by creating an outreach program, “Know Your Status,” that raises awareness of HIV education and prevention. Research on HIV stigma and on ideologies for program development and implementation shows that HIV positive individuals face both internalized and externalized stigma. Program development and implementation can be effective by assessing and addressing the specific needs of those living within the community. This project includes the data needed for program development and implementation, collected through anonymous surveys from HIV positive community members, interviews with professionals …

Management Of Pediatric Headaches In The Emergency Department At Connecticut Children’S Medical Center, Chevaughn Wellington

Honors Scholar Theses

Headaches are a common complaint for children presenting to the Emergency Department (ED) at Connecticut Children’s Medical Center (CCMC). Currently, there is little published regarding a standard treatment plan for pediatric headaches. The purpose of this study is to determine which medications are most commonly utilized and which are most effective in managing pediatric headaches. Differences in management of acute and chronic headaches in the ED at CCMC were examined. A retrospective chart review was conducted of all children who presented to the ED from January 1 to March 31, 2013 with a chief complaint or discharge diagnosis of “headache” …

Use Of The Robson Classification To Assess Caesarean Section Trends In 21 Countries: A Secondary Analysis Of Two Who Multicountry Surveys, Joshua P. Vogel, Ana Pilar Betrán, Nadia Vindevoghel, João Paulo Souza, Maria Regina Torloni, Jun Zhang, Özge Tunçalp, Rintaro Mori, Naho Morisaki, Eduardo Ortiz-Panozo, Bernardo Hernandez, Ricardo Pérez-Cuevas, Zahida Qureshi, A Metin Gülmezoglu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age.

Methods: We studied deliveries in 287 facilities in 21 countries that …

Mesothelioma Patients With Germline Bap1 Mutations Have 7-Fold Improved Long-Term Survival, F. Baumann, E. Flores, A. Napolitano, S. Kanodia, E. Taioli, H. Pass, H. Yang, M. Carbone

Journal Articles

BRCA1-associated protein-1 (BAP1) mutations cause a new cancer syndrome, with a high rate of malignant mesothelioma (MM). Here, we tested the hypothesis that MM associated with germline BAP1 mutations has a better prognosis compared with sporadic MM. We compared survival among germline BAP1 mutation MM patients with that of all MM (N = 10 556) recorded in the United States Surveillance, Epidemiology, and End Results (SEER) data from 1973 to 2010. We identified 23 MM patients-11 alive-with germline BAP1 mutations and available data on survival. Ten patients had peritoneal MM, ten pleural MM and three MM in both locations. Thirteen …

The Glass Is Half Full: Evidence For Efficacy Of Alcohol-Wise At One University But Not The Other, K. Croom, L. Staiano-Coico, M. Lesser, D. K. Lewis, V. F. Reyna, T. C. Marchell, J. Frank, S. Ives

Journal Articles

This research extends the growing literature about online alcohol prevention programs for first-year college students. Two independent randomized control studies, conducted at separate universities, evaluated the short-term effectiveness of Alcohol-Wise, an online alcohol prevention program not previously studied. It was hypothesized the prevention program would increase alcohol knowledge and reduce alcohol consumption, including high-risk alcohol-related behaviors, among first-year college students. At both universities, the intervention significantly increased alcohol-related knowledge. At one university, the prevention program also significantly reduced alcohol consumption and high-risk drinking behaviors, such as playing drinking games, heavy drinking, and extreme ritualistic alcohol consumption. Implications for the use …

Circulating Adipokines And Inflammatory Markers And Postmenopausal Breast Cancer Risk, M. J. Gunter, T. Wang, M. Cushman, X. Xue, S. Wassertheil-Smoller, H. D. Strickler, T. E. Rohan, J. E. Manson, A. Mctiernan, G. Y. Ho, +5 Additional Authors

Journal Articles

BACKGROUND: Adipokines and inflammation may provide a mechanistic link between obesity and postmenopausal breast cancer, yet epidemiologic data on their associations with breast cancer risk are limited. METHODS: In a case-cohort analysis nested within the Women's Health Initiative Observational Study, a prospective cohort of postmenopausal women, baseline plasma samples from 875 incident breast cancer case patients and 839 subcohort participants were tested for levels of seven adipokines, namely leptin, adiponectin, resistin, interleukin-6, tumor necrosis factor-alpha, hepatocyte growth factor, and plasminogen activator inhibitor-1, and for C-reactive protein (CRP), an inflammatory marker. Data were analyzed by multivariable Cox modeling that included established …

Heart Failure: An Exploration Of Recent Advances In Research And Treatment (A), A. Szema, A. Mclarty, H. Skopicki, M. Bloom, R. Jermyn

Journal Articles

No abstract provided.

Emerging Novel Therapies For Heart Failure, A. M. Szema, S. Dang, J. C. Li

Journal Articles

No abstract provided.

Metformin And Myocardial Injury In Patients With Diabetes And St-Segment Elevation Myocardial Infarction: A Propensity Score Matched Analysis, S. Basnet, A. Kozikowski, A. N. Makaryus, R. Pekmezaris, R. Zeltser, M. Akerman, M. Lesser, G. Wolf-Klein

Journal Articles

No abstract provided.

Tlr7 Influences Germinal Center Selection In Murine Sle, A. Boneparth, W. Huang, R. Bethunaickan, M. Woods, R. Sahu, S. Arora, M. Akerman, M. Lesser, A. Davidson

Journal Articles

TLR7 enhances germinal center maturation and migration of B cells to the dark zone where proliferation and somatic hypermutation occur. Our goal was to determine how Tlr7 dose influences selection of the autoreactive B cell repertoire in NZW/BXSB. Yaa mice bearing the site-directed heavy chain transgene 3H9 that encodes for the TLR7 regulated anti-CL response. To create a physiologic setting in which autoreactive B cells compete for survival with non-autoreactive B cells, we generated bone marrow chimeras in which disease onset occurred with similar kinetics and the transferred 3H9+ female non-Yaa, male Yaa or male TLR7(-/Yaa) cells could be easily …

Effectiveness Of Fecal-Derived Microbiota Transfer Using Orally Administered Capsules For Recurrent Clostridium Difficile Infection, B. E. Hirsch, N. Saraiya, K. Poeth, R. M. Schwartz, M. E. Epstein, G. Honig

Journal Articles

BACKGROUND: Clostridium difficile infection (CDI), a complication of antibiotic-induced injury to the gut microbiome, is a prevalent and dangerous cause of infectious diarrhea. Antimicrobial therapy for CDI is typically effective for acute symptoms, but up to one third of patients later experience recurrent CDI. Fecal-derived microbiota transplantation (FMT) can ameliorate the underlying dysbiosis and is highly effective for recurrent CDI. Traditional methods of FMT are limited by patient discomfort, risk and inefficient procedures. Many individuals with recurrent CDI have extensive comorbidities and advanced age. Widespread use of FMT requires strategies that are non-invasive, scalable and applicable across healthcare settings. METHODS: …

Seasonal Variations Of Complete Blood Count And Inflammatory Biomarkers In The Us Population - Analysis Of Nhanes Data, B. Liu, E. Taioli

Journal Articles

BACKGROUND: Recent studies reported seasonal differences in gene expression in white blood cells, adipose tissue, and inflammatory biomarkers of the immune system. There is no data on the seasonal variations of these biomarkers in the US general population of both children and adults. Then aim of this study is to explore the seasonal trends in complete blood count (CBC), and C-reactive protein (CRP) in a large non-institutionalized US population. METHODS: Seven cross-sectional data collected in the National Health and Nutrition Examination Survey (NHANES) during 1999-2012 were aggregated; participants reporting recent use of prescribed steroids, chemotherapy, immunomodulators and antibiotics were excluded. …

Determinants Of Survival In Malignant Pleural Mesothelioma: A Surveillance, Epidemiology, And End Results (Seer) Study Of 14,228 Patients, E. Taioli, A. S. Wolf, M. Camacho-Rivera, A. Kaufman, D. S. Lee, D. Nicastri, K. Rosenzweig, R. M. Flores

Journal Articles

INTRODUCTION: Left untreated, malignant pleural mesothelioma (MPM) is associated with uniformly poor prognosis. Better survival has been reported with surgery-based multimodality therapy, but to date, no trial has demonstrated survival benefit of surgery over other therapies. We evaluated whether cancer-directed surgery influenced survival independently from other predictors in a large population-based dataset. METHODS: The SEER database was explored from 1973 to 2009 to identify all cases of pathologically-proven MPM. Age, sex, race, year of diagnosis, histology stage, cancer-directed surgery, radiation, and vital status were analyzed. The association between prognostic factors and survival was estimated using Cox regression and propensity matched …

Frequency Of Surgery In Black Patients With Malignant Pleural Mesothelioma, E. Taioli, A. S. Wolf, J. Moline, M. Camacho-Rivera, R. M. Flores

Journal Articles

Introduction. Malignant Pleural Mesothelioma (MPM) is a rare disease, even less frequently described in minority patients. We used a large population-based dataset to study the role of race in MPM presentation, treatment, and survival. Methods. All cases of pathologically proven MPM were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race (black or white). Results. There were 13,046 white and 688 black MPM patients (incidence: 1.1 per 100,000 whites; 0.5 per 100,000 blacks; age-adjusted,P = 0.01). Black patients were more likely to …

Breast Cancer Risk In Metabolically Healthy But Overweight Postmenopausal Women, M. J. Gunter, X. Xie, X. Xue, G. C. Kabat, T. E. Rohan, S. Wassertheil-Smoller, G. Y. Ho, J. Wylie-Rosett, J. Beasley, H. D. Strickler, +2 Additional Authors

Journal Articles

Adiposity is an established risk factor for postmenopausal breast cancer. Recent data suggest that high insulin levels in overweight women may play a major role in this relationship, due to insulin's mitogenic/antiapoptotic activity. However, whether overweight women who are metabolically healthy (i.e., normal insulin sensitivity) have elevated risk of breast cancer is unknown. We investigated whether overweight women with normal insulin sensitivity [i.e., homeostasis model assessment of insulin resistance (HOMA-IR) index, or fasting insulin level, within the lowest quartile (q1)] have increased breast cancer risk. Subjects were incident breast cancer cases (N = 497) and a subcohort (N = 2,830) …

Differential Expression Of Circulating Micrornas According To Severity Of Colorectal Neoplasia, G. Y. Ho, H. J. Jung, R. E. Schoen, T. Wang, J. Lin, Z. Williams, J. L. Weissfeld, J. Y. Park, O. Loudig, Y. Suh

Journal Articles

There is a need to develop a colorectal cancer (CRC) screening test that is noninvasive, cost effective, and sensitive enough to detect preneoplastic lesions. This case-control study examined the feasibility of using circulating extracellular microRNAs (miRNAs) to differentiate a spectrum of colorectal neoplasia of various severity and hence for early detection of colorectal neoplasia. Archived serum samples of 10 normal controls and 31 cases, including 10 with nonadvanced adenoma, 10 with advanced adenoma, and 11 with CRC, were profiled for circulating miRNAs using next-generation sequencing. Multiple linear regression, adjusting for age, gender, and smoking status, compared controls and the 3 …

Oral Bisphosphonate Use And Risk Of Postmenopausal Endometrial Cancer, P. A. Newcomb, M. N. Passarelli, A. I. Phipps, G. L. Anderson, J. Wactawski-Wende, G. Y. Ho, M. J. O'Sullivan, R. T. Chlebowski

Journal Articles

PURPOSE: Bisphosphonates are common medications used for the treatment of osteoporosis and are also used to reduce metastases to bone in patients with cancer. Several studies, including the Women's Health Initiative (WHI), have found that use of bisphosphonates is associated with reduced risk of developing breast cancer, but less is known about associations with other common malignancies. This study was aimed at examining the effects of bisphosphonates on the risk of endometrial cancer. METHODS: We evaluated the relationship between use of oral bisphosphonates and endometrial cancer risk in a cohort of 89,918 postmenopausal women participating in the WHI. A detailed …

Ebola Scare And Measles Resurgence: Mandatory Isolation/Quarantine And Vaccination, Mark C. Aita Md, Takeem T. Ragland Ma

Journal of Health Ethics

Public outcry for radical isolation and quarantine policies followed the first Ebola diagnosis in the United States when Eric Duncan, upon his return home Oct 2014 from West Africa, then in the midst of a catastrophic Ebola epidemic, tested positive for Ebola. Likewise, the Dec 2014 Disneyland measles outbreak unleashed an angry backlash against parents who refused to have their children vaccinated; and there was public momentum to repeal all legal exemptions to mandatory vaccination of school children. This paper presents an ethical and legal analysis to adjudicate the issue which is at stake in both controversies; namely the inherent …

Factors Associated With High Rates Of Antiretroviral Medication Adherence Among Youth Living With Perinatal Hiv In Thailand, Ezer Kang

Department of Psychology Faculty Publications

 Antiretroviral medication adherence behaviour among Thai youth with perinatal HIV in Thailand has received growingattention. However, few studies have examined individual predictors of antiretroviral adherence using multipleself-reports. A convenience sample of 89 Thai youth (interquartile range 14–16 years) with perinatal HIV at threepaediatric programmes in Chiang Mai completed a structured questionnaire and reported their antiretroviral adherencein the past one, seven and 30 days using count-based recall and a visual analog scale. Mean self-reported adherencerates ranged from 83.5% (past 30 days) to 99.8% (yesterday) of the time. One-inflated beta regression models were usedto examine the associations between antiretroviral adherence outcomes, treatment …