Health Services Research Commons^™

Profile Of Caregiving Activities And Association With Physical Health Among Dementia Spousal Caregivers, Jinmyoung Cho, Laura P Sands, Alan B Stevens, Heather G Allore, Molly J Horstman

Faculty, Staff and Students Publications

Background and objectives: This study aims to identify patterns of caregiving intensity and assess associations between caregiving intensity and multidimensional physical health indicators and health behaviors among spousal caregivers of persons with Alzheimer's disease and related dementia.

Research design and methods: Using data from 152 spousal caregivers aged 65 and older, the intensity of their caregiving experience was measured as the number and frequency of health- and medical-related helping activities for their care recipient. Multidimensional health indicators included self-reported fatigue, sleep disturbance, physical functioning, pain interference, general health, and the number of chronic conditions from the electronic health records. Self-reported …

Variability In Chest Radiology Interpretation Between Thoracic And Non-Thoracic Radiologists: Implications For Pulmonary Fibrosis Care, Daniel M Guidot, Danielle Seaman, Roy A Pleasants, Armando Bedoya, Robert M Tighe, Bhavika Kaul

Faculty, Staff and Students Publications

No abstract provided.

Characteristics And Contributing Factors Of Diagnostic Error In Surgery: Analysis Of Closed Medico-Legal Cases And Complaints In Canada, Janice L Kwan, Lisa A Calder, Cara L Bowman, Anna Macintyre, Richard Mimeault, Liisa Honey, Cynthia Dunn, Gary Garber, Hardeep Singh

Faculty, Staff and Students Publications

Background: Diagnostic errors lead to patient harm; however, most research has been conducted in nonsurgical disciplines. We sought to characterize diagnostic error in the pre-, intra-, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm.

Methods: We performed a retrospective analysis of closed medico-legal cases and complaints using a database representing more than 95% of all Canadian physicians. We included cases if they involved a legal action or complaint that closed between 2014 and 2018 and involved a diagnostic error assigned by peer expert review to a surgeon.

Results: We identified 387 surgical …

How Users' Perceptions Of Friends' Content Influence Their "Annoyance" After Viewing Facebook Posts, Mai-Ly N Steers, Robert E Wickham, Olivia M Tabaczyk, Chelsie M Young, Michelle C Quist, Lindsey B Eikenburg, Jennifer L Bryan

Faculty, Staff and Students Publications

Social media posts may elicit strong, instantaneous feelings of irritation, or "annoyance." The current experiment investigated how participants' ratings of Facebook posts and their levels of closeness to the poster impacted these feelings. Respondents (N = 476) were asked to rate how irrelevant, inappropriate, mundane, and annoying Facebook posts from an imagined close friend, moderately close friend, and acquaintance were. A cross-classified, Bayesian structural equation model determined the unique contributions at the rater level, target level, and the distinct combination of rater and target at the within level. At the within level, results suggested irrelevance, mundaneness, and inappropriateness of posts …

A Pilot Study Of A Scalable Training Programme For Coaches Delivering Webstair, Sherry Yam, Jamie S Kim, Annapoorna Ayyagari, Julianna Hogan, Jan A Lindsay, Marylene Cloitre

Faculty, Staff and Students Publications

Background: Accessible, low-cost digital programmes are emerging as a means by which to address high rates of mental health problems. However, the development and assessment of scalable training programmes for effective use of digital interventions has lagged. This is particularly important, as coach-supported digital interventions provide benefits that substantially and consistently exceed those of programmes that are entirely self-guided.

Objectives: This report describes the evaluation of a brief coach training programme consisting of a two-hour workshop and six 1-hour consultation sessions for delivery of webSTAIR, a 10-module transdiagnostic web-based programme for trauma-exposed populations.

Method: The training was provided to 68 …

Hepatocellular Carcinoma Incidence Threshold For Surveillance In Virologically Cured Hepatitis C Individuals, Jagpreet Chhatwal, Ali Hajjar, Peter P Mueller, Gizem Nemutlu, Neeti Kulkarni, Mary Linton B Peters, Fasiha Kanwal

Faculty, Staff and Students Publications

Background & aims: Guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in hepatitis C individuals with cirrhosis if the HCC incidence rate is above 1.5 per 100 person-years (PY). However, the incidence threshold for surveillance in individuals who achieve a virologic cure is unknown. We estimated the HCC incidence rate above which routine HCC surveillance is cost-effective in this growing population of virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis.

Methods: We developed a Markov-based microsimulation model of the natural history of HCC in individuals with hepatitis C who achieved virologic cure with oral direct-acting antivirals. We used …

Corrigendum: Combining Charlson Comorbidity And Vacs Indices Improves Prognostic Accuracy For All-Cause Mortality For Patients With And Without Hiv In The Veterans Health Administration, Kathleen A Mcginnis, Amy C Justice, Vincent C Marconi, Maria C Rodriguez-Barradas, Ronald G Hauser, Krisann K Oursler, Sheldon T Brown, Kendall J Bryant, Janet P Tate

Faculty, Staff and Students Publications

[This corrects the article DOI: 10.3389/fmed.2023.1342466.].

Preclinical Evaluation Of A Novel Antibiotic-Eluting Bioenvelope For Cied Infection Prevention, Zerelda Esquer Garrigos, John N Catanzaro, Daniel Deegan, Ji Zhang, M Rizwan Sohail

Faculty, Staff and Students Publications

The risk of infection remains a significant concern with cardiovascular implantable electronic devices, necessitating the development of new strategies. This study explores the efficacy of a novel antibiotic-eluting biologic envelope designed to mitigate infection risk through localized antibiotic delivery while preserving the regenerative properties of biological matrix. Antibiotics, rifampin and minocycline, are released through polymer discs, ensuring extended drug release. Utilizing an established model of infection in a New Zealand White rabbit, the study assessed performance against Gram-positive bacterial strains, including common pathogens such as Staphylococcus aureus and S. epidermidis associated with CIED infections, and Gram-negative bacterial strains. Results demonstrated …

Twenty Years Of Epithelial-Mesenchymal Transition: A State Of The Field From Temtia X, Pierre Savagner, Thomas Brabletz, Chonghui Cheng, Christine Gilles, Tian Hong, Myriam Polette, Guojun Sheng, Marc P Stemmler, Erik W Thompson

Faculty, Staff and Students Publications

This report summarizes the 10th biennial meeting of The Epithelial Mesenchymal Transition International Association (TEMTIA), that took place in Paris on November 7-10, 2022. It provides a short but comprehensive introduction to the presentations and discussions that took place during the 3-day meeting. Similarly to previous TEMTIA meetings, TEMTIA X reviewed the most recent aspects of the epithelial-mesenchymal transition (EMT), a cellular process involved during distinct stages of development but also during wound healing and fibrosis to some degree. EMT has also been associated at various levels during tumor cell progression and metastasis. The meeting emphasized the intermediate stages of …

Gatekeeping At Bio, Daniel A Gorelick

Faculty, Staff and Students Publications

No abstract provided.

Providers’ Perspectives On The Impact Of Culture In The Recognition And Diagnosis Of Anxiety, Darius B Dawson, Christie G-J Tsao, Patricia Chen, Traber D Giardina, Terri L Fletcher

Faculty, Staff and Students Publications

Objectives: We examined providers' perspectives about how culture affects diagnosing and recognizing anxiety.

Methods: We interviewed providers about diagnosing anxiety ("How do you think culture impacts expression and diagnosis of anxiety?") and used inductive analysis, with open coding, to allow themes to emerge organically.

Results: We identified three themes: (1) Impartiality toward Culture: downplaying culture in recognizing or diagnosing anxiety and not acknowledging necessary cultural diagnostic considerations; (2) Acknowledgment of Cultural Impact: detailed variations across different cultural communities in how patients present with and describe anxiety, with differing levels of stigma associated with expressing and treating anxiety; (3) Culturally Integrated …

Blood Test Result Communication In Primary Care: Mixed-Methods Systematic Review Protocol, Helen Nankervis, Alyson Huntley, Penny Whiting, William Hamilton, Hardeep Singh, Sarah Dawson, Jane Sprackman, Anna Ferguson Montague, Jessica Watson

Faculty, Staff and Students Publications

Background: After testing, ensuring test results are communicated and actioned is important for patient safety, with failure or delay in diagnosis the most common cause of malpractice claims in primary care worldwide. Identifying interventions to improve test communication from the decision to test through to sharing of results has important implications for patient safety, GP workload, and patient engagement.

Aim: To assess the factors around communication of blood test results between primary care providers (for example GPs, nurses, reception staff) and their patients and carers.

Design & setting: A mixed methods systematic review including primary studies involving communication of blood …

A Multisociety Delphi Consensus Statement On New Fatty Liver Disease Nomenclature, Mary E Rinella, Jeffrey V Lazarus, Vlad Ratziu, Sven M Francque, Arun J Sanyal, Fasiha Kanwal, Diana Romero, Manal F Abdelmalek, Quentin M Anstee, Juan Pablo Arab, Marco Arrese, Ramon Bataller, Ulrich Beuers, Jerome Boursier, Elisabetta Bugianesi, Christopher D Byrne, Graciela E Castro Narro, Abhijit Chowdhury, Helena Cortez-Pinto, Donna R Cryer, Kenneth Cusi, Mohamed El-Kassas, Samuel Klein, Wayne Eskridge, Jiangao Fan, Samer Gawrieh, Cynthia D Guy, Stephen A Harrison, Seung Up Kim, Bart G Koot, Marko Korenjak, Kris V Kowdley, Florence Lacaille, Rohit Loomba, Robert Mitchell-Thain, Timothy R Morgan, Elisabeth E Powell, Michael Roden, Manuel Romero-Gómez, Marcelo Silva, Shivaram Prasad Singh, Silvia C Sookoian, C Wendy Spearman, Dina Tiniakos, Luca Valenti, Miriam B Vos, Vincent Wai-Sun Wong, Stavra Xanthakos, Yusuf Yilmaz, Zobair Younossi, Ansley Hobbs, Marcela Villota-Rivas, Philip N Newsome, Nafld Nomenclature Consensus Group

Faculty, Staff and Students Publications

The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favour of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panellists from 56 countries participated in 4 …

Prevention, Diagnosis, Evaluation, And Treatment Of Hepatitis C In Chronic Kidney Disease: Synopsis Of The Kidney Disease: Improving Global Outcomes 2022 Clinical Practice Guideline, Ahmed Arslan Yousuf Awan, Marina C Berenguer, Annette Bruchfeld, Fabrizio Fabrizi, David S Goldberg, Jidong Jia, Nassim Kamar, Rosmawati Mohamed, Mário Guimarães Pessôa, Stanislas Pol, Meghan E Sise, Ethan M Balk, Craig E Gordon, Gaelen Adam, Michael Cheung, Amy Earley, Paul Martin, Michel Jadoul

Faculty, Staff and Students Publications

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2022 clinical practice guideline on prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease (CKD) is an update of the 2018 guideline from KDIGO.

Methods: The KDIGO Work Group (WG) updated the guideline, which included reviewing and grading new evidence that was identified and summarized. As in the previous guideline, the WG used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of recommendations and used expert judgment to develop recommendations. New evidence led to updating of recommendations in the chapters …

Corrigendum To “Phenotypes Of Disease Severity In A Cohort Of Hospitalized Covid-19 Patients: Results From The Impacc Study” [Ebiomedicine 83 (2022) 104208], Al Ozonoff, Joanna Schaenman, Naresh Doni Jayavelu, Carly E Milliren, Carolyn S Calfee, Charles B Cairns, Monica Kraft, Lindsey R Baden, Albert C Shaw, Florian Krammer, Harm Van Bakel, Denise A Esserman, Shanshan Liu, Ana Fernandez Sesma, Viviana Simon, David A Hafler, Ruth R Montgomery, Steven H Kleinstein, Ofer Levy, Chris Bime, Elias K Haddad, David J Erle, Bali Pulendran, Kari C Nadeau, Mark M Davis, Catherine L Hough, William B Messer, Nelson I Agudelo Higuita, Jordan P Metcalf, Mark A Atkinson, Scott C Brakenridge, David Corry, Farrah Kheradmand, Lauren I R Ehrlich, Esther Melamed, Grace A Mccomsey, Rafick Sekaly, Joann Diray-Arce, Bjoern Peters, Alison D Augustine, Elaine F Reed, Matthew C Altman, Patrice M Becker, Nadine Rouphael, Impacc Study Group Members

Faculty, Staff and Students Publications

No abstract provided.

Reducing Prescribing Of Antibiotics For Acute Respiratory Infections Using A Frontline Nurse-Led Ehr-Integrated Clinical Decision Support Tool: Protocol For A Stepped Wedge Randomized Control Trial, Elizabeth R Stevens, Ruth Agbakoba, Devin M Mann, Rachel Hess, Safiya I Richardson, Thomas Mcginn, Paul D Smith, Wendy Halm, Marlon P Mundt, Katherine L Dauber-Decker, Simon A Jones, Dawn M Feldthouse, Eun Ji Kim, David A Feldstein

Faculty, Staff and Students Publications

Background: Overprescribing of antibiotics for acute respiratory infections (ARIs) remains a major issue in outpatient settings. Use of clinical prediction rules (CPRs) can reduce inappropriate antibiotic prescribing but they remain underutilized by physicians and advanced practice providers. A registered nurse (RN)-led model of an electronic health record-integrated CPR (iCPR) for low-acuity ARIs may be an effective alternative to address the barriers to a physician-driven model.

Methods: Following qualitative usability testing, we will conduct a stepped-wedge practice-level cluster randomized controlled trial (RCT) examining the effect of iCPR-guided RN care for low acuity patients with ARI. The primary hypothesis to be tested …

Prevalence And Characteristics Of Diagnostic Error In Pediatric Critical Care: A Multicenter Study, Christina L Cifra, Jason W Custer, Craig M Smith, Kristen A Smith, Dayanand N Bagdure, Jodi Bloxham, Emily Goldhar, Stephen M Gorga, Elizabeth M Hoppe, Christina D Miller, Max Pizzo, Sonali Ramesh, Joseph Riffe, Katharine Robb, Shari L Simone, Haley D Stoll, Jamie Ann Tumulty, Stephanie E Wall, Katie K Wolfe, Linder Wendt, Patrick Ten Eyck, Christopher P Landrigan, Jeffrey D Dawson, Heather Schacht Reisinger, Hardeep Singh, Loreen A Herwaldt

Faculty, Staff and Students Publications

Objectives: Effective interventions to prevent diagnostic error among critically ill children should be informed by diagnostic error prevalence and etiologies. We aimed to determine the prevalence and characteristics of diagnostic errors and identify factors associated with error in patients admitted to the PICU.

Design: Multicenter retrospective cohort study using structured medical record review by trained clinicians using the Revised Safer Dx instrument to identify diagnostic error (defined as missed opportunities in diagnosis). Cases with potential errors were further reviewed by four pediatric intensivists who made final consensus determinations of diagnostic error occurrence. Demographic, clinical, clinician, and encounter data were also …

Sex And Gender In Copd And Asthma, Joan B Soriano, Francesca Polverino

Faculty, Staff and Students Publications

No abstract provided.

P2y2 Purinergic Receptor Gene Deletion Protects Mice From Bacterial Endotoxin And Sepsis-Associated Liver Injury And Mortality, Athis R Arunachalam, Sanju S Samuel, Arunmani Mani, Janielle P Maynard, Kelsey M Stayer, Eric Dybbro, Subapradha Narayanan, Aalekhya Biswas, Saliha Pathan, Krishnakant Soni, Abu Hena Mostafa Kamal, Chandra Shekar R Ambati, Nagireddy Putluri, Moreshwar S Desai, Sundararajah Thevananther

Faculty, Staff and Students Publications

The liver plays a significant role in regulating a wide range of metabolic, homeostatic, and host-defense functions. However, the impact of liver injury on the host's ability to control bacteremia and morbidity in sepsis is not well understood. Leukocyte recruitment and activation lead to cytokine and chemokine release, which, in turn, trigger hepatocellular injury and elevate nucleotide levels in the extracellular milieu. P2Y2 purinergic receptors, G protein-coupled and activated by extracellular ATP/UTP, are expressed at the cell surface of hepatocytes and nonparenchymal cells. We sought to determine whether P2Y2 purinergic receptor function is necessary for the maladaptive host response to …

Integrating Clinical Decision Support Into Electronic Health Record Systems Using A Novel Platform (Evidencepoint): Developmental Study, Jeffrey Solomon, Katherine Dauber-Decker, Safiya Richardson, Sera Levy, Sundas Khan, Benjamin Coleman, Rupert Persaud, John Chelico, D'Arcy King, Alex Spyropoulos, Thomas Mcginn

Faculty, Staff and Students Publications

Background: Through our work, we have demonstrated how clinical decision support (CDS) tools integrated into the electronic health record (EHR) assist providers in adopting evidence-based practices. This requires confronting technical challenges that result from relying on the EHR as the foundation for tool development; for example, the individual CDS tools need to be built independently for each different EHR.

Objective: The objective of our research was to build and implement an EHR-agnostic platform for integrating CDS tools, which would remove the technical constraints inherent in relying on the EHR as the foundation and enable a single set of CDS tools …

Got Pidd1? Natural Killer Cells Clear Polyploid Cells To Ensure A Balanced Genome, Alexandra N Brown-Suedel, Lisa Bouchier-Hayes

Faculty, Staff and Students Publications

Removal of polyploid cells is essential to preventing cancer and restricting tumor growth. A new study published in The EMBO Journal shows assembly of the NEMO-PIDDosome on extra centrioles. Activation of this protein complex leads to NF-κB activation that, in turn, induces NK cell-mediated cell clearance.

Five Strategies For A Safer Ehr Modernization Journey, Dean F Sittig, Edward E Yackel, Hardeep Singh

Faculty, Staff and Students Publications

No abstract provided.

Selecting A Quality Improvement Project: 5 Questions For Trainees And Mentors, Molly J Horstman, Anne M Tomolo, Blake Webb, Lindsay Vaclavik

Faculty, Staff and Students Publications

No abstract provided.

Universal Ehrs Clinical Decision Support For Thromboprophylaxis In Medical Inpatients: A Cluster Randomized Trial, Alex C Spyropoulos, Mark Goldin, Ioannis Koulas, Jeffrey Solomon, Michael Qiu, Sam Ngu, Kolton Smith, Tungming Leung, Kanta Ochani, Fatima Malik, Stuart L Cohen, Dimitrios Giannis, Sundas Khan, Thomas Mcginn

Faculty, Staff and Students Publications

Background: Thromboprophylaxis for medically ill patients during hospitalization and postdischarge remains underutilized. Clinical decision support (CDS) may address this need if embedded within workflow, interchangeable among electronic health records (EHRs), and anchored on a validated model.

Objectives: The purpose of this study was to assess the clinical impact of a universal EHR-integrated CDS tool based on the International Medical Prevention Registry on Venous Thromboembolism plus D-Dimer venous thromboembolism model.

Methods: This was a cluster randomized trial of 4 tertiary academic hospitals from December 21, 2020 to January 21, 2022. Inpatients over age 60 with key medical illnesses were eligible. We …

Seminar: Extracellular Vesicles As Mediators Of Environmental Stress In Human Disease, Vrinda Kalia, Andrea A Baccarelli, Christine Happel, Jonathan A Hollander, Anne Marie Jukic, Kimberly A Mcallister, Ramkumar Menon, Bruce A Merrick, Aleksander Milosavljevic, Lingamanaidu V Ravichandran, Matthew E Roth, Anita Subramanian, Frederick L Tyson, Leroy Worth, Daniel T Shaughnessy

Faculty, Staff and Students Publications

Background: Extracellular vesicles (EVs), membrane-bound particles containing a variety of RNA types, DNA, proteins, and other macromolecules, are now appreciated as an important means of communication between cells and tissues, both in normal cellular physiology and as a potential indicator of cellular stress, environmental exposures, and early disease pathogenesis. Extracellular signaling through EVs is a growing field of research for understanding fundamental mechanisms of health and disease and for the potential for biomarker discovery and therapy development. EVs are also known to play important roles in mediating the effects of exposure to environmental stress.

Objectives: This seminar addresses the application …

Understanding The Gap Between Nursing Workforce In The United States And Population Needs-A Policy Brief, Mayar Al Mohajer

Faculty, Staff and Students Publications

Purpose  This report is intended to analyze the root causes for the current gap between the nursing workforce and population needs in the United States. It aims to consolidate what is known about these contributing reasons and provide evidence-based recommendations for action.

Methods  The report utilized the Sample, Phenomenon of Interest, Design, Evaluation, Research type framework to develop the research question and the 5 Whys methodology for the root cause analysis.

Results  This report highlighted six major causative problems, including workforce market mismatch, poor financing design, inadequate governance, flawed technologies, insufficient research, and suboptimal service delivery. A detailed evaluation of …

Author Correction: Histone H2a Lys130 Acetylation Epigenetically Regulates Androgen Production In Prostate Cancer, Thanh Nguyen, Dhivya Sridaran, Surbhi Chouhan, Cody Weimholt, Audrey Wilson, Jingqin Luo, Tiandao Li, John Koomen, Bin Fang, Nagireddy Putluri, Arun Sreekumar, Felix Y Feng, Kiran Mahajan, Nupam P Mahajan

Faculty, Staff and Students Publications

No abstract provided.

Integrating Participant Feedback And Concerns To Improve Community And Individual Level Chemical Exposure Assessment Reports, Samantha M Samon, Michael Barton, Kim Anderson, Abiodun Oluyomi, Melissa Bondy, Georgina Armstrong, Diana Rohlman

Faculty, Staff and Students Publications

BACKGROUND: As exposure assessment has shifted towards community-engaged research there has been an increasing trend towards reporting results to participants. Reports aim to increase environmental health literacy, but this can be challenging due to the many unknowns regarding chemical exposure and human health effects. This includes when reports encompass a wide-range of chemicals, limited reference or health standards exist for those chemicals, and/or incompatibility of data generated from exposure assessment tools with published reference values (e.g., comparing a wristband concentration to an oral reference dose).

METHODS: Houston Hurricane Harvey Health (Houston-3H) participants wore silicone wristbands that were analyzed for 1,530 …

Approach To Non-Type 2 Asthma, Muhammad Adrish, Praveen Akuthota

Faculty, Staff and Students Publications

No abstract provided.

Il17a Blockade With Ixekizumab Suppresses Muvb Signaling In Clinical Psoriasis, Scott A Ochsner, Mesias Pedroza, Rudolf T Pillich, Venkatesh Krishnan, Bruce W Konicek, Ernst R Dow, So Young Park, Sandeep K Agarwal, Neil J Mckenna

Faculty, Staff and Students Publications

Unbiased informatics approaches have the potential to generate insights into uncharacterized signaling pathways in human disease. In this study, we generated longitudinal transcriptomic profiles of plaque psoriasis lesions from patients enrolled in a clinical trial of the anti-IL17A antibody ixekizumab (IXE). This dataset was then computed against a curated matrix of over 700 million data points derived from published psoriasis and signaling node perturbation transcriptomic and chromatin immunoprecipitation-sequencing datasets. We observed substantive enrichment within both psoriasis-induced and IXE-repressed gene sets of transcriptional targets of members of the MuvB complex, a master regulator of the mitotic cell cycle. These gene sets …