Health Services Research Commons^™

Ai Driven Analysis Of Mri To Measure Health And Disease Progression In Fshd, Lara Riem, Olivia Ducharme, Matthew Cousins, Xue Feng, Allison Kenney, Jacob Morris, Stephen J Tapscott, Rabi Tawil, Jeff Statland, Dennis Shaw, Leo Wang, Michaela Walker, Leann Lewis, Michael A Jacobs, Doris G Leung, Seth D Friedman, Silvia S Blemker

Faculty, Staff and Student Publications

Facioscapulohumeral muscular dystrophy (FSHD) affects roughly 1 in 7500 individuals. While at the population level there is a general pattern of affected muscles, there is substantial heterogeneity in muscle expression across- and within-patients. There can also be substantial variation in the pattern of fat and water signal intensity within a single muscle. While quantifying individual muscles across their full length using magnetic resonance imaging (MRI) represents the optimal approach to follow disease progression and evaluate therapeutic response, the ability to automate this process has been limited. The goal of this work was to develop and optimize an artificial intelligence-based image …

Caregiver Recruitment Strategies For Interventions Designed To Optimize Transitions From Hospital To Home: Lessons From A Randomized Trial, Allison M Gustavson, Molly J Horstman, Jodie A Cogswell, Diane E Holland, Catherine E Vanderboom, Jay Mandrekar, William S Harmsen, Brystana G Kaufman, Cory Ingram, Joan M Griffin

Faculty, Staff and Students Publications

Challenges to recruitment of family caregivers exist and are amplified when consent must occur in the context of chaotic healthcare circumstances, such as the transition from hospital to home. The onset of the COVID-19 pandemic during our randomized controlled trial provided an opportunity for a natural experiment exploring and examining different consent processes for caregiver recruitment. The purpose of this publication is to describe different recruitment processes (in-person versus virtual) and compare diversity in recruitment rates in the context of a care recipient's hospitalization. We found rates of family caregiver recruitment for in-person versus virtual were 28% and 23%, respectively …

The Key Elements And Driving Paths Of Digital Empowerment For The Efficient Construction Of The Rural Medical And Health Service System: Based On 28 Cases Through Fsqca, Liqing Li, Ming Yu

Journal of Scientific Information Research

[Purpose/significance]This paper explores the linkage effect and improvement path of technology-organization-environment antecedents on the efficient construction of digital empowerment rural medical and health service system, in order to accelerate the research progress of digital construction of rural medical and health service. [Method/process]Based on the technology-organization-environment (TOE) framework and China's real-life scenarios, this paper constructs a theoretical analysis framework for the efficient construction of digital empowerment rural medical and health service system, Using the method of fuzzy set qualitative comparative analysis, this paper takes the rural areas of 28 provinces (autonomous regions and municipalities directly under the central government) in China …

Occupational Stress And Coping During A Public Health Emergency: A Mixed-Methods Approach To Understand The Experiences Of Lactation Professionals In Clinical Settings, Mya Michele Carter

Health Services Research Dissertations

Introduction: During public health emergencies, such as the coronavirus 2019 pandemic, breastfeeding is still the recommended feeding option, and mothers and babies may need additional support to reach breastfeeding goals. Pandemic-related, clinic-level restrictions posed new challenges for postpartum mothers and their healthcare teams, including lactation professionals (LPs). The pandemic and subsequent restrictions may have impacted lactation professionals’ work-related stress and limited their ability to provide lactation support. Coping strategies to mitigate occupational stress can be useful in preventing adverse outcomes for both the provider and the patient. The need for continuous support for this profession of healthcare workers is paramount. …

Distinct Genetic Liability Profiles Define Clinically Relevant Patient Strata Across Common Diseases, Lucia Trastulla, Georgii Dolgalev, Sylvain Moser, Laura T. Jiménez-Barrón, Till F. M. Andlauer, Moritz Von Scheidt, Schizophrenia Working Group Of The Psychiatric Genomics Consortium:, Douglas M. Ruderfer, Stephan Ripke, Andrew Mcquillin, Eli A. Stahl, Enrico Domenici, Rolf Adolfsson, Ingrid Agartz, Esben Agerbo, Margot Albus, Madeline Alexander, Farooq Amin, Silviu A. Bacanu, Martin Begemann, Richard A. Belliveau Jr., Judit Bene, Sarah E. Bergen, Elizabeth Bevilacqua, Tim B. Bigdeli, Donald W. Black, Douglas H. R. Blackwood, Anders D. Borglum, Nancy G. Buccola, Et Al

School of Nursing Faculty Publications

Stratified medicine holds great promise to tailor treatment to the needs of individual patients. While genetics holds great potential to aid patient stratification, it remains a major challenge to operationalize complex genetic risk factor profiles to deconstruct clinical heterogeneity. Contemporary approaches to this problem rely on polygenic risk scores (PRS), which provide only limited clinical utility and lack a clear biological foundation. To overcome these limitations, we develop the CASTom-iGEx approach to stratify individuals based on the aggregated impact of their genetic risk factor profiles on tissue specific gene expression levels. The paradigmatic application of this approach to coronary artery …

Exploring Negotiated Autonomy In The Physician–Physician Assistant Collaborative Dyad, Stephen Robie

Doctor of Philosophy in Translational Health Sciences Dissertations

Physician Assistants (PAs) are integral members of multidisciplinary medical care teams who practice medicine legally under the supervision of physicians. During medical care, supervision is a dynamic process of collaboration wherein a PA who displays competence is granted increasing independence by the supervising physician. This process has been referred to as negotiated autonomy. Despite being noted in work-force literature, the mechanics of how negotiated autonomy operates in real-time have not been described. As organizations increasingly work to integrate PAs into practice, new-hire training programs called ‘on-boarding’ have been implemented to accelerate PA professional development with a goal of increased efficiency …

Financial Incentives For Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial, Darla Kendzor, Michael Businelle, Summer Frank-Pearce, Joseph Waring, Sixia Chen, Emily Hébert, Michael Swartz, Adam Alexander, Munjireen Sifat, Laili Kharazi Boozary, David Wetter

Kimmel Cancer Center Faculty Papers

IMPORTANCE: Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions.

OBJECTIVES: To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES.

DESIGN, SETTING, AND PARTICIPANTS: This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024.

INTERVENTIONS: Participants were randomized to usual care (UC) for smoking cessation (counseling …

Pediatric Oral Health Literacy Among Caregivers Of Young Children, Melissa L. Sullivan

Health Services Research Dissertations

Early childhood caries (ECC) is a common dental condition that affects the primary teeth of infants and young children. ECC can have a significant negative impact on a child’s oral health and overall well-being. Caregivers have an important role in the prevention of early childhood caries through knowledge, understanding, and awareness of good oral hygiene practices. Caregivers who possess adequate oral health literacy (OHL) may be more likely to recognize the risks associated with ECC, implement proper oral hygiene practices, and make informed oral health choices for themselves and their child.

The overarching purpose of this dissertation is to explore …

Exome Sequencing Identifies Novel Genes Underlying Primary Congenital Glaucoma In The National Birth Defects Prevention Study, Elizabeth E Blue, Kristin J Moore, Kari E North, Tania A Desrosiers, Suzan L Carmichael, Janson J White, Jessica X Chong, Michael J Bamshad, Mary M Jenkins, Lynn M Almli, Lawrence C Brody, Sharon F Freedman, Jennita Reefhuis, Paul A Romitti, Gary M Shaw, Martha Werler, Denise M Kay, Marilyn L Browne, Marcia L Feldkamp, Richard H Finnell, Wendy N Nembhard, Faith Pangilinan, Andrew F Olshan, National Institutes Of Health Intramural Sequencing Center, University Of Washington Center For Mendelian Genomics, National Birth Defects Prevention Study

Faculty, Staff and Students Publications

Background: Primary congenital glaucoma (PCG) affects approximately 1 in 10,000 live born infants in the United States (U.S.). PCG has a autosomal recessive inheritance pattern, and variable expressivity and reduced penetrance have been reported. Likely causal variants in the most commonly mutated gene, CYP1B1, are less prevalent in the U.S., suggesting that alternative genes may contribute to the condition. This study utilized exome sequencing to investigate the genetic architecture of PCG in the U.S. and to identify novel genes and variants.

Methods: We studied 37 family trios where infants had PCG and were part of the National Birth Defects Prevention …

The Saga Of Covid-19 In Chronic Lung Disease: History Repeats Itself, Amir Sharafkhaneh, Javad Razjouyan

Faculty, Staff and Students Publications

No abstract provided.

Thrombosis Risk Prediction In Lymphoma Patients: A Multi-Institutional, Retrospective Model Development And Validation Study, Shengling Ma, Jennifer La, Kaitlin N Swinnerton, Danielle Guffey, Raka Bandyo, Giordana De Las Pozas, Katy Hanzelka, Xiangjun Xiao, Cristhiam M Rojas-Hernandez, Christopher I Amos, Vipul Chitalia, Katya Ravid, Kelly W Merriman, Christopher R Flowers, Nathanael Fillmore, Ang Li

Faculty, Staff and Students Publications

Venous thromboembolism (VTE) poses a significant risk to cancer patients receiving systemic therapy. The generalizability of pan-cancer models to lymphomas is limited. Currently, there are no reliable risk prediction models for thrombosis in patients with lymphoma. Our objective was to create a risk assessment model (RAM) specifically for lymphomas. We performed a retrospective cohort study to develop Fine and Gray sub-distribution hazard model for VTE and pulmonary embolism (PE)/ lower extremity deep vein thrombosis (LE-DVT) respectively in adult lymphoma patients from the Veterans Affairs national healthcare system (VA). External validations were performed at the Harris Health System (HHS) and the …

Sars-Cov-2 Triggers Dickkopf-1 (Dkk-1) Modulation Of T Helper Cells And Lung Pathology In Mice, Yifan Wu, Freedom M Green, Stephen A Shaw, Lauren J Bonilla, Shannon E Ronca, Maria Elena Bottazzi, Farrah Kheradmand, Jill E Weatherhead

Faculty, Staff and Students Publications

No abstract provided.

Mechanisms Of Gelofusine Protection In An In Vitro Model Of Polymyxin B-Associated Renal Injury, Cole S Hudson, Anirban Roy, Qingtian Li, Aniket S Joshi, Taijun Yin, Ashok Kumar, David Sheikh-Hamad, Vincent H Tam

Faculty, Staff and Students Publications

Polymyxins are a last-resort treatment option for multidrug-resistant gram-negative bacterial infections, but they are associated with nephrotoxicity. Gelofusine was previously shown to reduce polymyxin-associated kidney injury in an animal model. However, the mechanism(s) of renal protection has not been fully elucidated. Here, we report the use of a cell culture model to provide insights into the mechanisms of renal protection. Murine epithelial proximal tubular cells were exposed to polymyxin B. Cell viability, lactate dehydrogenase (LDH) release, polymyxin B uptake, mitochondrial superoxide production, nuclear morphology, and apoptosis activation were evaluated with or without concomitant gelofusine. A megalin knockout cell line was …

Author Reply To Letter By Topkan Et Al Regarding Delays In Starting Postoperative Radiotherapy, Kelsey A Duckett, Byung Joo Lee, Bhisham S Chera, Sidharth V Puram, Vlad C Sandulache, Russel Kahmke, Shaun A Nguyen, Brian Nussenbaum, Anthony J Alberg, Chanita Hughes Halbert, Katherine R Sterba, Evan M Graboyes

Faculty, Staff and Students Publications

No abstract provided.

Achieving Equitable Cardiovascular Care For All: Acc Board Of Trustees Health Equity Task Force Action Plan, Paul L Douglass, Dipti Itchhaporia, Biykem Bozkurt, Robert O Roswell, Akshay Khandelwal, Quinn Capers, Kathryn Berlacher, Modele O Ogunniyi, Alison L Bailey, Phillip D Levy, Aubrey J Grant, Jack Tocco, Angela Natcheva, Akua G Asare, Ami B Bhatt, Jennifer H Mieres, Maghee F Disch, Melvin R Echols

Faculty, Staff and Students Publications

Advancements in cardiovascular (CV) disease management are notable, yet health inequities prevail, associated with increased morbidity and mortality noted among non-Hispanic African Americans in the United States. The 2002 Institute of Medicine Report revealed ongoing racial and ethnic health care disparities, spearheading a deeper understanding of the social determinants of health and systemic racism to develop strategies for CV health equity (HE). This article outlines the strategic HE approach of the American College of Cardiology, comprising 6 strategic equity domains: workforce pathway inclusivity, health care, data, science, and tools; education and training; membership, partnership, and collaboration; advocacy and policy; and …

Community Participation Of The “Kampung Kb” Program: Study In Malang City Year 2020, Rany Ekawati, Ema Novita Deniati, Anindya Hapsari, Lu'luim Mutakifah, Annisaa Annisaa, Lilik Ariyanti

Preventia: The Indonesian Journal of Public Health

Indonesia has a significant population problem. The national population grows by a staggering 4.5 million people annually, and Malang is one example of a city experiencing this rapid growth. The government is implementing a program called "Kampung KB" to address this issue. The purpose of this research is to provide an overview of the participation of the people of “Kampung KB” Malang City. This study uses qualitative research with in-depth interviews, then analyzed using data triangulation. This research was conducted from September to December 2020. The research location was six “Kampung KB” in Malang City. The result of this research …

Determinants Of Utilization Of Covid-19 Vaccination Services For Pregnant Women, Risa Septi Astutik, Ayun Sriatmi, Eka Yunila Fatmasari

Preventia: The Indonesian Journal of Public Health

The COVID-19 pandemic has caused an increase in the death rate of pregnant women. The government is taking preventive action by providing COVID-19 vaccination to pregnant women in accordance with the Circular Letter of the Ministry of Health of the Republic of Indonesia HK.02.01/I/2007/2021. Even though it has been carried out for 2 months, vaccination coverage is still low, especially in Temanggung Regency. This study aims to determine behavioral determinants in the use of COVID-19 vaccination services for pregnant women. This research uses an analytical survey method with a quantitative approach through a cross-sectional study. Taking 200 samples using the …

Determinan Utilisasi Layanan Wisata Kebugaran (Wellness Tourism) Di Rsup Dr. Sardjito, Yogyakarta, Firman Firman, Kartika Lestari, Citra Corneriski Garnet

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Wellness tourism have become a new trend for Indonesian people in maintaining their physical and spiritual health. Dr. Sardjito General Central Hospital is one of the hospital institutions that develops medical & wellness tourism services by utilizing Javanese culture and using traditional materials. This study aims to determine the factors that influence patients using wellness tourism. Qualitative research with a phenomenological approach and sample selection using purposive sampling with specified criteria. The total informants were 10 patients, and 5 from service providers such as management, administration and therapists at the Kalimosodo polyclinic. Data collection was carried out through in-depth interviews …

Analisis Pelaporan Nilai Kritis Hasil Pemeriksaan Laboratorium Di Rumah Sakit Mayjend Hm Ryacudu Kabupaten Lampung Utara, Rahmat Hidayat, Entuy Kurniawan, Ira Gustira Rahayu, Wiwin Wiryanti

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Critical values are abnormal values indicating high-risk/pathophysiological conditions that threaten the patient's life and require immediate medical intervention. Reporting critical laboratory values must be done quickly and accurately to the patient's responsible physician (DPJP) to ensure prompt and appropriate treatment. The aim of this study is to understand the reporting of critical laboratory values and its impact on the clinical decisions of doctors. This research uses both quantitative and qualitative methods with a descriptive analysis approach. Data collection was conducted through in-depth interviews, documentation, and observation. Informants were 15 DPJP. The results of this study show that the reporting system …

Analysis Of Accessibility Of People With Sensory Disabilities In Rsud Pasar Minggu, Daffaldo Suryoputra, Masyitoh Basabih, Fify Mulyani

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

People with a disability is someone who has conditions, whether physically and mentally that make a person experience difficulty in certain conditions and interact with their environment. Pasar Minggu Regional Hospital (RSUD Pasar Minggu) has achieved a general patient satisfaction indicator with satisfaction rate of 90% in 2022. This satisfaction indicator mainly comes from infrastructure and facility factors, along with the competence of service providers and costs. As a regional referral hospital, this hospital certainly has patients with physical limitations due to disabilities or illnesses. To ensure patient satisfaction can also be felt by patients with physical limitations, this study …

Disability Among Older Adults With Hypertension In Southeast Asia: A Scoping Review, Utoomporn Wongsin, Arnat Wannasri, Dichapong Pongpattrachai, Tuo-Yu Chen

Journal of Demography

Background: The prevalence of chronic disease and disability is expected to increase when age increases. This study aims to investigate the published articles related to disability among older adults living with hypertension in Southeast Asia.

Study Design: A scoping review

Data source: Web of science, Pubmed, CINAHL ,Cochrane and a google search, from 2000 to 2023.

Results: There were six observational studies from Indonesia, Vietnam, Malaysia, and Thailand met our inclusion criteria. The studies mainly focus on investigating the prevalence, risk factors and sex difference in risk factors associated with disabilities among the older adults.

Conclusion: Our scoping review has …

Using Human Intestinal Organoids To Understand The Small Intestine Epithelium At The Single Cell Transcriptional Level, Carolyn Bomidi, Xi-Lei Zeng, Victoria Poplaski, Cristian Coarfa, Mary K Estes, Sarah E Blutt

Faculty, Staff and Students Publications

Single cell transcriptomics has revolutionized our understanding of the cell biology of the human body. State-of-the-art human small intestinal organoid cultures provide ex vivo model systems that bridge the gap between animal models and clinical studies. The application of single cell transcriptomics to human intestinal organoid (HIO) models is revealing previously unrecognized cell biology, biochemistry, and physiology of the GI tract. The advanced single cell transcriptomics platforms use microfluidic partitioning and barcoding to generate cDNA libraries. These barcoded cDNAs can be easily sequenced by next generation sequencing platforms and used by various visualization tools to generate maps. Here, we describe …

A Comprehensive Analysis Of How Pet Ownership Impacts The Experiences And Well-Being Of Homeless Individuals, Alexandra G. Watson, Nancy A. Dreschel

People and Animals: The International Journal of Research and Practice

This paper conducts a thorough examination of the relationship between pet ownership and homelessness. In a context where homelessness in the United States is a growing concern, we delve into an aspect that has received little attention: how homeless individuals and their pets interact. Through an extensive review of existing research, this paper aims to uncover the demographic characteristics of homeless pet owners and understand the significant effects of this bond. Our findings reveal that homeless individuals with pets come from diverse backgrounds, including various ages, genders, and racial backgrounds. Their pets provide not only companionship but also emotional support, …

The Frailty Trajectory's Additional Edge Over The Frailty Index: Retrospective Cohort Study Of Veterans With Heart Failure, Javad Razjouyan, Ariela R Orkaby, Molly J Horstman, Parag Goyal, Orna Intrator, Aanand D Naik

Faculty, Staff and Students Publications

No abstract provided.

Understanding Organ Donation Messaging: A Qualitative Inquiry, Rebecca K. Britt, Amy A. Ritchart

The Qualitative Report

Promoting health communication about organ donation remains a crucial objective within Native American communities. The goals of the current study were to communicate with young adult Native Americans about the Organ Donation Willingness Model (ODWM; Horton & Horton, 1991) to gain their responses to materials from campaigns about donation strategies tailored to Native American communities. Six focus groups were conducted with a total of 31 participants. Data were analyzed using thematic analysis (Braun & Clarke, 2019, 2022) and following Smith’s guidelines (2008), which include showing deep respect for the group participants, conducting the study in a face-to-face setting, and being …

Identifying Interventions To Improve Diagnostic Safety In Emergency Departments: Protocol For A Participatory Design Study, Woosuk Seo, Sun Young Park, Zhan Zhang, Hardeep Singh, Kalyan Pasupathy, Prashant Mahajan

Faculty, Staff and Students Publications

Background: Emergency departments (EDs) are complex and fast-paced clinical settings where a diagnosis is made in a time-, information-, and resource-constrained context. Thus, it is predisposed to suboptimal diagnostic outcomes, leading to errors and subsequent patient harm. Arriving at a timely and accurate diagnosis is an activity that occurs after an effective collaboration between the patient or caregiver and the clinical team within the ED. Interventions such as novel sociotechnical solutions are needed to mitigate errors and risks.

Objective: This study aims to identify challenges that frontline ED health care providers and patients face in the ED diagnostic process and …

The Cost Of Healthy Eating, Diana Prychyna

University Honors Theses

Background: Each year in the United States, 15-20% of 1 million visits to the Emergency Department for Acute Heart Failure result in home discharge, with patients often experiencing adverse health outcomes within 30 days. The study, Get With the Guidelines in Emergency Department Patients With Heart Failure, utilized 'Self-Care Coaches' who meet participants via telehealth calls to discuss self-care maintenance after discharge as a strategy to mitigate adverse health outcomes; and offer provisions of resources, including a cookbook by the American Association for Heart Failure Nurses (AAHFN).

During telehealth calls, we observed gaps in self-care for retired older adults (62+), …

Health Equity In Stroke Prophylaxis For New Atrial Fibrillation In The Emergency Department, Mariam Anwar

University Honors Theses

Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and often, first diagnosed in the emergency department (ED). AF increases the risk of stroke, which can be decreased by 64% if the appropriate oral anticoagulation (OAC) is prescribed. However, many patients are not prescribed OAC for new AF. We investigate whether patient ethnicity, specifically Hispanic-Latino & Russian/Ukrainian, affects OAC prescription.

Method: This retrospective chart review study included patients at an academic tertiary care center and a community hospital >17 years old with a primary ED diagnosis of AF or paroxysmal AF from January 2020-2024. Patients with valvular heart disease …

Chagas Disease In Immunocompromised Patients, Eva H Clark, Louisa A Messenger, Jeffrey D Whitman, Caryn Bern

Faculty, Staff and Students Publications

As Chagas disease remains prevalent in the Americas, it is important that healthcare professionals and researchers are aware of the screening, diagnosis, monitoring, and treatment recommendations for the populations of patients they care for and study. Management of Trypanosoma cruzi infection in immunocompromised hosts is challenging, particularly because, regardless of antitrypanosomal treatment status, immunocompromised patients with Chagas disease are at risk for T. cruzi reactivation, which can be lethal. Evidence-based practices to prevent and manage T. cruzi reactivation vary depending on the type of immunocompromise. Here, we review available data describing Chagas disease epidemiology, testing, and management practices for various …

Supporting Ontario Public Health Units To Address Adverse Childhood Experiences In Pandemic Recovery Planning: A Priority-Setting Exercise, Kimberly B Harding, Erica Di Ruggiero, Erick Gonzalez, Amanda Hicks, Daniel W Harrington, Sarah Carsley

Faculty, Staff and Student Publications

BACKGROUND: Adverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units' work towards ACEs-informed pandemic recovery plans.

METHODS: The Child Health and Nutrition Research Initiative method …