HEAL Network
Stanford Faculty working in partnership to achieve health equity
In response to growing interest and expertise among faculty that are dedicated to addressing health disparities, we have launched a Health Equity Action Leadership (HEAL) Network. Based in research and scholarship, the HEAL Network brings faculty together to determine how we can better address health inequities. Through the Network members are able to:
- Participate in education and training
- Identify collaborative funding opportunities
- Develop local and National policies to address health disparities
- Receive or provide mentorship
HEAL Network membership is currently open to Stanford Medicine faculty who are involved or interested in Health Equity Research. While membership is currently limited to faculty, most HEAL Network activities are open to anyone at Stanford with an interest in Health Equity research. We will promote HEAL Network activities to a broad audience through the HEAL and SPHERE Websites and other communication approaches. See who is in the HEAL Network.
The HEAL Network builds upon the vision from Stanford Precision Health for Ethnic and Racial Equity (SPHERE), a five-year initiative led by Bonnie Maldonado that is dedicated to reducing disease in minority populations through the implementation of precision health projects and community engagement.
Please learn more about SPHERE by visiting the SPHERE Website.
HEAL Network Steering Committee
Bio
Publications
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Toward decolonized fiscal relationships between universities and community organizations: lessons learned from the California community engagement alliance against COVID-19
CRITICAL PUBLIC HEALTH
Burke, N. J., Espinosa, P., Corchado, C. C., Vazquez, E., Rosas, L. G., Wooe, K. J., Lesarre, M., Gallegos-Castillo, A., Cheney, A., Lo, D. D., Hintz, R., Vassar, S. D., Brown, A. F.
2024; 34 (1): 1-13
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View details for DOI 10.1080/09581596.2024.2323715
View details for Web of Science ID 001187561900001
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The Effectiveness of Recipe4Health: A Quasi-Experimental Evaluation.
American journal of preventive medicine
Rosas, L. G., Chen, S., Xiao, L., Baiocchi, M., Ng, E., Emmert-Aronson, B. O., Chen, W. T., Thompson-Lastad, A., Martinez, E., Perez, J., Melendez, E., Markle, E., Radtke, M. D., Tester, J.
2024
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Abstract
Food as Medicine is increasingly recognized as an important strategy for addressing the related challenges of food insecurity and nutrition-related chronic conditions. Food as Medicine refers to integration of food-based nutrition interventions into healthcare to prevent and treat disease. However, there is limited evidence to understand the effectiveness of Food as Medicine.Recipe4Health, a comprehensive Food as Medicine program, was implemented in 4 Federally Qualified Health Centers in California for patients with food insecurity and/or nutrition-related chronic conditions. Patients were referred by a healthcare provider to a 'Food Farmacy' (16 weekly produce home deliveries) alone or in combination with a 'Behavioral Pharmacy' (16 weekly group visits). A quasi-experimental study with pre/post surveys (4 months) and propensity score matched controls for Electronic Health Record (EHR) outcomes over 12 months was conducted. Participants were 2,643 Recipe4Health patients and 2,643 controls identified from 1/2020 to 12/2022; data were analyzed from 2023-2024.There was a significant increase in produce consumption from baseline to four months (0.41 servings/day [0.11, 0.72], p=0.007) in the Food Farmacy in combination with Behavioral Pharmacy. Compared to controls, there were improvements in non-HDL cholesterol for the Food Farmacy alone (-17.1 mg/dl[-26.9, -7.2], p<0.001) and in combination with Behavioral Pharmacy (-17 mg/dl [-28.3, -5.8], p=0.003) at 12 months. Compared to controls, HbA1c significantly decreased in the Food Farmacy alone at 12 months (-0.37%, 95% CI [-0.65, -0.08]; p=0.01), but not the Food Farmacy with Behavioral Pharmacy.Recipe4Health resulted in improvements in diet and multiple clinical health outcomes, such as non-HDL cholesterol and HbA1c.
View details for DOI 10.1016/j.amepre.2024.10.020
View details for PubMedID 39491775
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Digital health equity - A call to action for clinical and translational scientists
JOURNAL OF CLINICAL AND TRANSLATIONAL SCIENCE
Rowland, S., Brewer, L. C., Rosas, L. G.
2024; 8 (1)
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View details for DOI 10.1017/cts.2024.564
View details for Web of Science ID 001331517200001
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Addressing diabetes by elevating access to nutrition (ADELANTE) - A multi-level approach for improving household food insecurity and glycemic control among Latinos with diabetes: A randomized controlled trial.
Contemporary clinical trials
Radtke, M. D., Chen, W. T., Xiao, L., Espinosa, P. R., Orizaga, M., Thomas, T., Venditti, E., Yaroch, A. L., Zepada, K., Rosas, L. G., Tester, J.
2024: 107699
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Abstract
Latinx adults are disproportionately impacted by the interrelated challenges of food insecurity and nutrition sensitive chronic diseases. Food and nutrition insecurity can exacerbate the development and progression of chronic diseases, such as diabetes. Sustainable, effective interventions aimed at improving food insecurity and diabetes management for Latinx populations are needed.This hybrid type 1 trial evaluates the effectiveness of a multi-level intervention that includes a medically supportive food and behavioral lifestyle program on the primary outcome of Hemoglobin A1c (HbA1c) at 6 months. Latinx adults (n = 355) with type 2 diabetes (HbA1c of 6.0-12.0 %), overweight/obesity (BMI > 25 kg/m2), and self-reported risk of food insecurity will be randomized 1:1 to intervention (12 weekly deliveries of vegetables, fruits, and whole-grain foods + culturally-modified behavioral lifestyle program) versus control (food deliveries after a 6-month delay). Outcome asessments will occur at 0, 6 and 12 months, and include HbA1c, dietary intake, psychosocial health outcomes, and diabetes-related stressors. In addition, food insecurity and the impact of the intervention on up to two household members will be measured. Qualitative interviews with patients, healthcare providers, and community partners will be conducted in accordance with Reach, Effectivenes, Adoption, Implementation, and Maintenence (RE-AIM) framework to identify barriers and best practices for future dissemination.The ADELANTE trial will provide novel insight to the effectiveness of a multi-level intervention on diabetes-related outcomes in Latinx adults. The mixed-method approach will also identity the reach of this 'Food is Medicine' intervention on additional household members to inform diabetes prevention efforts.NCT05228860.
View details for DOI 10.1016/j.cct.2024.107699
View details for PubMedID 39322114
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A Randomized Controlled Trial of a Culturally Adapted, Community-Based, Remotely Delivered Mindfulness Program for Latinx Patients With Breast Cancer is Acceptable and Feasible While Reducing Anxiety.
Global advances in integrative medicine and health
Juarez-Reyes, M., Martinez, E., Xiao, L., Goldman Rosas, L.
2024; 13: 27536130241274240
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Abstract
Few Spanish mindfulness interventions have been evaluated in Latinx patients with cancer. We culturally adapted a mindfulness intervention for Spanish speaking Latinx patients. The objective was to measure feasibility and acceptability as primary outcomes, with changes in anxiety, depression, and sleep as secondary outcomes.Spanish-speaking Latinx patients with breast cancer (n = 31) were randomized, between April 2021 and May 2022 to either intervention or wait-list control groups. The mindfulness intervention consisted of 6-weekly 1.5-hour sessions remotely delivered by a novice facilitator. Cultural adaptations included language, metaphor, goal, concept, trauma informed, and acknowledgement of spirituality. Feasibility was benchmarked as 75% of participants attending their first session, 75% of participants completing 4 of 6 sessions, and scoring ≥ 4 on a 5-point Likert feasability scale measuring ability to implement changes after 6-weeks. Acceptability was measured as scoring ≥ 4 on a 5-point Likert scale measuring usefulness and relevance of the mindfulness intervention for each session. An intention-to-treat, linear mixed model with repeated measures analysis examined changes in anxiety, depression, and sleep at week 6 and 18 (3 months post intervention).All three feasibility benchmarks were met with 75% of first session attendance, 96% of participants completing 4 of 6 sessions, and 94% scoring ≥ 4, on the feasibility scale (Mean (SD) = 4.3 (0.6)). Acceptability scores for both usefulness and relevance questions were ≥ 4 across all 6 sessions. Anxiety was significantly reduced at 3 months (-3.6 (CI -6.9, -0.2), P = .04), but is of unclear clinical significance given the small change. Depression scores declined, but not significantly, and there were no changes in sleep.This culturally adapted, remotely delivered mindfulness intervention using a novice facilitator was acceptable and feasible and demonstrated associated reductions in anxiety amongst Spanish speaking Latinx patients with breast cancer.ClinicalTrials.gov ID# NCT04834154.
View details for DOI 10.1177/27536130241274240
View details for PubMedID 39157776
View details for PubMedCentralID PMC11329901
Bio
Publications
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Factors Associated with Lipoprotein(a) Testing Among Multiethnic Individuals.
Journal of general internal medicine
Brar, S., Huang, Q., Yan, X., Dudum, R., Jose, P., Sarraju, A., Palaniappan, L., Rodriguez, F.
2024
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Abstract
Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and clinical guidelines recommend incorporating Lp(a) testing in routine care.Examine real-world, contemporary clinical testing patterns of Lp(a) among multiethnic populations.In this nested case-control study, we assessed the prevalence and factors associated with Lp(a) testing within a large Northern Californian health system between 2010 and 2021. Incident density matching was used to select controls matched with a case for a case:control ratio of up to 1:5. Conditional logistic regression was used to assess the relationship between Lp(a) testing, sociodemographic, and clinical characteristics.We included individuals aged 18 years or older with ≥ 2 primary care visits during the study period.Lp(a) testing rates over time and factors associated with testing based on demographic, medical, and healthcare utilization variables.Of the 1,484,410 individuals in the cohort, 14,818 (1.0%) underwent Lp(a) testing. The median Lp(a) level was 35 mg/dL and over a third of individuals had Lp(a) levels > 50 mg/dL. After adjustment, South Asian individuals were three times more likely to have undergone Lp(a) testing, as compared to non-Hispanic White individuals [OR = 3.19, (95% CI = 2.98, 3.41)], while those identified as non-Hispanic Black and Hispanic were significantly less likely to have undergone Lp(a) testing [OR = 0.70, (95% CI = 0.62, 0.80) and 0.64 (95% CI = 0.59, 0.69), respectively]. Those with a history of ASCVD had over twice the odds of undergoing testing [OR = 2.14 (95% CI = 1.99, 2.29)], as did individuals with more frequent primary care visits [OR = 1.99 (95% CI = 1.84, 2.15)].Lp(a) testing rates in real-world settings are low, with significant disparities by race, ethnicity, and healthcare utilization. Expanding access to Lp(a) testing may help reduce disparities within ASCVD risk assessment and treatment as new targeted therapeutic agents become available.
View details for DOI 10.1007/s11606-024-09126-6
View details for PubMedID 39455482
View details for PubMedCentralID 10547299
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Neonatal mortality among disaggregated Asian American and Native Hawaiian/Pacific Islander populations.
Journal of perinatology : official journal of the California Perinatal Association
Maricar, I. N., Helkey, D., Nadarajah, S., Akiba, R., Bacong, A. M., Razdan, S., Palaniappan, L., Phibbs, C. S., Profit, J.
2024
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Abstract
We compared neonatal (<28 days) mortality rates (NMRs) across disaggregated Asian American and Native Hawaiian/Pacific Islander (AANHPI) groups using recent, national data.We used 2015-2019 cohort-linked birth-infant death records from the National Vital Statistics System. Our sample included 61,703 neonatal deaths among 18,709,743 births across all racial and ethnic groups. We compared unadjusted NMRs across disaggregated AANHPI groups, then compared NMRs adjusting for maternal sociodemographic, maternal clinical, and neonatal risk factors.Unadjusted NMRs differed by over 3-fold amongst disaggregated AANHPI groups. Native Hawaiian/Pacific Islander neonates in aggregate had the highest fully-adjusted odds of mortality (OR: 1.08 [95% CI: 0.89, 1.31]) compared to non-Hispanic White neonates. Filipino, Asian Indian, and Other Asian neonates experienced significant decreases in odds ratios after adjusting for neonatal risk factors.Aggregating AANHPI neonates masks large heterogeneity and undermines opportunities to provide targeted care to higher-risk groups.
View details for DOI 10.1038/s41372-024-02149-1
View details for PubMedID 39397056
View details for PubMedCentralID 6805610
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Cancer Mortality among Hispanic groups in the US, by birthplace (2003-2017).
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
He, Y., Pinheiro, P. S., Tripathi, O., Nguyen, H., Srinivasan, M., Palaniappan, L. P., Thompson, C. A.
2024
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BACKGROUND: The Hispanic population is the second largest racial/ethnic group in the US, consisting of multiple distinct ethnicities. Ethnicity-specific variations in cancer mortality may be attributed to countries of birth, so we aimed to understand differences in cancer mortality among disaggregated Hispanics by nativity (native- or foreign- born vs. US-born) over 15 years.METHODS: 228,197 Hispanic decedents (Mexican, Puerto Rican [PR], Cuban, and Central or South American) with cancer-related deaths from US death certificates (2003-2017) were analyzed. Seven cancers that contribute significantly to Hispanic male (lung and bronchus, colon and rectum, liver, prostate, and pancreas cancers) and female (lung and bronchus, liver, pancreas, colon and rectum, female breast, and ovary cancers) mortality were selected for analysis. 5-year age-adjusted mortality rates [AAMR (95% CI); per 100,000] and standardized mortality ratios [SMR (95% CI)] using foreign-born as the reference group were calculated. Joinpoint regression analysis was used to model cancer-related mortality trends.RESULTS: Puerto Rico-born PRs, Cuba-born Cubans, and US-born Mexicans had some of the highest cancer death rates among all the Hispanic groups. In general, foreign-born Hispanics had higher cancer mortality rates than US-born, except Mexicans. Overall, US-born and non-US-born (i.e. native- or foreign- born) Hispanic groups experienced decreasing rates of cancer deaths over the years.CONCLUSIONS: We noted vast heterogeneity in mortality rates by nativity across Hispanic groups, a fast-growing diverse US population.IMPACT: Understanding disaggregated patterns and trends in cancer burden can motivate deeper discussion around community health resources, which may improve the health of Hispanics across the US.
View details for DOI 10.1158/1055-9965.EPI-24-0792
View details for PubMedID 39361352
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Associations between accurate measures of adiposity and fitness, blood proteins, and insulin sensitivity among South Asians and Europeans.
medRxiv : the preprint server for health sciences
Kho, P. F., Stell, L., Jimenez, S., Zanetti, D., Panyard, D. J., Watson, K. L., Sarraju, A., Chen, M. L., Lind, L., Petrie, J. R., Chan, K. N., Fonda, H., Kent, K., Myers, J. N., Palaniappan, L., Abbasi, F., Assimes, T. L.
2024
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Abstract
South Asians (SAs) may possess a unique predisposition to insulin resistance (IR). We explored this possibility by investigating the relationship between 'gold standard' measures of adiposity, fitness, selected proteomic biomarkers, and insulin sensitivity among a cohort of SAs and Europeans (EURs).A total of 46 SAs and 41 EURs completed 'conventional' (lifestyle questionnaires, standard physical exam) as well as 'gold standard' (dual energy X-ray absorptiometry scan, cardiopulmonary exercise test, and insulin suppression test) assessments of adiposity, fitness, and insulin sensitivity. In a subset of 28 SAs and 36 EURs, we also measured the blood-levels of eleven IR-related proteins. We conducted Spearman correlation to identify correlates of steady-state plasma glucose (SSPG) derived from the insulin suppression test, followed by multivariable linear regression analyses of SSPG, adjusting for age, sex and ancestral group.Sixteen of 30 measures significantly associated with SSPG, including one conventional and eight gold standard measures of adiposity, one conventional and one gold standard measure of fitness, and five proteins. Multivariable regressions revealed that gold standard measures and plasma proteins attenuated ancestral group differences in IR, suggesting their potential utility in assessing IR, especially among SAs.Ancestral group differences in IR may be explained by accurate measures of adiposity and fitness, with specific proteins possibly serving as useful surrogates for these measures, particularly for SAs.
View details for DOI 10.1101/2024.09.06.24313199
View details for PubMedID 39281745
View details for PubMedCentralID PMC11398600
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Trends in cigarette smoking and the risk of incident cardiovascular disease among Asian American, Pacific Islander, and multiracial populations
AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY
Li, J., Daida, Y. G., Bacong, A., Rosales, A., Frankland, T. B., Varga, A., Chung, S., Fortmann, S. P., Waitzfelder, B., Palaniappan, L.
2024; 19
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View details for DOI 10.1016/j.ajpc.2024.100688
View details for Web of Science ID 001265185400001
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Temporal trends in lipoprotein(a) testing among United States veterans from 2014 to 2023
AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY
Gomez, S. E., Furst, A., Chen, T., Din, N., Maron, D. J., Heidenreich, P., Kalwani, N., Nallamshetty, S., Ward, J. H., Lozama, A., Sandhu, A., Rodriguez, F.
2024; 20
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View details for DOI 10.1016/j.ajpc.2024.100872
View details for Web of Science ID 001331656700001
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Temporal trends in lipoprotein(a) testing among United States veterans from 2014 to 2023.
American journal of preventive cardiology
Gomez, S. E., Furst, A., Chen, T., Din, N., Maron, D. J., Heidenreich, P., Kalwani, N., Nallamshetty, S., Ward, J. H., Lozama, A., Sandhu, A., Rodriguez, F.
2024; 20: 100872
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Abstract
Lipoprotein (a) [Lp(a)] is a causal, genetically-inherited risk amplifier for atherosclerotic cardiovascular disease (ASCVD). Practice guidelines increasingly recommend broad Lp(a) screening among various populations to optimize preventive care. Corresponding changes in testing rates and population-level detection of elevated Lp(a) in recent years has not been well described.Using Veterans Affairs electronic health record data, we performed a retrospective cohort study evaluating temporal trends in Lp(a) testing and detection of elevated Lp(a) levels (defined as greater than 50 mg/dL) from January 1, 2014 to December 31, 2023 among United States Veterans without prior Lp(a) testing. Testing rates were stratified based on demographic and clinical factors to investigate possible drivers for and disparities in testing: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability.Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023, while the proportion of elevated Lp(a) levels remained stable. Factors associated with higher likelihood of Lp(a) testing over time were a history of ASCVD, Asian race, and residing in neighborhoods with less social vulnerability.Despite a 9-fold increase in Lp(a) testing among US Veterans over the last decade, the overall testing rate remains extremely low. The steady proportion of Veterans with elevated Lp(a) over time supports the clinical utility of testing expansion. Efforts to increase testing, especially among Veterans living in neighborhoods with high social vulnerability, will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.
View details for DOI 10.1016/j.ajpc.2024.100872
View details for PubMedID 39430431
View details for PubMedCentralID PMC11489823
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Factors Associated with Lipoprotein(a) Testing Among Multiethnic Individuals.
Journal of general internal medicine
Brar, S., Huang, Q., Yan, X., Dudum, R., Jose, P., Sarraju, A., Palaniappan, L., Rodriguez, F.
2024
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Abstract
Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and clinical guidelines recommend incorporating Lp(a) testing in routine care.Examine real-world, contemporary clinical testing patterns of Lp(a) among multiethnic populations.In this nested case-control study, we assessed the prevalence and factors associated with Lp(a) testing within a large Northern Californian health system between 2010 and 2021. Incident density matching was used to select controls matched with a case for a case:control ratio of up to 1:5. Conditional logistic regression was used to assess the relationship between Lp(a) testing, sociodemographic, and clinical characteristics.We included individuals aged 18 years or older with ≥ 2 primary care visits during the study period.Lp(a) testing rates over time and factors associated with testing based on demographic, medical, and healthcare utilization variables.Of the 1,484,410 individuals in the cohort, 14,818 (1.0%) underwent Lp(a) testing. The median Lp(a) level was 35 mg/dL and over a third of individuals had Lp(a) levels > 50 mg/dL. After adjustment, South Asian individuals were three times more likely to have undergone Lp(a) testing, as compared to non-Hispanic White individuals [OR = 3.19, (95% CI = 2.98, 3.41)], while those identified as non-Hispanic Black and Hispanic were significantly less likely to have undergone Lp(a) testing [OR = 0.70, (95% CI = 0.62, 0.80) and 0.64 (95% CI = 0.59, 0.69), respectively]. Those with a history of ASCVD had over twice the odds of undergoing testing [OR = 2.14 (95% CI = 1.99, 2.29)], as did individuals with more frequent primary care visits [OR = 1.99 (95% CI = 1.84, 2.15)].Lp(a) testing rates in real-world settings are low, with significant disparities by race, ethnicity, and healthcare utilization. Expanding access to Lp(a) testing may help reduce disparities within ASCVD risk assessment and treatment as new targeted therapeutic agents become available.
View details for DOI 10.1007/s11606-024-09126-6
View details for PubMedID 39455482
View details for PubMedCentralID 10547299
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Seeing Is Knowing: Noninvasive Imaging Outperforms Traditional Risk Assessment.
Journal of the American College of Cardiology
Maron, D. J., Rodriguez, F.
2024; 84 (15): 1404-1406
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View details for DOI 10.1016/j.jacc.2024.06.048
View details for PubMedID 39357938
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Low-Density Lipoprotein Cholesterol Control as a Performance Measure: A National Analysis of the VHA.
Journal of the American College of Cardiology
Jain, S. S., Skye, M., Din, N., Furst, A., Maron, D. J., Heidenreich, P., Kalwani, N., Bhatt, A. S., Sandhu, A. T., Rodriguez, F.
2024; 84 (13): 1272-1275
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View details for DOI 10.1016/j.jacc.2024.07.025
View details for PubMedID 39293887
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International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial.
Circulation. Cardiovascular quality and outcomes
Ikemura, N., Spertus, J. A., Nguyen, D., Fu, Z., Jones, P. G., Reynolds, H. R., Bangalore, S., Bhargava, B., Senior, R., Elghamaz, A., Goodman, S. G., Lopes, R. D., Pracoń, R., López-Sendón, J., Maggioni, A. P., Kohsaka, S., Roth, G. A., White, H. D., Mavromatis, K., Boden, W. E., Rodriguez, F., Hochman, J. S., Maron, D. J.
2024: e010534
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Abstract
The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions.Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04-4.50] in North America to 4.66 points [95% CI, 2.46-6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was <5 points.In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease.URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
View details for DOI 10.1161/CIRCOUTCOMES.123.010534
View details for PubMedID 39301726
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Equity in Heart Failure Care: A Get With the Guidelines Analysis of Between- and Within-Hospital Differences in Care by Sex, Race, Ethnicity, and Insurance.
Circulation. Heart failure
Sandhu, A. T., Grau-Sepulveda, M. V., Witting, C., Tisdale, R. L., Zheng, J., Rodriguez, F., Edward, J. A., Ambrosy, A. P., Greene, S. J., Alhanti, B., Fonarow, G. C., Joynt Maddox, K. E., Heidenreich, P. A.
2024: e011177
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BACKGROUND: Disparities in guideline-based quality measures likely contribute to differences in heart failure (HF) outcomes. We evaluated between- and within-hospital differences in the quality of care across sex, race, ethnicity, and insurance for patients hospitalized for HF.METHODS: This retrospective analysis included patients hospitalized for HF across 596 hospitals in the Get With the Guidelines-HF registry between 2016 and 2021. We evaluated performance across 7 measures stratified by patient sex, race, ethnicity, and insurance. We evaluated differences in performance with and without adjustment for the treating hospital. We also measured variation in hospital-specific disparities.RESULTS: Among 685 227 patients, the median patient age was 72 (interquartile range, 61-82) and 47.2% were women. Measure performance was significantly lower (worse) for women compared with men for all 7 measures before adjustment. For 4 of 7 measures, there were no significant sex-related differences after patient-level adjustment. For 20 of 25 other comparisons, racial and ethnic minorities and Medicaid/uninsured patients had similar or higher (better) adjusted measure performance compared with White and Medicare/privately insured patients, respectively. Angiotensin receptor neprilysin inhibitor measure performance was significantly lower for Asian, Hispanic, and Medicaid/uninsured patients, and cardiac resynchronization therapy implant/prescription was lower among women and Black patients after hospital adjustment, indicating within-hospital differences. There was hospital-level variation in these differences. For cardiac resynchronization therapy implantation/prescription, 278 hospitals (46.6%) had ≥2% lower implant/prescription for Black versus White patients compared with 109 hospitals (18.3%) with the same or higher cardiac resynchronization therapy implantation/prescription for Black patients.CONCLUSIONS: HF quality measure performance was equitable for most measures. There were within-hospital differences in angiotensin receptor neprilysin inhibitor and cardiac resynchronization therapy implant/prescription for historically marginalized groups. The magnitude of hospital-specific disparities varied across hospitals.
View details for DOI 10.1161/CIRCHEARTFAILURE.123.011177
View details for PubMedID 39291393
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Low prevalence of testing for apolipoprotein B and lipoprotein (a) in the real world
AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY
Murdock, D. J., Moll, K., Sanchez, R. J., Gu, J., Fazio, S., Geba, G. P., Rodriguez, F.
2024; 19
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View details for DOI 10.1016/j.ajpc.2024.100721
View details for Web of Science ID 001304013600001
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Low prevalence of testing for apolipoprotein B and lipoprotein (a) in the real world.
American journal of preventive cardiology
Murdock, D. J., Moll, K., Sanchez, R. J., Gu, J., Fazio, S., Geba, G. P., Rodriguez, F.
2024; 19: 100721
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Abstract
Apolipoprotein B (ApoB) and lipoprotein (a) (Lp[a]) are predictors of cardiovascular disease (CVD) risk; therefore, current recommendations for CVD risk assessment and management advocate that patients receive testing for ApoB and Lp(a) in addition to the standard lipid panel. However, US guidelines around ApoB and Lp(a) testing have evolved over time and vary slightly by expert committee. The objective of this analysis was to estimate the number of insured individuals in the USA who received any component of a lipid test, or ApoB and/or Lp(a) testing, during 2019.We conducted a cross-sectional analysis to estimate the prevalence of any component of a lipid test, ApoB, and/or Lp(a) in the USA using four different claim data sources (including Medicaid, Medicare, and commercially insured enrollees). Prevalence estimates were age-, sex-, payor-, and region-standardized to the 2019 US Annual Social and Economic Supplement of the Current Population Survey. We also described the clinical profile of patients who received lipid testing between 2019 and 2021 (cohort analysis) in Optum claims database. Enrollees were grouped into four non-mutually exclusive cohorts based on their completion of any component of the lipid panel, ApoB, Lp(a), or ApoB and Lp(a).In the prevalence cohort, over a third (38 %) of insured adults in the USA underwent testing for any component of a lipid panel in 2019. This proportion was higher for individuals aged ≥65 years compared to younger adults (62% vs 31 %). The proportion of ApoB and Lp(a) testing represented only <1 % of testing for any component of a lipid panel. In the cohort analysis, we found that lipid testing increased with age and comorbidities.These data should be considered by guideline-issuing agencies and organizations to develop education campaigns encouraging more frequent use of tests beyond the standard lipid panel.
View details for DOI 10.1016/j.ajpc.2024.100721
View details for PubMedID 39281349
View details for PubMedCentralID PMC11399648
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Gender disparities in utilization of statins for low density lipoprotein management across the spectrum of atherosclerotic cardiovascular disease: Insights from the houston methodist cardiovascular disease learning health system registry.
American journal of preventive cardiology
Shahid, I., Satish, P., Gullapelli, R., Nicholas, J. C., Javed, Z., Avenatti, E., Bose, B., Mahajan, S., Roy, T., Sharma, G., Rodriguez, F., Andrieni, J., Jones, S. L., Al-Kindi, S., Cainzos-Achirica, M., Nasir, K.
2024; 19: 100722
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Lower statin utilization is reported among women compared to men, however large-scale studies evaluating gender disparities in LDL-C management in individuals with ASCVD and its subtypes remain limited, particularly across age and racial/ethnic subgroups. In this study, we address this knowledge gap using data from a large US healthcare system.All adult patients with established ASCVD in the Houston Methodist Learning Health System Registry during 2016-2022 were included. Statin use and dose were extracted from the database. The association between gender and statin utilization was evaluated using multivariate logistic regression analyses in patients with ASCVD overall, across ASCVD subtypes, and by age, racial/ethnic subgroups, and socioeconomic risk factors.A total of 97,819 patients with prevalent ASCVD were included. Women with ASCVD had lower utilization of any statin (64.3% vs 72.6 %; p < 0.001) and high-intensity statin (29.8% vs 42.5 % p < 0.001) compared with men. In fully adjusted models, women had 40 % lower odds of any (adjusted odds ratio [aOR]:0.58, 95 % CI 0.57-0.60) and high-intensity statin use (aOR:0.59, 0.57-0.61) relative to men. Women were also less likely to have guideline-recommended LDL-C < 70 mg/dL (30.2% vs 42.7 %; p < 0.01). These differences persisted across age, racial/ethnic and socioeconomic subgroups.Significant gender disparities exist in contemporary lipid management among patients with ASCVD, with women being less likely to receive any and high-intensity statin and achieving guideline defined LDL-C goal compared with men across age and racial/ethnic subgroups. These disparities underscore the need to further understand potential socioeconomic drivers of the observed lower statin uptake in women.
View details for DOI 10.1016/j.ajpc.2024.100722
View details for PubMedID 39281350
View details for PubMedCentralID PMC11402022
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Gender disparities in utilization of statins for low density lipoprotein management across the spectrum of atherosclerotic cardiovascular disease: Insights from the houston methodist cardiovascular disease learning health system registry
AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY
Shahid, I., Satish, P., Gullapelli, R., Nicholas, J. C., Javed, Z., Avenatti, E., Bose, B., Mahajan, S., Roy, T., Sharma, G., Rodriguez, F., Andrieni, J., Jones, S. L., Al-Kindi, S., Cainzos-Achirica, M., Nasir, K.
2024; 19
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View details for DOI 10.1016/j.ajpc.2024.100722
View details for Web of Science ID 001307353200001
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Digital Footprints of Obesity Treatment: GLP-1 Receptor Agonists and the Health Equity Divide.
Circulation
Azizi, Z., Rodriguez, F., Assimes, T. L.
2024; 150 (3): 171-173
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Abstract
Our research investigates the societal implications of access to glucagon-like peptide-1 (GLP-1) agonists, particularly in light of recent clinical trials demonstrating the efficacy of semaglutide in reducing cardiovascular mortality. A decade-long analysis of Google Trends indicates a significant increase in searches for GLP-1 agonists, primarily in North America. This trend contrasts with the global prevalence of obesity. Given the high cost of GLP-1 agonists, a critical question arises: Will this disparity in medication accessibility exacerbate the global health equity gap in obesity treatment? This viewpoint explores strategies to address the health equity gap exacerbated by this emerging medication. Because GLP-1 agonists hold the potential to become a cornerstone in obesity treatment, ensuring equitable access is a pressing public health concern.
View details for DOI 10.1161/CIRCULATIONAHA.124.069680
View details for PubMedID 39008562
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Using large language models to assess public perceptions around glucagon-like peptide-1 receptor agonists on social media.
Communications medicine
Somani, S., Jain, S. S., Sarraju, A., Sandhu, A. T., Hernandez-Boussard, T., Rodriguez, F.
2024; 4 (1): 137
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Abstract
The prevalence of obesity has been increasing worldwide, with substantial implications for public health. Obesity is independently associated with cardiovascular morbidity and mortality and is estimated to cost the health system over
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Characterization of Peripheral Artery Disease and Associations with Traditional Risk Factors, Mobility, and Biomarkers in the Project Baseline Health Study.
American heart journal
Kercheval, J. B., Narcisse, D. I., Nguyen, M., Rao, S. V., Gutierrez, J. A., Leeper, N. J., Maron, D. J., Rodriguez, F., Hernandez, A. F., Mahaffey, K. W., Shah, S. H., Swaminathan, R. V.
2024
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Abstract
There is a dearth of research on immunophenotyping in peripheral artery disease (PAD). This study aimed to describe the baseline characteristics, immunophenotypic profile, and quality of life (QoL) of participants with PAD in the Project Baseline Health Study (PBHS).The PBHS study is a prospective, multi-center, longitudinal cohort study that collected clinical, molecular, and biometric data from participants recruited between 2017 and 2018. In this analysis, baseline demographic, clinical, mobility, QoL, and flow cytometry data were stratified by the presence of PAD (ankle brachial index [ABI] ≤0.90).Of 2,209 participants, 58 (2.6%) had lower-extremity PAD, and only 2 (3.4%) had pre-existing PAD diagnosed prior to enrollment. Comorbid smoking (29.3% vs. 14%, p<0.001), hypertension (54% vs. 30%, p<0.001), diabetes (25% vs. 14%, p=0.031), and at least moderate coronary calcifications (Agatston score >100: 32% vs. 17%, p=0.01) were significantly higher in participants with PAD than in those with normal ABIs, as were high-sensitivity C-reactive protein levels (5.86 vs. 2.83, p<0.001). After adjusting for demographic and risk factors, participants with PAD had significantly fewer circulating CD56-high natural killer cells, IgM+ memory B cells, and CD10/CD27 double-positive B cells (p<0.05 for all).This study reinforces existing evidence that a large proportion of PAD without claudication may be underdiagnosed, particularly in female and Black or African American participants. We describe a novel immunophenotypic profile of participants with PAD that could represent a potential future screening or diagnostic tool to facilitate earlier diagnosis of PAD.NCT03154346, https://clinicaltrials.gov/ct2/show/NCT03154346.
View details for DOI 10.1016/j.ahj.2024.06.010
View details for PubMedID 38969081
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Sociodemographic Differences Among Patients Receiving Coronary Artery Calcium Imaging vs Nongated Chest Computed Tomography Imaging.
JACC. Advances
Peng, A. W., Skye, M., Jain, S. S., Dudum, R., Maron, D. J., Din, N., Patel, B. N., Chaudhari, A. S., Sandhu, A. T., Rodriguez, F.
2024; 3 (7): 100963
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View details for DOI 10.1016/j.jacadv.2024.100963
View details for PubMedID 39129975
View details for PubMedCentralID PMC11312303
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Sex, Age, and Patient Experience in Cardiologist Reviews: A Large-Scale Artificial Intelligence-Enabled Analysis.
JACC. Advances
Yang, A., Rodriguez, F., Woo, J. P.
2024; 3 (7): 101046
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Patients are increasingly using online reviews to evaluate cardiologists. Online reviews can provide insights into factors driving patient satisfaction. Little is known about the effects of age and sex on the patient experience with cardiologists.The purpose of this study was to apply natural language processing techniques on online reviews to determine the factors underlying positive and negative patient experiences and the effects of age and sex on the patient experience with cardiologists.Mixed effects logistic regression and sentiment analysis were applied to online cardiologist reviews from Healthgrades between 1998 and 2023. The results were then analyzed by sex and age to show trends with respect to rating statistics, sentiment analysis, and frequency of 2-word phrases.There were 100,334 online reviews of 9,461 cardiologists. Female cardiologists received lower average ratings compared to male cardiologists and were 34.5% less likely to receive a positive review (OR: 0.655; 95% CI: 0.481-0.893; P = 0.015). Older cardiologists received lower average ratings compared to younger cardiologists (4.145 ± 0.908 vs 4.348 ± 0.795; P < 0.01). Positive reviews were associated with time spent with patients (OR: 1.383; 95% CI: 1.251-1.528; P < 0.01), answering questions (OR: 2.622; 95% CI: 2.324-2.959; P < 0.01), and patients feeling they could trust their providers' decisions (OR: 2.285; 95% CI: 2.053-2.543; P < 0.01).Positive reviews were associated with cardiologists being comprehensive and patients feeling a sense of trust in the relationship. There was a difference in ratings based on age and sex with female and older cardiologists receiving lower ratings.
View details for DOI 10.1016/j.jacadv.2024.101046
View details for PubMedID 39129993
View details for PubMedCentralID PMC11312787
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Relationship between body mass index and cardiometabolic health in a multi-ethnic population: A project baseline health study.
American journal of preventive cardiology
Shah, N. P., Lu, R., Haddad, F., Shore, S., Schaack, T., Mega, J., Pagidipati, N. J., Palaniappan, L., Mahaffey, K., Shah, S. H., Rodriguez, F.
2024; 18: 100646
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Obesity is associated with a higher risk of cardiovascular disease. Understanding the associations between comprehensive health parameters and body mass index (BMI) may lead to targeted prevention efforts.Project Baseline Health Study (PBHS) participants were divided into six BMI categories: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), class I obesity (30-34.9 kg/m2), class II obesity (35-39.9 kg/m2), and class III obesity (BMI ≥40 kg/m2). Demographic, cardiometabolic, mental health, and physical health parameters were compared across BMI categories, and multivariable logistic regression models were fit to evaluate associations.A total of 2,493 PBHS participants were evaluated. The mean age was 50±17.2 years; 55 % were female, 12 % Hispanic, 16 % Black, and 10 % Asian. The average BMI was 28.4 kg/m2±6.9. The distribution of BMI by age group was comparable to the 2017-2018 National Health and Nutrition Examination Survey (NHANES) dataset. The obesity categories had higher proportions of participants with CAC scores >0, hypertension, diabetes, lower HDL-C, lower vitamin D, higher triglycerides, higher hsCRP, lower mean step counts, higher mean PHQ-9 scores, and higher mean GAD-7 scores.We identified associations of cardiometabolic and mental health characteristics with BMI, thereby providing a deeper understanding of cardiovascular health across BMI.
View details for DOI 10.1016/j.ajpc.2024.100646
View details for PubMedID 38550633
View details for PubMedCentralID PMC10966449
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Lipoprotein(a) Levels in Disaggregated Racial and Ethnic Subgroups Across Atherosclerotic Cardiovascular Disease Risk Levels.
JACC. Advances
Dudum, R., Huang, Q., Yan, X. S., Fonseca, M. A., Jose, P., Sarraju, A., Palaniappan, L., Rodriguez, F.
2024; 3 (6): 100940
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Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD).The authors assessed differences in Lp(a) testing and levels by disaggregated race, ethnicity, and ASCVD risk.This was a retrospective cohort study of patients from a large California health care system from 2010 to 2021. Eligible individuals were ≥18 years old, with ≥2 primary care visits, and complete race and ethnicity data who underwent Lp(a) testing. Race and ethnicity were self-reported and categorized as follows: non-Hispanic (NH) White, NH-Black, Hispanic (Mexican, Puerto Rican, other), NH-Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other). Logistic regression models tested associations between elevated Lp(a) (≥50 mg/dL) and race, ethnicity, and ASCVD risk.13,689 (0.9%) individuals underwent Lp(a) testing with a mean age of 54.6 ± 13.8 years, 49% female, 28.8% NH Asian. Over one-third of those tested had Lp(a) levels ≥50 mg/dL, ranging from 30.7% of Mexican patients to 62.6% of NH-Black patients. The ASCVD risk of those tested varied by race: 73.6% of Asian Indian individuals had <5% 10-year risk, whereas 27.2% of NH-Black had established ASCVD. Lp(a) prevalence ≥50 mg/dL increased across the ASCVD risk spectrum. After adjustment, Hispanic (OR: 0.76 [95% CI: 0.66-0.88]) and Asian (OR: 0.88 [95% CI: 0.81-0.96]) had lower odds of Lp(a) ≥50 mg/dL, whereas Black individuals had higher odds (OR: 2.46 [95% CI: 1.97-3.07]).Lp(a) testing is performed infrequently. Of those tested, Lp(a) levels were frequently elevated and differed significantly across disaggregated race and ethnicity groups. The prevalence of elevated Lp(a) increased with increasing ASCVD risk, with significant variation by race and ethnicity.
View details for DOI 10.1016/j.jacadv.2024.100940
View details for PubMedID 38938854
View details for PubMedCentralID PMC11198068
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Statin utilization and cardiovascular outcomes in a real-world primary prevention cohort of older adults.
American journal of preventive cardiology
Walker, A. J., Zhu, J., Thoma, F., Marroquin, O., Makani, A., Gulati, M., Gianos, E., Virani, S. S., Rodriguez, F., Reis, S. E., Ballantyne, C., Mulukutla, S., Saeed, A.
2024; 18: 100664
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Background: Statins are a cost-effective therapy for prevention of atherosclerotic cardiovascular disease (ASCVD). Guidelines on statins for primary prevention are unclear for older adults (>75 years).Objective: Investigate statin utility in older adults without ASCVD events, by risk stratifying in a large healthcare network.Methods: We included 8,114 older adults, without CAD, PVD or ischemic stroke. Statin utilization based on ACC/AHA 10-year ASCVD risk calculation, was evaluated in intermediate (7.5%-19.9%) and high-risk patients (≥ 20%); and categorized using low and 'moderate or high' intensity statins with a follow up period of 7 years. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization. Data was adjusted for competing risk using Elixhauser Comorbidity Index.Results: Compared with those on moderate or high intensity statins, high-risk older patients not on any statin had a significantly increased risk of MI [HR 1.51 (1.17-1.95); p<0.01], stroke [HR 1.47 (1.14-1.90); p<0.01] and all-cause mortality [HR 1.37 (1.19-1.58); p<0.001] in models adjusted for Elixhauser Comorbidity Index. When comparing the no statin group versus the moderate or high intensity statin group in the intermediate risk cohort, although a trend for increased risk was seen, it did not meet statistical significance thresholds for MI, stroke or all-cause mortality.Conclusion: Lack of statin use was associated with increased cardiovascular events and mortality in high-risk older adults. Given the benefits appreciated, statin use may need to be strongly considered for primary ASCVD prevention among high-risk older adults. Future studies will assess the risk-benefit ratio of statin intervention in older adults.
View details for DOI 10.1016/j.ajpc.2024.100664
View details for PubMedID 38665251
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Artificial Intelligence in Cardiovascular Disease Prevention: Is it Ready for Prime Time?
Current atherosclerosis reports
Parsa, S., Somani, S., Dudum, R., Jain, S. S., Rodriguez, F.
2024
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PURPOSE OF REVIEW: This review evaluates how Artificial Intelligence (AI) enhances atherosclerotic cardiovascular disease (ASCVD) risk assessment, allows for opportunistic screening, and improves adherence to guidelines through the analysis of unstructured clinical data and patient-generated data. Additionally, it discusses strategies for integrating AI into clinical practice in preventive cardiology.RECENT FINDINGS: AI models have shown superior performance in personalized ASCVD risk evaluations compared to traditional risk scores. These models now support automated detection of ASCVD risk markers, including coronary artery calcium (CAC), across various imaging modalities such as dedicated ECG-gated CT scans, chest X-rays, mammograms, coronary angiography, and non-gated chest CT scans. Moreover, large language model (LLM) pipelines are effective in identifying and addressing gaps and disparities in ASCVD preventive care, and can also enhance patient education. AI applications are proving invaluable in preventing and managing ASCVD and are primed for clinical use, provided they are implemented within well-regulated, iterative clinical pathways.
View details for DOI 10.1007/s11883-024-01210-w
View details for PubMedID 38780665
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Inequities in atherosclerotic cardiovascular disease prevention.
Progress in cardiovascular diseases
Gomez, S., Dudum, R., Rodriguez, F.
2024
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Atherosclerotic cardiovascular (CV) disease (ASCVD) prevention encompasses interventions across the lifecourse: from primordial to primary and secondary prevention. Primordial prevention begins in childhood and involves the promotion of ideal CV health (CVH) via optimizing physical activity, body mass index, blood glucose levels, total cholesterol levels, blood pressure, and sleep while minimizing tobacco use. Primary and secondary prevention of ASCVD thereafter centers around mitigating ASCVD risk factors via medical therapy and lifestyle interventions. Disparities in optimal preventive efforts exist among historically marginalized groups in each of these three prongs of ASCVD prevention. Children and adults with a high burden of social determinants of health also face inequity in preventive measures. Inadequate screening, risk factor management and prescription of preventive therapeutics permeate the care of certain groups, especially women, Black, and Hispanic individuals in the United States. Beyond this, individuals belonging to historically marginalized groups also are much more likely to experience other ASCVD risk-enhancing factors, placing them at higher risk for ASCVD over their lifetime. These disparities translate to worse outcomes, with higher rates of ASCVD and CV mortality among these groups. Possible solutions to promoting equity involve community-based youth lifestyle interventions, improved risk-factor screening, and increasing accessibility to healthcare resources and novel preventive diagnostics and therapeutics.
View details for DOI 10.1016/j.pcad.2024.05.002
View details for PubMedID 38734044
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Racial and Ethnic Disparities in the Management of Chronic Coronary Disease.
The Medical clinics of North America
Tang, W. L., Rodriguez, F.
2024; 108 (3): 595-607
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Chronic coronary disease (CCD) comprises a continuum of conditions that include obstructive and non-obstructive coronary artery disease with or without prior acute coronary syndrome. Racial and ethnic representation disparities are pervasive in CCD guideline-informing clinical trials and evidence-based management. These disparities manifest across the entire spectrum of CCD management, spanning from non-pharmacological lifestyle changes to guideline-directed medical therapy, and cardiac rehabilitation to invasive procedures. Recognizing and addressing the historical factors underlying these disparities is crucial for enhancing the quality and equity of CCD management within an increasingly diverse population.
View details for DOI 10.1016/j.mcna.2023.11.008
View details for PubMedID 38548466
View details for PubMedCentralID PMC10979033
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Cardiovascular Disease in Hispanic Women: JACC Review Topic of the Week.
Journal of the American College of Cardiology
Quesada, O., Crousillat, D., Rodriguez, F., Bravo-Jaimes, K., Briller, J., Ogunniyi, M. O., Mattina, D. J., Aggarwal, N. R., Rodriguez, C. J., De Oliveira, G. M., Velarde, G.
2024; 83 (17): 1702-1712
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Cardiovascular disease affects 37% of Hispanic women and is the leading cause of death among Hispanic women in the United States. Hispanic women have a higher burden of cardiovascular risk factors, are disproportionally affected by social determinants of health, and face additional barriers related to immigration, such as discrimination, language proficiency, and acculturation. Despite this, Hispanic women show lower rates of cardiovascular disease and mortality compared with non-Hispanic White women. However, this "Hispanic paradox" is challenged by recent studies that account for the diversity in culture, race, genetic background, country of origin, and social determinants of health within Hispanic subpopulations. This review provides a comprehensive overview of the cardiovascular risk factors in Hispanic women, emphasizing the role of social determinants, and proposes a multipronged approach for equitable care.
View details for DOI 10.1016/j.jacc.2024.02.039
View details for PubMedID 38658109
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Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients.
Journal of clinical medicine
Yiadom, M. Y., Gong, W., Bloos, S. M., Bunney, G., Kabeer, R., Pasao, M. A., Rodriguez, F., Baugh, C. W., Mills, A. M., Gavin, N., Podolsky, S. R., Salazar, G. A., Patterson, B., Mumma, B. E., Tanski, M. E., Liu, D.
2024; 13 (9)
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Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Results: Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs (p = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) (p = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. Conclusions: D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.
View details for DOI 10.3390/jcm13092650
View details for PubMedID 38731180
View details for PubMedCentralID PMC11084706
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Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial.
Circulation. Cardiovascular interventions
Pracoń, R., Spertus, J. A., Broderick, S., Bangalore, S., Rockhold, F. W., Ruzyllo, W., Demchenko, E., Nageh, T., Grossman, G. B., Mavromatis, K., Manjunath, C. N., Smanio, P. E., Stone, G. W., Mancini, G. B., Boden, W. E., Newman, J. D., Reynolds, H. R., Hochman, J. S., Maron, D. J.
2024: e013435
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Abstract
ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coronary disease; however, there were conservative strategy participants who underwent invasive coronary angiography early postrandomization (within 6 months). Identifying factors associated with angiography in conservative strategy participants will inform clinical decision-making in patients with chronic coronary disease.Factors independently associated with angiography performed within 6 months of randomization were identified using Fine and Gray proportional subdistribution hazard models, including demographics, region of randomization, medical history, risk factor control, symptoms, ischemia severity, coronary anatomy based on protocol-mandated coronary computed tomography angiography, and medication use.Among 2591 conservative strategy participants, angiography within 6 months of randomization occurred in 8.7% (4.7% for a suspected primary end point event, 1.6% for persistent symptoms, and 2.6% due to protocol nonadherence) and was associated with the following baseline characteristics: enrollment in Europe versus Asia (hazard ratio [HR], 1.81 [95% CI, 1.14-2.86]), daily and weekly versus no angina (HR, 5.97 [95% CI, 2.78-12.86] and 2.63 [95% CI, 1.51-4.58], respectively), poor to fair versus good to excellent health status (HR, 2.02 [95% CI, 1.23-3.32]) assessed with Seattle Angina Questionnaire, and new/more frequent angina prerandomization (HR, 1.80 [95% CI, 1.34-2.40]). Baseline low-density lipoprotein cholesterol <70 mg/dL was associated with a lower risk of angiography (HR, 0.65 [95% CI, 0.46-0.91) but not baseline ischemia severity nor the presence of multivessel or proximal left anterior descending artery stenosis >70% on coronary computed tomography angiography.Among ISCHEMIA participants randomized to the conservative strategy, angiography within 6 months of randomization was performed in <10% of patients. It was associated with frequent or increasing baseline angina and poor quality of life but not with objective markers of disease severity. Well-controlled baseline low-density lipoprotein cholesterol was associated with a reduced likelihood of angiography. These findings point to the importance of a comprehensive assessment of symptoms and a review of guideline-directed medical therapy goals when deciding the initial treatment strategy for chronic coronary disease.URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
View details for DOI 10.1161/CIRCINTERVENTIONS.123.013435
View details for PubMedID 38629312
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Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography.
European heart journal
Nurmohamed, N. S., van Rosendael, A. R., Danad, I., Ngo-Metzger, Q., Taub, P. R., Ray, K. K., Figtree, G., Bonaca, M. P., Hsia, J., Rodriguez, F., Sandhu, A. T., Nieman, K., Earls, J. P., Hoffmann, U., Bax, J. J., Min, J. K., Maron, D. J., Bhatt, D. L.
2024
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Abstract
Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.
View details for DOI 10.1093/eurheartj/ehae190
View details for PubMedID 38606889
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IMPACT OF CLINICIAN TELEMEDICINE USE ON NEW MEDICATION ORDERS FOR PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
Joshi, M., Koos, H. T., Sandhu, A., Scheinker, D., Rodriguez, F., Kalwani, N.
ELSEVIER SCIENCE INC. 2024: 632
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View details for Web of Science ID 001291434300633
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CHARACTERISTICS AND OUTCOMES FOR STATIN-INTOLERANT HISPANIC/LATINX PATIENTS RECEIVING BEMPEDOIC ACID: RESULTS FROM A CLEAR OUTCOMES PRE-SPECIFIED SUBANALYSIS
Rodriguez, F., Brennan, D., Lei, L., Nissen, S. E., Powell, H., Plutzky, J.
ELSEVIER SCIENCE INC. 2024: 1811
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View details for Web of Science ID 001324901501843
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ARTIFICIAL INTELLIGENCE-ENABLED ANALYSIS OF CORONARY ARTERY CALCIUM TOPICS ON SOCIAL MEDIA
Somani, S., Balla, S., Peng, A. W., Dudum, R., Rodriguez, F.
ELSEVIER SCIENCE INC. 2024: 4611
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View details for Web of Science ID 001324901504649
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IMPACT OF CLINICIAN TELEMEDICINE USE ON NEW MEDICATION ORDERS FOR PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
Joshi, M., Koos, H. T., Sandhu, A., Scheinker, D., Rodriguez, F., Kalwani, N.
ELSEVIER SCIENCE INC. 2024: 632
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View details for Web of Science ID 001324901500633
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LOW-DENSITY LIPOPROTEIN CHOLESTEROL TESTING AND CONTROL AS PERFORMANCE METRICS: A NATIONAL ANALYSIS OF VETERANS AFFAIRS HEALTH CARE SYSTEMS
Jain, S. S., Skye, M., Din, N., Maron, D., Heidenreich, P. A., Kalwani, N., Bhatt, A., Sandhu, A., Rodriguez, F.
ELSEVIER SCIENCE INC. 2024: 2014
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View details for Web of Science ID 001324901502048
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An Inclisiran First Strategy vs Usual Care in Patients with Atherosclerosis.
Journal of the American College of Cardiology
Koren, M. J., Rodriguez, F., East, C., Toth, P. P., Watwe, V., Abbas, C. A., Sarwat, S., Kleeman, K., Kumar, B., Ali, Y., Jaffrani, N.
2024
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Abstract
Most patients with atherosclerotic cardiovascular disease (ASCVD) fail to achieve guideline-directed low-density lipoprotein cholesterol (LDL-C) goals. Twice-yearly inclisiran lowers LDL-C by ∼50% when added to statins.To evaluate the effectiveness of an "inclisiran first" implementation strategy (adding inclisiran immediately upon failure to reach LDL-C <70 mg/dL despite receiving maximally tolerated statins) versus representative usual care in US patients with ASCVD.VICTORION-INITIATE, a prospective, pragmatically designed trial, randomized patients 1:1 to inclisiran (284 mg at Days 0, 90, and 270) plus usual care (lipid management at treating physician's discretion) versus usual care alone. Primary endpoints were percentage change in LDL-C from baseline and statin discontinuation rates.We randomized 450 patients (30.9% female, 12.4% Black, 15.3% Hispanic); mean baseline LDL-C 97.4 mg/dL. The "inclisiran first" strategy led to significantly greater reductions in LDL-C from baseline to Day 330 versus usual care (60.0% vs 7.0%; p<0.001). Statin discontinuation rates with "inclisiran first" (6.0%) were noninferior versus usual care (16.7%). More "inclisiran first" patients achieved LDL-C goals vs usual care (<70 mg/dL: 81.8% vs 22.2%; <55 mg/dL: 71.6% vs 8.9%; p<0.001). Treatment-emergent adverse event (TEAE) and serious TEAE rates compared similarly between treatment strategies (62.8% vs 53.7% and 11.5% vs 13.4%, respectively). Injection-site TEAEs and TEAEs causing treatment withdrawal occurred more commonly with "inclisiran first" than usual care (10.3% vs 0.0%, and 2.6% vs 0.5%, respectively).An "inclisiran first" implementation strategy led to greater LDL-C lowering compared with usual care without discouraging statin use or raising new safety concerns.
View details for DOI 10.1016/j.jacc.2024.03.382
View details for PubMedID 38593947
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Contemporary attitudes and beliefs on coronary artery calcium from social media using artificial intelligence.
NPJ digital medicine
Somani, S., Balla, S., Peng, A. W., Dudum, R., Jain, S., Nasir, K., Maron, D. J., Hernandez-Boussard, T., Rodriguez, F.
2024; 7 (1): 83
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Abstract
Coronary artery calcium (CAC) is a powerful tool to refine atherosclerotic cardiovascular disease (ASCVD) risk assessment. Despite its growing interest, contemporary public attitudes around CAC are not well-described in literature and have important implications for shared decision-making around cardiovascular prevention. We used an artificial intelligence (AI) pipeline consisting of a semi-supervised natural language processing model and unsupervised machine learning techniques to analyze 5,606 CAC-related discussions on Reddit. A total of 91 discussion topics were identified and were classified into 14 overarching thematic groups. These included the strong impact of CAC on therapeutic decision-making, ongoing non-evidence-based use of CAC testing, and the patient perceived downsides of CAC testing (e.g., radiation risk). Sentiment analysis also revealed that most discussions had a neutral (49.5%) or negative (48.4%) sentiment. The results of this study demonstrate the potential of an AI-based approach to analyze large, publicly available social media data to generate insights into public perceptions about CAC, which may help guide strategies to improve shared decision-making around ASCVD management and public health interventions.
View details for DOI 10.1038/s41746-024-01077-w
View details for PubMedID 38555387
View details for PubMedCentralID PMC10981728
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Characteristics and Outcomes for Hispanic/Latinx Participants with Statin-Intolerance Receiving Bempedoic Acid.
Journal of the American College of Cardiology
Rodriguez, F., Cho, L., Foody, J., Lincoff, A. M., Lei, L., Nicholls, S. J., Nissen, S. E., Powell, H. A., Plutzky, J.
2024
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View details for DOI 10.1016/j.jacc.2024.03.390
View details for PubMedID 38537915
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Beyond Primary Prevention: The Intersection of Severe Coronary Calcium, Left Main Coronary Calcium, and Diabetes.
JACC. Cardiovascular imaging
Rodriguez, F., Dudum, R.
2024
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View details for DOI 10.1016/j.jcmg.2024.01.013
View details for PubMedID 38520427
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Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity.
American journal of preventive cardiology
Sarraju, A., Yan, X., Huang, Q., Dudum, R., Palaniappan, L., Rodriguez, F.
2024; 17: 100647
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Abstract
There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity.From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression.Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81-0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity.In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation.
View details for DOI 10.1016/j.ajpc.2024.100647
View details for PubMedID 38525197
View details for PubMedCentralID PMC10958062
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Ten simple rules to leverage large language models for getting grants.
PLoS computational biology
Seckel, E., Stephens, B. Y., Rodriguez, F.
2024; 20 (3): e1011863
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View details for DOI 10.1371/journal.pcbi.1011863
View details for PubMedID 38427611
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Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial.
Journal of the American Heart Association
Reynolds, H. R., Cyr, D. D., Merz, C. N., Shaw, L. J., Chaitman, B. R., Boden, W. E., Alexander, K. P., Rosenberg, Y. D., Bangalore, S., Stone, G. W., Held, C., Spertus, J., Goetschalckx, K., Bockeria, O., Newman, J. D., Berger, J. S., Elghamaz, A., Lopes, R. D., Min, J. K., Berman, D. S., Picard, M. H., Kwong, R. Y., Harrington, R. A., Thomas, B., O'Brien, S. M., Maron, D. J., Hochman, J. S., ISCHEMIA Research Group *, Mavromatis, K., Linefsky, J., Miller, T., Banerjee, S., Reynolds, H. R., Newman, J. D., Bangalore, S., Donnino, R. M., Phillips, L. M., Saric, M., Abdul-Nour, K., Stone, P. H., Jang, J. J., Yee, G., Weitz, S., Arnold, S., O'Keefe, J. H., Shapiro, M. D., El-Hajjar, M., Sidhu, M. S., Fein, S. A., Torosoff, M. T., Lyubarova, R., Mookherjee, S., Drzymalski, K., McFalls, E. O., Garcia, S. A., Bertog, S. C., Siddiqui, R. A., Ishani, A., Hansen, R. A., Khouri, M. G., Goldberg, J. L., Goldweit, R., Cohen, R. A., Mirrer, B., Navarro, V., Winchester, D. E., Kronenberg, M., Rogal, P., McFarren, C., Heitner, J. F., Dauber, I. M., Cannan, C., Sudarshan, S., Mehta, P. K., McDaniel, M., Lerakis, S., Quyyumi, A., Wenger, N. K., Hedgepeth, C. M., Hurlburt, H., Rosen, A., Sahul, Z., Booth, D., Leung, S., Abdel-Latif, A., Reda, H., Ziada, K., Setty, S., Barua, R. S., Hage, F., Caldeira, C., Davies, J. E., Leesar, M., Heo, J., Iskandrian, A., Al Solaiman, F., Singh, S., Dajani, K., El-Hajjar, M., Der Mesropian, P., Sacco, J., McCandless, B., Orgera, M., Sidhu, M. S., Arif, I., Kerr, H., Trejo Gutierrez, J. F., Fletcher, G., Lane, G. E., Neeson, L. M., Parikh, P. P., Pollak, P. M., Shapiro, B. P., Landolfo, K., Gemignani, A., O'Rourke, D., Meadows, J. L., Call, J. T., Hannan, J., Bojar, R., Kumar, D., Mukai, J., Martin, E. T., Vorobiof, G., Moorman, A., Kinlay, S., Hamburger, R. J., Rocco, T. P., Bhatt, D. L., Croce, K., Quin, J. A., Anumpa, J., Zenati, M., Faxon, D. P., Rayos, G., Seedhom, A., Sullenberger, L., Kumkumian, G., Sedlis, S. P., Donnino, R. M., Lorin, J., Tamis-Holland, J. E., Kornberg, R., Leber, R., Saba, S., Lee, M. W., Small, D. R., Nona, W., Alexander, P. B., Rehman, I., Badami, U., Marzo, K., Robbins, I. H., Levite, H. A., Shetty, S., Patel, M., Hamroff, G. S., Little, R. W., Zimbelman, B. D., Lui, C. Y., Smith, B. R., Vezina, D. P., Khor, L. L., Abraham, J. D., Bull, D. A., McKellar, S. H., Booth, D., Kotter, J., Abdel-Latif, A., Hu, B., Labovitz, A. J., Berlowitz, M., Rogal, P., McFarren, C., Matar, F., Caldeira, C., Maron, D. J., Rodriguez, F., Schnittger, I., Fearon, W. F., Deedwania, P., Reddy, K., Sweeny, J., Spizzieri, C., Hochberg, C. P., Salerno, W. D., Wyman, R., Zarka, A., Shah, A. V., Haldis, T., Kohn, J. A., Girotra, S., Almousalli, O., Krishnam, M. S., Milliken, J. C., Patel, P. M., Seto, A. H., Harley, K. T., Gibson, M. A., Allen, B. J., Coram, R., Thomas, S., Schwartz, R. G., Chen, W., El Shahawy, M., Stafford, J., Abernethy, W. B., Zurick, A., Meyer, T. M., Morford, R. G., Rutkin, B., Bokhari, S., Sokol, S. I., Meisner, J., Hamzeh, I., Misra, A., Wall, M., De Rosen, V. L., Alam, M., Turner, M. C., Mulhearn, T. J., Good, A. P., Shammas, N. W., Chilton, R., Nguyen, P. K., Jezior, M., Gordon, P. C., Crain, T., Stenberg, R., Pedalino, R. P., Wiesel, J., Juang, G. J., Al-Amoodi, M., Wohns, D., Lader, E. W., Mumma, M., Dharmarajan, L., McGarvey, J. F., Downes, T. R., Luckasen, G. J., Cheong, B., Potluri, S., Mastouri, R. A., Breall, J. A., Revtyak, G. E., Bazeley, J. W., Li, D., Giedd, K., Old, W., Burt, F., Sokhon, K., Gopal, D., Valeti, U. S., Kobashigawa, J., Govindan, S. C., Nair, R. G., Manjunath, C. N., Moorthy, N., Manjunath, S. C., Narayanappa, S., Pandit, N., Nath, R. K., Dwivedi, S. K., Narain, V. S., Chandra, S., Wander, G. S., Tandon, R., Ralhan, S., Aslam, N., Goyal, A., Bhargava, B., Karthikeyan, G., Ramakrishnan, S., Seth, S., Yadav, R., Singh, S., Roy, A., Parakh, N., Verma, S. K., Narang, R., Mishra, S., Naik, N., Sharma, G., Choudhary, S. K., Patel, C., Gulati, G., Sharma, S., Bahl, V. K., Mathew, A., Punnoose, E., Gadkari, M. A., Gadage, S., Pillay, T. U., Satheesh, S., Mathur, A., Kaul, U., Christopher, J., Menon, R., Kumar, N., Oomman, A., Mao, R., Solomon, H., Naik, S., Khan, S. P., Christopher, J., Kumar, N., Grant, P., Kachru, R., Ajit Kumar, V. K., Ganapathi, S., Jayakumar, K., Sivadasanpillai, H., Sasidharan, B., Kapilamoorthy, T. R., Christopher, J., Polamuri, P., Kaul, U., Senior, R., Elghamaz, A., Gurunathan, S., Karogiannis, N., Shah, B. N., Trimlett, R. H., Rubens, M. B., Nicol, E. D., Mittal, T. K., Hampson, R., Gamma, R. A., de Belder, M. A., Thambyrajah, J., Nageh, T., Davies, J. R., Lindsay, S. J., Kurian, J., Jamil, H., Raheem, O., Hoye, A., Donnelly, P., Valecka, B., Chauhan, A., Barr, C., Alfakih, K., Byrne, J., Webb, I., Henriksen, P., OKane, P., de Silva, R., Conway, D. S., Sirker, A. A., Hoole, S. P., Witherow, F. N., Johnston, N., Harbinson, M., Walsh, S., Douglas, H., Luckie, M., Sobolewska, J., Jeetley, P., Patel, N., Kotecha, T., Travill, C., Karimullah, I., Al-Bustami, M., Braganza, D., Henderson, R., Pointon, K., Naik, S., Mathew, T., Berry, C., Collison, D., Roditi, G., Moriarty, A. J., Glover, J. D., Pradhan, J., Mikhail, G., Francis, D. P., Gosselin, G., Diaz, A., Rheault, P., Barrero, M., Gagne, C., Pepin-Dubois, Y., Costa, R., Sia, Y. T., Lemay, C., Gisbert, A., Gervais, P., Rheault, A., Phaneuf, D. C., Gosselin, G., Garg, P., Chow, B. J., Hessian, R. C., Beanlands, R. S., Davies, R. F., Bainey, K. R., Cheema, A. N., Bagai, A., Wald, R., Goodman, S., Graham, J. J., Peterson, M., Chow, C., Abramson, B., Cheema, A. N., Vakani, M. T., Cha, J., Howarth, A. G., Wong, G., Uxa, A., Galiwango, P., Kassam, S., Mukherjee, A., Ricci, A. J., Lam, A., Mehta, S., Udell, J., Genereux, P., Hameed, A., Daba, L., Hueb, W., Rezende, P. C., Silva, E. E., Hueb, A. C., Smanio, P. E., de Quadros, A. S., Kalil, R. A., da Costa Vieira, J. L., Grossmann, G., de Oliveira, P. P., Bridi, L., Savaris, S., Vitola, J. V., Cerci, R. J., Farias, F. R., Fernandes, M. M., Marin-Neto, J. A., Schmidt, A., de Oliveira Lima Filho, M., Oliveira, R. M., Chierice, J. R., Polanczyk, C. A., Furtado, M. V., Smidt, L. F., Carvalho, A. C., Pucci, G., Lyra, F., Junior, A. R., Dracoulakis, M. D., Lima, R. G., Figueiredo, E., Caramori, P. R., Tumelero, R., Dall'Orto, F., Mesquita, C. T., Colafranseschi, A. S., Oliveira, A. C., Carvalho, L. A., Palazzo, I. C., Sousa, A. S., da Silva, E. E., de Barros, P. G., de Padua Silva Baptista, L., Rodrigues, M. J., de Resende, M. V., Saraiva, J. F., Costantini, C., Demkow, M., Pracon, R., Kepka, C., Teresinska, A., Kryczka, K., Henzel, J., Solecki, M., Kaczmarska, E., Mazurek, T., Drozdz, J., Czarniak, B., Frach, M., Szymczyk, K., Niedzwiecka, I., Sobczak, S., Ciurus, T., Jakubowski, P., Misztal-Teodorczyk, M., Teodorczyk, D., Fratczak, A., Szkopiak, M., Lebioda, P., Wlodarczyk, M., Plachcinska, A., Kusmierek, J., Miller, M., Marciniak, H., Wojtczak-Soska, K., Luczak, K., Tarchalski, T., Cichocka-Radwan, A., Szwed, H., Szulczyk, G. A., Witkowski, A., Kukula, K., Celinska-Spodar, M., Zalewska, J., Gajos, G., Bury, K., Pruszczyk, P., Roik, M., Loboz-Grudzien, K., Sokalski, L., Brzezinska, B., Lesiak, M., Lanocha, M., Reczuch, K. W., Kalarus, Z., Swiatkowski, A., Szulik, M., Musial, W. J., Bockeria, L., Petrosyan, K., Trifonova, T., Chernyavskiy, A. M., Kretov, E. I., Grazhdankin, I. O., Bershtein, L. L., Sayganov, S. A., Kuzmina-Krutetskaya, A. M., Zbyshevskaya, E. V., Katamadze, N. O., Demchenko, E. A., Kozlov, P. S., Kozulin, V. Y., Lubinskaya, E. I., Lopez-Sendon, J., Castro, A., Salicio, E. R., Guzman, G., Galeote, G., Valbuena, S., Peteiro, J., Martinez-Ruiz, M. D., Perez-Fernandez, R., Cuenca-Castillo, J. J., Flores-Rios, X., Prada-Delgado, O., Barge-Caballero, G., Juanatey, J. R., Bayarri, M. S., Nunez, V. P., Sanchez, R. O., Alvarez, B. C., Gil, C. P., Monzonis, A. M., Sionis, A., Perales, M. V., Padro, J. M., Penaranda, A. S., Picart, J. G., Iglesias, A. G., Marimon, X. G., Llado, G. P., Costa, F. C., Miro, V., Diez, J. L., Calvillo, P., Ortuno, F. M., Chavarri, M. V., Montolliu, A. T., Bermudez, E. P., De La Morena, G., Blancas, M. G., Luena, J. E., Fernandez-Aviles, F., Chen, J., Wu, Y., Ma, Y., Yang, Y., Ji, Z., Yang, X., Lin, W., Zeng, H., Fu, X., Yang, B., Wang, S., Cheng, G., Zhao, Y., Fang, X., Zeng, Q., Su, X., Li, Q., Nie, S., Yu, Q., Wang, J., Zhang, S., Liu, Z., Perna, G. P., Marini, M., Gabrielli, G., Provasoli, S., Verna, E., Monti, L., Nardi, B., Di Chiara, A., Mortara, A., Galvani, M., Ottani, F., Sicuro, M., Calabro, P., Formisano, T., Tarantini, G., Cucchini, U., Andres, A. L., Racca, E., Briguori, C., Amati, R., Vergoni, W., Russo, A., Fanelli, R., Poh, K., Chai, P., Lau, T., Loh, J. P., Tay, E. L., Teoh, K., Teo, L. L., Ong, C., Wong, R. C., Loh, P., Kofidis, T., Chan, W. X., Chan, K. H., Foo, D., Kong, J. L., Er, C. M., Jafary, F. H., Chua, T., Doerr, R., Stumpf, J., Matschke, K., Simonis, G., Kadalie, C. T., Sechtem, U., Ong, P., Schulze, P. C., Goebel, B., Lenk, K., Nickenig, G., Schuchlenz, H., Weikl, S., Lang, I. M., Huber, K., Jakl-Kotauschek, G., Vertes, A., Varga, A., Fontos, G., Merkely, B., Kerecsen, G., Hinic, S., Zdravkovic, M., Mudrenovic, V., Crnokrak, B., Beleslin, B. D., Boskovic, N. N., Petrovic, M. T., Dobric, M. R., Markovic, Z. Z., Mladenovic, A. S., Cemerlic-Adjic, N., Davidovic, G., Vucic, R., Dekleva, M. N., Stankovic, G., Apostolovic, S., Escobedo, J., Baleon-Espinosa, R., Campos-Santaolalla, A. S., Duran-Cortes, E., Flores-Palacios, J. M., Garcia-Rincon, A., Jimenez-Santos, M., Penafiel, J. V., Ortega-Ramirez, J. A., Valdespino-Estrada, A., Rosas, E. A., Selvanayagam, J. B., Joseph, M. X., Thambar, S. T., Beltrame, J. F., Hillis, G. S., Thuaire, C., Dutoiu, T., Steg, P. G., Juliard, J., Slama, M. S., El Mahmoud, R., Nicollet, E., Goube, P., Barone-Rochette, G., Furber, A., Biere, L., Laucevicius, A., Celutkiene, J., Kedhi, E., Timmer, J., Hermanides, R., Kaplan, E., Riezebos, R. K., Samadi, P., van Dongen, E., Niehe, S. R., Suryapranata, H., van Vugt, S., Ramos, R., Cacela, D., Santana, A., Fiarresga, A., Sousa, L., Marques, H., Patricio, L., Bernanrdes, L., Rio, P., Carvalho, R., Ferreira, R., Silva, T., Rodrigues, I., Modas, P., Portugal, G., Fragata, J., Pinto, F. J., Menezes, M. N., Lopes, G. C., Almeida, A. G., Silva, P. C., Nobre, A., Francisco, A. R., Ferreira, N., Lopes, R. L., Guzman, L., Figal, J. C., Mendiz, O., Cortes, C., Favaloro, R. R., Alvarez, C., Courtis, J., Zeballos, G., Schiavi, L., Rubio, M., Devlin, G. P., Fisher, R., Stewart, R. A., White, H. D., Benatar, J., Kedev, S., Mitevska, I. P., Kostovska, E. S., Pejkov, H., Held, C., Eggers, K., Frostfelt, G., Johnston, N., Olsowka, M., Akerblom, A., Soveri, I., Aspberg, J., Sharir, T., Elian, D., Kerner, A., Massalha, S., Fukuda, K., Kohsaka, S., Yasuda, S., Nishimura, S., Goetschalckx, K., Van de Werf, F., Claes, K., Hung, C., Yun, C., Hou, C. J., Kuo, J., Yeh, H., Hung, T., Li, J., Chien, C., Tsai, C., Liu, C., Yu, F., Lin, Y., Lan, W., Yen, C., Tsai, J., Sung, K., Ntsekhe, M., Pandie, S., Viljoen, C. A., De Andrade, M., Moccetti, T., Rossi, M. G., Abdelhamid, M., Adel, A., Kamal, A., Mahrous, H., El Kaffas, S., El Fishawy, H., Pop, C., Claudia, M., Popescu, B. A., Ginghina, C., Deleanu, D., Iliescu, V. A., Al-Mallah, M. H., Aljzeeri, A., Najm, H., Alghamdi, A., Ramos, W. E., Kuanprasert, S., Prommintikul, A., Nawarawong, W., Woragidpoonpol, S., Tepsuwan, T., Taksaudom, N., Rimsukcharoenchai, C., Euathrongchit, J., Wannasopha, Y., Yamwong, S., Sritara, P., Aramcharoen, S., Meemuk, K., Khairuddin, A., Hadi, H. A., Yahaya, S. A.
2024: e029850
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Abstract
BACKGROUND: Women with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management.METHODS AND RESULTS: The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline-directed medical therapy, or initial conservative management with guideline-directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Invasive group catheterization rates were similar, with less revascularization among women (73.4% of invasive-assigned women revascularized versus 81.2% of invasive-assigned men; P<0.001). Women had less coronary artery disease: multivessel in 60.0% of invasive-assigned women and 74.8% of invasive-assigned men, and no ≥50% stenosis in 12.3% versus 4.5% (P<0.001). In the conservative group, 4-year catheterization rates were 26.3% of women versus 25.6% of men (P=0.72). Guideline-directed medical therapy use was lower among women with fewer risk factor goals attained. There were no sex differences in the primary outcome (adjusted hazard ratio [HR] for women versus men, 0.93 [95% CI, 0.77-1.13]; P=0.47) or the major secondary outcome of cardiovascular death/myocardial infarction (adjusted HR, 0.93 [95% CI, 0.76-1.14]; P=0.49), with no significant sex-by-treatment-group interactions.CONCLUSIONS: Women had less extensive coronary artery disease and, therefore, lower revascularization rates in the invasive group. Despite lower risk factor goal attainment, women with chronic coronary disease experienced similar risk-adjusted outcomes to men in the ISCHEMIA trial.REGISTRATION: URL: http://wwwclinicaltrials.gov. Unique identifier: NCT01471522.
View details for DOI 10.1161/JAHA.122.029850
View details for PubMedID 38410945
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Prevalence of frequent premature ventricular contractions and nonsustained ventricular tachycardia in older women screened for atrial fibrillation in the Women's Health Initiative.
Heart rhythm
Gomez, S. E., Larson, J., Hlatky, M. A., Rodriguez, F., Wheeler, M., Greenland, P., LaMonte, M., Froelicher, V., Stefanick, M. L., Wallace, R., Kooperberg, C., Tinker, L. F., Schoenberg, J., Soliman, E. Z., Vitolins, M. Z., Saquib, N., Nuño, T., Haring, B., Perez, M. V.
2024
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Abstract
Frequent premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) have been associated with cardiovascular disease and mortality. Their prevalence, especially in ambulatory populations, is under-studied and limited by few female participants and the use of short-duration (24-48 hour) monitoring.Report the prevalence of frequent PVCs and NSVT in a community-based population of women likely to undergo ECG screening using sequential patch monitoring.Participants from the Women's Health Initiative Strong and Healthy (WHISH) trial with no history of atrial fibrillation (AF) but 5-year predicted risk of incident AF ≥ 5% by CHARGE-AF score were randomly selected to undergo screening with 7-day ECG patch monitors at baseline, 6 months, and 12 months. Recordings were reviewed for PVCs and NSVT (> 5 beats); data was analyzed using multivariate regression models.There were 1,067 participants who underwent ECG screening at baseline, 866 at 6-months and 777 at 12-months. Frequent PVCs were found on at least one patch from 4.3% of participants and one or more episodes of NSVT was found in 12 (1.1%) women. PVC frequency directly correlated with CHARGE-AF score and NSVT on any patch. Detection of frequent PVCs increased with sequential monitoring.Among postmenopausal women at high risk for AF, frequent PVCs were relatively common (4.3%), and correlated with higher CHARGE-AF score. As strategies for AF screening continue to evolve, particularly in those individuals at high risk of AF, the prevalence of incidental ventricular arrhythmias is an important benchmark to guide clinical decision-making.
View details for DOI 10.1016/j.hrthm.2024.02.040
View details for PubMedID 38403238
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Coronary artery calcium and cardiovascular outcomes in patients with lymphoma undergoing autologous hematopoietic cell transplantation.
Cancer
Wu, S., Rhee, J. W., Iukuridze, A., Bosworth, A., Chen, S., Atencio, L., Manubolu, V., Bhandari, R., Jamal, F., Mei, M., Herrera, A., Rodriguez, F., Forman, S., Nakamura, R., Wong, F. L., Budoff, M., Armenian, S. H.
2024
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Abstract
Patients undergoing autologous hematopoietic cell transplantation (HCT) have a >2-fold risk of developing cardiovascular disease (CVD; heart failure, myocardial infarction, and stroke), compared to the general population. Coronary artery calcium (CAC) is predictive of CVD in nononcology patients but is not as well studied in patients who underwent HCT and survivors of HCT.The objective of this study was to examine the association between CAC and CVD risk and outcomes after HCT in patients with lymphoma.This was a retrospective cohort study of 243 consecutive patients who underwent a first autologous HCT for lymphoma between 2009 and 2014. CAC (Agatston score) was determined from chest computed tomography obtained <60 days from HCT. Multivariable Cox regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CIs), adjusted for covariates (age, conventional risk factors [e.g., hypertension and dyslipidemia], and cancer treatment).The median age at HCT was 55.7 years (range, 18.5-75.1 years), 59% were male, and 60% were non-Hispanic White. The prevalence of CAC was 37%. The 5-year CVD incidence for the cohort was 12%, and there was an incremental increase in the incidence according to CAC score: 0 (6%), 1-100 (20%), and >100 (32%) (p = .001). CAC was significantly associated with CVD risk (HR, 3.0; 95% CI, 1.2-7.5) and worse 5-year survival (77% vs. 50%; p < .001; HR, 2.0; 95% CI, 1.1-3.4), compared to those without CAC.CAC is independently associated with CVD and survival after HCT. This highlights the importance of integrating readily available imaging information in risk stratification and decision-making in patients undergoing HCT, which sets the stage for strategies to optimize outcomes after HCT.
View details for DOI 10.1002/cncr.35252
View details for PubMedID 38358333
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Racial and ethnic disparities in cardiovascular disease - analysis across major US national databases.
Journal of the National Medical Association
Minhas, A. M., Talha, K. M., Abramov, D., Johnson, H. M., Antoine, S., Rodriguez, F., Fudim, M., Michos, E. D., Misra, A., Abushamat, L., Nambi, V., Fonarow, G. C., Ballantyne, C. M., Virani, S. S.
2024
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Abstract
There are several studies that have analyzed disparities in cardiovascular disease (CVD) health using a variety of different administrative databases; however, a unified analysis of major databases does not exist. In this analysis of multiple publicly available datasets, we sought to examine racial and ethnic disparities in different aspects of CVD, CVD-related risk factors, CVD-related morbidity and mortality, and CVD trainee representation in the US.We used National Health and Nutrition Examination Survey, National Ambulatory Medical Care Survey, National Inpatient Sample, Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research, United Network for Organ Sharing, and American Commission for Graduate Medical Education data to evaluate CVD-related disparities among Non-Hispanic (NH) White, NH Black and Hispanic populations.The prevalence of most CVDs and associated risk factors was higher in NH Black adults compared to NH White adults, except for dyslipidemia and ischemic heart disease (IHD). Statins were underutilized in IHD in NH Black and Hispanic patients. Hospitalizations for HF and stroke were higher among Black patients compared to White patients. All-cause, CVD, heart failure, acute myocardial infarction, IHD, diabetes mellitus, hypertension and cerebrovascular disease related mortality was highest in NH Black or African American individuals. The number of NH Black and Hispanic trainees in adult general CVD fellowship programs was disproportionately lower than NH White trainees.Racial disparities are pervasive across the spectrum of CVDs with NH Black adults at a significant disadvantage compared to NH White adults for most CVDs.
View details for DOI 10.1016/j.jnma.2024.01.022
View details for PubMedID 38342731
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Patient Representativeness With Virtual Enrollment in the PRO-HF Trial.
Journal of the American Heart Association
Gupta, A., Skye, M., Calma, J., Din, N., Azizi, Z., Hernandez, M. F., Zheng, J., Kalwani, N. M., Malunjkar, S., Schirmer, J., Wang, P., Rodriguez, F., Heidenreich, P., Sandhu, A. T.
2024; 13 (2): e030903
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View details for DOI 10.1161/JAHA.123.030903
View details for PubMedID 38226522
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Design and Implementation of an Electronic Health Record-Integrated Hypertension Management Application.
Journal of the American Heart Association
Funes Hernandez, M., Babakhanian, M., Chen, T. P., Sarraju, A., Seninger, C., Ravi, V., Azizi, Z., Tooley, J., Chang, T. I., Lu, Y., Downing, N. L., Rodriguez, F., Li, R. C., Sandhu, A. T., Turakhia, M., Bhalla, V., Wang, P. J.
2024; 13 (2): e030884
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Abstract
High blood pressure affects approximately 116 million adults in the United States. It is the leading risk factor for death and disability across the world. Unfortunately, over the past decade, hypertension control rates have decreased across the United States. Prediction models and clinical studies have shown that reducing clinician inertia alone is sufficient to reach the target of ≥80% blood pressure control. Digital health tools containing evidence-based algorithms that are able to reduce clinician inertia are a good fit for turning the tide in blood pressure control, but careful consideration should be taken in the design process to integrate digital health interventions into the clinical workflow.We describe the development of a provider-facing hypertension management platform. We enumerate key steps of the development process, including needs finding, clinical workflow analysis, treatment algorithm creation, platform design and electronic health record integration. We interviewed and surveyed 5 Stanford clinicians from primary care, cardiology, and their clinical care team members (including nurses, advanced practice providers, medical assistants) to identify needs and break down the steps of clinician workflow analysis. The application design and development stage were aided by a team of approximately 15 specialists in the fields of primary care, hypertension, bioinformatics, and software development.Digital monitoring holds immense potential for revolutionizing chronic disease management. Our team developed a hypertension management platform at an academic medical center to address some of the top barriers to adoption and achieving clinical outcomes. The frameworks and processes described in this article may be used for the development of a diverse range of digital health tools in the cardiovascular space.
View details for DOI 10.1161/JAHA.123.030884
View details for PubMedID 38226516
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Digital Health Interventions for Heart Failure Management in Underserved Rural Areas of the United States: A Systematic Review of Randomized Trials.
Journal of the American Heart Association
Azizi, Z., Broadwin, C., Islam, S., Schenk, J., Din, N., Hernandez, M. F., Wang, P., Longenecker, C. T., Rodriguez, F., Sandhu, A. T.
2024; 13 (2): e030956
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Heart failure disproportionately affects individuals residing in rural areas, leading to worse health outcomes. Digital health interventions have been proposed as a promising approach for improving heart failure management. This systematic review aims to identify randomized trials of digital health interventions for individuals living in underserved rural areas with heart failure.We conducted a systematic review by searching 6 databases (CINAHL, EMBASE, MEDLINE, Web of Science, Scopus, and PubMed; 2000-2023). A total of 30 426 articles were identified and screened. Inclusion criteria consisted of digital health randomized trials that were conducted in underserved rural areas of the United States based on the US Census Bureau's classification. Two independent reviewers screened the studies using the National Heart, Lung, and Blood Institute tool to evaluate the risk of bias. The review included 5 trials from 6 US states, involving 870 participants (42.9% female). Each of the 5 studies employed telemedicine, 2 studies used remote monitoring, and 1 study used mobile health technology. The studies reported improvement in self-care behaviors in 4 trials, increased knowledge in 2, and decreased cardiovascular mortality in 1 study. However, 3 trials revealed no change or an increase in health care resource use, 2 showed no change in cardiac biomarkers, and 2 demonstrated an increase in anxiety.The results suggest that digital health interventions have the potential to enhance self-care and knowledge of patients with heart failure living in underserved rural areas. However, further research is necessary to evaluate their impact on clinical outcomes, biomarkers, and health care resource use.URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022366923.
View details for DOI 10.1161/JAHA.123.030956
View details for PubMedID 38226517
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Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System.
Journal of general internal medicine
Martinez, K. A., Montori, V. M., Rodriguez, F., Tereshchenko, L. G., Kovach, J. D., Hurwitz, H. M., Rothberg, M. B.
2024
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Abstract
Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice.To describe real-world use of an SDM encounter tool for statin prescribing, Statin Choice, embedded into the workflow of an electronic health record.Cross-sectional study.Clinicians and their statin-eligible patients who had outpatient encounters between January 2020 and June 2021 in Cleveland Clinic Health System.Clinician use of Statin Choice was recorded within the Epic record system. We categorized each patient's 10-year atherosclerotic cardiovascular disease risk into low (< 5%), borderline (5-7.5%), intermediate (7.5-20%), and high (≥ 20%). Other patient factors included age, sex, insurance, and race. We used mixed effects logistic regression to assess the odds of using Statin Choice for statin-eligible patients, accounting for clustering by clinician and site. We generated a residual intraclass correlation coefficient (ICC) to characterize the impact of the clinician on Statin Choice use.Statin Choice was used in 7% of 68,505 eligible patients. Of 1047 clinicians, 48% used Statin Choice with ≥ 1 patient, and these clinicians used it with a median 9% of their patients (interquartile range: 3-22%). In the mixed effects logistic regression model, patient age (adjusted OR per year: 1.04; 95%CI 1.03-1.04) and 10-year ASVCD risk (aOR for 5-7.5% versus < 5% risk: 1.28; 95%CI: 1.14-1.44) were associated with use of Statin Choice. Black versus White race was associated with a lower odds of Statin Choice use (aOR: 0.83; 95%CI: 0.73-0.95), as was female versus male sex (aOR: 0.83; 95%CI: 0.76-0.90). The model ICC demonstrated that 53% of the variation in use of Statin Choice was clinician-driven.Patient factors, including race and sex, were associated with clinician use of Statin Choice; half the variation in use was attributable to individual clinicians.
View details for DOI 10.1007/s11606-023-08597-3
View details for PubMedID 38191974
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Evidence Of Genetic Testing In A Large, Real -world DCM Cohort And Association With Heart Failure Risk
Bhasin, K., Longoni, M., Ward, A., Nisson, M., White, B., Lee, D., Bhatt, S., Rodriguez, F., Dash, R.
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. 2024: 128
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View details for Web of Science ID 001162343100023
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Underrepresentation of Women in Reduced Ejection Heart Failure Clinical Trials With Improved Mortality or Hospitalization.
JACC. Advances
Ekpo, E., Balla, S., Ngo, S., Witting, C., Sarraju, A., Furst, A., Rodriguez, F.
2024; 3 (1)
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Abstract
BACKGROUND: There are established sex-specific differences in heart failure with reduced ejection fraction (HFrEF) outcomes. Randomized clinical trials (RCTs) based on cardiovascular outcome benefits, typically either reduced cardiovascular mortality or hospitalization for heart failure (HHF), influence current guidelines for therapy.OBJECTIVES: The authors evaluate the representation of women in HFrEF RCTs that observed reduced all-cause or cardiovascular mortality or HHF.METHODS: We queried Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, and PubMed for HFrEF RCTs that reported a statistically significant benefit of intervention resulting in improved mortality or HHF published from 1980 to 2021. We estimated representation using the participation-to-prevalence ratio (PPR). A PPR of 0.8 to 1.2 was considered representative.RESULTS: The final analysis included 33 RCTs. Women represented only 23.2% of all enrolled participants (n = 24,366/104,972), ranging from 11.4% to 40.1% per trial. Overall PPR was 0.58, with per-trial PPR estimates ranging from 0.29 to 1.00. Only 5 trials (15.2%) had a PPR of women representative of the disease population. Representation did not change significantly over time. The proportion of women in North American trials was significantly greater than trials conducted in Europe (P = 0.03). The proportion of women was greater in industry trials compared to government-funded trials (P = 0.05).CONCLUSIONS: Women are underrepresented in HFrEF RCTs that have demonstrated mortality or HHF benefits and influence current guidelines. Representation is key to further delineation of sex-specific differences in major trial results. Sustained efforts are warranted to ensure equitable and appropriate inclusion of women in HFrEF trials.
View details for DOI 10.1016/j.jacadv.2023.100743
View details for PubMedID 38405270
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Drivers of telemedicine in primary care clinics at a large academic medical centre.
Journal of telemedicine and telecare
Parameswaran, V., Koos, H., Kalwani, N., Qureshi, L., Rosengaus, L., Dash, R., Scheinker, D., Rodriguez, F., Johnson, C. B., Stange, K., Aron, D., Lyytinen, K., Sharp, C.
2023: 1357633X231219311
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Abstract
COVID-19 disrupted healthcare routines and prompted rapid telemedicine implementation. We investigated the drivers of visit modality selection (telemedicine versus in-person) in primary care clinics at an academic medical centre.We used electronic medical record data from March 2020 to May 2022 from 13 primary care clinics (N = 21,031 new, N = 207,292 return visits), with 55% overall telemedicine use. Hierarchical logistic regression and cross-validation methods were used to estimate the variation in visit modality explained by the patient, clinician and visit factors as measured by the mean-test area under the curve (AUC).There was significant variation in telemedicine use across clinicians (ranging from 0-100%) for the same visit diagnosis. The strongest predictors of telemedicine were the clinician seen for new visits (mean AUC of 0.79) and the primary visit diagnosis for return visits (0.77). Models based on all patient characteristics combined accounted for relatively little variation in modality selection, 0.54 for new and 0.58 for return visits, respectively. Amongst patient characteristics, males, patients over 65 years, Asians and patient's with non-English language preferences used less telemedicine; however, those using interpreter services used significantly more telemedicine.Clinician seen and primary visit diagnoses were the best predictors of visit modality. The distinction between new and return visits and the minimal impact of patient characteristics on visit modality highlights the complexity of clinical care and warrants research approaches that go beyond linear models to uncover the emergent causal effects of specific technology features mediated by tasks, people and organisations.
View details for DOI 10.1177/1357633X231219311
View details for PubMedID 38130140
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Opportunities to Increase Science of Diversity and Inclusion in Clinical Trials: Equity and a Lack of a Control.
Journal of the American Heart Association
Igwe, J., Wangdak Yuthok, T. Y., Cruz, E., Mueller, A., Lan, R. H., Brown-Johnson, C., Idris, M., Rodriguez, F., Clark, K., Palaniappan, L., Echols, M., Wang, P., Onwuanyi, A., Pemu, P., Lewis, E. F.
2023: e030042
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Abstract
The United States witnessed a nearly 4-fold increase in personal health care expenditures between 1980 and 2010. Despite innovations and obvious benefits to health, participants enrolled in clinical trials still do not accurately represent the racial and ethnic composition of patients nationally or globally. This lack of diversity in cohorts limits the generalizability and significance of results among all populations and has deep repercussions for patient equity. To advance diversity in clinical trials, robust evidence for the most effective strategies for recruitment of diverse participants is needed. A major limitation of previous literature on clinical trial diversity is the lack of control or comparator groups for different strategies. To date, interventions have focused primarily on (1) community-based interventions, (2) institutional practices, and (3) digital health systems. This review article outlines prior intervention strategies across these 3 categories and considers health policy and ethical incentives for substantiation before US Food and Drug Administration approval. There are no current studies that comprehensively compare these interventions against one another. The American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials represents a multicenter, collaborative network between Stanford School of Medicine and Morehouse School of Medicine created to understand the barriers to diversity in clinical trials by contemporaneous head-to-head interventional strategies accessing digital, institutional, and community-based recruitment strategies to produce informed recruitment strategies targeted to improve underrepresented patient representation in clinical trials.
View details for DOI 10.1161/JAHA.123.030042
View details for PubMedID 38108253
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National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020.
JAMA network open
Lu, Y., Liu, Y., Dhingra, L. S., Caraballo, C., Mahajan, S., Massey, D., Spatz, E. S., Sharma, R., Rodriguez, F., Watson, K. E., Masoudi, F. A., Krumholz, H. M.
2023; 6 (12): e2345964
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Despite efforts to improve the quality of care for patients with atherosclerotic cardiovascular disease (ASCVD), it is unclear whether the US has made progress in reducing racial and ethnic differences in utilization of guideline-recommended therapies for secondary prevention.To evaluate 21-year trends in racial and ethnic differences in utilization of guideline-recommended pharmacological medications and lifestyle modifications among US adults with ASCVD.This cross-sectional study includes data from the National Health and Nutrition Examination Survey between 1999 and 2020. Eligible participants were adults aged 18 years or older with a history of ASCVD. Data were analyzed between March 2022 and May 2023.Self-reported race and ethnicity.Rates and racial and ethnic differences in the use of guideline-recommended pharmacological medications and lifestyle modifications.The study included 5218 adults with a history of ASCVD (mean [SD] age, 65.5 [13.2] years, 2148 women [weighted average, 44.2%]), among whom 1170 (11.6%) were Black, 930 (7.7%) were Hispanic or Latino, and 3118 (80.7%) were White in the weighted sample. Between 1999 and 2020, there was a significant increase in total cholesterol control and statin use in all racial and ethnic subgroups, and in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) utilization in non-Hispanic White individuals and Hispanic and Latino individuals (Hispanic and Latino individuals: 17.12 percentage points; 95% CI, 0.37-37.88 percentage points; P = .046; non-Hispanic White individuals: 12.14 percentage points; 95% CI, 6.08-18.20 percentage points; P < .001), as well as smoking cessation within the Hispanic and Latino population (-27.13 percentage points; 95% CI, -43.14 to -11.12 percentage points; P = .002). During the same period, the difference in smoking cessation between Hispanic and Latino individuals and White individuals was reduced (-24.85 percentage points; 95% CI, -38.19 to -11.51 percentage points; P < .001), but racial and ethnic differences for other metrics did not change significantly. Notably, substantial gaps persisted between current care and optimal care throughout the 2 decades of data analyzed. In the period of 2017 to 2020, optimal regimens were observed in 47.4% (95% CI, 39.3%-55.4%), 48.7% (95% CI, 36.7%-60.6%), and 53.0% (95% CI, 45.6%-60.4%) of Black, Hispanic and Latino, and White individuals, respectively.In this cross-sectional study of US adults with ASCVD, significant disparities persisted between current care and optimal care, surpassing any differences observed among demographic groups. These findings highlight the critical need for sustained efforts to bridge these gaps and achieve better outcomes for all patients, regardless of their racial and ethnic backgrounds.
View details for DOI 10.1001/jamanetworkopen.2023.45964
View details for PubMedID 38039001
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Readability and reliability of online patient education materials about statins.
American journal of preventive cardiology
Ngo, S., Asirvatham, R., Baird, G. L., Sarraju, A., Maron, D. J., Rodriguez, F.
2023; 16: 100594
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Abstract
Statins are the cornerstone for the prevention and treatment of cardiovascular disease. Patients often consult online patient education materials (OPEMs) to inform medical decision-making. We therefore aimed to assess the readability and reliability of OPEMs related to statins.A total of 17 statin-related terms were queried using an online search engine to identify the top 20 search results for each statin-related term. Each OPEM was then grouped into the following categories based on 2 independent reviewers: government OPEMs (national, state, or local government agencies); healthcare/nonprofit OPEMs (major health systems and nonprofit organizations with a specific cardiovascular health focus); industry/commercial OPEMs (pharmaceutical manufacturers and online pharmacies); lay press OPEMs (healthcare-oriented news organizations); and dictionary/encyclopedia OPEMs. Grade-level readability for each OPEM was calculated using 5 standard readability metrics and compared with AMA-recommended readability recommendations. Reliability of each OPEM was evaluated using the JAMA benchmark criteria for online health information and certification from Health on the Net (HONCode).A total of 340 websites were identified across the 17 statin search terms. There were 211 statin OPEMs after excluding non-OPEM results; 172 OPEMs had unique content. Statin OPEM readability exceeded the recommended 6th grade AMA reading level (average reading grade level of 10.9). The average JAMA benchmark criteria score was 2.13 (on a scale of 0-4, with higher scores indicating higher reliability), and only 60% of statin OPEMs were HONCode-certified. There was an inverse association between readability and reliability. The most readable results were from industry and commercial sources, while the most reliable sites were from lay press sources.Statin OPEMs are written at an overall averaging reading grade level of 10.9. There was an inverse association between readability and reliability. Lack of accessible, high-quality online health information may contribute to statin nonadherence.
View details for DOI 10.1016/j.ajpc.2023.100594
View details for PubMedID 37822580
View details for PubMedCentralID PMC10562660
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Opportunistic assessment of ischemic heart disease risk using abdominopelvic computed tomography and medical record data: a multimodal explainable artificial intelligence approach.
Scientific reports
Zambrano Chaves, J. M., Wentland, A. L., Desai, A. D., Banerjee, I., Kaur, G., Correa, R., Boutin, R. D., Maron, D. J., Rodriguez, F., Sandhu, A. T., Rubin, D., Chaudhari, A. S., Patel, B. N.
2023; 13 (1): 21034
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Current risk scores using clinical risk factors for predicting ischemic heart disease (IHD) events-the leading cause of global mortality-have known limitations and may be improved by imaging biomarkers. While body composition (BC) imaging biomarkers derived from abdominopelvic computed tomography (CT) correlate with IHD risk, they are impractical to measure manually. Here, in a retrospective cohort of 8139 contrast-enhanced abdominopelvic CT examinations undergoing up to 5 years of follow-up, we developed multimodal opportunistic risk assessment models for IHD by automatically extracting BC features from abdominal CT images and integrating these with features from each patient's electronic medical record (EMR). Our predictive methods match and, in some cases, outperform clinical risk scores currently used in IHD risk assessment. We provide clinical interpretability of our model using a new method of determining tissue-level contributions from CT along with weightings of EMR features contributing to IHD risk. We conclude that such a multimodal approach, which automatically integrates BC biomarkers and EMR data, can enhance IHD risk assessment and aid primary prevention efforts for IHD. To further promote research, we release the Opportunistic L3 Ischemic heart disease (OL3I) dataset, the first public multimodal dataset for opportunistic CT prediction of IHD.
View details for DOI 10.1038/s41598-023-47895-y
View details for PubMedID 38030716
View details for PubMedCentralID 7734661
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Trends and Site-level Variation of Novel Cardiovascular Medication Utilization among Patients Admitted for Heart Failure or Coronary Artery Disease in the US Veterans Affairs System: 2017-2021.
American heart journal
Salahuddin, T., Hebbe, A., Daus, M., Essien, U. R., Waldo, S. W., Rodriguez, F., Ho, P. M., Simons, C., Gilmartin, H. M., Doll, J. A.
2023
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Abstract
We assessed trends in novel cardiovascular medication utilization in US Veterans Affairs (VA) for angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 Inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA).We retrospectively identified cohorts from 114 VA hospitals with admission for prevalent 1) systolic heart failure (HF, N=82,375) or 2) coronary artery disease and diabetes (CAD+T2D, N=74,209). Site-level data for prevalent filled prescriptions were assessed at hospital admission, discharge, or within 6 months of discharge. Variability among sites was estimated with median odds ratios (mOR), and within-site Pearson correlations of utilization of each medication class were calculated. Site- and patient-level characteristics were compared by high-, mixed-, and low-utilizing sites.ARNI and SGTL2i use for HF increased from <5% to 20% and 21% respectively, while SGTL2i or GLP-1 RA use for CAD+T2D increased from <5% to 30% from 2017-2021. Adjusted mOR and 95% confidence intervals for ARNI, SGTL2i for HF, and SGTL2i or GLP-1 RA for CAD+T2D were 1.73 (1.64-1.91), 1.72 (1.59-1.81), and 1.53 (1.45-1.62), respectively. Utilization of each medication class correlated poorly with use of other novel classes (Pearson <0.38 for all). Higher patient volume, number of beds, and hospital complexity correlated with high-utilizing sites.Utilization of novel medications has increased over time but remains suboptimal for US Veterans with HF and CAD+T2D, with substantial site-level heterogeneity despite a universal medication formulary and low out-of-pocket costs for patients. Future work should include further characterization of hospital- and clinician-level practice patterns to serve as targets to increase implementation.
View details for DOI 10.1016/j.ahj.2023.11.009
View details for PubMedID 37956920
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Eligibility for Cardiovascular Risk Reduction Therapy in the U.S. Based on SELECT Trial Criteria: Insights from the National Health and Nutrition Examination Survey.
Circulation. Cardiovascular quality and outcomes
Lu, Y., Liu, Y., Jastreboff, A. M., Khera, R., Ndumele, C. D., Rodriguez, F., Watson, K. E., Krumholz, H. M.
2023
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View details for DOI 10.1161/CIRCOUTCOMES.123.010640
View details for PubMedID 37950677
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Who Are We Missing? Reporting of Transgender and Gender-Expansive Populations in Clinical Trials.
Journal of the American Heart Association
Rice, E. N., Lan, R. H., Nunes, J. C., Shah, R., Clark, K., Periyakoil, V. S., Chen, J. H., Lin, B., Echols, M., Awad, C., Idris, M. Y., Cruz, E. R., Poullos, P. D., Lewis, E. F., Brown-Johnson, C., Igwe, J., Shen, S., Palaniappan, L., Stefanick, M. L., Ritter, V., Pemu, P., Rodriguez, F., Deb, B., Pundi, K., Wang, P. J.
2023: e030209
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View details for DOI 10.1161/JAHA.123.030209
View details for PubMedID 37947088
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Leveraging Digital Health to Improve the Cardiovascular Health of Women.
Current cardiovascular risk reports
Azizi, Z., Adedinsewo, D., Rodriguez, F., Lewey, J., Merchant, R. M., Brewer, L. C.
2023; 17 (11): 205-214
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Abstract
In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women.Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care.Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.
View details for DOI 10.1007/s12170-023-00728-z
View details for PubMedID 37868625
View details for PubMedCentralID PMC10587029
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Leveraging Digital Health to Improve the Cardiovascular Health of Women
CURRENT CARDIOVASCULAR RISK REPORTS
Azizi, Z., Adedinsewo, D., Rodriguez, F., Lewey, J., Merchant, R. M., Brewer, L. C.
2023
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View details for DOI 10.1007/s12170-023-00728
View details for Web of Science ID 001073191000001
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Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging With Cardiovascular Outcomes.
Journal of the American College of Cardiology
Peng, A. W., Dudum, R., Jain, S. S., Maron, D. J., Patel, B. N., Khandwala, N., Eng, D., Chaudhari, A. S., Sandhu, A. T., Rodriguez, F.
2023; 82 (12): 1192-1202
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Abstract
Coronary artery calcium (CAC) is a strong predictor of cardiovascular events across all racial and ethnic groups. CAC can be quantified on nonelectrocardiography (ECG)-gated computed tomography (CT) performed for other reasons, allowing for opportunistic screening for subclinical atherosclerosis.The authors investigated whether incidental CAC quantified on routine non-ECG-gated CTs using a deep-learning (DL) algorithm provided cardiovascular risk stratification beyond traditional risk prediction methods.Incidental CAC was quantified using a DL algorithm (DL-CAC) on non-ECG-gated chest CTs performed for routine care in all settings at a large academic medical center from 2014 to 2019. We measured the association between DL-CAC (0, 1-99, or ≥100) with all-cause death (primary outcome), and the secondary composite outcomes of death/myocardial infarction (MI)/stroke and death/MI/stroke/revascularization using Cox regression. We adjusted for age, sex, race, ethnicity, comorbidities, systolic blood pressure, lipid levels, smoking status, and antihypertensive use. Ten-year atherosclerotic cardiovascular disease risk was calculated using the pooled cohort equations.Of 5,678 adults without ASCVD (51% women, 18% Asian, 13% Hispanic/Latinx), 52% had DL-CAC >0. Those with DL-CAC ≥100 had an average 10-year ASCVD risk of 24%; yet, only 26% were on statins. After adjustment, patients with DL-CAC ≥100 had increased risk of death (HR: 1.51; 95% CI: 1.28-1.79), death/MI/stroke (HR: 1.57; 95% CI: 1.33-1.84), and death/MI/stroke/revascularization (HR: 1.69; 95% CI: 1.45-1.98) compared with DL-CAC = 0.Incidental CAC ≥100 was associated with an increased risk of all-cause death and adverse cardiovascular outcomes, beyond traditional risk factors. DL-CAC from routine non-ECG-gated CTs identifies patients at increased cardiovascular risk and holds promise as a tool for opportunistic screening to facilitate earlier intervention.
View details for DOI 10.1016/j.jacc.2023.06.040
View details for PubMedID 37704309
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Artificial intelligence in clinical workflow processes in vascular surgery and beyond.
Seminars in vascular surgery
Dossabhoy, S. S., Ho, V. T., Ross, E. G., Rodriguez, F., Arya, S.
2023; 36 (3): 401-412
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Abstract
In the past decade, artificial intelligence (AI)-based applications have exploded in health care. In cardiovascular disease, and vascular surgery specifically, AI tools such as machine learning, natural language processing, and deep neural networks have been applied to automatically detect underdiagnosed diseases, such as peripheral artery disease, abdominal aortic aneurysms, and atherosclerotic cardiovascular disease. In addition to disease detection and risk stratification, AI has been used to identify guideline-concordant statin therapy use and reasons for nonuse, which has important implications for population-based cardiovascular disease health. Although many studies highlight the potential applications of AI, few address true clinical workflow implementation of available AI-based tools. Specific examples, such as determination of optimal statin treatment based on individual patient risk factors and enhancement of intraoperative fluoroscopy and ultrasound imaging, demonstrate the potential promise of AI integration into clinical workflow. Many challenges to AI implementation in health care remain, including data interoperability, model bias and generalizability, prospective evaluation, privacy and security, and regulation. Multidisciplinary and multi-institutional collaboration, as well as adopting a framework for integration, will be critical for the successful implementation of AI tools into clinical practice.
View details for DOI 10.1053/j.semvascsurg.2023.07.002
View details for PubMedID 37863612
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2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., Kazi, D. S., Kolte, D., Kumbhani, D. J., Lofaso, J., Mahtta, D., Mark, D. B., Minissian, M., Navar, A., Patel, A. R., Piano, M. R., Rodriguez, F., Talbot, A. W., Taqueti, V. R., Thomas, R. J., van Diepen, S., Wiggins, B., Williams, M. S.
2023; 82 (9): 833-955
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View details for DOI 10.1016/j.jacc.2023.04.003
View details for Web of Science ID 001068846800001
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Response by Sandhu et al to Letter Regarding Article, "Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project)".
Circulation
Sandhu, A. T., Rodriguez, F., Maron, D. J.
2023; 148 (5): 441
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View details for DOI 10.1161/CIRCULATIONAHA.123.065360
View details for PubMedID 37523759
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Cardiovascular Disease Prevention Recommendations From an Online Chat-Based AI Reply
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
Sarraju, A., Rodriguez, F., Laffin, L.
2023; 330 (1): 83
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View details for Web of Science ID 001058995600028
View details for PubMedID 37395774
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Cardiovascular Disease Prevention Recommendations From an Online Chat-Based AI Model-Reply.
JAMA
Sarraju, A., Rodriguez, F., Laffin, L.
2023; 330 (1): 83
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View details for DOI 10.1001/jama.2023.8181
View details for PubMedID 37395774
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Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic.
American heart journal
Osmanlliu, E., Kalwani, N. M., Parameswaran, V., Qureshi, L., Dash, R., Scheinker, D., Rodriguez, F.
2023
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Abstract
The COVID-19 pandemic accelerated adoption of telemedicine in cardiology clinics. Early in the pandemic, there were sociodemographic disparities in telemedicine use. It is unknown if these disparities persisted and whether they were associated with changes in the population of patients accessing care.We examined all adult cardiology visits at an academic and an affiliated community practice in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). We compared patient sociodemographic characteristics between these periods. We used logistic regression to assess the association of patient/visit characteristics with visit modality (in-person vs telemedicine and video- vs phone-based telemedicine) during the COVID period.There were 54,948 pre-COVID and 58,940 COVID visits. Telemedicine use increased from <1% to 70.7% of visits (49.7% video, 21.0% phone) during the COVID period. Patient sociodemographic characteristics were similar during both periods. In adjusted analyses, visits for patients from some sociodemographic groups were less likely to be delivered by telemedicine, and when delivered by telemedicine, were less likely to be delivered by video versus phone. The observed disparities in the use of video-based telemedicine were greatest for patients aged ≥80 years (vs age <60, OR 0.24, 95% CI 0.21, 0.28), Black patients (vs non-Hispanic White, OR 0.64, 95% CI 0.56, 0.74), patients with limited English proficiency (vs English proficient, OR 0.52, 95% CI 0.46-0.59), and those on Medicaid (vs privately insured, OR 0.47, 95% CI 0.41-0.54).During the first year of the pandemic, the sociodemographic characteristics of patients receiving cardiovascular care remained stable, but the modality of care diverged across groups. There were differences in the use of telemedicine vs in-person care and most notably in the use of video- vs phone-based telemedicine. Future studies should examine barriers and outcomes in digital healthcare access across diverse patient groups.
View details for DOI 10.1016/j.ahj.2023.06.011
View details for PubMedID 37369269
View details for PubMedCentralID PMC10290766
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Evaluating Recommendations About Atrial Fibrillation for Patients and Clinicians Obtained From Chat-Based Artificial Intelligence Algorithms.
Circulation. Arrhythmia and electrophysiology
Azizi, Z., Alipour, P., Gomez, S., Broadwin, C., Islam, S., Sarraju, A., Rogers, A. J., Sandhu, A. T., Rodriguez, F.
2023: e012015
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View details for DOI 10.1161/CIRCEP.123.012015
View details for PubMedID 37334705
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Testing the Appropriateness of Diabetes Prevention and Care Information Given by the Online Conversational AI ChatGPT.
Clinical diabetes : a publication of the American Diabetes Association
Hong, J., Kikuta, N. T., Simos, A., Tsai, S., Lin, B., Rodriguez, F., Palaniappan, L.
2023; 41 (4): 549-552
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View details for DOI 10.2337/cd23-0026
View details for PubMedID 37849522
View details for PubMedCentralID PMC10577494
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Natural language processing to identify reasons for sex disparity in statin prescriptions.
American journal of preventive cardiology
Witting, C., Azizi, Z., Gomez, S. E., Zammit, A., Sarraju, A., Ngo, S., Hernandez-Boussard, T., Rodriguez, F.
2023; 14: 100496
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Background: Statins are the cornerstone of treatment of patients with atherosclerotic cardiovascular disease (ASCVD). Despite this, multiple studies have shown that women with ASCVD are less likely to be prescribed statins than men. The objective of this study was to use Natural Language Processing (NLP) to elucidate factors contributing to this disparity.Methods: Our cohort included adult patients with two or more encounters between 2014 and 2021 with an ASCVD diagnosis within a multisite electronic health record (EHR) in Northern California. After reviewing structured EHR prescription data, we used a benchmark deep learning NLP approach, Clinical Bidirectional Encoder Representations from Transformers (BERT), to identify and interpret discussions of statin prescriptions documented in clinical notes. Clinical BERT was evaluated against expert clinician review in 20% test sets.Results: There were 88,913 patients with ASCVD (mean age 67.8±13.1 years) and 35,901 (40.4%) were women. Women with ASCVD were less likely to be prescribed statins compared with men (56.6%vs 67.6%, p <0.001), and, when prescribed, less likely to be prescribed guideline-directed high-intensity dosing (41.4%vs 49.8%, p <0.001). These disparities were more pronounced among younger patients, patients with private insurance, and those for whom English is their preferred language. Among those not prescribed statins, women were less likely than men to have statins mentioned in their clinical notes (16.9%vs 19.1%, p <0.001). Women were less likely than men to have statin use reported in clinical notes despite absence of recorded prescription (32.8%vs 42.6%, p <0.001). Women were slightly more likely than men to have statin intolerance documented in structured data or clinical notes (6.0%vs 5.3%, p=0.003).Conclusions: Women with ASCVD were less likely to be prescribed guideline-directed statins compared with men. NLP identified additional sex-based statin disparities and reasons for statin non-prescription in clinical notes of patients with ASCVD.
View details for DOI 10.1016/j.ajpc.2023.100496
View details for PubMedID 37128554
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Cardiovascular Health in Hispanic/Latino Patients: From Research to Practice.
Journal of the American College of Cardiology
Rodriguez, F., Blumer, V.
2023; 81 (15): 1521-1523
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View details for DOI 10.1016/j.jacc.2023.02.025
View details for PubMedID 37045522
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How Low Can You Go? New Evidence Supports No Lower Bound to Low-Density Lipoprotein Cholesterol Level in Secondary Prevention.
Circulation
Rodriguez, F., Khera, A.
2023; 147 (16): 1204-1207
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View details for DOI 10.1161/CIRCULATIONAHA.123.064041
View details for PubMedID 37068134
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Clinical Trial Technologies for Improving Equity and Inclusion in Cardiovascular Clinical Research.
Cardiology and therapy
Broadwin, C., Azizi, Z., Rodriguez, F.
2023
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Approximately one-third of clinical trials fail to meet their recruitment goals, which can cause costly delays to sponsors and compromise the scientific integrity and generalizability of a trial. Inadequate recruitment and retention of patient groups who have the disease under investigation may produce insufficient medical knowledge about the therapeutic effects of drugs or products for the population at large. It is essential to address these issues to ensure that certain groups are not unduly subjected to disproportionate risks or denied the benefits of research. This commentary will present opportunities for clinical trialists to use emerging technologies and decentralized approaches to improve clinical trial recruitment, mitigate disparities, and improve individual and population-level outcomes within cardiovascular medicine.
View details for DOI 10.1007/s40119-023-00311-y
View details for PubMedID 37043079
View details for PubMedCentralID 9072305
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Clinical Trial Technologies for Improving Equity and Inclusion in Cardiovascular Clinical Research
Cardiology and Therapy
Broadwin, C., Azizi, Z., Rodriguez, F.
2023
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Abstract
Approximately one-third of clinical trials fail to meet their recruitment goals, which can cause costly delays to sponsors and compromise the scientific integrity and generalizability of a trial. Inadequate recruitment and retention of patient groups who have the disease under investigation may produce insufficient medical knowledge about the therapeutic effects of drugs or products for the population at large. It is essential to address these issues to ensure that certain groups are not unduly subjected to disproportionate risks or denied the benefits of research. This commentary will present opportunities for clinical trialists to use emerging technologies and decentralized approaches to improve clinical trial recruitment, mitigate disparities, and improve individual and population-level outcomes within cardiovascular medicine.
View details for DOI 10.1007/s40119-023-00311-y
View details for PubMedCentralID 9072305
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Longitudinal Trends in Cardiovascular Risk Factor Profiles and Complications Among Patients Hospitalized for COVID-19 Infection: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry.
Circulation. Cardiovascular quality and outcomes
Hall, E. J., Ayers, C. R., Kolkailah, A. A., Rutan, C., Walchok, J., Williams, J. H., Wang, T. Y., Rodriguez, F., Bradley, S. M., Stevens, L., Hall, J. L., Mallya, P., Roth, G. A., Morrow, D. A., Elkind, M. S., Das, S. R., de Lemos, J. A.
2023: e009652
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The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time.We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection. The time period from April 2020 to December 2021 was divided into 3-month epochs, with March 2020 analyzed separately as a potential outlier. Participating centers varied over the study period. Trends in all-cause in-hospital mortality, CVD risk factors, and in-hospital CVD outcomes, including a composite primary outcome of cardiovascular death, cardiogenic shock, new heart failure, stroke, and myocardial infarction, were evaluated across time epochs. Risk-adjusted analyses were performed using generalized linear mixed-effects models.A total of 46 007 patient admissions from 134 hospitals were included (mean patient age 61.8 years, 53% male, 22% Black race). Patients admitted later in the pandemic were younger, more likely obese, and less likely to have existing CVD (Ptrend ≤0.001 for each). The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% in October to December 2021 (risk-adjusted Ptrend=0.006). This was driven by an increase in the diagnosis of myocardial infarction and stroke (Ptrend<0.0001 for each). The overall rate of in-hospital mortality was 14.2%, which declined over time (20.8% in March 2020 versus 10.8% in the last epoch; adjusted Ptrend<0.0001). When the analysis was restricted to July 2020 to December 2021, no temporal change in all-cause mortality was seen (adjusted Ptrend=0.63).Despite a shifting risk factor profile toward a younger population with lower rates of established CVD, the incidence of diagnosed cardiovascular complications of COVID increased from the onset of the pandemic through December 2021. All-cause mortality decreased during the initial months of the pandemic and thereafter remained consistently high through December 2021.
View details for DOI 10.1161/CIRCOUTCOMES.122.009652
View details for PubMedID 37017087
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Artificial Intelligence-Enabled Analysis of Statin-Related Topics and Sentiments on Social Media.
JAMA network open
Somani, S., van Buchem, M. M., Sarraju, A., Hernandez-Boussard, T., Rodriguez, F.
2023; 6 (4): e239747
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Despite compelling evidence that statins are safe, are generally well tolerated, and reduce cardiovascular events, statins are underused even in patients with the highest risk. Social media may provide contemporary insights into public perceptions about statins.To characterize and classify public perceptions about statins that were gleaned from more than a decade of statin-related discussions on Reddit, a widely used social media platform.This qualitative study analyzed all statin-related discussions on the social media platform that were dated between January 1, 2009, and July 12, 2022. Statin- and cholesterol-focused communities, were identified to create a list of statin-related discussions. An artificial intelligence (AI) pipeline was developed to cluster these discussions into specific topics and overarching thematic groups. The pipeline consisted of a semisupervised natural language processing model (BERT [Bidirectional Encoder Representations from Transformers]), a dimensionality reduction technique, and a clustering algorithm. The sentiment for each discussion was labeled as positive, neutral, or negative using a pretrained BERT model.Statin-related posts and comments containing the terms statin and cholesterol.Statin-related topics and thematic groups.A total of 10 233 unique statin-related discussions (961 posts and 9272 comments) from 5188 unique authors were identified. The number of statin-related discussions increased by a mean (SD) of 32.9% (41.1%) per year. A total of 100 discussion topics were identified and were classified into 6 overarching thematic groups: (1) ketogenic diets, diabetes, supplements, and statins; (2) statin adverse effects; (3) statin hesitancy; (4) clinical trial appraisals; (5) pharmaceutical industry bias and statins; and (6) red yeast rice and statins. The sentiment analysis revealed that most discussions had a neutral (66.6%) or negative (30.8%) sentiment.Results of this study demonstrated the potential of an AI approach to analyze large, contemporary, publicly available social media data and generate insights into public perceptions about statins. This information may help guide strategies for addressing barriers to statin use and adherence.
View details for DOI 10.1001/jamanetworkopen.2023.9747
View details for PubMedID 37093597
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Underutilization Of Guideline-directed Genetic Testing In Cardiomyopathies: A Missed Opportunity
Longoni, M., Ward, A., Bhasin, K., Lee, D., Bhatt, S., Rodriguez, F., Dash, R.
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. 2023: 704-705
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View details for Web of Science ID 001009258900393
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Identifying Reasons for Statin Nonuse in Patients With Diabetes Using Deep Learning of Electronic Health Records.
Journal of the American Heart Association
Sarraju, A., Zammit, A., Ngo, S., Witting, C., Hernandez-Boussard, T., Rodriguez, F.
2023: e028120
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Background Statins are guideline-recommended medications that reduce cardiovascular events in patients with diabetes. Yet, statin use is concerningly low in this high-risk population. Identifying reasons for statin nonuse, which are typically described in unstructured electronic health record data, can inform targeted system interventions to improve statin use. We aimed to leverage a deep learning approach to identify reasons for statin nonuse in patients with diabetes. Methods and Results Adults with diabetes and no statin prescriptions were identified from a multiethnic, multisite Northern California electronic health record cohort from 2014 to 2020. We used a benchmark deep learning natural language processing approach (Clinical Bidirectional Encoder Representations from Transformers) to identify statin nonuse and reasons for statin nonuse from unstructured electronic health record data. Performance was evaluated against expert clinician review from manual annotation of clinical notes and compared with other natural language processing approaches. Of 33 461 patients with diabetes (mean age 59±15 years, 49% women, 36% White patients, 24% Asian patients, and 15% Hispanic patients), 47% (15 580) had no statin prescriptions. From unstructured data, Clinical Bidirectional Encoder Representations from Transformers accurately identified statin nonuse (area under receiver operating characteristic curve [AUC] 0.99 [0.98-1.0]) and key patient (eg, side effects/contraindications), clinician (eg, guideline-discordant practice), and system reasons (eg, clinical inertia) for statin nonuse (AUC 0.90 [0.86-0.93]) and outperformed other natural language processing approaches. Reasons for nonuse varied by clinical and demographic characteristics, including race and ethnicity. Conclusions A deep learning algorithm identified statin nonuse and actionable reasons for statin nonuse in patients with diabetes. Findings may enable targeted interventions to improve guideline-directed statin use and be scaled to other evidence-based therapies.
View details for DOI 10.1161/JAHA.122.028120
View details for PubMedID 36974740
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Locking the Revolving Door: Racial Disparities in Cardiovascular Disease.
Journal of the American Heart Association
Velarde, G., Bravo-Jaimes, K., Brandt, E. J., Wang, D., Douglass, P., Castellanos, L. R., Rodriguez, F., Palaniappan, L., Ibebuogu, U., Bond, R., Ferdinand, K., Lundberg, G., Thaman, R., Vijayaraghavan, K., Watson, K.
2023: e025271
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Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strategies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.
View details for DOI 10.1161/JAHA.122.025271
View details for PubMedID 36942617
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SOCIAL DETERMINANTS OF HEALTH AND CORONARY ARTERY CALCIUM: RESULTS FROM THE PROJECT BASELINE HEALTH STUDY
Dudum, R., Ling, A., Short, S., Koweek, L. H., Carroll, M., Daubert, M. A., Haddad, F., Hernandez, A. F., Shah, S., Mahaffey, K. W., Douglas, P. S., Mega, J., Maron, D., Rodriguez, F.
ELSEVIER SCIENCE INC. 2023: 1843
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View details for Web of Science ID 000990866101855
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READABILITY AND RELIABILITY OF ONLINE PATIENT EDUCATIONAL MATERIALS ON STATINS
Asirvatham, R., Ngo, S., Baird, G., Sarraju, A., Rodriguez, F.
ELSEVIER SCIENCE INC. 2023: 1762
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View details for Web of Science ID 000990866101774
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OPPORTUNISTIC SCREENING OF INCIDENTAL CORONARY ARTERY CALCIUM WITH DEEP-LEARNING ALGORITHM ON NON-ECG GATED CHEST CT IMAGING AND ASSOCIATION WITH CARDIOVASCULAR EVENTS AND MORTALITY
Peng, A., Dudum, R., Maron, D., Sandhu, A., Rodriguez, F.
ELSEVIER SCIENCE INC. 2023: 2123
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View details for Web of Science ID 000990866102135
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TOPICS AND SENTIMENTS AROUND STATINS ON REDDIT USING ARTIFICIAL INTELLIGENCE
Somani, S., Van Buchem, M., Sarraju, A., Hernandez-Boussard, T., Rodriguez, F.
ELSEVIER SCIENCE INC. 2023: 1637
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View details for Web of Science ID 000990866101649
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PERSISTENT SOCIODEMOGRAPHIC DISPARITIES IN CARDIOVASCULAR TELEMEDICINE USE DURING THE COVID-19 PANDEMIC
Kalwani, N., Osmanlliu, E., Parameswaran, V., Qureshi, L., Dash, R., Scheinker, D., Rodriguez, F.
ELSEVIER SCIENCE INC. 2023: 2287
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View details for Web of Science ID 000990866102298
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ANTIRACIST AI: A MACHINE LEARNING MODEL USING ELECTROCARDIOGRAMS AND ECHOCARDIOGRAMS CAN DETECT TRANSTHYRETIN CARDIAC AMYLOIDOSIS AND DECREASE RACIAL BIAS IN DIAGNOSTIC TESTING
Jain, S. S., Sun, T., Brown, K., Ramlall, V., Tatonetti, N., Elhadad, N., Rodriguez, F., Witteles, R., Maurer, M. S., Poterucha, T., Elias, P.
ELSEVIER SCIENCE INC. 2023: 338
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View details for Web of Science ID 000990866100339
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PATTERNS AND GAPS IN GUIDELINE-DIRECTED STATIN USE FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN DISAGGREGATED HISPANIC AND ASIAN SUBGROUPS
Sarraju, A., Yan, S., Huang, Q., Dudum, R., Palaniappan, L. P., Rodriguez, F.
ELSEVIER SCIENCE INC. 2023: 1785
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View details for Web of Science ID 000990866101797
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Circulating ketone bodies and cardiovascular outcomes: the MESA study.
European heart journal
Shemesh, E., Chevli, P. A., Islam, T., German, C. A., Otvos, J., Yeboah, J., Rodriguez, F., deFilippi, C., Lima, J. A., Blaha, M., Pandey, A., Vaduganathan, M., Shapiro, M. D.
2023
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AIMS: Ketone bodies (KB) are an important alternative metabolic fuel source for the myocardium. Experimental and human investigations suggest that KB may have protective effects in patients with heart failure. This study aimed to examine the association between KB and cardiovascular outcomes and mortality in an ethnically diverse population free from cardiovascular disease (CVD).METHODS AND RESULTS: This analysis included 6796 participants (mean age 62 ± 10 years, 53% women) from the Multi-Ethnic Study of Atherosclerosis. Total KB was measured by nuclear magnetic resonance spectroscopy. Multivariable-adjusted Cox proportional hazard models were used to examine the association of total KB with cardiovascular outcomes. At a mean follow-up of 13.6 years, after adjusting for traditional CVD risk factors, increasing total KB was associated with a higher rate of hard CVD, defined as a composite of myocardial infarction, resuscitated cardiac arrest, stroke, and cardiovascular death, and all CVD (additionally included adjudicated angina) [hazard ratio, HR (95% confidence interval, CI): 1.54 (1.12-2.12) and 1.37 (1.04-1.80) per 10-fold increase in total KB, respectively]. Participants also experienced an 87% (95% CI: 1.17-2.97) increased rate of CVD mortality and an 81% (1.45-2.23) increased rate of all-cause mortality per 10-fold increase in total KB. Moreover, a higher rate of incident heart failure was observed with increasing total KB [1.68 (1.07-2.65), per 10-fold increase in total KB].CONCLUSION: The study found that elevated endogenous KB in a healthy community-based population is associated with a higher rate of CVD and mortality. Ketone bodies could serve as a potential biomarker for cardiovascular risk assessment.
View details for DOI 10.1093/eurheartj/ehad087
View details for PubMedID 36881667
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Sociodemographic determinants of oral anticoagulant prescription in patients with atrial fibrillations: findings from the PINNACLE registry using machine learning.
Heart rhythm O2
Azizi, Z., Ward, A. T., Lee, D. J., Gad, S. S., Bhasin, K., Beetel, R. J., Ferreira, T., Shankar, S., Rumsfeld, J. S., Harrington, R. A., Virani, S. S., Gluckman, T. J., Dash, R., Rodriguez, F.
2023; 4 (3): 158-168
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Current risk scores that are solely based on clinical factors have shown modest predictive ability for understanding of factors associated with gaps in real-world prescription of oral anticoagulation (OAC) in patients with atrial fibrillation (AF).In this study, we sought to identify the role of social and geographic determinants, beyond clinical factors associated with variation in OAC prescriptions using a large national registry of ambulatory patients with AF.Between January 2017 and June 2018, we identified patients with AF from the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) Registry. We examined associations between patient and site-of-care factors and prescription of OAC across U.S. counties. Several machine learning (ML) methods were used to identify factors associated with OAC prescription.Among 864,339 patients with AF, 586,560 (68%) were prescribed OAC. County OAC prescription rates ranged from 26.8% to 93%, with higher OAC use in the Western United States. Supervised ML analysis in predicting likelihood of OAC prescriptions and identified a rank order of patient features associated with OAC prescription. In the ML models, in addition to clinical factors, medication use (aspirin, antihypertensives, antiarrhythmic agents, lipid modifying agents), and age, household income, clinic size, and U.S. region were among the most important predictors of an OAC prescription.In a contemporary, national cohort of patients with AF underuse of OAC remains high, with notable geographic variation. Our results demonstrated the role of several important demographic and socioeconomic factors in underutilization of OAC in patients with AF.
View details for DOI 10.1016/j.hroo.2022.11.004
View details for PubMedID 36993910
View details for PubMedCentralID PMC10041076
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Sex Disparities in Prevention of Atherosclerotic Cardiovascular Disease Across the Life Course.
Circulation
Rodriguez, F.
2023; 147 (7): 523-525
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View details for DOI 10.1161/CIRCULATIONAHA.122.063148
View details for PubMedID 36780384
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Appropriateness of Cardiovascular Disease Prevention Recommendations Obtained From a Popular Online Chat-Based Artificial Intelligence Model.
JAMA
Sarraju, A., Bruemmer, D., Van Iterson, E., Cho, L., Rodriguez, F., Laffin, L.
2023
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Abstract
This study examines the appropriateness of artificial intelligence model responses to fundamental cardiovascular disease prevention questions.
View details for DOI 10.1001/jama.2023.1044
View details for PubMedID 36735264
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The leaky pipeline of diverse race and ethnicity representation in academic science and technology training in the United States, 2003-2019.
PloS one
Sarraju, A., Ngo, S., Rodriguez, F.
2023; 18 (4): e0284945
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INTRODUCTION: Diverse race and ethnicity representation remains lacking in science and technology (S&T) careers in the United States (US). Due to systematic barriers across S&T training stages, there may be sequential loss of diverse representation leading to low representation, often conceptualized as a leaky pipeline. We aimed to quantify the contemporary leaky pipeline of S&T training in the US.METHODS: We analyzed US S&T degree data, stratified by sex and then by race or ethnicity, obtained from survey data the National Science Foundation and the National Center for Science and Engineering Statistics. We assessed changes in race and ethnicity representation in 2019 at two major S&T transition points: bachelor to doctorate degrees (2003-2019) and doctorate degrees to postdoctoral positions (2010-2019). We quantified representation changes at each point as the ratio of representation in the later stage to earlier stage (representation ratio [RR]). We assessed secular trends in the representation ratio through univariate linear regression.RESULTS: For 2019, the survey data included for bachelor degrees, 12,714,921 men and 10.612,879 women; for doctorate degrees 14,259 men and 12,860 women; and for postdoctoral data, 11,361 men and 8.672 women. In 2019, we observed that Black, Asian, and Hispanic women had comparable loss of representation among women in the bachelor to doctorate transition (RR 0.86, 95% confidence interval [CI] 0.81-0.92; RR 0.85, 95% CI 0.81-0.89; and RR 0.82, 95% CI 0.77-0.87, respectively), while among men, Black and Asian men had the greatest loss of representation (Black men RR 0.72, 95% CI 0.66-0.78; Asian men RR 0.73, 95% CI 0.70-0.77)]. We observed that Black men (RR 0.60, 95% CI 0.51-0.69) and Black women (RR 0.56, 95% CI 0.49-0.63) experienced the greatest loss of representation among men and women, respectively, in the doctorate to postdoctoral transition. Black women had a statistically significant decrease in their representation ratio in the doctorate to postdoctoral transition from 2010 to 2019 (p-trend = 0.02).CONCLUSION: We quantified diverse race and ethnicity representation in contemporary US S&T training and found that Black men and women experienced the most consistent loss in representation across the S&T training pipeline. Findings should spur efforts to mitigate the structural racism and systemic barriers underpinning such disparities.
View details for DOI 10.1371/journal.pone.0284945
View details for PubMedID 37099545
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Real-world utilization of guideline-directed genetic testing in inherited cardiovascular diseases.
Frontiers in cardiovascular medicine
Longoni, M., Bhasin, K., Ward, A., Lee, D., Nisson, M., Bhatt, S., Rodriguez, F., Dash, R.
2023; 10: 1272433
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Abstract
Background: Cardiovascular disease continues to be the leading cause of death globally. Clinical practice guidelines aimed at improving disease management and positively impacting major cardiac adverse events recommend genetic testing for inherited cardiovascular conditions such as dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), hereditary amyloidosis, and familial hypercholesterolemia (FH); however, little is known about how consistently practitioners order genetic testing for these conditions in routine clinical practice. This study aimed to assess the adoption of guideline-directed genetic testing for patients diagnosed with DCM, HCM, LQTS, hereditary amyloidosis, or FH.Methods: This retrospective cohort study captured real-world evidence of genetic testing from ICD-9-CM and ICD-10-CM codes, procedure codes, and structured text fields of de-identified patient records in the Veradigm Health Insights Ambulatory EHR Research Database linked with insurance claims data. Data analysis was conducted using an automated electronic health record analysis engine. Patient records in the Veradigm database were sourced from more than 250,000 clinicians serving over 170 million patients in outpatient primary care and specialty practice settings in the United States and linked insurance claims data from public and private insurance providers. The primary outcome measure was evidence of genetic testing within six months of condition diagnosis.Results: Between January 1, 2017, and December 31, 2021, 224,641 patients were newly diagnosed with DCM, HCM, LQTS, hereditary amyloidosis, or FH and included in this study. Substantial genetic testing care gaps were identified. Only a small percentage of patients newly diagnosed with DCM (827/101,919; 0.8%), HCM (253/15,507; 1.6%), LQTS (650/56,539; 1.2%), hereditary amyloidosis (62/1,026; 6.0%), or FH (718/49,650; 1.5%) received genetic testing.Conclusions: Genetic testing is underutilized across multiple inherited cardiovascular conditions. This real-world data analysis provides insights into the delivery of genomic healthcare in the United States and suggests genetic testing guidelines are rarely followed in practice.
View details for DOI 10.3389/fcvm.2023.1272433
View details for PubMedID 37915745
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Disparities in Adoption of New Diabetic Therapies with Cardiovascular Benefits.
Diabetes research and clinical practice
Vasti, E. C., Basina, M., Calma, J., Maron, D. J., Rodriguez, F., Sandhu, A. T.
2022: 110233
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Abstract
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 agonists (GLP1a) have cardiovascular benefit, but adoption into clinical practice has been lagging. We aim to evaluate use of SGLT2i and GLP1a across socioeconomic strata (SES), medical risk as well as provider type.We conducted a retrospective cohort study of the prescription of SGLT2i or GLP1a within 12 months of clinic visit between January 1, 2018 and January 1, 2019 using de-identified claims data. The primary outcome was the composite of a medication fill of either an SGLT2i and/or GLP1a within 180 days of the index visit.Of the total cohort, 125,636 (15.8%) received either a GLP-1a or SGLT2i.The odds of prescription of either medication was 0.64 [p=0.006)] in patients with heart failure. Patients who identified as Black, Hispanic or Asian had lower odds of the primary outcome [Black: (AOR 0.81, p<0.000); Hispanic: (AOR 0.87, p<0.000); Asian: (AOR 0.83, p<0.000). The odds was higher for those treated by an endocrinologist versus primary care clinician [AOR 2.12, p<0.000)].Prescriptionof SGLT2i or GLP1a was lower among patients with cardiovascular co-morbidities and those who identified as Black, Hispanic or Asian. Further efforts to minimize these disparities should be pursued.
View details for DOI 10.1016/j.diabres.2022.110233
View details for PubMedID 36581144
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Incidental Coronary Artery Calcium: Opportunistic Screening of Prior Non-Gated Chest Cts to Improve Statin Rates
Sandhu, A. T., Rodriguez, F., Ngo, S., Patel, B., Mastrodicasa, D., Eng, D. T., Khandwala, N., Balla, S., Sousa, D., Maron, D. J.
LIPPINCOTT WILLIAMS & WILKINS. 2022: E601-E602
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View details for Web of Science ID 000928164500084
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Use of lipid-lowering therapy preceding first hospitalization for acute myocardial infarction or stroke.
American journal of preventive cardiology
Sandhu, A. T., Rodriguez, F., Maron, D. J., Heidenreich, P. A.
2022; 12: 100426
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View details for DOI 10.1016/j.ajpc.2022.100426
View details for PubMedID 36304918
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Health Techequity: Opportunities for Digital Health Innovations to Improve Equity and Diversity in Cardiovascular Care.
Current cardiovascular risk reports
Hernandez, M. F., Rodriguez, F.
2022: 1-20
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Abstract
In this review, we define health equity, disparities, and social determinants of health; the different components of digital health; the barriers to digital health equity; and cardiovascular digital health trials and possible solutions to improve health equity through digital health.Digital health interventions show incredible potential to improve cardiovascular diseases by obtaining longitudinal, continuous, and actionable patient data; increasing access to care; and by decreasing delivery barriers and cost. However, certain populations have experienced decreased access to digital health innovations and decreased representation in cardiovascular digital health trials.Special efforts will need to be made to expand access to the different elements of digital health, ensuring that the digital divide does not exacerbate health disparities. As the expansion of digital health technologies continues, it is vital to increase representation of minoritized groups in all stages of the process: product development (needs findings and screening, concept generation, product creation, and testing), clinical research (pilot studies, feasibility studies, and randomized control trials), and finally health services deployment.
View details for DOI 10.1007/s12170-022-00711-0
View details for PubMedID 36465151
View details for PubMedCentralID PMC9703416
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Incidental Coronary Artery Calcium: Opportunistic Screening of Prior Non-gated Chest CTs to Improve Statin Rates (NOTIFY-1 Project).
Circulation
Sandhu, A. T., Rodriguez, F., Ngo, S., Patel, B. N., Mastrodicasa, D., Eng, D., Khandwala, N., Balla, S., Sousa, D., Maron, D. J.
2022
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BACKGROUND: Coronary artery calcium (CAC) can be identified on non-gated chest CTs, but this finding is not consistently incorporated into care. A deep learning algorithm enables opportunistic CAC screening of non-gated chest CTs. Our objective was to evaluate the impact of notifying clinicians and patients of incidental CAC on statin initiation.METHODS: NOTIFY-1 was a randomized quality improvement project in the Stanford healthcare system. Patients without known atherosclerotic cardiovascular disease (ASCVD) or prior statin prescription were screened for CAC on a prior non-gated chest CT from 2014-2019 using a validated deep learning algorithm with radiologist confirmation. Patients with incidental CAC were randomized to notification of the primary care clinician and patient versus usual care. Notification included a patient-specific image of CAC and guideline recommendations regarding statin use. The primary outcome was statin prescription within 6 months.RESULTS: Among 2,113 patients who met initial clinical inclusion criteria, CAC was identified by the algorithm in 424 patients. After additional exclusions following chart review, a radiologist confirmed CAC among 173 of 194 patients (89.2%) who were randomized to notification or usual care. At 6 months, the statin prescription rate was 51.2% (44/86) in the notification arm versus 6.9% (6/87) with usual care (p<0.001). There was also more coronary artery disease testing in the notification arm (15.1% [13/86] vs. 2.3% [2/87], p=0.008).CONCLUSIONS: Opportunistic CAC screening of prior non-gated chest CTs followed by clinician and patient notification led to a significant increase in statin prescriptions. Further research is needed to determine whether this approach can reduce ASCVD events.
View details for DOI 10.1161/CIRCULATIONAHA.122.062746
View details for PubMedID 36342823
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Association of Race and Ethnicity With Oral Anticoagulation and Associated Outcomes in Patients With Atrial Fibrillation: Findings From the Get With The Guidelines-Atrial Fibrillation Registry.
JAMA cardiology
Essien, U. R., Chiswell, K., Kaltenbach, L. A., Wang, T. Y., Fonarow, G. C., Thomas, K. L., Turakhia, M. P., Benjamin, E. J., Rodriguez, F., Fang, M. C., Magnani, J. W., Yancy, C. W., Piccini, J. P.
2022
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Abstract
Oral anticoagulation (OAC) is underprescribed in underrepresented racial and ethnic group individuals with atrial fibrillation (AF). Little is known of how differential OAC prescribing relates to inequities in AF outcomes.To compare OAC use at discharge and AF-related outcomes by race and ethnicity in the Get With The Guidelines-Atrial Fibrillation (GWTG-AFIB) registry.This retrospective cohort analysis used data from the GWTG-AFIB registry, a national quality improvement initiative for hospitalized patients with AF. All registry patients hospitalized with AF from 2014 to 2020 were included in the study. Data were analyzed from November 2021 to July 2022.Self-reported race and ethnicity assessed in GWTG-AFIB registry.The primary outcome was prescription of direct-acting OAC (DOAC) or warfarin at discharge. Secondary outcomes included cumulative 1-year incidence of ischemic stroke, major bleeding, and mortality postdischarge. Outcomes adjusted for patient demographic, clinical, and socioeconomic characteristics as well as hospital factors.Among 69 553 patients hospitalized with AF from 159 sites between 2014 and 2020, 863 (1.2%) were Asian, 5062 (7.3%) were Black, 4058 (5.8%) were Hispanic, and 59 570 (85.6%) were White. Overall, 34 113 (49.1%) were women; the median (IQR) age was 72 (63-80) years, and the median (IQR) CHA2DS2-VASc score (calculated as congestive heart failure, hypertension, age 75 years and older, diabetes, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, and sex category) was 4 (2-5). At discharge, 56 385 patients (81.1%) were prescribed OAC therapy, including 41 760 (74.1%) receiving DOAC. OAC prescription at discharge was lowest in Hispanic patients (3010 [74.2%]), followed by Black patients (3935 [77.7%]) Asian patients (691 [80.1%]), and White patients (48 749 [81.8%]). Black patients were less likely than White patients to be discharged while taking any anticoagulant (adjusted odds ratio, 0.75; 95% CI, 0.68-0.84) and DOACs (adjusted odds ratio, 0.73; 95% CI, 0.65-0.82). In 16 307 individuals with 1-year follow up data, bleeding risks (adjusted hazard ratio [aHR], 2.08; 95% CI, 1.53-2.83), stroke risks (aHR, 2.07; 95% CI, 1.34-3.20), and mortality risks (aHR, 1.22; 95% CI, 1.02-1.47) were higher in Black patients than White patients. Hispanic patients had higher stroke risk (aHR, 2.02; 95% CI, 1.38-2.95) than White patients.In a national registry of hospitalized patients with AF, compared with White patients, Black patients were less likely to be discharged while taking anticoagulant therapy and DOACs in particular. Black and Hispanic patients had higher risk of stroke compared with White patients; Black patients had a higher risk of bleeding and mortality. There is an urgent need for interventions to achieve pharmacoequity in guideline-directed AF management to improve overall outcomes.
View details for DOI 10.1001/jamacardio.2022.3704
View details for PubMedID 36287545
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Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control.
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
Gomez, S. E., Fazal, M., Nunes, J. C., Shah, S., Perino, A. C., Narayan, S. M., Tamirisa, K. P., Han, J. K., Rodriguez, F., Baykaner, T.
2022
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Abstract
BACKGROUND: Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups.METHODS: This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials.RESULTS: Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection.CONCLUSION: Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.
View details for DOI 10.1007/s10840-022-01383-x
View details for PubMedID 36224481
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Drivers of variation in telemedicine use during the COVID-19 pandemic: The experience of a large academic cardiovascular practice.
Journal of telemedicine and telecare
Koos, H., Parameswaran, V., Claire, S., Chen, C., Kalwani, N., Osmanlliu, E., Qureshi, L., Dash, R., Scheinker, D., Rodriguez, F.
2022: 1357633X221130288
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BACKGROUND: COVID-19 spurred rapid adoption and expansion of telemedicine. We investigated the factors driving visit modality (telemedicine vs. in-person) for outpatient visits at a large cardiovascular center.METHODS: We used electronic health record data from March 2020 to February 2021 from four cardiology subspecialties (general cardiology, electrophysiology, heart failure, and interventional cardiology) at a large academic health system in Northern California. There were 21,912 new and return visits with 69% delivered by telemedicine. We used hierarchical logistic regression and cross-validation methods to estimate the variation in visit modality explained by patient, clinician, and visit factors as measured by the mean area under the curve.RESULTS: Across all subspecialties, the clinician seen was the strongest predictor of telemedicine usage, while primary visit diagnosis was the next most predictive. In general cardiology, the model based on clinician seen had a mean area under the curve of 0.83, the model based on the primary diagnosis had a mean area under the curve of 0.69, and the model based on all patient characteristics combined had a mean area under the curve of 0.56. There was significant variation in telemedicine use across clinicians within each subspecialty, even for visits with the same primary visit diagnosis.CONCLUSION: Individual clinician practice patterns had the largest influence on visit modality across subspecialties in a large cardiovascular medicine practice, while primary diagnosis was less predictive, and patient characteristics even less so. Cardiovascular clinics should reduce variability in visit modality selection through standardized processes that integrate clinical factors and patient preference.
View details for DOI 10.1177/1357633X221130288
View details for PubMedID 36214200
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Association between remnant lipoprotein cholesterol, high-sensitivity C-reactive protein, and risk of atherosclerotic cardiovascular disease events in the Multi-Ethnic Study of Atherosclerosis (MESA).
Journal of clinical lipidology
Chevli, P. A., Islam, T., Pokharel, Y., Rodriguez, F., Virani, S. S., Blaha, M. J., Bertoni, A. G., Budoff, M., Otvos, J. D., Shapiro, M. D.
2022
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Abstract
BACKGROUND: Elevated remnant-lipoprotein (RLP)-cholesterol (RLP-C) and high-sensitivity C-reactive protein (hsCRP) are each individually associated with atherosclerotic cardiovascular disease (ASCVD).OBJECTIVE: To evaluate the interplay of nuclear magnetic resonance (NMR)-derived RLP-C and hsCRP and their association with ASCVD in the Multi-Ethnic Study of Atherosclerosis (MESA).METHODS: Lipoprotein particles were measured using NMR spectroscopic analysis at baseline. RLP-C includes very-low-density lipoprotein cholesterol and intermediate-density lipoprotein cholesterol. Four groups were created as follows: Group 1: RLP-C ≤ median (≤29.14 mg/dL) and hsCRP < 2 mg/L; Group 2: RLP-C ≤ median and hsCRP≥ 2 mg/L; Group 3: RLP-C > median and hsCRP level < 2 mg/L; and Group 4: RLP-C > median and hsCRP level ≥ 2 mg/L. Kaplan-Meier survival curves and multivariable-adjusted Cox proportional hazard models were used to examine the relationship between RLP-C and hsCRP with incident ASCVD.RESULTS: A total of 6,720 MESA participants (mean age 62.2 y, 53% female) with a median follow-up of 15.6 years were included. In the fully adjusted model, compared to those in the reference group (Group 1), participants in Group 2, Group 3, and Group 4 demonstrated a 20% (95% CI, -2%-48%), 18% (-4%-44%), and 43% (18%-76%) increased risk of incident ASCVD events, respectively (p<0.01). An additive and multiplicative interaction between RLP-C and hsCRP was not statistically significant.CONCLUSION: NMR-derived RLP-C and hsCRP showed a similar independent association with incident ASCVD. Notably, the combination of increased RLP-C and hsCRP was associated with an increased risk of future ASCVD events.
View details for DOI 10.1016/j.jacl.2022.09.005
View details for PubMedID 36180367
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Association between Obesity and Length of COVID-19 Hospitalization: Unexpected Insights from the American Heart Association National COVID-19 Registry.
Journal of obesity & metabolic syndrome
Collins, W. J., Chang, A. Y., Weng, Y., Dahlen, A., O'Brien, C. G., Hom, J., Ahuja, N., Rodriguez, F., Rohatgi, N.
2022
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Abstract
Background: Observational analyses have noted an association between obesity and poor clinical outcome from Coronavirus Disease 2019 (COVID-19). The mechanism for this finding remains unclear.Methods: We analyzed data from 22,915 COVID-19 patients hospitalized in non-intensive care units using the American Heart Association National COVID Registry of adult COVID-19 admissions from March 2020 to April 2021. A multivariable Poisson model adjusted for age, sex, medical history, admission respiratory status, hospitalization characteristics, and select laboratory findings was used to calculate length of stay (LOS) as a function of body mass index (BMI) category. Additionally, 5,327 patients admitted to intensive care units were similarly analyzed for comparison.Results: Relative to normal BMI subjects, overweight, class I obese, and class II obese patients had approximately half-day reductions in LOS (-0.469 days, P<0.01; -0.480 days, P<0.01; -0.578 days, P<0.01, respectively).Conclusion: The model identified a dose-dependent, inverse relationship between BMI category and LOS for COVID-19, which was not seen when the model was applied to critically ill patients.
View details for DOI 10.7570/jomes22042
View details for PubMedID 36058896
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LDL-C target attainment in secondary prevention of ASCVD in the United States: barriers, consequences of nonachievement, and strategies to reach goals.
Postgraduate medicine
Underberg, J., Toth, P. P., Rodriguez, F.
2022
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Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States. Elevated low-density lipoprotein cholesterol (LDL-C) is a major causal risk factor for ASCVD. Current evidence overwhelmingly demonstrates that lowering LDL-C reduces the risk of secondary cardiovascular events in patients with previous myocardial infarction or stroke. There is no lower limit for LDL-C: large, randomized studies and meta-analyses have found continuous benefit and no safety concerns in patients achieving LDL-C levels <25 mg/dL. As 'Time is plaque' in patients with ASCVD, early, sustained reductions in LDL-C are critical to slow or halt disease progression. However, despite use of lipid-lowering medications, <30% of patients with ASCVD achieve guideline-recommended reductions in LDL-C, resulting in a substantial societal burden of preventable cardiovascular events and early mortality. LDL-C goals are not met due to several factors: lipid-lowering therapy is not initiated and intensified as directed by clinical guidelines (clinical inertia); most patients do not adhere to prescribed medications; and high-risk patients are frequently denied access to add-on therapies by their insurance providers. Promoting patient and clinician education, multidisciplinary collaboration, and other interventions may help to overcome these barriers. Ultimately, achieving population-level guideline-recommended reductions in LDL-C will require a collaborative effort from patients, clinicians, relevant professional societies, drug manufacturers, and payers.
View details for DOI 10.1080/00325481.2022.2117498
View details for PubMedID 36004573
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Publications
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Good Friends and Good Neighbors: Social Capital and Food Insecurity in Families with Newborns.
The Journal of pediatrics
Lambert, J. O., Lutz, M. R., Orr, C. J., Schildcrout, J. S., Bian, A., Flower, K. B., Yin, H. S., Sanders, L. M., Heerman, W. J., Rothman, R. L., Delamater, A. M., Wood, C. T., White, M. J., Perrin, E. M.
2024: 114355
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To examine the association between social capital and household food insecurity among US families with newborns.This cross-sectional analysis used enrollment data from 881 newborn-caregiver dyads at six geographically-diverse US academic sites enrolled in the Greenlight Plus Trial, a comparative effectiveness trial to prevent childhood obesity. Ordinal proportional-odds models were used to characterize the associations of two self-reported measures of social capital: 1) caregiver social support and 2) neighborhood social cohesion, with household food insecurity after controlling for sociodemographic characteristics.Among 881 newborn-caregiver dyads (49% Hispanic, 23% non-Hispanic white, 17% non-Hispanic Black; 49% with annual household income <
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Improving Hospital-to-Home for Medically Complex Children: Views From Spanish-Speaking Caregivers.
Hospital pediatrics
Squires, S. S., Hoang, K., Grajales, L., Halpern-Felsher, B., Sanders, L.
2024
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Abstract
Children with medical complexity (CMC) experience increased risk of adverse events during and after hospitalization, and these risks are even greater for CMC whose caregiver has a preferred language other than English. Because many adverse events for CMC may be attributable to communication challenges, understanding caregiver and physician perspectives may help prevent adverse events.We conducted semistructured interviews with Spanish-speaking caregivers of hospitalized CMC and their inpatient attending physicians. Each interview was conducted 24 to 72 hours after hospital discharge. Interviews continued until thematic sufficiency was reached. Interviews were audio recorded, transcribed, and translated verbatim. Investigators independently coded and reconciled codes using constant comparison to develop themes via inductive thematic analysis.We conducted 28 interviews (14 caregivers, 14 physicians). Three themes were identified: (1) barriers exist in providing language-concordant care in planning for transitions from hospital-to-home; (2) both physicians and caregivers perceived logistical challenges in using interpreters at the point of care; and (3) many caregivers felt uncomfortable asking physicians questions related to their child's medical management because of their language barrier. Participants also offered strategies to improve the transition from hospital to home: (1) empower families to ask questions and take notes, (2) consider the use of medical educators, and (3) improve the ability of hospital-based physicians to follow up with patients after discharge.Physicians strive for language-concordant care at each stage of discharge planning. However, unresolved gaps such as the lack of interpreter availability during medical-device education, require attention to promote safe transitions from hospital to home.
View details for DOI 10.1542/hpeds.2024-007925
View details for PubMedID 39410907
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Infant Feeding Outcomes from a Culturally-Adapted Early Obesity Prevention Program for Immigrant Chinese American Parents.
Academic pediatrics
Duh-Leong, C., Au, L., Chang, L. Y., Feldman, N. M., Pierce, K. A., Mendelsohn, A. L., Perrin, E. M., Sanders, L. M., Velazquez, J. J., Lei, Y., Xing, S. X., Shonna Yin, H.
2024
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Abstract
To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices.Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N=298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences.At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% CI: 1.65, 19.63], p=0.006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], p<0.001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], p=0.03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], p= 0.003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption.A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low-income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices like breastfeeding and evaluate long-term weight outcomes.
View details for DOI 10.1016/j.acap.2024.06.005
View details for PubMedID 38880393
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Initial validation of the Health Environment Rating Scale-Early Childhood Consultation-Classroom (HERS-ECC-C).
Infant mental health journal
Futterer, J., Mullins, C., Bulotsky-Shearer, R. J., Guzman, E., Hildago, T., Kolomeyer, E., Howe, E., Horen, N., Sanders, L. M., Natale, R.
2024
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Abstract
The present study validated a newly developed easy-to-use observational instrument, the Health Environment Rating Scale-Early Childhood Consultation-Classroom version (HERS-ECC-C), to measure the quality of the classroom environment within early care and education centers participating in a mental health consultation program in a diverse area of the southeastern United States.Using a confirmatory factor analysis, three factors emerged capturing critical aspects of a high-quality classroom environment and demonstrated good reliability: (1) Supportive Practices, Positive Socioemotional Practices, and Classroom Management (alpha=.88), (2) Health and Family Communication (alpha=.79), and (3) Individualizing to Children's Needs (alpha=.80). Criterion-related validity was established through concurrent associations between the three HERS-ECC-C subscales and the domains of the Classroom Assessment Scoring System (CLASS) and predictive associations with the Childcare Worker Job Stress Inventory. The HERS-ECC-C Supportive Practices and Health and Family Communication subscales were associated with all three CLASS domains, and the Individualizing to Children's Needs subscale was associated with the CLASS Instructional support domain. Higher HERS-ECC-C subscale scores were associated with lower teacher-reported job stress. Findings provide initial evidence to support the use and continued development of the HERS-ECC-C as a tool to evaluate programs and classrooms engaged in mental health consultation professional development interventions.
View details for DOI 10.1002/imhj.22116
View details for PubMedID 38780350
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The Effect of an Obesity Prevention Intervention Among Specific Subpopulations: A Heterogeneity of Treatment Effect Analysis of the Greenlight Trial.
Childhood obesity (Print)
Heerman, W. J., Yin, H. S., Schildcrout, J. S., Bian, A., Rothman, R. L., Flower, K. B., Delamater, A. M., Sanders, L., Wood, C., Perrin, E. M.
2024
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Abstract
Background: Understanding how different populations respond to a childhood obesity intervention could help optimize personalized treatment strategies, especially with the goal to reduce disparities in obesity. Methods: We conducted a secondary analysis of the Greenlight Cluster Randomized Controlled Trial, a health communication focused pediatric obesity prevention trial, to evaluate for heterogeneity of treatment effect (HTE) by child biological sex, caregiver BMI, caregiver reported race and ethnicity, primary language, and health literacy. To examine HTE on BMI z-score from 2 to 24 months of age, we fit linear mixed effects models. Results: We analyzed 802 caregiver-child pairs, of which 52% of children were female, 58% of households reported annual family income of <
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Assessing health behavior change and comparing remote, hybrid and in-person implementation of a school-based health promotion and coaching program for adolescents from low-income communities.
Health education research
Gefter, L., Morioka-Douglas, N., Srivastava, A., Jiang, C. A., Lewis, M., Sanders, L., Rodriguez, E.
2024
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Abstract
To assess the impact of a school-based health intervention on adolescents' health knowledge, psychosocial assets and health behaviors, including comparisons of implementation mode: remote, hybrid or in-person. The Stanford Youth Diabetes Coaches Program, an 8-week, school-based health promotion and coaching skills program, was offered to adolescents (ages 14-18 years) from four low-income US communities. Mode of program implementation was remote, hybrid or in-person. Participants completed online pre- and postsurveys. Analysis included paired t-tests, linear regression and qualitative coding. From Fall 2020 to Fall 2021, 262 adolescents enrolled and 179 finished the program and completed pre- and postsurveys. Of the 179, 80% were female, with a mean age of 15.9 years; 22% were Asian; 8% were Black or African American; 25% were White; and 40% were Hispanic. About 115 participants were remote, 25 were hybrid and 39 were in-person. Across all participants, significant improvements (P < 0.01) were reported in health knowledge, psychosocial assets (self-esteem, self-efficacy and problem-solving) and health behaviors (physical activity, nutrition and stress reduction). After adjusting for sex and age, these improvements were roughly equivalent across the three modes of delivery. Participation was associated with significant improvements in adolescent health behaviors. Furthermore, remote mode of instruction was just as effective as in-person and hybrid modes.
View details for DOI 10.1093/her/cyae015
View details for PubMedID 38687641
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The Injury Prevention Program to Reduce Early Childhood Injuries: A Cluster Randomized Trial.
Pediatrics
Perrin, E. M., Skinner, A. C., Sanders, L. M., Rothman, R. L., Schildcrout, J. S., Bian, A., Barkin, S. L., Coyne-Beasley, T., Delamater, A. M., Flower, K. B., Heerman, W. J., Steiner, M. J., Yin, H. S.
2024
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Abstract
The American Academy of Pediatrics designed The Injury Prevention Program (TIPP) in 1983 to help pediatricians prevent unintentional injuries, but TIPP's effectiveness has never been formally evaluated. We sought to evaluate the impact of TIPP on reported injuries in the first 2 years of life.We conducted a stratified, cluster-randomized trial at 4 academic medical centers: 2 centers trained their pediatric residents and implemented TIPP screening and counseling materials at all well-child checks (WCCs) for ages 2 to 24 months, and 2 centers implemented obesity prevention. At each WCC, parents reported the number of child injuries since the previous WCC. Proportional odds logistic regression analyses with generalized estimating equation examined the extent to which the number of injuries reported were reduced at TIPP intervention sites compared with control sites, adjusting for baseline child, parent, and household factors.A total of 781 parent-infant dyads (349 TIPP; 432 control) were enrolled and had sufficient data to qualify for analyses: 51% Hispanic, 28% non-Hispanic Black, and 87% insured by Medicaid. Those at TIPP sites had significant reduction in the adjusted odds of reported injuries compared with non-TIPP sites throughout the follow-up (P = .005), with adjusted odds ratios (95% CI) of 0.77 (0.66-0.91), 0.60 (0.44-0.82), 0.32 (0.16-0.62), 0.26 (0.12-0.53), and 0.27 (0.14-0.52) at 4, 6, 12, 18, and 24 months, respectively.In this cluster-randomized trial with predominantly low-income, Hispanic, and non-Hispanic Black families, TIPP resulted in a significant reduction in parent-reported injuries. Our study provides evidence for implementing the American Academy of Pediatrics' TIPP in routine well-child care.
View details for DOI 10.1542/peds.2023-062966
View details for PubMedID 38557871
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Readmission after NICU Discharge: The Importance of Social Drivers of Health.
The Journal of pediatrics
Feister, J., Kan, P., Lee, H. C., Sanders, L.
2024: 114014
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Abstract
To determine associations between sociodemographic and medical factors and odds of readmission after discharge from the neonatal intensive care unit (NICU) for infants with very low birth weight (VLBW, <1500g).Cohort study using linked data from the California Perinatal Quality Care Collaborative, California Vital Statistics, and the Child Opportunity Index 2.0 (COI). Infants with VLBW born from 2009 through 2018 in California were considered. Odds ratios of readmission within 30 days of discharge adjusting for infant medical factors, maternal sociodemographic factors, and birth hospital were calculated via multivariable logistic regression and fixed effect logistic regression models.42,411 infants met inclusion criteria. 8.5% of all infants were readmitted within 30 days of discharge. In addition to traditional medical risk factors, two sociodemographic factors were significantly associated with increased odds of readmission in adjusted models: payor other than private insurance for delivery [aOR =1.25 (95% CI 1.14-1.36)] and maternal education of less than high school degree [aOR = 1.19 (95% CI 1.06-1.33)]. Neighborhood COI was not associated with odds of readmission.Sociodemographic factors, including lack of private insurance and lower maternal educational attainment, are significantly and independently associated with increased odds of readmission after NICU discharge, in addition to traditional medical risk factors. Socioeconomic deprivation and health literacy may contribute to risk of readmission. Targeted discharge interventions focused on addressing social drivers of health warrant exploration.
View details for DOI 10.1016/j.jpeds.2024.114014
View details for PubMedID 38494087
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Language Disparities in Caregiver Satisfaction with Physician Communication At Well Visits From 0-2 Years.
Academic pediatrics
Gutierrez-Wu, J. C., Ritter, V., McMahon, E. L., Heerman, W. J., Rothman, R. L., Perrin, E. M., Shonna Yin, H., Sanders, L. M., Delamater, A. M., Flower, K. B.
2024
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Abstract
This study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity.Longitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity.Of 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)].Caregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.Caregiver satisfaction with physician communication improves during the first two years of well-child visits and varies by language and with interpreter use and physician continuity.
View details for DOI 10.1016/j.acap.2024.03.004
View details for PubMedID 38458488
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Evidence for changes in screen use in the US during early childhood related to COVID-19 pandemic parent stressors.
JMIR pediatrics and parenting
Glassman, J., Humphreys, K. L., Jauregui, A., Milstein, A., Sanders, L.
2024
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Abstract
BACKGROUND: The COVID-19 pandemic transformed the home lives of many families in the US, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development.OBJECTIVE: To assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare/school closures.METHODS: Design, Setting, and Participants: In spring of 2021 we administered a survey, similar to one administered in spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were >18 years of age, proficient in English or Spanish, and residing in the US. Main Outcomes and Measures: The main outcomes were changes in child screen time (e.g., mobile phone, tablet, computer, television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, daycare/school access, and family health and socioeconomic status.RESULTS: We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1 hour, SD 0.9), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46 (SD 1.03); mean parenting technoference score 3.89 (SD 2.05)), second highest for working parents who did not lose their job (mean change in child screen time=1.02 (SD 0.83); mean parenting technoference score 3.37 (SD 1.94), and lowest for non-working parents (mean change in child screen time 0.68 (SD 0.66); mean parenting technoference score 2.66 (SD 1.70)), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01).CONCLUSIONS: Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use in the home and social factors that are necessary to support early child health and development. It also supports possible enhanced recommendations for primary-care providers and child-care educators to guide parents in establishing home-based "screen time rules" not only for their children but also for themselves.CLINICALTRIAL:
View details for DOI 10.2196/43315
View details for PubMedID 38446995
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Incidence of mental health conditions following pediatric hospital admissions: analysis of a national database.
Frontiers in pediatrics
Daughtrey, H. R., Ruiz, M. O., Felix, N., Saynina, O., Sanders, L. M., Anand, K. J.
2024; 12: 1344870
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Abstract
Introduction: Despite increasing survival of children following hospitalization, hospitalization may increase iatrogenic risk for mental health (MH) disorders, including acute stress, post-traumatic stress, anxiety, or depression. Using a population-based retrospective cohort study, we assessed the rates of new MH diagnoses during the 12 months after hospitalization, including the moderating effects of ICU exposure.Study design/methods: This was a retrospective case control study using the Truven Health Analytics insurance database. Inclusion criteria included children aged 3-21 years, insurance enrollment for >12 months before and after hospital admission. We excluded children with hospitalization 2 years prior to index hospitalization and those with prior MH diagnoses. We extracted admission type, ICD-10 codes, demographic, clinical, and service coordination variables from the database. We established age- and sex-matched cohorts of non-hospitalized children. The primary outcome was a new MH diagnosis. Multivariable regression methods examined the risk of incident MH disorder(s) between hospitalized and non-hospitalized children. Among hospitalized children, we further assessed effect modification from ICU (vs. non-ICU) stay, admission year, length of stay, medical complexity, and geographic region.Results: New MH diagnoses occurred among 19,418 (7%) hospitalized children, 3,336 (8%) ICU-hospitalized children and 28,209 (5%) matched healthy controls. The most common MH diagnoses were anxiety (2.5%), depression (1.9%), and stress/trauma (2.2%) disorders. Hospitalization increased the odds of new MH diagnoses by 12.3% (OR: 1.123, 95% CI: 1.079-1.17) and ICU-hospitalization increased these odds by 63% (OR: 1.63, 95% CI: 1.483-1.79) as compared to matched, non-hospitalized children. Children with non-complex chronic diseases (OR: 2.91, 95% CI: 2.84-2.977) and complex chronic diseases (OR: 5.16, 95% CI: 5.032-5.289) had a substantially higher risk for new MH diagnoses after hospitalization compared to patients with acute illnesses.Conclusion: Pediatric hospitalization is associated with higher, long-term risk of new mental health diagnoses, and ICU hospitalization further increases that risk within 12 months of the acute episode. Acute care hospitalization confers iatrogenic risks that warrant long-term mental and behavioral health follow-up.
View details for DOI 10.3389/fped.2024.1344870
View details for PubMedID 38450296
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Advancing early relational health: a collaborative exploration of a research agenda.
Frontiers in pediatrics
Dumitriu, D., Lavallée, A., Riggs, J. L., Frosch, C. A., Barker, T. V., Best, D. L., Blasingame, B., Bushar, J., Charlot-Swilley, D., Erickson, E., Finkel, M. A., Fortune, B., Gillen, L., Martinez, M., Ramachandran, U., Sanders, L. M., Willis, D. W., Shearman, N.
2023; 11: 1259022
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Abstract
Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection-a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.
View details for DOI 10.3389/fped.2023.1259022
View details for PubMedID 38143537
View details for PubMedCentralID PMC10748603
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"WHO KNOWS WHAT IS THE TRUTH AND WHAT ISN'T?": EXPLORING YOUNG ADULTS' EXPERIENCES WITH ABORTION MISINFORMATION
John, J. N., Sanders, L. M., Blumenthal, P. D.
ELSEVIER SCIENCE INC. 2023: 20
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View details for DOI 10.1016/j.contraception.2023.110204
View details for Web of Science ID 001114085100059
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TV Time, Especially During Meals, is Associated with Less Healthy Dietary Practices in Toddlers.
Academic pediatrics
Lutz, M. R., Orr, C. J., Shonna Yin, H., Heerman, W. J., Flower, K. B., Sanders, L. M., Rothman, R. L., Schildcrout, J. S., Bian, A., Kay, M. C., Wood, C. T., Delamater, A. M., Perrin, E. M.
2023
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BACKGROUND: While several studies examine the relationship between screen time and dietary practices in children and teenagers, there is limited research in toddlers. This study evaluates the association between television (TV) exposure and dietary practices in two-year-old children.METHODS: We conducted a cross-sectional, secondary data analysis from the Greenlight Intervention Study. Toddlers' daily TV watching time, mealtime TV, and dietary practices were assessed by caregiver report at the 24-month well child visit. Separate regression models were used and adjusted for sociodemographic/household characteristics and clinic site.RESULTS: 532 toddlers were included (51% Latino; 30% non-Latino Black; 59% ≤
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Stress Symptoms Among Children and Their Parents After ICU Hospitalization.
Journal of intensive care medicine
Daughtrey, H. R., Lee, J., Boothroyd, D. B., Burnside, G. M., Shaw, R. J., Anand, K. J., Sanders, L. M.
2023: 8850666231201836
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Abstract
Objective: Child survival after intensive care unit (ICU) hospitalization has increased, yet many children experience acute stress that may precipitate mental/behavioral health comorbidities. Parents report stress after their child's hospitalization. Little is known about the individual and family characteristics that may moderate intergenerational relationships of acute stress. Design: Following ICU admission at a large academic medical center, a prospective cross-sectional cohort study assessed the associations between intergenerational characteristics and acute stress among children and families. Patients: Parent-child dyads (N = 88) were recruited from the pediatric ICU and pediatric cardiovascular ICU (CVICU) following ICU discharge. Eligible children were between 8 and 18 years old with ICU stays longer than 24 hours. Children with developmental delays were excluded. Caregivers were proficient in English or Spanish. Surveys were collected before hospital discharge. Measurements/Main Results: The primary outcome was "child stress" defined as a score≥17, measured by the Children's Revised Impact of Events Scale (CRIES-8). "Parent stress" was defined as an elevated composite score on the Stanford Acute Stress Reaction Questionnaire. We used validated scales to assess the child's clinical and family social characteristics. Acute stress was identified in 34 (39.8%) children and 50 (56.8%) parents. In multivariate linear regression analyses adjusting for social characteristics, parent stress was associated with increased risk of child stress (adjusted odds ratio 2.58, 95% confidence interval 0.69, 4.46, p < .01). In unadjusted analyses, Hispanic ethnicity was associated with greater child stress. In adjusted analyses, race, income, ICU length of stay, and language were not associated with child stress and did not moderate the parent-child stress relationship. Conclusions: Parent stress is closely correlated with child stress during ICU hospitalization. Hispanic ethnicity may be associated with increased risk for child stress, but further studies are required to define the roles of other social and clinical measures.
View details for DOI 10.1177/08850666231201836
View details for PubMedID 37743757
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Educational achievement to age 11 years in children born at late preterm and early term gestations.
Archives of disease in childhood
Copper, C., Waterman, A., Nicoletti, C., Pettinger, K., Sanders, L., Hill, L. J., Clare Copper
2023
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OBJECTIVE: To investigate the effects of being born late preterm (LPT, 34-36 weeks' gestation) or early term (37-38 weeks) on children's educational achievement between ages 5 and 11 years.DESIGN: A series of observational studies of longitudinal linked health and education data.SETTING: The Born-in-Bradford (BiB) birth cohort study, which recruited mothers during pregnancy between 2007 and 2011.PARTICIPANTS: The participants are children born between 2007 and 2011. Children with missing data, looked-after-children, multiple births and births post-term were excluded. The sample size varies by age according to amount of missing data, from 7860 children at age 5 years to 2386 at age 11 years (8031 at age 6 years and 5560 at age 7 years).MAIN OUTCOME MEASURES: Binary variables of whether a child reached the 'expected' level of overall educational achievement across subjects at the ages of 5, 6, 7 and 11 years. The achievement levels are measured using standardised teacher assessments and national tests.RESULTS: Compared with full-term births (39-41 weeks), there were significantly increased adjusted odds of children born LPT, but not early term, of failing to achieve expected levels of overall educational achievement at ages 5 years (adjusted OR (aOR) 1.72,95% CI 1.34 to 2.21) and 7 years (aOR 1.46, 95% CI 1.08 to 1.97) but not at age 11 years (aOR 1.51, 95%CI 0.99 to 2.30). Being born LPT still had statistically significant effects on writing and mathematics at age 11 years.CONCLUSIONS: There is a strong association between LPT and education at age 5 years, which remains strong and statistically significant through age 11 years for mathematics but not for other key subjects.
View details for DOI 10.1136/archdischild-2023-325453
View details for PubMedID 37722763
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Prenatal Risks to Healthy Food Access and High Birthweight Outcomes.
Academic pediatrics
Duh-Leong, C., Perrin, E. M., Heerman, W., Schildcrout, J., Wallace, S., Mendelsohn, A., Lee, D. C., Flower, K., Sanders, L. M., Rothman, R. L., Delamater, A., Gross, R. S., Wood, C., Shonna Yin, H.
2023
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Abstract
Infants with high birthweight have increased risk for adverse outcomes at birth and across childhood. Prenatal risks to healthy food access may increase odds of high birthweight. We tested whether having a poor neighborhood food environment and/or food insecurity had associations with high birthweight.We analyzed cross-sectional baseline data in Greenlight Plus, an obesity prevention trial across 6 US cities (n=787), which included newborns with a gestational age greater than 34 weeks and a birthweight greater than 2500 grams. We assessed neighborhood food environment using the Place-Based Survey and food insecurity using the US Household Food Security Module. We performed logistic regression analyses to assess the individual and additive effects of risk factors on high birthweight. We adjusted for potential confounders: infant sex, race, ethnicity, gestational age, birthing parent age, education, income, and study site.Thirty-four percent of birthing parents reported poor neighborhood food environment and/or food insecurity. Compared to those without food insecurity, food insecure families had greater odds of delivering an infant with high birthweight (aOR 1.96, 95% CI: 1.01, 3.82) after adjusting for poor neighborhood food environment, which was not associated with high birthweight (aOR 1.35, 95% CI: 0.78, 2.34). Each additional risk to healthy food access was associated with a 56% (95% CI: 4%-132%) increase in high birthweight odds.Prenatal risks to healthy food access may increase high infant birthweight odds. Future studies designed to measure neighborhood factors should examine infant birthweight outcomes in the context of prenatal social determinants of health.
View details for DOI 10.1016/j.acap.2023.08.017
View details for PubMedID 37659601
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Early sweet tooth: Juice introduction during early infancy is related to toddler juice intake.
Academic pediatrics
Kay, M. C., Pankiewicz, A. R., Schildcrout, J. S., Wallace, S., Wood, C. T., Shonna Yin, H., Rothman, R. L., Sanders, L. M., Orr, C., Delamater, A. M., Flower, K. B., Perrin, E. M.
2023
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Abstract
To assess if 100% fruit juice intake prior to 6 months is associated with juice and sugar-sweetened beverage (SSB) intake at 24 months and whether this differs by sociodemographic factors.We used longitudinal data from infants enrolled in the control (no obesity intervention) arm of Greenlight, a cluster randomized trial to prevent childhood obesity which included parent-reported child 100% fruit juice intake at all well child checks between two and 24 months. We studied the relationship between the age of juice introduction (before versus after six months) and juice and SSB intake at 24 months using negative binomial regression while controlling for baseline sociodemographic factors.We report results for 187 participants (43% Hispanic, 39% non-Hispanic Black), more than half (54%) of whom had reported 100% fruit juice intake before six months. Average 100% fruit juice intake at 24 months was greater than the recommended amount (of 4 oz) and was 8.2 oz and 5.3 oz for those who had and had not, respectively, been introduced to juice before six months. In adjusted models, early introduction of juice was associated with a 43% (95% CI: 5% to 96%) increase in juice intake at 24 months.100% fruit juice intake exceeding recommended levels at six and 24 months in this diverse cohort was prevalent. Introducing 100% fruit juice prior to six months may put children at greater risk for more juice intake as they age. Further research is necessary to determine if early guidance can reduce juice intake.
View details for DOI 10.1016/j.acap.2023.04.009
View details for PubMedID 37150479
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Feeding, television, and sleep behaviors at one year of age in a diverse sample.
Obesity Pillars (Online)
Gorecki, M. C., Perrin, E. M., Orr, C. J., White, M. J., Yin, H. S., Sanders, L. M., Rothman, R. L., Delamater, A. M., Truong, T., Green, C. L., Flower, K. B.
2023; 5: 100051
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Background: Healthy lifestyle behaviors that can prevent adverse health outcomes, including obesity, are formed in early childhood. This study describes feeding, television, and sleep behaviors among one-year-old infants and examines differences by sociodemographic factors.Methods: Caregivers of one-year-olds presenting for well care at two clinics, control sites for the Greenlight Study, were queried about feeding, television time, and sleep. Adjusted associations between sociodemographic factors and behaviors were performed by modified Poisson (binary), multinomial logistic (multi-category), or linear (continuous) regression models.Results: Of 235 one-year-olds enrolled, 81% had Medicaid, and 45% were Hispanic, 36% non-Hispanic Black, 19% non-Hispanic White. Common behaviors included 20% exclusive bottle use, 32% put to bed with bottle, mean daily juice intake of 4.1±4.6 ounces, and active television time 45±73min. In adjusted analyses compared to Hispanic caregivers, non-Hispanic Black caregivers were less likely to report exclusive bottle use (odds ratio: 0.11, 95% confidence interval [CI] 0.03-0.39), reported 2.4 ounces more juice (95% CI 1.0-3.9), 124min more passive television time (95% CI 60-188), and 37min more active television time (95% CI 10-64). Increased caregiver education and higher income were associated with 0.4 (95% CI 0.13-0.66) and 0.3 (95% CI 0.06-0.55) more servings of fruits and vegetables per day, respectively.Conclusion: In a diverse sample of one-year-olds, caregivers reported few protective behaviors that reduce the risk for adverse health outcomes including obesity. Differences in behavior by race/ethnicity, income, and education can inform future interventions and policies. Future interventions should strive to create culturally effective messaging to address common adverse health behaviors.
View details for DOI 10.1016/j.obpill.2022.100051
View details for PubMedID 37990745
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Parental Perspectives on the Impact of the COVID-19 Pandemic on Infant, Child, and Adolescent Development.
Journal of developmental and behavioral pediatrics : JDBP
Raffa, B. J., Heerman, W. J., Lampkin, J., Perrin, E. M., Flower, K. B., Delamater, A. M., Yin, H. S., Rothman, R. L., Sanders, L., Schilling, S.
2023
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OBJECTIVE: The purpose of this study is to understand how families from diverse sociodemographic backgrounds perceived the impact of the pandemic on the development of their children.METHODS: We used a multimethod approach guided by Bronfenbrenner's Ecological Systems Theory, which identifies 5 developmental systems (micro, meso, exo, macro, and chrono). Semistructured interviews were conducted in English or Spanish with parents living in 5 geographic regions of the United States between July and September 2021. Participants also completed the COVID-19 Exposure and Family Impact Survey.RESULTS: Forty-eight families participated, half of whose preferred language was Spanish, with a total of 99 children ages newborn to 19 years. Most qualitative themes pertained to developmental effects of the microsystem and macrosystem. Although many families described negative effects of the pandemic on development, others described positive or no perceived effects. Some families reported inadequate government support in response to the pandemic as causes of stress and potential negative influences on child development. As context for their infant's development, families reported a variety of economic hardships on the COVID-19 Exposure and Family Impact Survey, such as having to move out of their homes and experiencing decreased income.CONCLUSION: In addition to negative impacts, many parents perceived positive pandemic-attributed effects on their child's development, mainly from increased time for parent-child interaction. Families described economic hardships that were exacerbated by the pandemic and that potentially affect child development and insufficient government responses to these hardships. These findings hold important lessons for leaders who wish to design innovative solutions that address inequities in maternal, family, and child health.
View details for DOI 10.1097/DBP.0000000000001166
View details for PubMedID 36716765
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Obesity and Overweight Among Children With Medical Complexity.
Pediatrics
Peinado Fabregat, M. I., Saynina, O., Sanders, L. M.
2022
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OBJECTIVES: To assess the prevalence of overweight or obesity among children with medical complexity (CMC), compared with children without medical complexity, and explore potentially modifiable mechanisms.METHODS: This study involved a retrospective cohort of 41905 children ages 2 to 18 seen in 2019 at a single academic medical center. The primary outcome was overweight or obesity, defined as a body mass index of ≥85% for age and sex. CMC was defined as ≥1 serious chronic condition in ≥1 system. Obesogenic conditions and medications were defined as those typically associated with excess weight gain. Multivariable logistic regression was used to adjust for common confounders.RESULTS: Of the children in the cohort, 29.5% were CMC. Overweight or obesity prevalence was higher among CMC than non-CMC (31.9% vs 18.4%, P ≤.001, adjusted odds ratio [aOR] 1.27, 95% confidence interval [CI] 1.20-1.35). Among CMC, the risk for overweight or obesity was higher among children with metabolic conditions (aOR 2.09, 95% CI 1.88-2.32), gastrointestinal conditions (aOR 1.23 95% CI 1.06-1.41), malignancies (aOR 1.21 95% CI 1.07-1.38), and Spanish-speaking parents (aOR 1.47 95% CI 1.30-1.67). Among overweight or obese CMC, 91.6% had no obesogenic conditions, and only 8.5% had been seen by a registered dietitian in the previous year.CONCLUSIONS: CMC are significantly more likely to be overweight or obese when compared with children without medical complexity. Although many CMC cases of overweight appear to be preventable, further research is necessary to determine if and how to prevent comorbid obesity among CMC.
View details for DOI 10.1542/peds.2022-058687
View details for PubMedID 36572640
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Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared DecisionMaking Pathway
Wang, P. J., Lu, Y., Mahaffey, K. W., Lin, A., Morin, D. P., Sears, S. F., Chung, M. K., Russo, A. M., Lin, B., Piccini, J. P., Hills, M. T., Berube, C., Pundi, K., Baykaner, T., Garay, G., Lhamo, K., Rice, E., Shah, R., Newswanger, P., DeSutter, K., Nunes, J., Albert, M. A., Schulman, K., Heidenreich, P. A., Bunch, T. J., Sanders, L., Turakhia, M., Stafford, R. S.
LIPPINCOTT WILLIAMS & WILKINS. 2022: E582-E583
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View details for Web of Science ID 000928164500042
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Social Support and Breastfeeding Outcomes Among a Racially and Ethnically Diverse Population.
American journal of preventive medicine
Lyons, G. C., Kay, M. C., Duke, N. N., Bian, A., Schildcrout, J. S., Perrin, E. M., Rothman, R. L., Yin, H. S., Sanders, L. M., Flower, K. B., Delamater, A. M., Heerman, W. J.
2022
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INTRODUCTION: Social support is a modifiable social determinant of health that shapes breastfeeding outcomes and may contribute to racial and ethnic breastfeeding disparities. This study characterizes the relationship between social support and early breastfeeding.METHODS: This is a cross-sectional analysis of baseline data collected in 2019-2021 for an RCT. Social support was measured using the Enhancing Recovery in Coronary Heart Disease Social Support Instrument. Outcomes, collected by self-report, included (1) early breastfeeding within the first 21 days of life, (2) planned breastfeeding duration, and (3) confidence in meeting breastfeeding goals. Each outcome was modeled using proportional odds regression, adjusting for covariates. Analysis was conducted in 2021-2022.RESULTS: Self-reported race and ethnicity among 883 mothers were 50% Hispanic, 17% Black, 23% White, and 10% other. A large proportion (88%) of mothers were breastfeeding. Most breastfeeding mothers (82%) planned to breastfeed for at least 6 months, with more than half (58%) planning to continue for 12 months or more. Most women (65%) were confident or very confident in meeting their breastfeeding duration goal. In adjusted models, perceived social support was associated with planned breastfeeding duration (p=0.042) but not with early breastfeeding (p=0.873) or confidence in meeting breastfeeding goals (p=0.427). Among the covariates, maternal depressive symptoms were associated with lower breastfeeding confidence (p<0.001).CONCLUSIONS: The associations between perceived social support and breastfeeding outcomes are nuanced. In this sample of racially and ethnically diverse mothers, social support was associated with longer planned breastfeeding duration but not with early breastfeeding or breastfeeding confidence.
View details for DOI 10.1016/j.amepre.2022.10.002
View details for PubMedID 36460526
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A Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision-Making Pathway.
Journal of the American Heart Association
Wang, P. J., Lu, Y., Mahaffey, K. W., Lin, A., Morin, D. P., Sears, S. F., Chung, M. K., Russo, A. M., Lin, B., Piccini, J., Hills, M. T., Berube, C., Pundi, K., Baykaner, T., Garay, G., Lhamo, K., Rice, E., Pourshams, I. A., Shah, R., Newswanger, P., DeSutter, K., Nunes, J. C., Albert, M. A., Schulman, K. A., Heidenreich, P. A., Bunch, T. J., Sanders, L. M., Turakhia, M., Verghese, A., Stafford, R. S.
2022: e8009
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Background Oral anticoagulation (OAC) reduces stroke and disability in atrial fibrillation (AF) but is underutilized. We evaluated the effects of a novel patient-clinician shared decision-making (SDM) tool in reducing OAC patient's decisional conflict as compared to usual care. Methods and Results We designed and evaluated a new digital decision aid in a multicenter, randomized, comparative effectiveness trial, ENHANCE-AF (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention). The digital AF SDM Toolkit was developed using patient-centered design with clear health communication principles (e.g. meaningful images, limited text). Available in English and Spanish, the toolkit included the following: 1) a brief animated video; 2) interactive questions with answers; 3) a quiz to check on understanding; 4) a worksheet to be used by the patient during the encounter; and 5) an online guide for clinicians. The study population included English or Spanish speakers with non-valvular AF and a CHA2DS2-VASc stroke score ≥1 for men or ≥2 for women. Participants were randomized in a 1:1 ratio to either Usual Care (UC) or the SDM Toolkit. The primary endpoint was the validated 16-item Decisional Conflict Scale (DCS) at 1 month. Secondary outcomes included DCS at 6 months and the 10-item Decision Regret Scale (DRS) at 1 and 6 months as well as a weighted average of Mann-Whitney U-statistics for both DCS and DRS. A total of 1001 participants were enrolled and followed at 5 different sites in the United States between 12/18/19 and 8/17/22. The mean patient age was 69 ±10years (40% females, 16.9% Black, 4.5% Hispanic, 3.6% Asian), and 50% of participants had CHA2DS2-VASc scores ≥3 (M) or ≥4 (F). The primary endpoint at 1 month showed a clinically meaningful reduction in decisional conflict: a 7-point difference in median scores between the two arms (16.4 v 9.4; Mann-Whitney U-statistics=0.550; p-value=0.007). For the secondary endpoint of 1-month DRS, the difference in median scores between arms was 5 points in the direction of less decisional regret (p-value of 0.078). The treatment effects lessened over time: at 6 months the difference in medians was 4.7 points for DCS (p-value=0.060) and 0 points for DRS (p-value=0.35). Conclusions Implementation of a novel, Shared Decision-Making Toolkit (afibguide.com; afibguide.com/clinician) achieved significantly lower decisional conflict compared to usual care in patients with AF.
View details for DOI 10.1161/JAHA.122.028562
View details for PubMedID 36342828
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The greenlight plus trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity.
Contemporary clinical trials
Heerman, W. J., Perrin, E. M., Yin, H. S., Schildcrout, J. S., Delamater, A. M., Flower, K. B., Sanders, L., Wood, C., Kay, M. C., Adams, L. E., Rothman, R. L.
2022: 106987
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The first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years.This study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months.By delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.
View details for DOI 10.1016/j.cct.2022.106987
View details for PubMedID 36323344
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Children in Immigrant Families Deserve Health Care.
Pediatrics
Mendoza, F. S., Sanders, L., Laitin, D. D.
2022
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View details for DOI 10.1542/peds.2022-057672
View details for PubMedID 36004547
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Barriers and Facilitators to the Implementation of Family-Centered Technology in Complex Care: Feasibility Study.
Journal of medical Internet research
Lin, J. L., Huber, B., Amir, O., Gehrmann, S., Ramirez, K. S., Ochoa, K. M., Asch, S. M., Gajos, K. Z., Grosz, B. J., Sanders, L. M.
2022; 24 (8): e30902
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BACKGROUND: Care coordination is challenging but crucial for children with medical complexity (CMC). Technology-based solutions are increasingly prevalent but little is known about how to successfully deploy them in the care of CMC.OBJECTIVE: The aim of this study was to assess the feasibility and acceptability of GoalKeeper (GK), an internet-based system for eliciting and monitoring family-centered goals for CMC, and to identify barriers and facilitators to implementation.METHODS: We used the Consolidated Framework for Implementation Research (CFIR) to explore the barriers and facilitators to the implementation of GK as part of a clinical trial of GK in ambulatory clinics at a children's hospital (NCT03620071). The study was conducted in 3 phases: preimplementation, implementation (trial), and postimplementation. For the trial, we recruited providers at participating clinics and English-speaking parents of CMC<12 years of age with home internet access. All participants used GK during an initial clinic visit and for 3 months after. We conducted preimplementation focus groups and postimplementation semistructured exit interviews using the CFIR interview guide. Participant exit surveys assessed GK feasibility and acceptability on a 5-point Likert scale. For each interview, 3 independent coders used content analysis and serial coding reviews based on the CFIR qualitative analytic plan and assigned quantitative ratings to each CFIR construct (-2 strong barrier to +2 strong facilitator).RESULTS: Preimplementation focus groups included 2 parents (1 male participant and 1 female participant) and 3 providers (1 in complex care, 1 in clinical informatics, and 1 in neurology). From focus groups, we developed 3 implementation strategies: education (parents: 5-minute demo; providers: 30-minute tutorial and 5-minute video on use in a clinic visit; both: instructional manual), tech support (in-person, virtual), and automated email reminders for parents. For implementation (April 1, 2019, to December 21, 2020), we enrolled 11 providers (7 female participants, 5 in complex care) and 35 parents (mean age 38.3, SD 7.8 years; n=28, 80% female; n=17, 49% Caucasian; n=16, 46% Hispanic; and n=30, 86% at least some college). One parent-provider pair did not use GK in the clinic visit, and few used GK after the visit. In 18 parent and 9 provider exit interviews, the key facilitators were shared goal setting, GK's internet accessibility and email reminders (parents), and GK's ability to set long-term goals and use at the end of visits (providers). A key barrier was GK's lack of integration into the electronic health record or patient portal. Most parents (13/19) and providers (6/9) would recommend GK to their peers.CONCLUSIONS: Family-centered technologies like GK are feasible and acceptable for the care of CMC, but sustained use depends on integration into electronic health records.TRIAL REGISTRATION: ClinicalTrials.gov NCT03620071; https://clinicaltrials.gov/ct2/show/NCT03620071.
View details for DOI 10.2196/30902
View details for PubMedID 35998021
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Continuity of Care in Primary Care for Young Children with Chronic Conditions.
Academic pediatrics
Bannett, Y., Gardner, R. M., Huffman, L. C., Feldman, H. M., Sanders, L. M.
2022
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OBJECTIVES: (1) To assess continuity of care (CoC) within primary-care practices for children with asthma and autism spectrum disorder (ASD) compared to children without chronic conditions, and (2) to determine patient and clinical-care factors associated with CoC.METHODS: Retrospective cohort study of electronic health records from office visits of children <9 years, seen ≥4 times between 2015 and 2019 in 10 practices of a community-based primary healthcare network in California. Three cohorts were constructed: (1)Asthma: ≥2 visits with asthma visit-diagnoses; (2)ASD: same method; (3)Controls: no chronic conditions. CoC, using Usual Provider of Care measure (range >0-1), was calculated for (1) all visits (overall) and (2) well-care visits. Fractional regression models examined CoC adjusting for patient age, medical insurance, practice affiliation, and number of visits.RESULTS: Of 30,678 children, 1875 (6.1%) were classified as Asthma, 294 (1.0%) as ASD, and 15,465 (50.4%) as Controls. Overall CoC was lower for Asthma (Mean=0.58, SD 0.21) and ASD (M=0.57, SD 0.20) than Controls (M=0.66, SD 0.21); differences in well-care CoC were minimal. In regression models, lower overall CoC was found for Asthma (aOR 0.90, 95% CI 0.85-0.94). Lower overall and well-care CoC were associated with public insurance (aOR 0.77, CI 0.74-0.81; aOR 0.64, CI 0.59-0.69).CONCLUSION: After accounting for patient and clinical-care factors, children with asthma, but not with ASD, in this primary-care network had significantly lower CoC compared to children without chronic conditions. Public insurance was the most prominent patient factor associated with low CoC, emphasizing the need to address disparities in CoC.
View details for DOI 10.1016/j.acap.2022.07.012
View details for PubMedID 35858663
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COVID-19 vaccine hesitancy among low-income, racially and ethnically diverse US parents.
Patient education and counseling
Schilling, S., Orr, C. J., Delamater, A. M., Flower, K. B., Heerman, W. J., Perrin, E. M., Rothman, R. L., Yin, H. S., Sanders, L.
2022
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OBJECTIVE: Examine factors impacting U.S. parents' intention to vaccinate their children against COVID-19.METHODS: Data were collected February-May 2021 from parents living in six geographically diverse locations. The COVID-19 Exposure and Family Impact Survey assessed perceived susceptibility and severity to adverse outcomes from the pandemic. Semi-structured interviews assessed perceptions about benefits and risks of vaccinating children.RESULTS: Fifty parents of 106 children (newborn-17 years) were included; half were Spanish-speaking and half English-speaking. 62% were hesitant about vaccinating their children against COVID-19. Efficacy and safety were the main themes that emerged: some parents perceived them as benefits while others perceived them as risks to vaccination. Parent hesitancy often relied on social media, and was influenced by narrative accounts of vaccination experiences. Many cited the lower risk of negative outcomes from COVID-19 among children, when compared with adults. Some also cited inaccurate and constantly changing information about COVID-19 vaccines.CONCLUSION: Main drivers of parent hesitancy regarding child COVID-19 vaccination include perceived safety and efficacy of the vaccines and lower severity of illness in children.PRACTICE IMPLICATIONS: Many vaccine-hesitant parents may be open to vaccination in the future and welcome additional discussion and data.
View details for DOI 10.1016/j.pec.2022.03.023
View details for PubMedID 35393230
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Racial and Ethnic Differences in Maternal Social Support and Relationship to Mother-Infant Health Behaviors.
Academic pediatrics
White, M. J., Kay, M. C., Truong, T., Green, C. L., Yin, H. S., Flower, K. B., Rothman, R. L., Sanders, L. M., Delamater, A. M., Duke, N. N., Perrin, E. M.
2022
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OBJECTIVES: To examine racial and ethnic differences in maternal social support in infancy and the relationship between social support and mother-infant health behaviors.METHODS: Secondary analysis of baseline data from a multisite obesity prevention trial that enrolled mothers and their two-month-old infants. Behavioral and social support data were collected via questionnaire. We used modified Poisson regression to determine association between health behaviors and financial and emotional social support, adjusted for sociodemographic characteristics.RESULTS: 826 mother-infant dyads (27.3% Non-Hispanic Black, 18.0% Non-Hispanic White, 50.1% Hispanic and 4.6% Non-Hispanic Other). Half of mothers were born in the U.S.; 87% were Medicaid-insured. There were no racial/ethnic differences in social support controlling for maternal nativity. U.S.-born mothers were more likely to have emotional and financial support (rate ratio [RR] 1.14 95% confidence interval [CI]: 1.07, 1.21 and RR 1.23 95% CI: 1.11, 1.37, respectively) versus mothers born outside the U.S. Mothers with financial support were less likely to exclusively feed with breast milk (RR 0.62; 95% CI: 0.45, 0.87) yet more likely to have tummy time ≥12min (RR 1.28; 95% CI: 1.02, 1.59) versus mothers without financial support. Mothers with emotional support were less likely to report feeding with breast milk (RR 0.82; 95% CI: 0.69, 0.97) versus mothers without emotional support.CONCLUSIONS: Nativity, not race or ethnicity, is a significant determinant of maternal social support. Greater social support was not universally associated with healthy behaviors. Interventions may wish to consider the complex nature of social support and population-specific social support needs.
View details for DOI 10.1016/j.acap.2022.02.008
View details for PubMedID 35227910
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How COVID-19 impacted child and family health and healthcare: a mixed-methods study incorporating family voices.
Translational behavioral medicine
Heerman, W. J., Gross, R., Lampkin, J., Nmoh, A., Eatwell, S., Delamater, A. M., Sanders, L., Rothman, R. L., Yin, H. S., Perrin, E. M., Flower, K. B.
2022
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To describe how social disruptions caused by the COVID-19 pandemic impacted child access to healthcare and child health behaviors in 2020. We used mixed-methods to conduct surveys and in-depth interviews with English- and Spanish-speaking parents of young children from five geographic regions in the USA. Participants completed the COVID-19 Exposure and Family Impact Survey (CEFIS). Semistructured telephone interviews were conducted between August and October 2020. Of the 72 parents interviewed, 45.8% of participants were Hispanic, 20.8% Black (non-Hispanic), and 19.4% White (non-Hispanic). On the CEFIS, the average (SD) number of social/family disruptions reported was 10.5 (3.8) out of 25. Qualitative analysis revealed multiple levels of themes that influenced accessing healthcare during the pandemic, including two broad contextual themes: (a) lack of trustworthiness of medical system/governmental organizations, and (b) uncertainty due to lack of consistency across multiple sources of information. This context influenced two themes that shaped the social and emotional environments in which participants accessed healthcare: (a) fear and anxiety and (b) social isolation. However, the pandemic also had some positive impacts on families: over 80% indicated that the pandemic made it "a lot" or "a little" better to care for their new infants. Social and family disruptions due to COVID-19 were common. These disruptions contributed to social isolation and fear, and adversely impacted multiple aspects of child and family health and access to healthcare. Some parents of infants reported improvements in specific health domains such as parenting, possibly due to spending more time together.
View details for DOI 10.1093/tbm/ibab166
View details for PubMedID 35192704
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The ENHANCE-AF Clinical Trial to Evaluate an Atrial Fibrillation Shared Decision-Making Pathway: Rationale and Study Design.
American heart journal
Baykaner, T., Pundi, K., Lin, B., Lu, Y., DeSutter, K., Lhamo, K., Garay, G., Nunes, J. C., Morin, D. P., Sears, S. F., Chung, M. K., Paasche-Orlow, M. K., Sanders, L. M., Bunch, T. J., Hills, M. T., Mahaffey, K. W., Stafford, R. S., Wang, P. J.
2022
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Shared decision making (SDM) may result in treatment plans that best reflect the goals and wishes of patients, increasing patient satisfaction with the decision-making process. There is a knowledge gap to support the use of decision aids in SDM for anticoagulation therapy in patients with atrial fibrillation (AF). We describe the development and testing of a new decision aid, including a multicenter, randomized, controlled, 2-arm, open-label ENHANCE-AF clinical trial (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention) to evaluate its effectiveness in 1,200 participants.Participants will be randomized to either usual care or to a shared decision-making pathway incorporating a digital tool designed to simplify the complex concepts surrounding AF in conjunction with a clinician tool and a non-clinician navigator to guide the participants through each step of the tool. The participant-determined primary outcome for this study is the Decisional Conflict Scale, measured at 1 month after the index visit during which a decision was made regarding anticoagulation use. Secondary outcomes at both 1 and 6 months will include other decision making related scales as well as participant and clinician satisfaction, oral anticoagulation adherence, and a composite rate of major bleeding, death, stroke, or transient ischemic attack. The study will be conducted at four sites selected for their ability to enroll participants of varying racial and ethnic backgrounds, health literacy, and language skills. Participants will be followed in the study for 6 months.The results of the ENHANCE-AF trial will determine whether a decision aid facilitates high quality shared decision making in anticoagulation discussions for stroke reduction in AF. An improved shared decision-making experience may allow patients to make decisions better aligned with their personal values and preferences, while improving overall AF care.
View details for DOI 10.1016/j.ahj.2022.01.013
View details for PubMedID 35092723
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Participating in Two Video Concussion Education Programs Sequentially Improves Concussion-Reporting Intention.
Neurotrauma reports
Daneshvar, D. H., Baugh, C. M., Lama, R. D., Yutsis, M., Pea, R. D., Goldman, S., Grant, G. A., Cantu, R. C., Sanders, L. M., Zafonte, R. D., Hainline, B., Sorcar, P.
2021; 2 (1): 581-591
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Undiagnosed concussions increase the risk of additional concussion and persistent symptoms from concussion. Because there are no reliable objective markers of concussion, self-reporting of subjective and non-visible symptoms are critical to ensuring proper concussion management. For this reason, educational interventions target concussion reporting, but the majority of studies have examined the efficacy of single educational interventions or compared interventions to one another. This randomized crossover study sought to identify whether there was benefit to administering multiple concussion education programs in tandem, back to back. The study randomized 313 male high school football players to first receive CrashCourse concussion education (CC) or Centers for Disease Control and Prevention video concussion education (CDC) followed by crossover with the other education. Athlete concussion-reporting intention, attitudes, subjective norms, perceived behavioral control, and enjoyment of education were assessed at baseline and after each intervention. There were statistically significant improvements across all measures, both after single intervention and crossover (all p < 0.001). Secondary analyses examining differences between education found that athletes reported higher enjoyment of concussion education immediately after participating in CC, as compared to CDC (p < 0.001). These findings demonstrate an additive benefit to implementing CC and CDC education in tandem, without decrement in enjoyment of concussion education after experiencing dual educations; in fact, enjoyment of concussion education improved after receiving education programs back to back. These educational programs appear to complement one another, and the results support the use of multi-modal concussion education to differentially target and maximize concussion reporting.
View details for DOI 10.1089/neur.2021.0033
View details for PubMedID 35018360
View details for PubMedCentralID PMC8742279
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Participating in Two Video Concussion Education Programs Sequentially Improves Concussion-Reporting Intention
NEUROTRAUMA REPORTS
Daneshvar, D. H., Baugh, C. M., Lama, R. D., Yutsis, M., Pea, R. D., Goldman, S., Grant, G. A., Cantu, R. C., Sanders, L. M., Zafonte, R. D., Hainline, B., Sorcar, P.
2021; 2 (1): 581-591
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View details for DOI 10.1089/neur.2021.0033
View details for Web of Science ID 000729358800001
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Addressing Parent Employment as an Essential Issue in Child Health.
Pediatrics
Glader, L., Comeau, M., Sanders, L.
2021
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View details for DOI 10.1542/peds.2021-050448
View details for PubMedID 34433690
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A community-based, multi-level, multi-setting, multi-component intervention to reduce weight gain among low socioeconomic status Latinx children with overweight or obesity: The Stanford GOALS randomised controlled trial.
The lancet. Diabetes & endocrinology
Robinson, T. N., Matheson, D., Wilson, D. M., Weintraub, D. L., Banda, J. A., McClain, A., Sanders, L. M., Haskell, W. L., Haydel, K. F., Kapphahn, K. I., Pratt, C., Truesdale, K. P., Stevens, J., Desai, M.
2021
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BACKGROUND: There are few long-term studies of interventions to reduce in low socioeconomic status children with overweight or obesity. The Stanford GOALS trial evaluated a 3-year, community-based, multi-level, multi-setting, multi-component (MMM) systems intervention, to reduce weight gain among low socioeconomic status, Latinx children with overweight or obesity.METHODS: We did a two-arm, parallel group, randomised, open-label, active placebo-controlled trial with masked assessment over 3 years. Families from low-income, primarily Latinx communities in Northern California, CA, USA, with 7-11-year-old children with overweight or obesity were randomly assigned to a MMM intervention or a Health Education (HE) comparison intervention. The MMM intervention included home environment changes and behavioural counselling, community after school team sports, and reports to primary health-care providers. The primary outcome was child BMI trajectory over three years. Secondary outcomes included one- and two-year changes in BMI. This trial is registered with ClinicalTrials.govNCT01642836.FINDINGS: Between July 13, 2012, and Oct 3, 2013, 241 families were recruited and randomly assigned to MMM (n=120) or HE (n=121). Children's mean age was 9·5 (SD 1·4) years, 134 (56%) were female and 107 (44%) were male, and 236 (98%) were Latinx. 238 (99%) children participated in year 1, 233 (97%) in year 2, and 227 (94%) in year 3 of follow-up assessments. In intention-to-treat analysis, over 3 years, the difference between intervention groups in BMI trajectory was not significant (mean adjusted difference -0·25 [95% CI -0·90 to 0·40] kg/m2; Cohen's d=0.10; p=0·45). Children in the MMM intervention group gained less BMI over 1 year than did children in the HE intervention group (-0·73 [-1·07 to -0·39] kg/m2, d=0.55); the same was true over 2 years (-0·63 [-1·13 to -0·14] kg/m2; d =0.33). No differential adverse events were observed.INTERPRETATION: The MMM intervention did not reduce BMI gain versus HE over 3 years but the effects over 1 and 2 years in this rigorous trial show the promise of this systems intervention approach for reducing weight gain and cardiometabolic risk factors in low socioeconomic status communities.FUNDING: US National Institutes of Health.
View details for DOI 10.1016/S2213-8587(21)00084-X
View details for PubMedID 33933181
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A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial.
Pediatrics
Sanders, L. M., Perrin, E. M., Yin, H. S., Delamater, A. M., Flower, K. B., Bian, A., Schildcrout, J. S., Rothman, R. L., Greenlight Study Team
2021
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BACKGROUND AND OBJECTIVES: Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months.METHODS: In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI z score).RESULTS: A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI z score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively.CONCLUSIONS: The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.
View details for DOI 10.1542/peds.2020-049866
View details for PubMedID 33911032
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Parents' Perspectives on Using Artificial Intelligence to Reduce Technology Interference During Early Childhood: Cross-sectional Online Survey.
Journal of medical Internet research
Glassman, J., Humphreys, K., Yeung, S., Smith, M., Jauregui, A., Milstein, A., Sanders, L.
2021; 23 (3): e19461
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BACKGROUND: Parents' use of mobile technologies may interfere with important parent-child interactions that are critical to healthy child development. This phenomenon is known as technoference. However, little is known about the population-wide awareness of this problem and the acceptability of artificial intelligence (AI)-based tools that help with mitigating technoference.OBJECTIVE: This study aims to assess parents' awareness of technoference and its harms, the acceptability of AI tools for mitigating technoference, and how each of these constructs vary across sociodemographic factors.METHODS: We administered a web-based survey to a nationally representative sample of parents of children aged ≤5 years. Parents' perceptions that their own technology use had risen to potentially problematic levels in general, their perceptions of their own parenting technoference, and the degree to which they found AI tools for mitigating technoference acceptable were assessed by using adaptations of previously validated scales. Multiple regression and mediation analyses were used to assess the relationships between these scales and each of the 6 sociodemographic factors (parent age, sex, language, ethnicity, educational attainment, and family income).RESULTS: Of the 305 respondents, 280 provided data that met the established standards for analysis. Parents reported that a mean of 3.03 devices (SD 2.07) interfered daily in their interactions with their child. Almost two-thirds of the parents agreed with the statements "I am worried about the impact of my mobile electronic device use on my child" and "Using a computer-assisted coach while caring for my child would help me notice more quickly when my device use is interfering with my caregiving" (187/281, 66.5% and 184/282, 65.1%, respectively). Younger age, Hispanic ethnicity, and Spanish language spoken at home were associated with increased technoference awareness. Compared to parents' perceived technoference and sociodemographic factors, parents' perceptions of their own problematic technology use was the factor that was most associated with the acceptance of AI tools.CONCLUSIONS: Parents reported high levels of mobile device use and technoference around their youngest children. Most parents across a wide sociodemographic spectrum, especially younger parents, found the use of AI tools to help mitigate technoference during parent-child daily interaction acceptable and useful.
View details for DOI 10.2196/19461
View details for PubMedID 33720026
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Evaluating the Effect of Concussion Education Programs on Intent to Report Concussion in High School Football.
Journal of athletic training
Daneshvar, D. H., Yutsis, M., Baugh, C. M., Pea, R. D., Goldman, S., Grant, G. A., Ghajar, J., Sanders, L. M., Chen, C., Tenekedjieva, L., Gurrapu, S., Zafonte, R. D., Sorcar, P.
2021
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CONTEXT: Concussion underreporting leads to delays in diagnosis and treatment, prolonging recovery time. Athletes' self-report of concussion symptoms therefore reduces risk.OBJECTIVE: Evaluate the efficacy of three concussion education programs in improving concussion-reporting intention.DESIGN: Randomized controlled clinical trial with assessment immediately and one-month after education.SETTING: Three high schools in California.PATIENTS OR OTHER PARTICIPANTS: 118 male football players were randomly assigned to receive concussion education via: CrashCourse (CC), Centers for Disease Control (CDC) video educational materials (Vi), or CDC written educational materials (Wr).MAIN OUTCOME MEASURES: Concussion-reporting intention was assessed at baseline, immediately after education, and at one-month follow-up. Secondary outcomes included concussion knowledge, attitudes, perceived reporting norms, and perceived behavioral control.RESULTS: Athletes across all educational formats had significant improvement in concussion-reporting intention immediately following education and at one-month follow-up (mean improvement 6.8% and 11.4%, respectively; p<0.001). Similar findings were observed across all education formats in secondary analyses examining knowledge, attitudes, and perceived behavioral control. However, there were significant differences by education and time (p=0.03). On post-hoc analysis, athletes who received CC had increased concussion-reporting intention immediately and at one-month (baseline=4.7, immediate=6.1, one-month=6.0; p=0.007 compared to significant increases only at one-month for CDC-Vi (baseline=4.3, immediate=5.2, one-month=5.8; p=0.001), and no significant improvement for CDC-Wr (p=0.10). Secondary analyses indicated significant differences between CC and both CDC interventions, in concussion knowledge and attitudes, immediately after education and at one-month. There were no significant differences in perceived behavioral control between-interventions or in perceived concussion-reporting norms across or between interventions.CONCLUSION: All athletes exhibited improved intent to report concussions, increased concussion knowledge, better concussion attitudes, and more perceived behavioral control, both immediately after education and at one-month follow-up. However, athletes randomized to CC reported greater intent to report concussion, more knowledge, and improved concussion-reporting attitudes, when compared to CDC-Vi and CDC-Wr.TRIAL REGISTRY: ClinicalTrials.gov trial ID number is XXX.
View details for DOI 10.4085/509-20
View details for PubMedID 33428746
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SHORT-TERM AND LONG-TERM EDUCATIONAL OUTCOMES OF INFANTS BORN MODERATELY AND LATE PRETERM.
The Journal of pediatrics
Flores, C. T., Gerstein, A. n., Phibbs, C. S., Sanders, L. M.
2021
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To assess the relationship of moderate and late preterm birth (32-36 6/7 weeks) to long-term educational outcomes.We hypothesized that moderate and late preterm birth would be associated with adverse outcomes in elementary school. To test this, we linked vital statistics-patient discharge data from the Office of Statewide Health Planning and Development including birth outcomes, to the school year 2015-2016 administrative data of a large, urban school district (N = 72,316). We compared the relative risk of moderate and late preterm and term infants for later adverse neurocognitive and behavioral outcomes in kindergarten through 12th grade.After adjusting for socioeconomic status, compared with term birth, moderate and late preterm birth was associated with increased risk of low performance in mathematics and English language arts, chronic absenteeism, and suspension. These risks emerged in kindergarten through second grade and remained in grades 3-5, but appeared to wash out in later grades, with the exception of suspension which remained through grades 9-12.Confirming our hypothesis, moderate and late preterm birth was associated with adverse educational outcomes in late elementary school, indicating that it is a significant risk factor that school districts could leverage when targeting early intervention. Future studies will need to test these relations in geographically and socioeconomically diverse school districts, include a wider variety of outcomes, and consider how early interventions moderate associations between birth outcomes and educational outcomes.
View details for DOI 10.1016/j.jpeds.2020.12.070
View details for PubMedID 33412166
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Athlete Enjoyment of Prior Education Moderates change in Concussion-Reporting Intention after Interactive Education.
Inquiry : a journal of medical care organization, provision and financing
Daneshvar, D. H., Baugh, C. M., Yutsis, M., Pea, R. D., Goldman, S., Grant, G. A., Cantu, R. C., Sanders, L. M., Chen, C. L., Lama, R. D., Zafonte, R. D., Sorcar, P.
2021; 58: 469580211022641
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Abstract
Undiagnosed concussions increase risk of additional injuries and can prolong recovery. Because of the difficulties recognizing concussive symptoms, concussion education must specifically target improving athlete concussion reporting. Many concussion education programs are designed without significant input from athletes, resulting in a less enjoyable athlete experience, with potential implications on program efficacy. Athlete enjoyment of previous concussion education programs moderates the improvement in concussion-reporting intention after experiencing the research version of CrashCourse (CC) concussion education. Prospective cohort study. Level of evidence: Level IV. Quantitative assessment utilizing ANOVA with moderation analysis of 173 male high school football players, aged 13 to 17, who completed baseline assessments of concussion knowledge, concussion reporting, and attitudes about prior educational interventions. Athletes were subsequently shown CC, before a follow-up assessment was administered assessing the same domains. At baseline, only 58.5% of athletes reported that they enjoyed their previous concussion education. After CC, athletes were significantly more likely to endorse that they would report a suspected concussion (from 69.3% of athletes to 85.6%; P<.01). Enjoyment of previous concussion education moderated concussion-reporting intention after CC (P=.02), with CC having a greater effect on concussion-reporting intention in athletes with low enjoyment of previous concussion education (b=0.21, P=.02), than on individuals with high enjoyment of previous concussion education (P=.99). Enjoyment of CC did not have a moderating effect on concussion-reporting intention. Athletes who previously did not enjoy concussion education exhibited greater gains in concussion-reporting intention than athletes who enjoyed previous education. Given the potential risks associated with undiagnosed concussions, concussion education has sought to improve concussion reporting. Because most athletes participate in concussion education programs due to league or state mandates, improving concussion-reporting intention in these low-enjoyment athletes is of particular relevance to improving concussion-reporting intention broadly.
View details for DOI 10.1177/00469580211022641
View details for PubMedID 34053328
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FAMILY CHARACTERISTICS ASSOCIATED WITH ACUTE STRESS IN CHILDREN AND CAREGIVERS AFTER PICU ADMISSION
Canty, H., Sanders, L., Burnside, G.
LIPPINCOTT WILLIAMS & WILKINS. 2021: 400
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View details for Web of Science ID 000672597101386
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Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality.
Journal of child neurology
Lin, J. L., Rigdon, J. n., Van Haren, K. n., Buu, M. n., Saynina, O. n., Bhattacharya, J. n., Owens, D. K., Sanders, L. M.
2021: 8830738211000179
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Abstract
Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment.We included all children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above.A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia.Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.
View details for DOI 10.1177/08830738211000179
View details for PubMedID 33750232
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Infant television watching predicts toddler television watching in a low-income population.
Academic pediatrics
Hish, A. J., Wood, C. T., Howard, J. B., Flower, K. B., Yin, H. S., Rothman, R. L., Delamater, A. M., Sanders, L. M., Bian, A., Schildcrout, J. S., Perrin, E. M.
2020
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OBJECTIVES: This study examines the development of active television (TV) watching behaviors across the first 2 years of life in a racially and ethnically diverse, low-income cohort and identifies caregiver and child predictors of early TV watching.METHODS: We used longitudinal data from infants enrolled in the active control group (N = 235; 39% Latino; 29% black; 15% white) of Greenlight, a cluster randomized multi-site trial to prevent childhood obesity. At preventive health visits from 2 months to 2 years, caregivers were asked: "How much time does [child's first name] spend watching television each day?" Proportional odds models and linear regression analyses were used to assess associations among TV introduction age, active TV watching amount at 2 years, and sociodemographic factors.RESULTS: 68% of children watched TV by 6 months, and 88% by 2 years. Age of TV introduction predicted amount of daily active TV watching at 2 years, with a mean time of 93 minutes if starting at 2 months; 64 minutes if starting at 4 or 6 months; and 42 minutes if starting after 6 months. Factors predicting earlier introduction included lower income, fewer children in household, care away from home, male sex, and non-Latino ethnicity of child.CONCLUSIONS: Many caregivers report that their infants actively watch TV in the first 6 months of life. Earlier TV watching is related to sociodemographic factors yet predicts more daily TV watching at 2 years even controlling those factors. Interventions to limit early TV watching should be initiated in infancy.
View details for DOI 10.1016/j.acap.2020.11.002
View details for PubMedID 33161116
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Parent Perspectives in Shared Decision-Making for Children With Medical Complexity
ACADEMIC PEDIATRICS
Lin, J. L., Clark, C. L., Halpern-Felsher, B., Bennett, P. N., Assis-Hassid, S., Amir, O., Nunez, Y., Cleary, N., Gehrmann, S., Grosz, B. J., Sanders, L. M.
2020; 20 (8): 1101–8
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View details for Web of Science ID 000587738600013
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Assessing Diet Quality in a Racially and Ethnically Diverse Cohort of Low-income Toddlers.
Journal of pediatric gastroenterology and nutrition
Kay, M. C., Silver, H. J., Yin, H. S., Flower, K. B., Rothman, R. L., Sanders, L. M., Delamater, A. M., Perrin, E. M.
2020; 71 (5): 679-685
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Abstract
Low-income racially and ethnically diverse children are at higher risk for obesity compared with their counterparts; yet, few studies have assessed their diet quality.The aim of the study was to evaluate the diet quality of a racially and ethnically diverse cohort of 2-year-olds using the Healthy Eating Index (HEI)-2010.We used 24-hour dietary recall data from caregivers of toddlers (24-34 months) at 4 pediatric resident clinics that participated in the Greenlight Study to calculate compliance with the Dietary Guidelines for Americans (DGA) using total HEI score (range 0-100) and 12 component scores.Participants (n = 231) were mostly Hispanic (57%) or non-Hispanic black (27%) and from low-income families. Mean HEI-2010 score was 62.8 (standard deviation [SD] 10.5). Though not significant, Hispanics had the highest HEI score. Toddlers of caregivers without obesity, older than 35 years and born outside the United States had higher HEI scores. Most had high HEI component scores for dairy, fruit, and protein foods, but few achieved maximum scores, particularly for whole grains (13%), vegetables (10%), and fatty acid ratio (7%).Despite scores reflective of DGA recommendations for fruit, dairy and protein foods, toddlers in this diverse sample had low quality diets as measured by the HEI, driven largely by low component scores for whole grains, vegetables, and ratio of unsaturated to saturated fatty acids.
View details for DOI 10.1097/MPG.0000000000002871
View details for PubMedID 33093378
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Associations Between Food Insecurity and Parental Feeding Behaviors of Toddlers
ACADEMIC PEDIATRICS
Orr, C. J., Ravanbakht, S., Flower, K. B., Yin, H., Rothman, R. L., Sanders, L. M., Delamater, A., Perrin, E. M.
2020; 20 (8): 1163–69
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View details for Web of Science ID 000587738600021
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Relationship Between Parental Locus of Control and Childhood Injury.
The journal of primary prevention
Schilling, S., Ritter, V. S., Skinner, A., Yin, H. S., Sanders, L. M., Rothman, R. L., Delamater, A. M., Perrin, E. M.
2020
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Abstract
Although pediatricians routinely counsel parents about preventing childhood injuries, we know little about parents' locus of control (LOC) in regards to preventing their children from being injured. We performed an observational analysis of sociodemographic differences in LOC for injury prevention, as measured by four items adapted from the Parental Health Beliefs Scales, in English- and Spanish-speaking parents of infants participating in the treatment arm of an obesity prevention study. First, we examined associations of parental LOC for injury prevention at the time their children were 2months old with parents' age, race/ethnicity, income, and education. Next, we analyzed time trends for repeated LOC measures when the children were 2, 6, 9, 12, and 24months old. Last, we examined the association between injury-related LOC items and children's injury (yes/no) at each time point. Of 452 parents, those with lower incomes had both lower internal and higher external LOC. Lower educational achievement was associated with higher external LOC. Both internal and external LOC scores decreased over time. Injuries were more common in children whose parents endorsed low internal and high external LOC. Future studies should examine whether primary care-based interventions can increase parents' sense of control over their children's safety and whether that, in turn, is associated with lower injury rates.Clinical Trial Registration: NCT01040897.
View details for DOI 10.1007/s10935-020-00615-y
View details for PubMedID 33104944
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Effects of Breastfeeding, Formula Feeding, and Complementary Feeding on Rapid Weight Gain in the First Year of Life.
Academic pediatrics
Wood, C. T., Witt, W. P., Skinner, A. C., Yin, H. S., Rothman, R. L., Sanders, L. M., Delamater, A. M., Flower, K. B., Kay, M. C., Perrin, E. M.
2020
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OBJECTIVE: To determine whether proportion of breast versus formula feeding, and timing of complementary food introduction affect the odds of rapid gain in weight status in a diverse sample of infants.METHODS: Using data from Greenlight Intervention Study, we analyzed the effects of type of milk feeding (breastfeeding, formula, or mixed feeding) from the 2 to 6 month well visits, and the introduction of complementary foods before 4 months on rapid increase in weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) before 12 months using multivariable logistic regression models.RESULTS: Of the 865 infants enrolled, 469 had complete data on all variables of interest, and 41% and 33% of those infants had rapid increases in WAZ and WLZ, respectively. Odds of rapid increase in WAZ remained lowest for infants breastfeeding from 2 to 6 months (aOR 0.34; 95% CI: 0.17, 0.69) when compared to infants who were formula fed. Adjusted for feeding, introduction of complementary foods after 4 months was associated with decreased odds of rapid increase in WLZ (aOR 0.64; 95% CI: 0.42, 0.96).CONCLUSION: Feeding typified by predominant breastfeeding and delaying introduction of complementary foods after 4 months reduces the odds of rapid increases in WAZ and WLZ in the first year of life.
View details for DOI 10.1016/j.acap.2020.09.009
View details for PubMedID 32961335
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Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder.
JAMA pediatrics
Loe, I. M., Kakar, P. A., Sanders, L. M.
2020
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View details for DOI 10.1001/jamapediatrics.2020.2218
View details for PubMedID 32777021
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Assessing Diet Quality in a Racially and Ethnically Diverse Cohort of Low-Income Toddlers.
Journal of pediatric gastroenterology and nutrition
Kay, M. C., Silver, H. J., Yin, H. S., Flower, K. B., Rothman, R. L., Sanders, L. M., Delamater, A. M., Perrin, E. M.
2020
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Abstract
BACKGROUND: Low-income racially and ethnically diverse children are at higher risk for obesity compared with their counterparts; yet, few studies have assessed their diet quality.OBJECTIVE: To evaluate the diet quality of a racially and ethnically diverse cohort of 2-year-olds using the Healthy Eating Index (HEI)-2010.METHODS: We used 24-hour dietary recall data from caregivers of toddlers (24-34 months) at 4 pediatric resident clinics that participated in the Greenlight Study to calculate compliance with the Dietary Guidelines for Americans (DGA) using total HEI score (range 0-100) and 12 component scores.RESULTS: Participants (n = 231) were mostly Hispanic (57%) or non-Hispanic black (27%) and from low-income families. Mean HEI-2010 score was 62.8 (SD 10.5). Though not significant, Hispanics had the highest HEI score. Toddlers of caregivers without obesity, older than 35 years and born outside the U.S. had higher HEI scores. Most had high HEI component scores for dairy, fruit, and protein foods, but few achieved maximum scores, particularly for whole grains (13%), vegetables (10%), and fatty acid ratio (7%).CONCLUSION: Despite scores reflective of DGA recommendations for fruit, dairy and protein foods, toddlers in this diverse sample had low quality diets as measured by the HEI, driven largely by low component scores for whole grains, vegetables and ratio of unsaturated to saturated fatty acids.
View details for DOI 10.1097/MPG.0000000000002871
View details for PubMedID 32740532
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Parent perspectives in shared decision-making for children with medical complexity.
Academic pediatrics
Lin, J. L., Clark, C. L., Halpern-Felsher, B., Bennett, P. N., Assis-Hassid, S., Amir, O., Nunez, Y. C., Cleary, N. M., Gehrmann, S., Grosz, B. J., Sanders, L. M.
2020
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OBJECTIVE: Shared decision-making (SDM) may improve outcomes for children with medical complexity (CMC). CMC have lower rates of SDM than other children, but little is known about how to improve SDM for CMC. The objective of this study is to describe parent perspectives of SDM for CMC and identify opportunities to improve elements of SDM specific to this vulnerable population.METHODS: Interviews with parents of CMC explored SDM preferences and experiences. Eligible parents were ≥18 years old, English- or Spanish-speaking, with a CMC < 12 years old. Interviews were recorded, transcribed, and analyzed by independent coders for shared themes using modified grounded theory. Codes were developed using an iterative process, beginning with open-coding of a subset of transcripts followed by discussion with all team members, and distillation into preliminary codes. Subsequent coding reviews were conducted until no new themes emerged and existing themes were fully explored.RESULTS: We conducted interviews with 32 parents (27 in English, mean parent age 34 years, SD=7; mean child age 4 years, SD=4; 50% with household income <
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Are Low-Income, Diverse Mothers Able to Meet Breastfeeding Intentions After 2 Months of Breastfeeding?
Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine
Kay, M. C., Cholera, R., Flower, K. B., Yin, H. S., Rothman, R. L., Sanders, L. M., Delamater, A. M., Perrin, E. M.
2020
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Background: Little is known about intended breastfeeding duration of women who initiate breastfeeding. We describe the association between intended and actual breastfeeding duration among low-income, diverse mothers who report maintaining breastfeeding for the first 2 months postpartum. Materials and Methods: We included mothers (64% Hispanic, 17% non-Hispanic black) participating in Greenlight, a cluster randomized childhood obesity prevention trial, who were providing breast milk at the 2-month preventive service visit and reported intended breastfeeding duration at this visit. Breastfeeding status was assessed at subsequent visits, up to 24 months. Poisson regression with a robust variance estimator was used to estimate risk ratios and 95% confidence intervals for meeting breastfeeding intentions. Covariates included race/ethnicity, income, receiving benefits from the Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC), education, age, employment, depression, maternal obesity, U.S. born, whether infant was first born, and study site. Results: Median intended breastfeeding duration was 11.5 months (interquartile range [IQR]: 6-12) and median actual breastfeeding duration was 8.6 months (IQR: 4-14) (n=349). Approximately half (49%) met intended breastfeeding duration. Breastfeeding duration differed based on milk type provided at the 2-month visit in that mothers providing mostly or only breast milk had increased likelihood of meeting breastfeeding intentions. Regardless of milk type provided at 2 months, the longer a mother intended to breastfeed, the less likely she was to meet her breastfeeding intentions. Conclusions: In this diverse sample of women less than half met breastfeeding intentions despite maintaining breastfeeding for 2 months. Understanding factors that prevent mothers from attaining intended breastfeeding duration is critical to improving breastfeeding outcomes, especially in low income and ethnic minority populations.
View details for DOI 10.1089/bfm.2020.0025
View details for PubMedID 32357088
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Parents' Use of Technologies for Health Management: A Health Literacy Perspective
ACADEMIC PEDIATRICS
Meyers, N., Glick, A. F., Mendelsohn, A. L., Parker, R. M., Sanders, L. M., Wolf, M. S., Bailey, S., Dreyer, B. P., Velazquez, J. J., Yin, H.
2020; 20 (1): 23–30
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View details for DOI 10.1016/j.acap.2019.01.008
View details for Web of Science ID 000508287800007
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Associations Between Food Insecurity and Parental Feeding Behaviors of Toddlers.
Academic pediatrics
Orr, C. J., Ravanbakht, S. n., Flower, K. B., Yin, H. S., Rothman, R. L., Sanders, L. M., Delamater, A. n., Perrin, E. M.
2020
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Abstract
We examined associations between household food insecurity status and parental feeding behavior, weight perception, and child weight status in a diverse sample of young children.Cross-sectional analysis of 2-year old children in Greenlight, a cluster randomized trial to prevent childhood obesity. The exposure was food insecurity, defined as a positive response to a validated screen. Outcomes were parent feeding behaviors/beliefs measured by the Child Feeding Questionnaire and child weight status. T-tests and linear regression were used to assess associations between food insecurity and each outcome. We adjusted for child sex, race/ethnicity, parent education, employment, site, number of children in the home, and WIC status.503 households (37%) were food insecure. After adjusting for covariates, parents from insecure households reported more pressuring feeding behaviors (mean factor score 3.2 compared to food secure parents mean factor score 2.9, p=0.01) and were more worried about their child becoming overweight (mean factor score 2.3 vs 2.0; p=0.02). No differences were observed in monitoring or restrictive feeding behaviors. After adjusting for covariates, there was no difference in weight status or prevalence of overweight/obesity of children or parents based on household food insecurity status.Parents from food insecure households reported more pressuring feeding behaviors. This finding underscores the need to address food insecurity and potentially prevent harmful effects on child feeding. Parents in food insecure households might benefit from linkage with resources and education to develop healthier feeding behaviors.
View details for DOI 10.1016/j.acap.2020.05.020
View details for PubMedID 32492577
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Do health literacy disparities explain racial disparities in family-centered care for youths with special health care needs?
Patient education and counseling
Chisolm, D. J., Keedy, H. E., Dolce, M. n., Chavez, L. n., Abrams, M. A., Sanders, L. n.
2020
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Abstract
To explore the relationship among youth health literacy, parental health literacy, and family-centered care (FCC) for youth with special health care needs (YSHCN) and assess potential racial disparities.HL and FCC were assessed in 486 Medicaid-enrolled YSHCN (ages 12-18) and their healthcare-responsible parent/caregiver. Analyses assessed racial differences in HL and FCC for parents and youth using logistic regression.Half of youth and over 80 percent of parents had adequate HL (REALM score ≥62). Adequate HL was significantly lower in African Americans (AA) for both YSHCN and parents. Only 57 % of parents and 29 % of YSHCN reported FCC. AA YSHCN reported significantly lower levels of FCC compared to White YSHCN. AA parents trended lower for FCC compared to Whites, though the disparity was not significant. AA youth and parents had significantly lower odds of reporting that doctors spent enough time with them compared to Whites.Results suggest that AA and those with less than adequate health literacy experience lower FCC, however the relationship between race and health literacy does not explain the racial disparity in FCC.Provider time spent focused on HL may not reduce the racial disparity in FCC, but opportunities for improvement exist.
View details for DOI 10.1016/j.pec.2020.09.023
View details for PubMedID 32994106
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Telehealth Opportunities and Challenges for Managing Pediatric Obesity.
Pediatric clinics of North America
Cueto, V. n., Sanders, L. M.
2020; 67 (4): 647–54
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Abstract
Telehealth is well positioned to address the common challenges of providing high-quality care to children and adolescents with obesity. The potential benefits of telehealth for pediatric obesity are applicable across the full spectrum of care from diagnosis and assessment to ongoing management. This article reviews the emerging field of telehealth for the treatment of pediatric obesity. The challenges of the current approach to pediatric obesity care are explored, and the potential benefits of incorporating and implementing telehealth in this field are presented. The care of pediatric patients with obesity is particularly well suited for telehealth.
View details for DOI 10.1016/j.pcl.2020.04.007
View details for PubMedID 32650862
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Advancing a More Health-Literate Approach to Patient Safety.
The Journal of pediatrics
Sanders, L. M.
2019
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View details for DOI 10.1016/j.jpeds.2019.07.003
View details for PubMedID 31474427
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Disparities in Inpatient Intensity of End-of-Life Care for Complex Chronic Conditions
PEDIATRICS
Johnston, E. E., Bogetz, J., Saynina, O., Chamberlain, L. J., Bhatia, S., Sanders, L.
2019; 143 (5)
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View details for DOI 10.1542/peds.2018-2228
View details for Web of Science ID 000474923900009
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Disparities in Inpatient Intensity of End-of-Life Care for Complex Chronic Conditions.
Pediatrics
Johnston, E. E., Bogetz, J., Saynina, O., Chamberlain, L. J., Bhatia, S., Sanders, L.
2019
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Abstract
BACKGROUND: Children with complex chronic conditions (CCCs) require a disproportionate share of health care services and have high mortality rates, but little is known about their end-of-life care.METHODS: We performed a retrospective population-based analysis using a California State administrative database of children aged 1 to 21 years with a CCC who died of disease-related causes between 2000 and 2013. Rates of and sociodemographic and clinical factors associated with previously defined inpatient end-of-life intensity indicators were determined. The intensity indicators included: (1) hospital death, (2) receipt of a medically intense intervention within 30 days of death (ICU admission, cardiopulmonary resuscitation, hemodialysis, and/or intubation), and (3) having ≥2 intensity markers (including hospital death).RESULTS: There were 8654 children in the study population with a mean death age of 11.8 years (SD 6.8). The 3 most common CCC categories were neuromuscular (47%), malignancy (43%), and cardiovascular (42%). Sixty-six percent of the children died in the hospital, 36% had a medically intense intervention in the last 30 days of life, and 35% had ≥2 intensity markers. Living in a low-income neighborhood was associated with increased odds of hospital death, a medically intense intervention, and ≥2 intensity markers. Hispanic and "other" race and/or ethnicity were associated with hospital death and ≥2 intensity markers. Age 15 to 21 years was associated with hospital death, a medically intense intervention, and ≥2 intensity markers.CONCLUSIONS: Sociodemographic disparities in the intensity of end-of-life care for children with CCCs raise concerns about whether all children are receiving high-quality and goal-concordant end-of-life care.
View details for PubMedID 30971431
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Parents' Use of Technologies for Health Management: A Health Literacy Perspective.
Academic pediatrics
Meyers, N., Glick, A. F., Mendelsohn, A. L., Parker, R. M., Sanders, L. M., Wolf, M. S., Bailey, S., Dreyer, B. P., Velazquez, J. J., Yin, H. S.
2019
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Abstract
OBJECTIVE: Parent use of technology to manage child health issues has the potential to improve access and health outcomes. Few studies have examined how parent health literacy affects usage of Internet and cell phone technologies for health management.METHODS: Cross-sectional analysis of data collected as part of a randomized controlled experiment in 3 urban pediatric clinics. English- and Spanish-speaking parents (n=858) of children ≤8 years answered questions regarding use of and preferences related to Internet and cell phone technologies. Parent health literacy was measured using the Newest Vital Sign.RESULTS: The majority of parents were high Internet (70.2%) and cell phone (85.1%) utilizers (multiple times a day). 75.1% had limited health literacy (32.1% marginal, 43.0% low). Parents with higher health literacy had greater Internet and cell phone use (adequate vs. low: AOR=1.7[1.2-2.5]) and were more likely to use them for health management (AOR=1.5[1.2-1.8]); those with higher health literacy were more likely to use the Internet for provider communication (adequate vs. marginal vs. low: 25.0 vs. 18.0 vs. 12.0%, p=0.001) and health-related cell phone apps (40.6 vs. 29.7 vs. 16.4%, p<0.001). Overall preference for using technology for provider communication was high (70%) and did not differ by health literacy, although Internet and cell phone apps were preferred by higher literacy parents; no differences seen for texting.CONCLUSIONS: Health literacy-associated disparities in parent use of Internet and cell phone technologies exist, but parents' desire for use of these technologies for provider communication was overall high and did not differ by health literacy.
View details for PubMedID 30862511
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Health Care System Factors Associated with Transition Preparation in Youth with Special Health Care Needs
POPULATION HEALTH MANAGEMENT
McKenzie, R., Sanders, L., Bhattacharya, J., Bundorf, M.
2019; 22 (1): 63–73
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View details for DOI 10.1089/pop.2018.0027
View details for Web of Science ID 000463371500010
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Development and use of an adjusted nurse staffing metric in the neonatal intensive care unit.
Health services research
Tawfik, D. S., Profit, J. n., Lake, E. T., Liu, J. B., Sanders, L. M., Phibbs, C. S.
2019
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Abstract
To develop a nurse staffing prediction model and evaluate deviation from predicted nurse staffing as a contributor to patient outcomes.Secondary data collection conducted 2017-2018, using the California Office of Statewide Health Planning and Development and the California Perinatal Quality Care Collaborative databases. We included 276 054 infants born 2008-2016 and cared for in 99 California neonatal intensive care units (NICUs).Repeated-measures observational study. We developed a nurse staffing prediction model using machine learning and hierarchical linear regression and then quantified deviation from predicted nurse staffing in relation to health care-associated infections, length of stay, and mortality using hierarchical logistic and linear regression.We linked NICU-level nurse staffing and organizational data to patient-level risk factors and outcomes using unique identifiers for NICUs and patients.An 11-factor prediction model explained 35 percent of the nurse staffing variation among NICUs. Higher-than-predicted nurse staffing was associated with decreased risk-adjusted odds of health care-associated infection (OR: 0.79, 95% CI: 0.63-0.98), but not with length of stay or mortality.Organizational and patient factors explain much of the variation in nurse staffing. Higher-than-predicted nurse staffing was associated with fewer infections. Prospective studies are needed to determine causality and to quantify the impact of staffing reforms on health outcomes.
View details for DOI 10.1111/1475-6773.13249
View details for PubMedID 31869865
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Hospitalization Patterns for Inpatient Surgery and Procedures in California:2000 – 2016
Anesthesia and Analgesia
Muffly, M. K., Honkanen, A., Scheinker, D., Wang, T., Saynina, O., Singleton, M. A., , Wang, C. J., Sanders, L. M.
2019
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View details for DOI 10.1213/ANE.0000000000004552
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Pneumonia Prevention Strategies for Children With Neurologic Impairment.
Pediatrics
Lin, J. L., Van Haren, K. n., Rigdon, J. n., Saynina, O. n., Song, H. n., Buu, M. C., Thakur, Y. n., Srinivas, N. n., Asch, S. M., Sanders, L. M.
2019
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Abstract
Children with neurologic impairment (NI) face high risk of recurrent severe pneumonia, with prevention strategies of unknown effectiveness. We evaluated the comparative effectiveness of secondary prevention strategies for severe pneumonia in children with NI.We included children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with NI and 1 pneumonia hospitalization. We examined associations between subsequent pneumonia hospitalization and expert-recommended prevention strategies: dental care, oral secretion management, gastric acid suppression, gastrostomy tube placement, chest physiotherapy, outpatient antibiotics before index hospitalization, and clinic visit before or after index hospitalization. We used a 1:2 propensity score matched model to adjust for covariates, including sociodemographics, medical complexity, and severity of index hospitalization.Among 3632 children with NI and index pneumonia hospitalization, 1362 (37.5%) had subsequent pneumonia hospitalization. Only dental care was associated with decreased risk of subsequent pneumonia hospitalization (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.49-0.85). Exposures associated with increased risk included gastrostomy tube placement (aOR: 2.15; 95% CI: 1.63-2.85), chest physiotherapy (aOR: 2.03; 95% CI: 1.29-3.20), outpatient antibiotics before hospitalization (aOR: 1.42; 95% CI: 1.06-1.92), clinic visit before (aOR: 1.30; 95% CI: 1.11-1.52), and after index hospitalization (aOR: 1.72; 95% CI: 1.35-2.20).Dental care was associated with decreased recurrence of severe pneumonia. Several strategies, including gastrostomy tube placement, were associated with increased recurrence, possibly due to unresolved confounding by indication. Our results support a clinical trial of dental care to prevent severe pneumonia in children with NI.
View details for DOI 10.1542/peds.2019-0543
View details for PubMedID 31537634
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Impact of a Mobile App-Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study.
JMIR mHealth and uHealth
Cueto, V. n., Wang, C. J., Sanders, L. M.
2019; 7 (11): e14458
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Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement.The aim of this study was to assess child engagement over time, with a mobile app-based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status.This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan.A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in -8.03 (95% CI -10.19 to -5.87) and -9.34 (95% CI -11.31 to -7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was -0.21 (95% CI -0.25 to -0.17) per additional coaching session (P<.001).Among overweight and obese children using a mobile app-based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status.
View details for DOI 10.2196/14458
View details for PubMedID 31730041
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Neighborhood Commute to Work Times and Self-Reported Caregiver Health Behaviors and Food Access
ACADEMIC PEDIATRICS
White, M. J., Yin, H., Rothman, R. L., Sanders, L. M., Delamater, A., Flower, K., Perrin, E. M.
2019; 19 (1): 74–79
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Time spent commuting is associated with obesity. The objective of this study was to assess the relationship between neighborhood-level commute to work (CTW) times and self-reported health behaviors and food access.We conducted a cross-sectional analysis of caregivers with infants as part of the Greenlight Study, a multisite obesity trial in Chapel Hill, New York City, Nashville, and Miami. ZIP code-based commuting estimates were determined using the US Census American Community Survey. Self-reported health behaviors and food access data were collected by directed interview. Logistic and linear regression models were used to determine associations between neighborhood CTW times and health behaviors and food access.The average neighborhood CTW time for all ZIP codes was 29 minutes (n = 846). Caregivers in longer CTW time neighborhoods were more likely to endorse fewer food choices (adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.15-1.69; P = .001) and difficulty accessing markets with fresh produce (AOR, 1.51; 95% CI, 1.02-2.25; P = .04). Neighborhood CTW time >30 minutes was associated with less caregiver physical activity (AOR, 0.58; 95% CI, 0.34-0.98; P = .044). Neighborhood CTW time was inversely related to infant television time (adjusted mean, 399 minutes/day for ≤30 minutes and 256 minutes/day for >30 minutes; P = .025). New York families in longer CTW neighborhoods were more likely to report difficulty accessing markets with fresh produce (AOR, 1.80; 95% CI, 1.03-3.14; P = .039).Neighborhood CTW time is associated with several self-reported health behaviors and perceived food access among caregivers with children. Neighborhood CTW times may represent city-specific features, including transportation infrastructure, which may impact the health of families.
View details for PubMedID 30041009
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Identifying and Advancing Best Practices for the Chock for updates Labeling and Dosing of Pediatric Liquid Medications: Progress and Challenges
ACADEMIC PEDIATRICS
Yin, H., Vuong, C., Parker, R. M., Sanders, L. M., Mendelsohn, A. L., Dreyer, B. P., Velazquez, J. J., Wolf, M. S.
2019; 19 (1): 1–3
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View details for PubMedID 30096446
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Parental Feeding Beliefs and Practices and Household Food Insecurity in Infancy
ACADEMIC PEDIATRICS
Orr, C. J., Ben -Davies, M., Ravanbakht, S. N., Yin, H., Sanders, L. M., Rothman, R. L., Delamater, A. M., Wood, C. T., Perrin, E. M.
2019; 19 (1): 80–89
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Food insecurity is associated with childhood obesity possibly mediated through caregiver feeding practices and beliefs. We examined if caregiver feeding practices differed by household food security status in a diverse sample of infants. We hypothesized that feeding practices differ based on food security status.Included in the baseline cross-sectional analysis of data from a randomized controlled trial to prevent obesity were 842 caregivers of 2-month-old infants presenting for well-child care at 4 academic institutions. Food insecurity exposure was based on an affirmative answer to 1 of 2 items in a 2-item validated questionnaire. Chi-square tests examined the association between parent feeding practices and food security status. Logistic regression adjusted for covariates. Differences in caregiver feeding practices by food security status and race/ethnicity were explored with an interaction term (food security status x race/ethnicity).Forty-three percent of families screened as food insecure. In adjusted logistic regression, parents from food-insecure households were more likely to endorse that "the best way to make an infant stop crying is to feed him or her" (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.28-2.29) and "when my baby cries, I immediately feed him or her" (aOR, 1.40; 95% CI, 1.06-1.83). Food-insecure caregivers less frequently endorsed paying attention to their baby when he or she is full or hungry (OR, 0.57; 95% CI, 0.34-0.96). Racial/ethnic differences in beliefs and behaviors were observed by food security status.During early infancy, feeding practices differed among caregivers by household food security status. Further research is needed to examine whether these practices are associated with increased risk of obesity and obesity-related morbidity.
View details for PubMedID 30248471
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A Brochure to Improve Understanding of Incomplete Mammogram Results Among Black Women at a Public Hospital in Miami, Florida.
Southern medical journal
Marcus, E. N., Sanders, L. M., Jones, B. A., Koru-Sengul, T.
2019; 112 (1): 1–7
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OBJECTIVES: Black women are at increased risk of being called back for additional studies after a screening mammogram. With focus group input, we developed a brochure to improve awareness of the frequency of abnormal results. This study explored the brochure's acceptability and effect on understanding risk and breast cancer fears among black mammography patients at an urban safety-net breast imaging center in Miami, Florida.METHODS: A randomized controlled trial of the brochure (plus the standard result notification letter) versus usual care (standard notification letter alone). Black English-speaking women with an incomplete mammography result were randomized to the intervention or control group. Consenting participants completed a telephone questionnaire. Outcomes included awareness of result, anxiety level, and brochure acceptability. The chi2 or Fisher exact test was used and a univariate logistic regression was performed for intervention and control odds ratios.RESULTS: A total of 106 women were randomly selected to receive the brochure plus the letter or the letter alone. One chose to opt out; a minimum of three attempts were made to reach each of the remaining 105 women by telephone. Verbal communication was established with 59 of the randomized women, and 51 of those women agreed to participate in a survey to evaluate the brochure. There was no significant difference between the surveyed groups in knowledge of the result and follow-up plan. Surveyed intervention subjects were more likely to agree that "it is very common for women to have to follow up after a mammogram" (odds ratio [OR] 25.91, P = 0.029) and less likely to agree with the statement "getting a follow-up mammogram is scary" (OR 0.24, P = 0.021). Most intervention subjects said the pamphlet helped them understand their result "a lot" (79%, 19) and viewed it as "extremely" or "mostly" clear (96%, 23). Intervention subjects also voiced greater awareness of a telephone number they could call for more information about cancer (OR 11.38, P = 0.029).CONCLUSIONS: A culturally tailored brochure explaining the frequency of abnormal mammograms was well received by women at a large safety-net health system. Pilot testing suggests that it may improve patient perception of risk and awareness of informational resources. This strategy should be considered to enhance result communication.
View details for PubMedID 30608622
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A Brochure to Improve Understanding of Incomplete Mammogram Results Among Black Women at a Public Hospital in Miami, Florida
SOUTHERN MEDICAL JOURNAL
Marcus, E. N., Sanders, L. M., Jones, B. A., Koru-Sengul, T.
2019; 112 (1): 1–7
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View details for DOI 10.14423/SMJ.0000000000000919
View details for Web of Science ID 000455050000001
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Parent Dosing Tool Use, Beliefs, and Access: A Health Literacy Perspective.
The Journal of pediatrics
Williams, T. A., Wolf, M. S., Parker, R. M., Sanders, L. M., Bailey, S. n., Mendelsohn, A. L., Dreyer, B. P., Velazquez, J. J., Yin, H. S.
2019
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Abstract
To assess parent decision-making regarding dosing tools, a known contributor to medication dosing errors, by evaluating parent dosing tool use, beliefs, and access, and the role of health literacy, with a focus on dosing cups, which are associated with an increased risk of multifold overdose.Cross-sectional analysis of data collected for randomized controlled study in 3 urban pediatric clinics. English/Spanish-speaking parents (n = 493) of children ≤8 years of age enrolled.reported tool use, beliefs, and access. Predictor variable: health literacy (Newest Vital Sign; limited [0-3], adequate [4-6]). Multiple logistic regression analyses conducted.Over two-thirds of parents had limited health literacy. Oral syringes (62%) and dosing cups (22%) were most commonly used. Overall, 24% believed dosing cups were the best tool type for dosing accuracy; 99% reported having access to ≥1 dosing tools with standard measurement markings. Parents with limited health literacy had greater odds of dosing cup use (limited vs adequate: aOR = 2.4 [1.2-4.6]). Parents who believed that dosing cups are best for accuracy had greater odds of dosing cup use (aOR = 16.3 [9.0-29.3]); this belief mediated health literacy-effects on dosing cup use.Factors associated with dosing tool choice, including parent health literacy and beliefs are important to consider in the design of interventions to reduce dosing errors; future larger-scale studies addressing this issue are needed.
View details for DOI 10.1016/j.jpeds.2019.08.017
View details for PubMedID 31604631
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End-of-Life Care Intensity in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: A Population-Level Analysis.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Johnston, E. E., Muffly, L., Alvarez, E., Saynina, O., Sanders, L. M., Bhatia, S., Chamberlain, L. J.
2018: JCO2018780957
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Purpose Intensity of end-of-life care receives much attention in oncology because of concerns that high-intensity care is inconsistent with patient goals, leads to worse caregiver outcomes, and is expensive. Little is known about such care in those undergoing allogeneic hematopoietic cell transplantation (HCT), a population at high risk for morbidity and mortality. Patients and Methods We conducted a population-based analysis of patients who died between 2000 and 2013, within 1 year of undergoing an inpatient allogeneic HCT using California administrative data. Previously validated markers of intensity were examined and included: hospital death, intensive care unit (ICU) admission, and procedures such as intubation and cardiopulmonary resuscitation at end of life. Multivariable logistic regression models determined clinical and sociodemographic factors associated with: hospital death, a medically intense intervention (ICU admission, cardiopulmonary resuscitation, hemodialysis, intubation), and ≥ two intensity markers. Results Of the 2,135 patients in the study population, 377 were pediatric patients (age ≤ 21 years), 461 were young adults (age 22 to 39 years), and 1,297 were adults (age ≥ 40 years). The most common intensity markers were: hospital death (83%), ICU admission (49%), and intubation (45%). Medical intensity varied according to age, underlying diagnosis, and presence of comorbidities at time of HCT. Patients with higher-intensity end-of-life care included patients age 15 to 21 years and 30 to 59 years, patients with acute lymphoblastic leukemia, and those with comorbidities at time of HCT. Conclusion Patients dying within 1 year of inpatient allogeneic HCT are receiving medically intense end-of-life care with variations related to age, underlying diagnosis, and presence of comorbidities at time of HCT. Future studies need to determine if these patterns are consistent with patient and family goals.
View details for PubMedID 30183467
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Immigration Policy: Valuing Children
ACADEMIC PEDIATRICS
Mendoza, F. S., Cueto, V., Lawrence, D., Sanders, L., Weintraub, D.
2018; 18 (7): 723–25
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View details for Web of Science ID 000443532400001
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In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight.
International journal of environmental research and public health
Eneriz-Wiemer, M., Sanders, L. M., McIntyre, M., Mendoza, F. S., Do, D. P., Wang, C. J.
2018; 15 (8)
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To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43⁻0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06⁻1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay.
View details for DOI 10.3390/ijerph15081570
View details for PubMedID 30044374
View details for PubMedCentralID PMC6121500
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Policy priorities for child health: results from a membership survey of the Society for Pediatric Research
PEDIATRIC RESEARCH
Shah, S., Balasubramaniam, V., Brumberg, H. L., Sanders, L.
2018; 84 (1): 6–9
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View details for PubMedID 29915410
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Immigration Policy: Valuing Children.
Academic pediatrics
Mendoza, F. S., Cueto, V., Lawrence, D., Sanders, L., Weintraub, D.
2018
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View details for PubMedID 29966712
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Health Care System Factors Associated with Transition Preparation in Youth with Special Health Care Needs.
Population health management
McKenzie, R. B., Sanders, L., Bhattacharya, J., Bundorf, M. K.
2018
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The aim of this study was to assess: (1) the proportion of youth with special health care needs (YSHCN) with adequate transition preparation, (2) whether transition preparation differs by individual, condition-related and health care system-related factors, and (3) whether specific components of the medical home are associated with adequate transition preparation. The authors conducted a cross-sectional analysis of the 2009-2010 National Survey of Children with Special Health Care Needs, which surveyed a nationally representative sample of 17,114 parents of YSHCN ages 12 to 18 years. Adequate transition preparation was based on positive responses to questions about transition to an adult provider, changing health care needs, maintaining insurance coverage, and if providers encouraged YSHCN to take responsibility for health care needs. Weighted descriptive, bivariate and multivariate analyses were conducted to determine the association between patient and health care system factors and adequate transition preparation. Overall, 32.1% of YSHCN had adequate transition preparation. Older age, female sex, income ≤400% of the poverty level, lack of medical complexity, and having shared decision making, family-centered care, and effective care coordination were associated with increased odds of transition preparation. The majority of YSHCN do not receive adequate transition preparation and younger, male adolescents with medical complexity were less likely to receive transition preparation. Different patterns of disparities were identified for each subcomponent measure of transition preparation, which may help target at-risk populations for specific services. Efforts to improve transition preparation should leverage specific components of the medical home including care coordination, shared decision making, and family-centered care.
View details for PubMedID 29957127
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How gaps in policy implementation cause public health malpractice
LANCET
Javier, J. R., Brumberg, H. L., Sanders, L., Hannon, T. S., Shah, S., Soc Pediat Res Advocacy Comm
2018; 391 (10138): 2414
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View details for PubMedID 29916382
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Inpatient Utilization and Disparities: The Last Year of Life of Adolescent and Young Adult Oncology Patients in California
CANCER
Johnston, E. E., Alvarez, E., Saynina, O., Sanders, L. M., Bhatia, S., Chamberlain, L. J.
2018; 124 (8): 1819–27
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Studies of adolescent and young adult (AYA) oncology end-of-life care utilization are critical because cancer is the leading cause of nonaccidental AYA death and end-of-life care contributes significantly to health care expenditures. This study was designed to determine the quantity of and disparities in inpatient utilization in the last year of life of AYAs with cancer.The California Office of Statewide Health Planning and Development administrative discharge database, linked to death certificates, was used to perform a population-based analysis of cancer patients aged 15 to 39 years who died in 2000-2011. The number of hospital days and the inpatient costs were determined for each patient in the last year of his or her life, as were clinical and sociodemographic factors associated with high inpatient utilization. Admission patterns as death approached were also evaluated.The 12,883 patients were admitted for 40 days on average in the last year of life, and this cost
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E-Health Care: Promise or Peril for Chronic Illness
JOURNAL OF PEDIATRICS
Sanders, L. M.
2018; 195: 15
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View details for PubMedID 29331325
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Leveraging Medical Conferences and Webinars for Hands-On Clinical Quality Improvement: An Intervention to Improve Health Literacy-Informed Communication in Pediatrics
AMERICAN JOURNAL OF MEDICAL QUALITY
Shaikh, U., Yin, H., Mistry, K. B., Randolph, G. D., Sanders, L. M., Ferguson, L. E.
2018; 33 (2): 213–15
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View details for PubMedID 28709388
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Status Complexicus? The Emergence of Pediatric Complex Care
PEDIATRICS
Cohen, E., Berry, J. G., Sanders, L., Schor, E. L., Wise, P. H.
2018; 141: S202–S211
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Abstract
Discourse about childhood chronic conditions has transitioned in the last decade from focusing primarily on broad groups of children with special health care needs to concentrating in large part on smaller groups of children with medical complexity (CMC). Although a variety of definitions have been applied, the term CMC has most commonly been defined as children and youth with serious chronic conditions, substantial functional limitations, increased health and other service needs, and increased health care costs. The increasing attention paid to CMC has occurred because these children are growing in impact, represent a disproportionate share of health system costs, and require policy and programmatic interventions that differ in many ways from broader groups of children with special health care needs. But will this change in focus lead to meaningful changes in outcomes for children with serious chronic diseases, or is the pediatric community simply adopting terminology with resonance in adult-focused health systems? In this article, we will explore the implications of the rapid emergence of pediatric complex care in child health services practice and research. As an emerging field, pediatric care systems should thoughtfully and rapidly develop evidence-based solutions to the new challenges of caring for CMC, including (1) clearer definitions of the target population, (2) a more appropriate incorporation of components of care that occur outside of hospitals, and (3) a more comprehensive outcomes measurement framework, including the recognition of potential limitations of cost containment as a target for improved care for CMC.
View details for PubMedID 29496971
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Models of Care Delivery for Children With Medical Complexity
PEDIATRICS
Pordes, E., Gordon, J., Sanders, L. M., Cohen, E.
2018; 141: S212–S223
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Children with medical complexity (CMC) are a subset of children and youth with special health care needs with high resource use and health care costs. Novel care delivery models in which care coordination and other services to CMC are provided are a focus of national and local health care and policy initiatives. Current models of care for CMC can be grouped into 3 main categories: (1) primary care-centered models, (2) consultative- or comanagement-centered models, and (3) episode-based models. Each model has unique advantages and disadvantages. Evaluations of these models have demonstrated positive outcomes, but most studies have limited generalizability for broader populations of CMC. A lack of standardized outcomes and population definitions for CMC hinders assessment of the comparative effectiveness of different models of care and identification of which components of the models lead to positive outcomes. Ongoing challenges include inadequate support for family caregivers and threats to the sustainability of models of care. Collaboration among key stakeholders (patients, families, providers, payers, and policy makers) is needed to address the gaps in care and create best practice guidelines to ensure the delivery of high-value care for CMC.
View details for PubMedID 29496972
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Shared decision making among children with medical complexity: results from a population-based survey
The Journal of Pediatrics
Lin, J. L., Cohen, E., Sanders, L. M.
2018: 216–22
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To compare the rates of shared decision making (SDM) reported by parents of children with medical complexity (CMC) with the rates of SDM reported by parents of noncomplex children with special health care needs (CSHCN).We examined the 2009-2010 National Survey of Children with Special Health Care Needs, a representative survey of 40 242 parents of CSHCN. CMC was defined as needing or using more medical care than usual, seeing 2 or more subspecialists, and positive response on at least 3 other items on the CSHCN screener. We identified 3 subgroups each of CMC and noncomplex CSHCN by sentinel diagnoses: asthma, seizures, and other diagnoses. SDM was defined as a binary composite variable, derived from 4 discrete items. We constructed 4 stepwise multivariable models to assess the relative odds of SDM, adjusted for sociodemographic characteristics (age, income, language, race, ethnicity, and marital status), behavioral comorbidity, family-centered care, and patient-centered medical home.The study population included 39 876 respondents. Compared with noncomplex CSHCN, CMC had a lower likelihood of SDM (aOR, 0.76; 95% CI, 0.64-0.91), which persisted in diagnostic subgroups: CMC with asthma (aOR, 0.67; 95% CI, 0.49-0.92) and CMC with other diagnoses (aOR, 0.74; 95% CI, 0.58-0.94), but not CMC with seizures (aOR, 0.95; 95% CI, 0.59-1.51).SDM is less common for CSHCN with complex needs than those without complex needs. Health system interventions targeting future-oriented care planning may improve SDM for CMC.
View details for DOI 10.1016/j.jpeds.2017.09.001
View details for PubMedCentralID PMC5732902
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Shared Decision Making among Children with Medical Complexity: Results from a Population-Based Survey.
The Journal of pediatrics
Lin, J. L., Cohen, E., Sanders, L. M.
2018; 192: 216-222
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To compare the rates of shared decision making (SDM) reported by parents of children with medical complexity (CMC) with the rates of SDM reported by parents of noncomplex children with special health care needs (CSHCN).We examined the 2009-2010 National Survey of Children with Special Health Care Needs, a representative survey of 40 242 parents of CSHCN. CMC was defined as needing or using more medical care than usual, seeing 2 or more subspecialists, and positive response on at least 3 other items on the CSHCN screener. We identified 3 subgroups each of CMC and noncomplex CSHCN by sentinel diagnoses: asthma, seizures, and other diagnoses. SDM was defined as a binary composite variable, derived from 4 discrete items. We constructed 4 stepwise multivariable models to assess the relative odds of SDM, adjusted for sociodemographic characteristics (age, income, language, race, ethnicity, and marital status), behavioral comorbidity, family-centered care, and patient-centered medical home.The study population included 39 876 respondents. Compared with noncomplex CSHCN, CMC had a lower likelihood of SDM (aOR, 0.76; 95% CI, 0.64-0.91), which persisted in diagnostic subgroups: CMC with asthma (aOR, 0.67; 95% CI, 0.49-0.92) and CMC with other diagnoses (aOR, 0.74; 95% CI, 0.58-0.94), but not CMC with seizures (aOR, 0.95; 95% CI, 0.59-1.51).SDM is less common for CSHCN with complex needs than those without complex needs. Health system interventions targeting future-oriented care planning may improve SDM for CMC.
View details for DOI 10.1016/j.jpeds.2017.09.001
View details for PubMedID 29102046
View details for PubMedCentralID PMC5732902
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In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight
International Journal of Environmental Research and Public Health
Eneriz-Wiemer, M., Sanders, L., McIntrye, M., Mendoza, F., Do, D., Wang, C.
2018; 15 (8)
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Abstract
To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43⁻0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06⁻1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay.
View details for DOI 10.3390/ijerph15081570
View details for PubMedCentralID PMC6121500
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The Patient Protection and Affordable Care Act dependent coverage expansion: Disparities in impact among young adult oncology patients
CANCER
Alvarez, E. M., Keegan, T. H., Johnston, E. E., Haile, R., Sanders, L., Wise, P. H., Saynina, O., Chamberlain, L. J.
2018; 124 (1): 110–17
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Abstract
Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer.The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level.Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods.The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7. © 2017 American Cancer Society.
View details for PubMedID 28940423
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Disparities in location of death of adolescents and young adults with cancer: A longitudinal, population study in California
CANCER
Rajeshuni, N., Johnston, E. E., Saynina, O., Sanders, L. M., Chamberlain, L. J.
2017; 123 (21): 4178–84
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Patients with a terminal illness should have access to their chosen location of death. Cancer is the leading cause of non-accidental death among adolescents and young adults (AYAs; those aged 15-39 years). Although surveys have suggested that a majority of these patients prefer a home death, to the authors' knowledge, little is known regarding their barriers to accessing their preferred location of death. As a first step, the authors sought to determine, across a large population, 20-year trends in the location of death among AYA patients with cancer.Using the Vital Statistics Death Certificate Database of the California Office of Statewide Health Planning and Development, the authors performed a retrospective, population-based analysis of California patients with cancer aged 15 to 39 years who died between 1989 and 2011. Sociodemographic and clinical factors associated with hospital death were examined using multivariable logistic regression.Of 30,573 AYA oncology decedents, 57% died in a hospital, 33% died at home, and 10% died in other locations (eg, hospice facility or nursing facility). Between 1989 and 1994, hospital death rates decreased from 68.3% to 53.6% and at-home death rates increased from 16.8% to 35.5%. Between 1995 and 2011, these rates were stable. Those individuals who were more likely to die in a hospital were those aged <30 years, of minority race, of Hispanic ethnicity, who lived ≤10 miles from a specialty center, and who had a diagnosis of leukemia or lymphoma.Overall, the majority of AYA cancer deaths occurred in a hospital, with a 5-year shift to more in-home deaths that abated after 1995. In-hospital deaths were more common among younger patients, patients of minority race/ethnicities, and those with a leukemia or lymphoma diagnosis. Further study is needed to determine whether these rates and disparities are consistent with patient preferences. Cancer 2017;123:4178-4184. © 2017 American Cancer Society.
View details for PubMedID 28700812
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Disparities in the Intensity of End-of-Life Care for Children With Cancer
PEDIATRICS
Johnston, E. E., Alvarez, E., Saynina, O., Sanders, L., Bhatia, S., Chamberlain, L. J.
2017; 140 (4)
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Many adult patients with cancer who know they are dying choose less intense care; additionally, high-intensity care is associated with worse caregiver outcomes. Little is known about intensity of end-of-life care in children with cancer.By using the California Office of Statewide Health Planning and Development administrative database, we performed a population-based analysis of patients with cancer aged 0 to 21 who died between 2000 and 2011. Rates of and sociodemographic and clinical factors associated with previously-defined end-of-life intensity indicators were determined. The intensity indicators included an intense medical intervention (cardiopulmonary resuscitation, intubation, ICU admission, or hemodialysis) within 30 days of death, intravenous chemotherapy within 14 days of death, and hospital death.The 3732 patients were 34% non-Hispanic white, and 41% had hematologic malignancies. The most prevalent intensity indicators were hospital death (63%) and ICU admission (20%). Sixty-five percent had ≥1 intensity indicator, 23% ≥2, and 22% ≥1 intense medical intervention. There was a bimodal association between age and intensity: ages <5 years and 15 to 21 years was associated with intense care. Patients with hematologic malignancies were more likely to have high-intensity end-of-life care, as were patients from underrepresented minorities, those who lived closer to the hospital, those who received care at a nonspecialty center (neither Children's Oncology Group nor National Cancer Institute Designated Cancer Center), and those receiving care after 2008.Nearly two-thirds of children who died of cancer experienced intense end-of-life care. Further research needs to determine if these rates and disparities are consistent with patient and/or family goals.
View details for PubMedID 28963112
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End-of-Life Intensity for Adolescents and Young Adults With Cancer: A Californian Population-Based Study That Shows Disparities
JOURNAL OF ONCOLOGY PRACTICE
Johnston, E. E., Alvarez, E., Saynina, O., Sanders, L., Bhatia, S., Chamberlain, L. J.
2017; 13 (9): E770–E781
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Abstract
Cancer is the leading cause of nonaccidental death among adolescents and young adults (AYAs). High-intensity end-of-life care is expensive and may not be consistent with patient goals. However, the intensity of end-of-life care for AYA decedents with cancer-especially the effect of care received at specialty versus nonspecialty centers-remains understudied.We conducted a retrospective, population-based analysis with the California administrative discharge database that is linked to death certificates. The cohort included Californians age 15 to 39 years who died between 2000 and 2011 with cancer. Intense end-of-life interventions included readmission, admission to an intensive care unit, intubation in the last month of life, and in-hospital death. Specialty centers were defined as Children's Oncology Group centers and National Cancer Institute-designated comprehensive cancer centers.Of the 12,938 AYA cancer decedents, 59% received at least one intense end-of-life care intervention, and 30% received two or more. Patients treated at nonspecialty centers were more likely than those at specialty-care centers to receive two or more intense interventions (odds ratio [OR], 1.46; 95% CI, 1.32 to 1.62). Sociodemographic and clinical factors associated with two or more intense interventions included minority race/ethnicity (Black [OR, 1.35, 95% CI, 1.17 to 1.56]; Hispanic [OR, 1.24; 95% CI, 1.12 to 1.36]; non-Hispanic white: reference), younger age (15 to 21 years [OR, 1.36; 95% CI, 1.19 to 1.56; 22 to 29 years [OR,1.26; 95% CI,1.14 to 1.39]; ≥ 30 years: reference), and hematologic malignancies (OR, 1.53; 95% CI, 1.41 to 1.66; solid tumors: reference).Thirty percent of AYA cancer decedents received two or more high-intensity end-of-life interventions. In addition to sociodemographic and clinical characteristics, hospitalization in a nonspecialty center was associated with high-intensity end-of-life care. Additional research is needed to determine if these disparities are consistent with patient preference.
View details for PubMedID 28829692
View details for PubMedCentralID PMC5598313
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Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study
PEDIATRICS
Yin, H., Parker, R. M., Sanders, L. M., Mendelsohn, A., Dreyer, B. P., Bailey, S., Patel, D. A., Jimenez, J. J., Kim, K. A., Jacobson, K., Smith, M. J., Hedlund, L., Meyers, N., McFadden, T., Wolf, M. S.
2017; 140 (1)
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View details for DOI 10.1542/peds.2016-3237
View details for Web of Science ID 000404482500013
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Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study.
Pediatrics
Yin, H. S., Parker, R. M., Sanders, L. M., Mendelsohn, A., Dreyer, B. P., Bailey, S. C., Patel, D. A., Jimenez, J. J., Kim, K. A., Jacobson, K., Smith, M. C., Hedlund, L., Meyers, N., McFadden, T., Wolf, M. S.
2017; 140 (1)
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Poorly designed labels and dosing tools contribute to dosing errors. We examined the degree to which errors could be reduced with pictographic diagrams, milliliter-only units, and provision of tools more closely matched to prescribed volumes.This study involved a randomized controlled experiment in 3 pediatric clinics. English- and Spanish-speaking parents (n = 491) of children ≤8 years old were randomly assigned to 1 of 4 groups and given labels and dosing tools that varied in label instruction format (text and pictogram, or text only) and units (milliliter-only ["mL"] or milliliter/teaspoon ["mL/tsp"]). Each parent measured 9 doses of liquid medication (3 amounts [2, 7.5, and 10 mL] and 3 tools [1 cup, 2 syringes (5- and 10-mL capacities)]) in random order. The primary outcome was dosing error (>20% deviation), and large error (>2× dose).We found that 83.5% of parents made ≥1 dosing error (overdosing was present in 12.1% of errors) and 29.3% of parents made ≥1 large error (>2× dose). The greatest impact on errors resulted from the provision of tools more closely matched to prescribed dose volumes. For the 2-mL dose, the fewest errors were seen with the 5-mL syringe (5- vs 10-mL syringe: adjusted odds ratio [aOR] = 0.3 [95% confidence interval: 0.2-0.4]; cup versus 10-mL syringe: aOR = 7.5 [5.7-10.0]). For the 7.5-mL dose, the fewest errors were with the 10-mL syringe, which did not necessitate measurement of multiple instrument-fulls (5- vs 10-mL syringe: aOR = 4.0 [3.0-5.4]; cup versus 10-mL syringe: aOR = 2.1 [1.5-2.9]). Milliliter/teaspoon was associated with more errors than milliliter-only (aOR = 1.3 [1.05-1.6]). Parents who received text only (versus text and pictogram) instructions or milliliter/teaspoon (versus milliliter-only) labels and tools made more large errors (aOR = 1.9 [1.1-3.3], aOR = 2.5 [1.4-4.6], respectively).Provision of dosing tools more closely matched to prescribed dose volumes is an especially promising strategy for reducing pediatric dosing errors.
View details for DOI 10.1542/peds.2016-3237
View details for PubMedID 28759396
View details for PubMedCentralID PMC5495522
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Inpatient Hospital Factors and Resident Time With Patients and Families
PEDIATRICS
Destino, L. A., Valentine, M., Sheikhi, F. H., Starmer, A. J., Landrigan, C. P., Sanders, L.
2017; 139 (5)
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Abstract
To define hospital factors associated with proportion of time spent by pediatric residents in direct patient care.We assessed 6222 hours of time-motion observations from a representative sample of 483 pediatric-resident physicians delivering inpatient care across 9 pediatric institutions. The primary outcome was percentage of direct patient care time (DPCT) during a single observation session (710 sessions). We used one-way analysis of variance to assess a significant difference in the mean percentage of DPCT between hospitals. We used the intraclass correlation coefficient analysis to determine within- versus between-hospital variations. We compared hospital characteristics of observation sessions with ≥12% DPCT to characteristics of sessions with <12% DPCT (12% is the DPCT in recent resident trainee time-motion studies). We conducted mixed-effects regression analysis to allow for clustering of sessions within hospitals and accounted for correlation of responses across hospital.Mean proportion of physician DPCT was 13.2% (SD = 8.6; range, 0.2%-49.5%). DPCT was significantly different between hospitals (P < .001). The intraclass correlation coefficient was 0.25, indicating more within-hospital than between-hospital variation. Observation sessions with ≥12% DPCT were more likely to occur at hospitals with Magnet designation (odds ratio [OR] = 3.45, P = .006), lower medical complexity (OR = 2.57, P = .04), and higher patient-to-trainee ratios (OR = 2.48, P = .05).On average, trainees spend <8 minutes per hour in DPCT. Variation exists in DPCT between hospitals. A less complex case mix, increased patient volume, and Magnet designation were independently associated with increased DPCT.
View details for DOI 10.1542/peds.2016-3011
View details for PubMedID 28557735
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Liquid Medication Dosing Errors by Hispanic Parents: Role of Health Literacy and English Proficiency
ACADEMIC PEDIATRICS
Harris, L. M., Dreyer, B. P., Mendelsohn, A. L., Bailey, S. C., Sanders, L. M., Wolf, M. S., Parker, R. M., Patel, D. A., Kim, K. Y., Jimenez, J. J., Jacobson, K., Smith, M., Yin, S.
2017; 17 (4): 403-410
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Abstract
Hispanic parents in the United States are disproportionately affected by low health literacy and limited English proficiency (LEP). We examined associations between health literacy, LEP, and liquid medication dosing errors in Hispanic parents.Cross-sectional analysis of data from a multisite randomized controlled experiment to identify best practices for the labeling/dosing of pediatric liquid medications (SAFE Rx for Kids study); 3 urban pediatric clinics. Analyses were limited to Hispanic parents of children aged ≤8 years with health literacy and LEP data (n = 1126). Parents were randomized to 1 of 5 groups that varied by pairing of units of measurement on the label/dosing tool. Each parent measured 9 doses (3 amounts [2.5, 5, 7.5 mL] using 3 tools [2 syringes in 0.2 or 0.5 mL increments, and 1 cup]) in random order. Dependent variable was a dosing error of >20% dose deviation. Predictor variables included health literacy (Newest Vital Sign) (limited = 0-3; adequate = 4-6) and LEP (speaks English less than "very well").A total of 83.1% made dosing errors (mean [SD] errors per parent = 2.2 [1.9]). Parents with limited health literacy and LEP had the greatest odds of making a dosing error compared to parents with adequate health literacy who were English proficient (trials with errors per parent = 28.8 vs 12.9%; adjusted odds ratio = 2.2 [95% confidence interval 1.7-2.8]). Parents with limited health literacy who were English proficient were also more likely to make errors (trials with errors per parent = 18.8%; adjusted odds ratio = 1.4 [95% confidence interval 1.1-1.9]).Dosing errors are common among Hispanic parents; those with both LEP and limited health literacy are at particular risk. Further study is needed to examine how the redesign of medication labels and dosing tools could reduce literacy- and language-associated disparities in dosing errors.
View details for Web of Science ID 000401298200010
View details for PubMedID 28477800
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Parent Preferences and Perceptions of mLs and Teaspoons: Role of Health Literacy and Experience.
Academic pediatrics
Torres, A., Parker, R. M., Sanders, L. M., Wolf, M. S., Bailey, S., Patel, D. A., Jimenez, J. J., Kim, K. A., Dreyer, B. P., Mendelsohn, A., Yin, H. S.
2017
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Abstract
A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience.Cross-sectional analysis of data collected as part of a randomized controlled study in 3 urban pediatric clinics (SAFE Rx for Kids study). English- and Spanish-speaking parents (n = 493) of children aged ≤8 years were randomized to 1 of 4 study arms and given labels and dosing tools which varied in label instruction format (text plus pictogram, text only) and units (milliliter only ["mL"], milliliter/teaspoon ["mL"/"tsp"]). Outcomes included teaspoon preference in dosing instructions and perceived difficulty with milliliter-only dosing. The predictor variable was health literacy (Newest Vital Sign; low [0-1], marginal [2-3], adequate [4-6]). The mediating variable was prior milliliter-dosing experience.Over two-thirds of parents had low or marginal health literacy. The majority (>70%) preferred to use milliliters, perceived milliliter-only dosing to be easy, and had prior milliliter-dosing experience; 11.5% had a teaspoon preference, 18.1% perceived milliliter-only dosing will be difficult, and 17.7% had no prior milliliter-dosing experience. Parents with lower health literacy had a higher odds of having a teaspoon preference (low vs adequate: adjusted odds ratio [AOR] = 2.9 [95% confidence interval [CI] 1.3-6.2]), and greater odds of perceiving difficulty with milliliter-only dosing (low vs adequate: AOR = 13.9 [95% CI 4.8-40.6], marginal vs adequate: AOR = 7.1 [95% CI 2.5-20.4]). Lack of experience with milliliter dosing partially mediated the impact of health literacy.Most parents were comfortable with milliliter-only dosing. Parents with low health literacy were more likely to perceive milliliter-only dosing to be difficult; educational efforts will need to target this group to ensure safe medication use.
View details for DOI 10.1016/j.acap.2017.04.001
View details for PubMedID 28400304
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Families as Partners in Hospital Error and Adverse Event Surveillance.
JAMA pediatrics
Khan, A., Coffey, M., Litterer, K. P., Baird, J. D., Furtak, S. L., Garcia, B. M., Ashland, M. A., Calaman, S., Kuzma, N. C., O'Toole, J. K., Patel, A., Rosenbluth, G., Destino, L. A., Everhart, J. L., Good, B. P., Hepps, J. H., Dalal, A. K., Lipsitz, S. R., Yoon, C. S., Zigmont, K. R., Srivastava, R., Starmer, A. J., Sectish, T. C., Spector, N. D., West, D. C., Landrigan, C. P., Allair, B. K., Alminde, C., Alvarado-Little, W., Atsatt, M., Aylor, M. E., Bale, J. F., Balmer, D., Barton, K. T., Beck, C., Bismilla, Z., Blankenberg, R. L., Chandler, D., Choudhary, A., Christensen, E., Coghlan-McDonald, S., Cole, F. S., Corless, E., Cray, S., Da Silva, R., Dahale, D., Dreyer, B., Growdon, A. S., Gubler, L., Guiot, A., Harris, R., Haskell, H., Kocolas, I., Kruvand, E., Lane, M. M., Langrish, K., Ledford, C. J., Lewis, K., Lopreiato, J. O., Maloney, C. G., Mangan, A., Markle, P., Mendoza, F., Micalizzi, D. A., Mittal, V., Obermeyer, M., O'Donnell, K. A., Ottolini, M., Patel, S. J., Pickler, R., Rogers, J. E., Sanders, L. M., Sauder, K., Shah, S. S., Sharma, M., Simpkin, A., Subramony, A., Thompson, E. D., Trueman, L., Trujillo, T., Turmelle, M. P., Warnick, C., Welch, C., White, A. J., Wien, M. F., Winn, A. S., Wintch, S., Wolf, M., Yin, H. S., Yu, C. E.
2017
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Abstract
Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection.To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports.We conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; κ, 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient.Error and AE rates.Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P = .006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates.Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety.
View details for DOI 10.1001/jamapediatrics.2016.4812
View details for PubMedID 28241211
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Adolescent and young adult oncology patients: Disparities in access to specialized cancer centers.
Cancer
Alvarez, E., Keegan, T., Johnston, E. E., Haile, R., Sanders, L., Saynina, O., Chamberlain, L. J.
2017
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Abstract
Adolescents and young adults (AYAs) ages 15 to 39 years with cancer continue to experience disparate survival outcomes compared with their younger and older counterparts. This may be caused in part by differential access to specialized cancer centers (SCCs), because treatment at SCCs has been associated with improved overall survival. The authors examined social and clinical factors associated with AYA use of SCCs (defined as Children's Oncology Group-designated or National Cancer Institute-designated centers).A retrospective, population-based analysis was performed on all hospital admissions of AYA oncology patients in California during 1991 through 2014 (n = 127,250) using the Office of Statewide Health Planning and Development database. Multivariable logistic regression analyses examined the contribution of social and clinical factors on always receiving care from an SCC (vs sometimes or never). Results are presented as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).Over the past 20 years, the percentage of patients always receiving inpatient care at an SCC increased over time (from 27% in 1991 to 43% in 2014). In multivariable regression analyses, AYA patients were less likely to always receive care from an SCC if they had public insurance (OR, 0.64; 95% CI, 0.62-0.66), were uninsured (OR, 0.51; 95% CI, 0.46-0.56), were Hispanic (OR, 0.88; 95% CI, 0.85-0.91), lived > 5 miles from an SCC, or had a diagnosis other than leukemia and central nervous system tumors.Receiving care at an SCC was influenced by insurance, race/ethnicity, geography, and tumor type. Identifying the barriers associated with decreased SCC use is an important first step toward improving outcomes in AYA oncology patients. Cancer 2017. © 2017 American Cancer Society.
View details for DOI 10.1002/cncr.30562
View details for PubMedID 28241089
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Care coordination for children with special health care needs: a cohort study
ITALIAN JOURNAL OF PEDIATRICS
Zanello, E., Calugi, S., Sanders, L. M., Lenzi, J., Faldella, G., Rucci, P., Fantini, M.
2017; 43: 18
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Abstract
Care coordination is widely recognized as a key element of care for patients with chronic and complex medical conditions and their families. In care for children with special health care needs the Family Pediatrician (FP) plays a central role as care coordinator. This study aims to evaluate the FPs' activities of care coordination for children with special health care needs in the pediatric primary care setting, using an on-line measurement tool.Within the prospective cohort study SpeNK (Special Needs Kids), newborns and children with special health care needs were recruited at discharge from three hospital facilities in Bologna province, from October 1st 2012 to September 30th 2014. Their FPs were invited to complete a questionnaire (SpeNK-FP) at each encounter for the patient during a 9-month period after hospital discharge. SpeNK-FP was developed by adapting the Care Coordination Measurement Tool (CCMT©) developed by Antonelli et al., to the Italian organizational context. The outcome of interest, derived from the questionnaire, is inappropriate use of services.Forty FPs completed assessments for 49 children at each of 382 clinical encounters. The majority of children (71.4%) had special health care needs, without complicating social issues. FPs reported "no need for care coordination" in 50.8% of the encounters and 41.1% of records about patient needs requiring care coordination. The most common activity implemented to meet children's needs was telephone contact with a medical provider. According to FPs, 80% of encounters prevented inappropriate services use. In multivariate regression, pediatric-specialist contact (telephone or in person) was associated with reduced odds of physician report of preventable hospitalization (OR = 0.06, 95% CI 0.01-0.42, p = 0.005).The study shows the potential for FPs in Italy to serve as care coordinators and facilitate the implementation of integrated care pathways for children with special health care needs.
View details for PubMedID 28257651
View details for PubMedCentralID PMC5347827
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Satisfaction With Communication In Primary Care For Spanish-Speaking And English-Speaking Parents.
Academic pediatrics
Flower, K. B., Skinner, A. C., Yin, H. S., Rothman, R. L., Sanders, L. M., Delamater, A., Perrin, E. M.
2017
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Abstract
Effective communication with primary care physicians is important yet incompletely understood for Spanish-speaking parents. We predicted lower satisfaction among Spanish-speaking compared to English-speaking Latino and non-Latino parents.Cross-sectional analysis at 2-month well visits within the Greenlight study at 4 pediatric resident clinics. Parents reported satisfaction with 14 physician communication items using the validated Communication Assessment Tool (CAT). High satisfaction was defined as "excellent" on each CAT item. Mean estimations compared satisfaction for communication items among Spanish- and English-speaking Latinos and non-Latinos. We used generalized linear regression modeling, adjusted for parent age, education, income, and clinic site. Among Spanish-speaking parents, we compared visits conducted in Spanish with and without an interpreter, and in English.Compared to English-speaking Latino (n = 127) and non-Latino parents (n = 432), fewer Spanish-speaking parents (n = 303) reported satisfaction with 14 communication items. No significant differences were found between English-speaking Latinos and non-Latinos. Greatest differences were found in the use of a greeting that made the parent comfortable (59.4% of Spanish-speaking Latinos endorsing "excellent" vs 77.5% English-speaking Latinos, P < .01) and discussing follow-up (62.5% of Spanish-speaking Latinos vs 79.8% English-speaking Latinos, P < .01). After adjusting for parent age, education, income, and study site, Spanish-speaking Latinos were still less likely to report high satisfaction with these communication items. Satisfaction was not different among Spanish-speaking parents when the physician spoke Spanish versus used an interpreter.Satisfaction with physician communication was associated with language but not ethnicity. Spanish-speaking parents less frequently report satisfaction with communication, and innovative solutions to enhance communication quality are needed.
View details for DOI 10.1016/j.acap.2017.01.005
View details for PubMedID 28104488
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Publications
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Stanford Emergency Medicine Partnership Program: a novel approach to streamlining the evaluation and implementation of emerging health technologies through academic-industry partnerships
BMJ INNOVATIONS
Dayton, J., Yiadom, M. B., Shen, S., Strehlow, M. C., Rose, C., Bunney, G., Ribeira, R.
2024
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View details for DOI 10.1136/bmjinnov-2023-001154
View details for Web of Science ID 001251125300001
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Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients.
Journal of clinical medicine
Yiadom, M. Y., Gong, W., Bloos, S. M., Bunney, G., Kabeer, R., Pasao, M. A., Rodriguez, F., Baugh, C. W., Mills, A. M., Gavin, N., Podolsky, S. R., Salazar, G. A., Patterson, B., Mumma, B. E., Tanski, M. E., Liu, D.
2024; 13 (9)
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Abstract
Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Results: Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs (p = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) (p = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. Conclusions: D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.
View details for DOI 10.3390/jcm13092650
View details for PubMedID 38731180
View details for PubMedCentralID PMC11084706
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Changes in low-acuity patient volume in an emergency department after launching a walk-in clinic.
Journal of the American College of Emergency Physicians open
Kurian, D., Sundaram, V., Naidich, A. G., Shah, S. A., Ramberger, D., Khan, S., Ravi, S., Patel, S., Ribeira, R., Brown, I., Wagner, A., Gharahbhagian, L., Miller, K., Shen, S., Yiadom, M. Y.
2023; 4 (4): e13011
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Unscheduled low-acuity care options are on the rise and are often expected to reduce emergency department (ED) visits. We opened an ED-staffed walk-in clinic (WIC) as an alternative care location for low-acuity patients at a time when ED visits exceeded facility capacity and the impending flu season was anticipated to increase visits further, and we assessed whether low-acuity ED patient visits decreased after opening the WIC.In this retrospective cohort study, we compared patient and clinical visit characteristics of the ED and WIC patients and conducted interrupted time-series analyses to quantify the impact of the WIC on low-acuity ED patient visit volume and the trend.There were 27,211 low-acuity ED visits (22.7% of total ED visits), and 7,058 patients seen in the WIC from February 26, 2018, to November 17, 2019. Low-acuity patient visits in the ED reduced significantly immediately after the WIC opened (P = 0.01). In the subsequent months, however, patient volume trended back to pre-WIC volumes such that there was no significant impact at 6, 9, or 12 months (P = 0.07). Had WIC patients been seen in the main ED, low-acuity volume would have been 27% of the total volume rather than the 22.7% that was observed.The WIC did not result in a sustained reduction in low-acuity patients in the main ED. However, it enabled emergency staff to see low-acuity patients in a lower resource setting during times when ED capacity was limited.
View details for DOI 10.1002/emp2.13011
View details for PubMedID 37484497
View details for PubMedCentralID PMC10361543
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Maximizing Equity in Acute Coronary Syndrome Screening across Sociodemographic Characteristics of Patients.
Diagnostics (Basel, Switzerland)
Bunney, G., Bloos, S. M., Graber-Naidich, A., Pasao, M. A., Kabeer, R., Kim, D., Miller, K., Yiadom, M. Y.
2023; 13 (12)
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We compared four methods to screen emergency department (ED) patients for an early electrocardiogram (ECG) to diagnose ST-elevation myocardial infarction (STEMI) in a 5-year retrospective cohort through observed practice, objective application of screening protocol criteria, a predictive model, and a model augmenting human practice. We measured screening performance by sensitivity, missed acute coronary syndrome (ACS) and STEMI, and the number of ECGs required. Our cohort of 279,132 ED visits included 1397 patients who had a diagnosis of ACS. We found that screening by observed practice augmented with the model delivered the highest sensitivity for detecting ACS (92.9%, 95%CI: 91.4-94.2%) and showed little variation across sex, race, ethnicity, language, and age, demonstrating equity. Although it missed a few cases of ACS (7.6%) and STEMI (4.4%), it did require ECGs on an additional 11.1% of patients compared to current practice. Screening by protocol performed the worst, underdiagnosing young, Black, Native American, Alaskan or Hawaiian/Pacific Islander, and Hispanic patients. Thus, adding a predictive model to augment human practice improved the detection of ACS and STEMI and did so most equitably across the groups. Hence, combining human and model screening--rather than relying on either alone--may maximize ACS screening performance and equity.
View details for DOI 10.3390/diagnostics13122053
View details for PubMedID 37370948
View details for PubMedCentralID PMC10297640
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Variation in ACS patient hospital resource utilization: Is it time for advanced NSTEMI risk stratification in the ED?
The American journal of emergency medicine
Saxena, M., Bloos, S. M., Graber-Naidich, A., Sundaram, V., Pasao, M., Yiadom, M. Y.
2023; 70: 171-174
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A majority of patients who experience acute coronary syndrome (ACS) initially receive care in the emergency department (ED). Guidelines for care of patients experiencing ACS, specifically ST-segment elevation myocardial infarction (STEMI) are well defined. We examine the utilization of hospital resources between patients with NSTEMI as compared to STEMI and unstable angina (UA). We then make the case that as NSTEMI patients are the majority of ACS cases, there is a great opportunity to risk stratify these patients in the emergency department.We examined hospital resource utilization measure between those with STEMI, NSTEMI, and UA. These included hospital length of stay (LOS), any intensive care unit (ICU) care time, and in-hospital mortality.The sample included 284,945 adult ED patients, of whom 1195 experienced ACS. Among the latter, 978 (70%) were diagnosed with NSTEMI, 225 (16%) with STEMI, and 194 with UA (14%). We observed 79.1% of STEMI patients receiving ICU care. 14.4% among NSTEMI patients, and 9.3% among UA patients. NSTEMI patients' mean hospital LOS was 3.7 days. This was shorter than that of non-ACS patients 4.75 days and UA patients 2.99. In-hospital mortality for NSTEMI was 1.6%, compared to, 4.4% for those with STEMI patients and 0% for UA. There are recommendations for risk stratification among NSTEMI patients to evaluate risk for major adverse cardiac events (MACE) that can be used in the ED to guide admission decisions and use of ICU care, thus optimizing care for a majority of ACS patients.
View details for DOI 10.1016/j.ajem.2023.05.028
View details for PubMedID 37327683
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Strategies to Mitigate Emergency Department Crowding and Its Impact on Cardiovascular Patients.
European heart journal. Acute cardiovascular care
Baugh, C. W., Freund, Y., Steg, P. G., Body, R., Maron, D. J., Yiadom, M. Y.
2023
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Emergency Department (ED) crowding is a worsening global problem caused by hospital capacity and other health system challenges. While patients across a broad spectrum of illnesses may be affected by crowding in the ED, patients with cardiovascular emergencies - such as acute coronary syndrome, malignant arrhythmias, pulmonary embolism, acute aortic syndrome, and cardiac tamponade - are particularly vulnerable. Because of crowding, patients with dangerous and time-sensitive conditions may either avoid the ED due to anticipation of extended waits, leave before their treatment is completed, or experience delays in receiving care. In this educational paper, we present the underlying causes of crowding and its impact on common cardiovascular emergencies using the input-throughput-output process framework for patient flow. In addition, we review current solutions and potential innovations to mitigate the negative effect of ED crowding on patient outcomes.
View details for DOI 10.1093/ehjacc/zuad049
View details for PubMedID 37163667
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Beyond chest pain: Incremental value of other variables to identify patients for an early ECG.
The American journal of emergency medicine
Bunney, G., Sundaram, V., Graber-Naidich, A., Miller, K., Brown, I., McCoy, A. B., Freeze, B., Berger, D., Wright, A., Yiadom, M. Y.
2023; 67: 70-78
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BACKGROUND: Chest pain (CP) is the hallmark symptom for acute coronary syndrome (ACS) but is not reported in 20-30% of patients, especially women, elderly, non-white patients, presenting to the emergency department (ED) with an ST-segment elevation myocardial infarction (STEMI).METHODS: We used a retrospective 5-year adult ED sample of 279,132 patients to explore using CP alone to predict ACS, then we incrementally added other ACS chief complaints, age, and sex in a series of multivariable logistic regression models. We evaluated each model's identification of ACS and STEMI.RESULTS: Using CP alone would recommend ECGs for 8% of patients (sensitivity, 61%; specificity, 92%) but missed 28.4% of STEMIs. The model with all variables identified ECGs for 22% of patients (sensitivity, 82%; specificity, 78%) but missed 14.7% of STEMIs. The model with CP and other ACS chief complaints had the highest sensitivity (93%) and specificity (55%), identified 45.1% of patients for ECG, and only missed 4.4% of STEMIs.CONCLUSION: CP alone had highest specificity but lacked sensitivity. Adding other ACS chief complaints increased sensitivity but identified 2.2-fold more patients for ECGs. Achieving an ECG in 10min for patients with ACS to identify all STEMIs will be challenging without introducing more complex risk calculation into clinical care.
View details for DOI 10.1016/j.ajem.2023.01.054
View details for PubMedID 36806978
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Fallacy of Median Door-to-ECG Time: Hidden Opportunities for STEMI Screening Improvement.
Journal of the American Heart Association
Yiadom, M. Y., Gong, W., Patterson, B. W., Baugh, C. W., Mills, A. M., Gavin, N., Podolsky, S. R., Salazar, G., Mumma, B. E., Tanski, M., Hadley, K., Azzo, C., Dorner, S. C., Ulintz, A., Liu, D.
2022; 11 (9): e024067
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Background ST-segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door-to-ECG (D2E) time of 10minutes. Methods and Results This 3-year descriptive retrospective cohort study, including 676 ED-diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10minutes. We also identified characteristics associated with D2E>10minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7minutes (IQR:4-16; range: 0-1407minutes; range of ED medians: 5-11minutes). Proportion of patients with D2E>10minutes was 37.9% (ED range: 21.5%-57.1%). Patients with D2E>10minutes, compared to those with D2E≤10minutes, were more likely female (32.8% versus 22.6%, P=0.005), Black (23.4% versus 12.4%, P=0.005), non-English speaking (24.6% versus 19.5%, P=0.032), diabetic (40.2% versus 30.2%, P=0.010), and less frequently reported chest pain (63.3% versus 87.4%, P<0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%. Conclusions Examining D2E>10minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.
View details for DOI 10.1161/JAHA.121.024067
View details for PubMedID 35492001
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Pragmatic clinical trial design in emergency medicine: study considerations and design types.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Gettel, C. J., Yiadom, M. Y., Bernstein, S. L., Grudzen, C. R., Nath, B., Li, F., Hwang, U., Hess, E. P., Melnick, E. R.
2022
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Pragmatic clinical trials (PCTs) focus on correlation between treatment and outcomes in real-world clinical practice, yet a guide highlighting key study considerations and design types for emergency medicine investigators pursuing this important study type is not available. Investigators conducting ED-based PCTs face multiple decisions within the planning phase to ensure robust and meaningful study findings. The PRagmatic Explanatory Continuum Indicator Summary 2 (PRECIS-2) tool allows trialists to consider both pragmatic and explanatory components across nine domains, shaping the trial design to the purpose intended by the investigators. Aside from the PRECIS-2 tool domains, ED-based investigators conducting PCTs should also consider randomization techniques, human subjects concerns, and integration of trial components within the electronic health record. The authors additionally highlight the advantages, disadvantages, and rationale for the use of four common randomized study design types to be considered in PCTs: parallel, crossover, factorial, and stepped-wedge. With increasing emphasis on the conduct of PCTs, emergency medicine investigators will benefit from a rigorous approach to clinical trial design.
View details for DOI 10.1111/acem.14513
View details for PubMedID 35475533
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ECG to Activation: Not an Appropriate Physician Metric, but a Worthy Process Metric.
The Journal of emergency medicine
Berger, D. A., Yiadom, M. Y.
1800; 62 (1): 129-130
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View details for DOI 10.1016/j.jemermed.2021.07.019
View details for PubMedID 35090729
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Understanding timely STEMI treatment performance: A 3-year retrospective cohort study using diagnosis-to-balloon-time and care subintervals.
Journal of the American College of Emergency Physicians open
Yiadom, M. Y., Olubowale, O. O., Jenkins, C. A., Miller, K. F., West, J. L., Vogus, T. J., Lehmann, C. U., Antonello, V. D., Bernard, G. R., Storrow, A. B., Lindsell, C. J., Liu, D.
2021; 2 (1): e12379
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From the perspective of percutaneous coronary intervention (PCI) centers, locations of ST-segment elevation myocardial infarction (STEMI) diagnosis can include a referring facility, emergency medical services (EMS) transporting to a PCI center, or the PCI center's emergency department (ED). This challenges the use of door-to-balloon-time as the primary evaluative measure of STEMI treatment pathways. Our objective was to identify opportunities to improve care by quantifying differences in the timeliness of STEMI treatment mobilization based on the location of the diagnostic ECG.This 3-year, single-center, retrospective cohort study classified patients by diagnostic ECG location: referring facility, EMS, or PCI center ED. We quantified door-to-balloon-time and diagnosis-to-balloon-time with its care subintervals.Of 207 ED STEMI patients, 180 (87%) received PCI. Median diagnosis-to-balloon-times were shortest among the ED-diagnosed (78 minutes [interquartile range (IQR), 61-92]), followed by EMS-identified patients (89 minutes [IQR, 78-122]), and longest among those referred (140 minutes [IQR, 119-160]), reflecting time for transport to the PCI center. Conversely, referred patients had the shortest median door-to-balloon-times (38 minutes [IQR, 34-43]), followed by the EMS-identified (64 minutes [IQR, 47-77]), whereas ED-diagnosed patients had the longest (89 minutes [IQR, 70-114]), reflecting diagnosis and catheterization lab activation frequently occurring before PCI center ED arrival for referred and EMS-identified patients.Diagnosis-to-balloon-time and its care subintervals are complementary to the traditional door-to-balloon-times as measures of the STEMI treatment process. Together, they highlight opportunities to improve timely identification among ED-diagnosed patients, use of out-of-hospital cath lab activation for EMS-identified patients, and encourage pathways for referred patients to bypass PCI center EDs.
View details for DOI 10.1002/emp2.12379
View details for PubMedID 33644777
View details for PubMedCentralID PMC7890036
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Comparing the Timeliness of Treatment in Younger vs. Older Patients with ST-Segment Elevation Myocardial Infarction: A Multi-Center Cohort Study.
The Journal of emergency medicine
Bloos, S. M., Kaur, K. n., Lang, K. n., Gavin, N. n., Mills, A. M., Baugh, C. W., Patterson, B. W., Podolsky, S. R., Salazar, G. n., Mumma, B. E., Tanski, M. n., Hadley, K. n., Roumie, C. n., McNaughton, C. D., Yiadom, M. Y.
2021
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ST-segment elevation myocardial infarction (STEMI) predominantly affects older adults. Lower incidence among younger patients may challenge diagnosis.We hypothesize that among patients ≤ 50 years old, emergent percutaneous coronary intervention (PCI) for STEMI is delayed when compared with patients aged > 50 years.This 3-year, 10-center retrospective cohort study included emergency department (ED) STEMI patients ≥ 18 years of age treated with emergent PCI. We excluded patients with an electrocardiogram (ECG) completed prior to ED arrival or a nondiagnostic initial ECG. Our primary outcome was door-to-balloon (D2B) time. We compared characteristics and outcomes among younger vs. older STEMI patients, and among age subgroups.There were 576 ED STEMI PCI patients, of whom 100 were ≤ 50 years old and 476 were > 50 years old. Median age was 44 years in the younger cohort (interquartile range [IQR] 41-47) vs. 62 years (IQR 57-70) among older patients. Median D2B time for the younger cohort was 76.5 min (IQR 67.5-102.5) vs. 81.0 min (IQR 65.0-105.5) in the older cohort (p = 0.91). This outcome did not change when ages 40 or 45 years were used to demarcate younger vs. older. The younger cohort had a higher prevalence of nonwhite races (38% vs. 21%; p < 0.001) and those currently smoking (36% vs. 23%; p = 0.005). The very young (≤30 years; 6/576) and very old (>80 years; 45/576) had 5.51 and 2.2 greater odds of delays.We found no statistically significant difference in D2B times between patients ≤ 50 years old and those > 50 years old. Nonwhite patients and those who smoke were disproportionately represented within the younger population. The very young and very old had higher odds of D2B times > 90 min.
View details for DOI 10.1016/j.jemermed.2021.01.031
View details for PubMedID 33676790
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Managing and Measuring Emergency Department Care: Results of the Fourth Emergency Department Benchmarking Definitions Summit
Academic Emergency Medicine
Yiadom, M. A.
2020; 27 (7): 600-611
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A shared language and vocabulary are essential for managing emergency department (ED) operations. This Fourth Emergency Department Benchmarking Alliance (EDBA) Summit brought together experts in the field to review, update, and add to key definitions and metrics of ED operations.Summit objectives were to review and revise existing definitions, define and characterize new practices related to ED operations, and introduce financial and regulatory definitions affecting ED reimbursement.Forty-six ED operations, data management, and benchmarking experts were invited to participate in the EDBA summit. Before arrival, experts were provided with documents from the three prior summits and assigned to update the terminology. Materials and publications related to standards of ED operations were considered and discussed. Each group submitted a revised set of definitions prior to the summit. Significantly revised, topical, or controversial recommendations were discussed among all summit participants. The goal of the in-person discussion was to reach consensus on definitions. Work group leaders made changes to reflect the discussion, which was revised with public and stakeholder feedback.The entire EDBA dictionary was updated and expanded. This article focuses on an update and discussion of definitions related to specific topics that changed since the last summit, specifically ED intake, boarding, diversion, and observation care. In addition, an extensive new glossary of financial and regulatory terminology germane to the practice of emergency medicine is included.A complete and precise set of operational definitions, time intervals, and utilization measures is necessary for timely and effective ED care. A common language of financial and regulatory definitions that affect ED operations is included for the first time. This article and its companion dictionary should serve as a resource to ED leadership, researchers, informatics and health policy leaders, and regulatory bodies.
View details for DOI 10.1111/acem.13978
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Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway.
Clinical and experimental emergency medicine
Monahan, K., Pan, M., Opara, C., Yiadom, M. Y., Munoz, D., Holmes, B. B., Stephen, D., Swiger, K. J., Collins, S. P.
2019; 6 (3): 196-203
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Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition.We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up.For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons.For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals.
View details for DOI 10.15441/ceem.18.066
View details for PubMedID 31295990
View details for PubMedCentralID PMC6774010
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Measuring outcome differences associated with STEMI screening and diagnostic performance: a multicentred retrospective cohort study protocol.
BMJ open
Yiadom, M. Y., Mumma, B. E., Baugh, C. W., Patterson, B. W., Mills, A. M., Salazar, G., Tanski, M., Jenkins, C. A., Vogus, T. J., Miller, K. F., Jackson, B. E., Lehmann, C. U., Dorner, S. C., West, J. L., Wang, T. J., Collins, S. P., Dittus, R. S., Bernard, G. R., Storrow, A. B., Liu, D.
2018; 8 (5): e022453
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Advances in ST-segment elevation myocardial infarction (STEMI) management have involved improving the clinical processes connecting patients with timely emergency cardiovascular care. Screening upon emergency department (ED) arrival for an early ECG to diagnose STEMI, however, is not optimal for all patients. In addition, the degree to which timely screening and diagnosis are associated with improved time to intervention and postpercutaneous coronary intervention outcomes, under more contemporary practice conditions, is not known.We present the methods for a retrospective multicentre cohort study anticipated to include 1220 patients across seven EDs to (1) evaluate the relationship between timely screening and diagnosis with treatment and postintervention clinical outcomes; (2) introduce novel measures for cross-facility performance comparisons of screening and diagnostic care team performance including: door-to-screening, door-to-diagnosis and door-to-catheterisation laboratory arrival times and (3) describe the use of electronic health record data in tandem with an existing disease registry.The completion of this study will provide critical feedback on the quality of screening and diagnostic performance within the contemporary STEMI care pathway that can be used to (1) improve emergency care delivery for patients with STEMI presenting to the ED, (2) present novel metrics for the comparison of screening and diagnostic care and (3) inform the development of screening and diagnostic support tools that could be translated to other care environments. We will disseminate our results via publication and quality performance data sharing with each site. Institutional ethics review approval was received prior to study initiation.
View details for DOI 10.1136/bmjopen-2018-022453
View details for PubMedID 29724744
View details for PubMedCentralID PMC5942471
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Measuring Emergency Department Acuity.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Yiadom, M. Y., Baugh, C. W., Barrett, T. W., Liu, X., Storrow, A. B., Vogus, T. J., Tiwari, V., Slovis, C. M., Russ, S., Liu, D.
2018; 25 (1): 65-75
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Emergency department (ED) acuity is the general level of patient illness, urgency for clinical intervention, and intensity of resource use in an ED environment. The relative strength of commonly used measures of ED acuity is not well understood.We performed a retrospective cross-sectional analysis of ED-level data to evaluate the relative strength of association between commonly used proxy measures with a full spectrum measure of ED acuity. Common measures included the percentage of patients with Emergency Severity Index (ESI) scores of 1 or 2, case mix index (CMI), academic status, annual ED volume, inpatient admission rate, percentage of Medicare patients, and patients seen per attending-hour. Our reference standard for acuity is the proportion of high-acuity charts (PHAC) coded and billed according to the Centers for Medicare and Medicaid Service's Ambulatory Payment Classification (APC) system. High-acuity charts included those APC 4 or 5 or critical care. PHAC was represented as a fractional response variable. We examined the strength of associations between common acuity measures and PHAC using Spearman's rank correlation coefficients (rs ) and regression models including a quasi-binomial generalized linear model and linear regression.In our univariate analysis, the percentage of patients ESI 1 or 2, CMI, academic status, and annual ED volume had statistically significant associations with PHAC. None explained more than 16% of PHAC variation. For regression models including all common acuity measures, academic status was the only variable significantly associated with PHAC.Emergency Severity Index had the strongest association with PHAC followed by CMI and annual ED volume. Academic status captures variability outside of that explained by ESI, CMI, annual ED volume, percentage of Medicare patients, or patients per attending per hour. All measures combined only explained only 42.6% of PHAC variation.
View details for DOI 10.1111/acem.13319
View details for PubMedID 28940546
View details for PubMedCentralID PMC5764775
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Change in Care Transition Practice for Patients With Nonspecific Chest Pain After Emergency Department Evaluation 2006 to 2012
ACADEMIC EMERGENCY MEDICINE
Yiadom, M. B., Baugh, C. W., Jenkins, C. A., Collins, S. P., Bhatia, M. C., Dittus, R. S., Storrow, A. B.
2017; 24 (12): 1527-1530
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From 2005 to 2010 health care financing shifts in the United States may have affected care transition practices for emergency department (ED) patients with nonspecific chest pain (CP) after ED evaluation. Despite being less acutely ill than those with myocardial infarction, these patients' management can be challenging. The risk of missing acute coronary syndrome is considerable enough to often warrant admission. Diagnostic advances and reimbursement limitations on the use of inpatient admission are encouraging the use of alternative ED care transition practices. In the setting of these health care changes, we hypothesized that there is a decline in inpatient admission rates for patients with nonspecific CP after ED evaluation.We retrospectively used the Nationwide ED Sample to quantify total and annual inpatient hospital admission rates from 2006 to 2012 for patients with a final ED diagnosis of nonspecific CP. We assessed the change in admission rates over time and stratified by facility characteristics including safety-net hospital status, U.S. geographic region, urban/teaching status, trauma-level designation, and hospital funding status.The admission rate for all patients with a final ED diagnosis of nonspecific CP declined from 19.2% in 2006 to 11.3% in 2012. Variability across regions was observed, while metropolitan teaching hospitals and trauma centers reflected lower admission rates.There was a 41.1% decline in inpatient hospital admission for patients with nonspecific CP after ED evaluation. This reduction is temporally associated with national policy changes affecting reimbursement for inpatient admissions.
View details for DOI 10.1111/acem.13279
View details for Web of Science ID 000417645200012
View details for PubMedID 28833882
View details for PubMedCentralID PMC5755372
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Acute Coronary Syndrome Screening and Diagnostic Practice Variation.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Yiadom, M. Y., Liu, X., McWade, C. M., Liu, D., Storrow, A. B.
2017; 24 (6): 701-709
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In the absence of the existing acute coronary syndrome (ACS) guidelines directing the clinical practice implementation of emergency department (ED) screening and diagnosis, there is variable screening and diagnostic clinical practice across ED facilities. This practice diversity may be warranted. Understanding the variability may identify opportunities for more consistent practice.This is a cross-sectional clinical practice epidemiology study with the ED as the unit of analysis characterizing variability in the ACS evaluation across 62 diverse EDs. We explored three domains of screening and diagnostic practice: 1) variability in criteria used by EDs to identify patients for an early electrocardiogram (ECG) to diagnose ST-elevation myocardial infarction (STEMI), 2) nonuniform troponin biomarker and formalized pre-troponin risk stratification use for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI), and 3) variation in the use of noninvasive testing (NIVT) to identify obstructive coronary artery disease or detect inducible ischemia.We found that 85% of EDs utilize a formal triage protocol to screen patients for an early ECG to diagnose STEMI. Of these, 17% use chest pain as the sole criteria. For the diagnosis of NSTEMI, 58% use intervals ≥4 hours for a second troponin and 34% routinely risk stratify before troponin testing. For the diagnosis of noninfarction ischemia, the median percentage of patients who have NIVT performed during their ED visit is 5%. The median percentage of patients referred for NIVT in hospital (observation or admission) is 61%. Coronary CT angiography is used in 66% of EDs. Exercise treadmill testing is the most frequently reported first-line NIVT (42%).Our results suggest highly variable ACS screening and clinical practice.
View details for DOI 10.1111/acem.13184
View details for PubMedID 28261908
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Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST-Segment Elevation Myocardial Infarction.
Journal of the American Heart Association
Yiadom, M. Y., Baugh, C. W., McWade, C. M., Liu, X., Song, K. J., Patterson, B. W., Jenkins, C. A., Tanski, M., Mills, A. M., Salazar, G., Wang, T. J., Dittus, R. S., Liu, D., Storrow, A. B.
2017; 6 (3)
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Timely diagnosis of ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) is made solely by ECG. Obtaining this test within 10 minutes of ED arrival is critical to achieving the best outcomes. We investigated variability in the timely identification of STEMI across institutions and whether performance variation was associated with the ED characteristics, the comprehensiveness of screening criteria, and the STEMI screening processes.We examined STEMI screening performance in 7 EDs, with the missed case rate (MCR) as our primary end point. The MCR is the proportion of primarily screened ED patients diagnosed with STEMI who did not receive an ECG within 15 minutes of ED arrival. STEMI was defined by hospital discharge diagnosis. Relationships between the MCR and ED characteristics, screening criteria, and STEMI screening processes were assessed, along with differences in door-to-ECG times for captured versus missed patients. The overall MCR for all 7 EDs was 12.8%. The lowest and highest MCRs were 3.4% and 32.6%, respectively. The mean difference in door-to-ECG times for captured and missed patients was 31 minutes, with a range of 14 to 80 minutes of additional myocardial ischemia time for missed cases. The prevalence of primarily screened ED STEMIs was 0.09%. EDs with the greatest informedness (sensitivity+specificity-1) demonstrated superior performance across all other screening measures.The 29.2% difference in MCRs between the highest and lowest performing EDs demonstrates room for improving timely STEMI identification among primarily screened ED patients. The MCR and informedness can be used to compare screening across EDs and to understand variable performance.
View details for DOI 10.1161/JAHA.116.003528
View details for PubMedID 28232323
View details for PubMedCentralID PMC5523988
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Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain.
The American journal of emergency medicine
Wu, W. K., Yiadom, M. Y., Collins, S. P., Self, W. H., Monahan, K.
2017; 35 (1): 132-135
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A triage cardiology program, in which cardiologists provide consultation to the Emergency Department (ED), may safely reduce admissions. For patients with chest pain, the HEART Pathway may obviate the need for cardiology involvement, unless there is a difference between ED and cardiology assessments. Therefore, in a cohort concurrently evaluated by both specialties, we analyzed discordance between ED and cardiology HEART scores.We performed a single-center, cross-sectional, retrospective study of adults presenting to the ED with chest pain who had a documented bedside evaluation by a triage cardiologist. Separate ED and cardiology HEART scores were computed based on documentation by the respective physicians. Discrepancies in HEART score between ED physicians and cardiologists were quantified using Cohen κ coefficient.Thirty-three patients underwent concurrent ED physician and cardiologist evaluation. Twenty-three patients (70%) had discordant HEART scores (κ = 0.13; 95% confidence interval, -0.02 to 0.32). Discrepancies in the description of patients' chest pain were the most common source of discordance and were present in more than 50% of cases. HEART scores calculated by ED physicians tended to overestimate the scores calculated by cardiologists. When categorized into low-risk or high-risk by the HEART Pathway, more than 25% of patients were classified as high risk by the ED physician, but low risk by the cardiologist.There is substantial discordance in HEART scores between ED physicians and cardiologists. A triage cardiology system may help refine risk stratification of patients presenting to the ED with chest pain, even when the HEART Pathway tool is used.
View details for DOI 10.1016/j.ajem.2016.09.058
View details for PubMedID 27745728
View details for PubMedCentralID PMC6805131
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Implementing Data Definition Consistency for Emergency Department Operations Benchmarking and Research.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Yiadom, M. Y., Scheulen, J., McWade, C. M., Augustine, J. J.
2016; 23 (7): 796-802
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The objective was to obtain a commitment to adopt a common set of definitions for emergency department (ED) demographic, clinical process, and performance metrics among the ED Benchmarking Alliance (EDBA), ED Operations Study Group (EDOSG), and Academy of Academic Administrators of Emergency Medicine (AAAEM) by 2017.A retrospective cross-sectional analysis of available data from three ED operations benchmarking organizations supported a negotiation to use a set of common metrics with identical definitions. During a 1.5-day meeting-structured according to social change theories of information exchange, self-interest, and interdependence-common definitions were identified and negotiated using the EDBA's published definitions as a start for discussion. Methods of process analysis theory were used in the 8 weeks following the meeting to achieve official consensus on definitions. These two lists were submitted to the organizations' leadership for implementation approval.A total of 374 unique measures were identified, of which 57 (15%) were shared by at least two organizations. Fourteen (4%) were common to all three organizations. In addition to agreement on definitions for the 14 measures used by all three organizations, agreement was reached on universal definitions for 17 of the 57 measures shared by at least two organizations. The negotiation outcome was a list of 31 measures with universal definitions to be adopted by each organization by 2017.The use of negotiation, social change, and process analysis theories achieved the adoption of universal definitions among the EDBA, EDOSG, and AAAEM. This will impact performance benchmarking for nearly half of US EDs. It initiates a formal commitment to utilize standardized metrics, and it transitions consistency in reporting ED operations metrics from consensus to implementation. This work advances our ability to more accurately characterize variation in ED care delivery models, resource utilization, and performance. In addition, it permits future aggregation of these three data sets, thus facilitating the creation of more robust ED operations research data sets unified by a universal language. Negotiation, social change, and process analysis principles can be used to advance the adoption of additional definitions.
View details for DOI 10.1111/acem.12988
View details for PubMedID 27121149
View details for PubMedCentralID PMC6805130
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Consensus statement on advancing research in emergency department operations and its impact on patient care.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Yiadom, M. Y., Ward, M. J., Chang, A. M., Pines, J. M., Jouriles, N., Yealy, D. M.
2015; 22 (6): 757-64
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The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications.
View details for DOI 10.1111/acem.12695
View details for PubMedID 26014365
View details for PubMedCentralID PMC4724862
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Diagnostic implications of an elevated troponin in the emergency department.
Disease markers
Yiadom, M. Y., Jarolim, P., Jenkins, C., Melanson, S. E., Conrad, M., Kosowsky, J. M.
2015; 2015: 157812
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To determine the proportion of initial troponin (cTn) elevations associated with Type I MI versus other cardiovascular and noncardiovascular diagnoses in an emergency department (ED) and whether or not a relationship exists between the cTn level and the likelihood of Type I MI.In the ED, cTn is used as a screening test for myocardial injury. However, the differential diagnosis for an initial positive cTn result is not clear.Hospital medical records were retrospectively reviewed for visits associated with an initial positive troponin I-ultra (cTnI), ≥0.05 μg/L. Elevated cTnI levels were stratified into low (0.05-0.09), medium (0.1-0.99), or high (≥1.0). Discharge diagnoses were classified into 3 diagnostic groups (Type I MI, other cardiovascular, or noncardiovascular).Of 23,731 ED visits, 4,928 (21%) had cTnI testing. Of those tested, 16.3% had initial cTnI ≥0.05. Among those with elevated cTn, 11% were classified as Type I MI, 34% had other cardiovascular diagnoses, and 55% had a noncardiovascular diagnosis. Type I MI was more common with high cTnI levels (41% incidence) than among subjects with medium (9%) or low (6%).A positive cTn is most likely a noncardiovascular diagnosis, but Type I MI is far more common with cTnI levels ≥1.0.
View details for DOI 10.1155/2015/157812
View details for PubMedID 25960590
View details for PubMedCentralID PMC4415742
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Emergency Department Treatment of Acute Coronary Syndromes
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA
Yiadom, M. B.
2011; 29 (4): 699-+
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Acute coronary syndrome (ACS) is a broad term encompassing a spectrum of acute myocardial ischemia and injury ranging from unstable angina and non-ST-segment elevation myocardial infarction to ST-segment elevation myocardial infarction. ACS accounts for approximately 1.2 million hospital admissions in the United States annually. The aging of the United States population, along with the national obesity epidemic and the associated increase in metabolic syndrome, means that the number of individuals at risk for ACS will continue to increase for the foreseeable future. This article reviews the current evidence and guidelines for the treatment of patients along the continuum of ACS.
View details for DOI 10.1016/j.emc.2011.09.016
View details for Web of Science ID 000297383100005
View details for PubMedID 22040701
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Acute Coronary Syndrome Clinical Presentations and Diagnostic Approaches in the Emergency Department
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA
Yiadom, M. B.
2011; 29 (4): 689-+
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This article discusses clinical presentations and diagnostic approaches to acute coronary syndrome in the emergency department.
View details for DOI 10.1016/j.emc.2011.08.006
View details for Web of Science ID 000297383100004
View details for PubMedID 22040700
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Management strategies for patients with low-risk chest pain in the emergency department.
Current treatment options in cardiovascular medicine
Yiadom, M. Y., Kosowsky, J. M.
2011; 13 (1): 57-67
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OPINION STATEMENT: There is abundant evidence to guide the management of chest pain patients with a confirmed or reasonably suspected diagnosis of acute coronary syndrome (ACS). But when it comes to the low-risk chest pain patient in the emergency department, there is limited evidence to support one approach over another. As a result, the evaluation of low-risk chest pain represents a distinct challenge for the emergency physician. Missing a diagnosis of ACS is certainly undesirable. However, the overuse of technology can result in misleading test results in populations with a low incidence of coronary disease. In this article, we dispel several myths surrounding low-risk chest pain and put forward a number of common-sense recommendations. We endorse taking a focused but thorough chest pain history; encourage the use of serial electrocardiogram, particularly for patients with ongoing or changing symptoms; comment on the interpretation of cardiac biomarkers in the era of highly sensitive troponin assays, drawing a distinction between myocardial injury and myocardial infarction; discuss the role of coronary computed tomography angiography as a test for coronary artery disease, rather than for ACS; and caution against the reflexive use of provocative testing in low-risk chest pain patients.
View details for DOI 10.1007/s11936-010-0108-3
View details for PubMedID 21153720
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Influence of time-to-diagnosis on time-to-percutaneous coronary intervention for emergency department ST-elevation myocardial infarction patients: Time-to-electrocardiogram matters.
Journal of the American College of Emergency Physicians open
Yiadom, M. Y., Gong, W., Patterson, B. W., Baugh, C. W., Mills, A. M., Gavin, N., Podolsky, S. R., Mumma, B. E., Tanski, M., Salazar, G., Azzo, C., Dorner, S. C., Hadley, K., Bloos, S. M., Bunney, G., Vogus, T. J., Liu, D.
2024; 5 (3): e13174
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Objectives: Earlier electrocardiogram (ECG) acquisition for ST-elevation myocardial infarction (STEMI) is associated with earlier percutaneous coronary intervention (PCI) and better patient outcomes. However, the exact relationship between timely ECG and timely PCI is unclear.Methods: We quantified the influence of door-to-ECG (D2E) time on ECG-to-PCI balloon (E2B) intervention in this three-year retrospective cohort study, including patients from 10 geographically diverse emergency departments (EDs) co-located with a PCI center. The study included 576 STEMI patients excluding those with a screening ECG before ED arrival or non-diagnostic initial ED ECG. We used a linear mixed-effects model to evaluate D2E's influence on E2B with piecewise linear terms for D2E times associated with time intervals designated as ED intake (0-10 min), triage (11-30min), and main ED (>30min). We adjusted for demographic and visit characteristics, past medical history, and included ED location as a random effect.Results: The median E2B interval was longer (76vs 68 min, p<0.001) in patients with D2E>10 min than in those with timely D2E. The proportion of patients identified at the intake, triage, and main ED intervals was 65.8%, 24.9%, and 9.7%, respectively. The D2E and E2B association was statistically significant in the triage phase, where a 1-minute change in D2E was associated with a 1.24-minute change in E2B (95% confidence interval [CI]: 0.44-2.05, p=0.003).Conclusion: Reducing D2E is associated with a shorter E2B. Targeting D2E reduction in patients currently diagnosed during triage (11-30 min) may be the greatest opportunity to improve D2B and could enable 24.9% more ED STEMI patients to achieve timely D2E.
View details for DOI 10.1002/emp2.13174
View details for PubMedID 38726468
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2023 Society for Academic Emergency Medicine Consensus Conference on Precision Emergency Medicine: Development of a policy-relevant, patient-centered research agenda.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Strehlow, M., Gisondi, M. A., Caretta-Weyer, H., Ankel, F., Brackett, A., Brar, P., Chan, T. M., Garabedian, A., Gunn, B., Isaacs, E., von Isenburg, M., Jarman, A., Kuehl, D., Limkakeng, A. T., Lydston, M., McGregor, A., Pierce, A., Raven, M. C., Salhi, R. A., Stave, C., Tan, J., Taylor, R. A., Wong, H. N., Yiadom, M. Y., Zachrison, K. S., Vogel, J.
2024
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Precision medicine is data-driven health care tailored to individual patients based on their unique attributes, including biologic profiles, disease expressions, local environments, and socioeconomic conditions. Emergency medicine (EM) has been peripheral to the precision medicine discourse, lacking both a unified definition of precision medicine and a clear research agenda. We convened a national consensus conference to build a shared mental model and develop a research agenda for precision EM.We held a conference to (1) define precision EM, (2) develop an evidence-based research agenda, and (3) identify educational gaps for current and future EM clinicians. Nine preconference workgroups (biomedical ethics, data science, health professions education, health care delivery and access, informatics, omics, population health, sex and gender, and technology and digital tools), comprising 84 individuals, garnered expert opinion, reviewed relevant literature, engaged with patients, and developed key research questions. During the conference, each workgroup shared how they defined precision EM within their domain, presented relevant conceptual frameworks, and engaged a broad set of stakeholders to refine precision EM research questions using a multistage consensus-building process.A total of 217 individuals participated in this initiative, of whom 115 were conference-day attendees. Consensus-building activities yielded a definition of precision EM and key research questions that comprised a new 10-year precision EM research agenda. The consensus process revealed three themes: (1) preeminence of data, (2) interconnectedness of research questions across domains, and (3) promises and pitfalls of advances in health technology and data science/artificial intelligence. The Health Professions Education Workgroup identified educational gaps in precision EM and discussed a training roadmap for the specialty.A research agenda for precision EM, developed with extensive stakeholder input, recognizes the potential and challenges of precision EM. Comprehensive clinician training in this field is essential to advance EM in this domain.
View details for DOI 10.1111/acem.14932
View details for PubMedID 38779704
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Trends of Academic Faculty Identifying as Hispanic at US Medical Schools, 1990-2021.
Journal of graduate medical education
Saxena, M. R., Ling, A. Y., Carrillo, E., Alvarez, A., Yiadom, M. Y., Bennett, C. L., Gallegos, M.
2023; 15 (2): 175-179
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Background: According to recent census data, Hispanic and Latino populations comprise the largest minority group in the United States. Despite ongoing efforts for improved diversity, equity, and inclusion, Hispanics remain underrepresented in medicine (UIM). In addition to well-established benefits to patient care and health systems, physician diversity and increased representation in academic faculty positively impact the recruitment of trainees from UIM backgrounds. Disproportionate representation (as compared to increases of certain underrepresented groups in the US population) has direct implications for recruitment of UIM trainees to residency programs.Objective: To examine the number of full-time US medical school faculty physicians who self-identify as Hispanic in light of the increasing Hispanic population in the United States.Methods: We analyzed data from the Association of American Medical Colleges from 1990 to 2021, looking at those academic faculty who were classified as Hispanic, Latino, of Spanish Origin, or of Multiple Race-Hispanic. We used descriptive statistics and visualizations to illustrate the level of representation of Hispanic faculty by sex, rank, and clinical specialty over time.Results: Overall, the proportion of faculty studied who identified as Hispanic increased from 3.1% (1990) to 6.01% (2021). Moreover, while the proportion of female Hispanic academic faculty increased, there remains a lag between females versus males.Conclusions: Our analysis shows that the number of full-time US medical school faculty who self-identify as Hispanic has not increased, though the population of Hispanics in the United States has increased.
View details for DOI 10.4300/JGME-D-22-00384.1
View details for PubMedID 37139207
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Effectiveness, safety, and efficiency of a drive-through care model as a response to the COVID-19 testing demand in the United States.
Journal of the American College of Emergency Physicians open
Ravi, S., Graber-Naidich, A., Sebok-Syer, S. S., Brown, I., Callagy, P., Stuart, K., Ribeira, R., Gharahbaghian, L., Shen, S., Sundaram, V., Yiadom, M. Y.
2022; 3 (6): e12867
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Objectives: Here we report the clinical performance of COVID-19 curbside screening with triage to a drive-through care pathway versus main emergency department (ED) care for ambulatory COVID-19 testing during a pandemic. Patients were evaluated from cars to prevent the demand for testing from spreading COVID-19 within the hospital.Methods: We examined the effectiveness of curbside screening to identify patients who would be tested during evaluation, patient flow from screening to care team evaluation and testing, and safety of drive-through care as 7-day ED revisits and 14-day hospital admissions. We also compared main ED efficiency versus drive-through care using ED length of stay (EDLOS). Standardized mean differences (SMD)>0.20 identify statistical significance.Results: Of 5931 ED patients seen, 2788 (47.0%) were walk-in patients. Of these patients, 1111 (39.8%) screened positive for potential COVID symptoms, of whom 708 (63.7%) were triaged to drive-through care (with 96.3% tested), and 403 (36.3%) triaged to the main ED (with 90.5% tested). The 1677 (60.2%) patients who screened negative were seen in the main ED, with 440 (26.2%) tested. Curbside screening sensitivity and specificity for predicting who ultimately received testing were 70.3% and 94.5%. Compared to the main ED, drive-through patients had fewer 7-day ED revisits (3.8%vs 12.5%, SMD=0.321), fewer 14-day hospital readmissions (4.5%vs 15.6%, SMD=0.37), and shorter EDLOS (0.56vs 5.12hours, SMD=1.48).Conclusion: Curbside screening had high sensitivity, permitting early respiratory isolation precautions for most patients tested. Low ED revisit, hospital readmissions, and EDLOS suggest drive-through care, with appropriate screening, is safe and efficient for future respiratory illness pandemics.
View details for DOI 10.1002/emp2.12867
View details for PubMedID 36570369
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Three decades of demographic trends among academic emergency physicians.
Journal of the American College of Emergency Physicians open
Cleveland Manchanda, E. C., Ling, A. Y., Bottcher, J. L., Marsh, R. H., Brown, D. F., Bennett, C. L., Yiadom, M. Y.
2022; 3 (4): e12781
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Purpose: To describe trends in emergency medicine faculty demographics, examining changes in the proportion of historically underrepresented groups including female, Black, and Latinx faculty over time.Methods: Data from the Association of American Medical Colleges faculty roster (1990-2020) were used to assess the changing demographics of full-time emergency medicine faculty. Descriptive statistics, graphic visualizations, and logistic regression modeling were used to illustrate trends in the proportion of female, Black, and Latinx faculty. Odds ratios (OR) were used to describe the estimated annual rate of change of underrepresented demographic groups.Results: The number of full-time emergency medicine faculty increased from 214 in 1990 to 5874 in 2020. Female emergency medicine faculty demonstrated increases in representation overall, from 35 (16.36%) in 1990 to 2247 (38.25%) in 2020, suggesting a 3% estimated annual rate of increase (OR 1.03, 95% CI 1.03-1.04) and within each academic rank. A very small positive trend was noted among Latinx faculty (n=3, 1.40% in 1990 to n=326, 5.55% in 2020; OR 1.01, 95% CI 1.01-1.02), whereas an even smaller, statistically insignificant increase was observed among Black emergency medicine faculty during the 31-year study period (N=9, 4.21% in 1990 and N=266, 4.53% in 2020; OR 1.00, 95% CI 0.99-1.00).Conclusions: Although female physicians have progressed toward equitable representation among academic emergency medicine faculty, no meaningful progress has been made toward racial parity. The persistent underrepresentation of Black and Latinx physicians in the academic emergency medicine workforce underscores the need for urgent structural changes to address contemporary manifestations of racism in academic medicine and beyond.
View details for DOI 10.1002/emp2.12781
View details for PubMedID 35982985
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OPERATIONALIZING A PANDEMIC-READY, TELEMEDICINE-ENABLED DRIVE-THROUGH AND WALK-IN CORONAVIRUS DISEASE GARAGE CARE SYSTEM AS AN ALTERNATIVE CARE AREA: A NOVEL APPROACH IN PANDEMIC MANAGEMENT
JOURNAL OF EMERGENCY NURSING
Callagy, P., Ravi, S., Khan, S., Yiadom, M. B., McClellen, H., Snell, S., Major, T. W., Yefimova, M.
2021; 47 (5): 721-732
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Emergency departments face unforeseen surges in patients classified as low acuity during pandemics such as the coronavirus disease pandemic. Streamlining patient flow using telemedicine in an alternative care area can reduce crowding and promote physical distancing between patients and clinicians, thus limiting personal protective equipment use. This quality improvement project describes critical elements and processes in the operationalization of a telemedicine-enabled drive-through and walk-in garage care system to improve ED throughput and conserve personal protective equipment during 3 coronavirus disease surges in 2020.Standardized workflows were established for the operationalization of the telemedicine-enabled drive-through and walk-in garage care system for patients presenting with respiratory illness as quality improvement during disaster. Statistical control charts present interrupted time series data on the ED length of stay and personal protective equipment use in the week before and after deployment in March, July, and November 2020.Physical space, technology infrastructure, equipment, and staff workflows were critical to the operationalization of the telemedicine-enabled drive-through and walk-in garage care system. On average, the ED length of stay decreased 17%, from 4.24 hours during the week before opening to 3.54 hours during the telemedicine-enabled drive-through and walk-in garage care system operation. There was an estimated 25% to 41% reduction in personal protective equipment use during this time.Lessons learned from this telemedicine-enabled alternative care area implementation can be used for disaster preparedness and management in the ED setting to reduce crowding, improve throughput, and conserve personal protective equipment during a pandemic.
View details for DOI 10.1016/j.jen.2021.05.010
View details for Web of Science ID 000762175400001
View details for PubMedID 34303530
View details for PubMedCentralID PMC8173460
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Examining Parity among Black and Hispanic Resident Physicians.
Journal of general internal medicine
Bennett, C. L., Yiadom, M. Y., Baker, O. n., Marsh, R. H.
2021
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The US physician workforce does not represent the racial or ethnic diversity of the population it serves.To assess whether the proportion of US physician trainees of Black race and Hispanic ethnicity has changed over time and then provide a conceptual projection of future trends.Cross-sectional, retrospective, analysis based on 11 years of publicly available data paired with recent US census population estimates.A total of 86,303 (2007-2008) to 103,539 (2017-2018) resident physicians in the 20 largest US Accreditation Council for Graduate Medical Education resident specialties.Changes in proportion of physician trainees of Black race and Hispanic ethnicity per academic year. Projected number of years it will then take, for specialties with positive changes, to reach proportions of Black race and Hispanic ethnicity comparable to that of the US population.Among the 20 largest specialty training programs, Radiology was the only specialty with a statistically significant increase in the proportion of Black trainees, but it could take Radiology 77 years to reach levels of Black representation comparable to that of the US population. Obstetrics/Gynecology, Emergency Medicine, Internal Medicine/Pediatrics, and Orthopedic Surgery demonstrated a statistically significant increase in the proportion of Hispanic trainees, but it could take these specialties 35, 54, 61, and 93 years respectively to achieve Hispanic representation comparable to that of the US population.Among US residents in the 20 largest specialties, no specialty represented either the Black or Hispanic populations in proportions comparable to the overall US population. Only a small number of specialties demonstrated statistically significant increases. This conceptual projection suggests that current efforts to promote diversity are insufficient.
View details for DOI 10.1007/s11606-021-06650-7
View details for PubMedID 33629264
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Impact of a Follow-up Telephone Call Program on 30-Day Readmissions (FUTR-30): A Pragmatic Randomized Controlled Real-world Effectiveness Trial.
Medical care
Yiadom, M. Y., Domenico, H. J., Byrne, D. W., Hasselblad, M., Kripalani, S., Choma, N., Tucker-Marlow, S., Gatto, C. L., Wang, L., Bhatia, M. C., Morrison, J., Harrell, F. E., Hartert, T. V., Lindsell, C. J., Bernard, G. R.
2020; 58 (9): 785-792
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Telephone call programs are a common intervention used to improve patients' transition to outpatient care after hospital discharge.To examine the impact of a follow-up telephone call program as a readmission reduction initiative.Pragmatic randomized controlled real-world effectiveness trial.We enrolled and randomized all patients discharged home from a hospital general medicine service to a follow-up telephone call program or usual care discharge. Patients discharged against medical advice were excluded. The intervention was a hospital program, delivering a semistructured follow-up telephone call from a nurse within 3-7 days of discharge, designed to assess understanding and provide education, and assistance to support discharge plan implementation.Our primary endpoint was hospital inpatient readmission within 30 days identified by the electronic health record. Secondary endpoints included observation readmission, emergency department revisit, and mortality within 30 days, and patient experience ratings.All 3054 patients discharged home were enrolled and randomized to the telephone call program (n=1534) or usual care discharge (n=1520). Using a prespecified intention-to-treat analysis, we found no evidence supporting differences in 30-day inpatient readmissions [14.9% vs. 15.3%; difference -0.4 (95% confidence interval, 95% CI), -2.9 to 2.1; P=0.76], observation readmissions [3.8% vs. 3.6%; difference 0.2 (95% CI, -1.1 to 1.6); P=0.74], emergency department revisits [6.1% vs. 5.4%; difference 0.7 (95% CI, -1.0 to 2.3); P=0.43], or mortality [4.4% vs. 4.9%; difference -0.5 (95% CI, -2.0 to 1.0); P=0.51] between telephone call and usual care groups.We found no evidence of an impact on 30-day readmissions or mortality due to the postdischarge telephone call program.
View details for DOI 10.1097/MLR.0000000000001353
View details for PubMedID 32732787
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Public Health Rationale for Investments in Emergency Medicine in Developing Countries - Ghana as a Case Study.
The Journal of emergency medicine
Yiadom, M. Y., McWade, C. M., Awoonor-Williams, K., Appiah-Denkyira, E., Moresky, R. T.
2018; 55 (4): 537-543
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Ghana is a developing country that has strategically invested in expanding emergency care services as a means of improving national health outcomes.Here we present Ghana as a case study for investing in emergency care to achieve public health benefits that fuel for national development.Ghana's health leadership has affirmed emergency care as a necessary adjunct to its preexisting primary health care model. Historically, developing countries prioritize primary care efforts and outpatient clinic-based health care models. Ghana has added emergency medicine infrastructure to its health care system in an effort to address the ongoing shift in disease epidemiology as the population urbanizes, mobilizes, and ages. Ghana's investments include prehospital care, personnel training, health care resource provision, communication improvements, transportation services, and new health facilities. This is in addition to re-educating frontline health care providers and developing infrastructure for specialist training. Change was fueled by public support, partnerships between international organizations and domestic stakeholders, and several individual champions.Emergency medicine as a horizontal component of low- to middle-income countries' health systems may fuel national health and economic development. Ghana's experience may serve as a model.
View details for DOI 10.1016/j.jemermed.2018.07.021
View details for PubMedID 30181077
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Randomised controlled pragmatic clinical trial evaluating the effectiveness of a discharge follow-up phone call on 30-day hospital readmissions: balancing pragmatic and explanatory design considerations.
BMJ open
Yiadom, M. Y., Domenico, H., Byrne, D., Hasselblad, M. M., Gatto, C. L., Kripalani, S., Choma, N., Tucker, S., Wang, L., Bhatia, M. C., Morrison, J., Harrell, F. E., Hartert, T., Bernard, G.
2018; 8 (2): e019600
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Abstract
Hospital readmissions within 30 days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients' successful transition from inpatient to outpatient care is a continued challenge.This is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions. Our primary endpoint is inpatient readmission within 30 days of hospital discharge censored for death analysed with an intention-to-treat approach. Secondary endpoints included observation status readmission within 30 days, time to readmission, all-cause emergency department revisits within 30 days, patient satisfaction (measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems scores) and 30-day mortality. Exploratory endpoints include the need for assistance with discharge plan implementation among those randomised to the intervention arm and reached by the study nurse, and the number of call attempts to achieve successful intervention delivery. Consistent with the Learning Healthcare System model for clinical research, timeliness is a critical quality for studies to most effectively inform hospital clinical practice. We are challenged to apply pragmatic design elements in order to maintain a high-quality practicable study providing timely results. This type of prospective pragmatic trial empowers the advancement of hospital-wide evidence-based practice directly affecting patients.Study results will inform the structure, objective and function of future iterations of the hospital's discharge follow-up phone call programme and be submitted for publication in the literature.NCT03050918; Pre-results.
View details for DOI 10.1136/bmjopen-2017-019600
View details for PubMedID 29444787
View details for PubMedCentralID PMC5829894
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Diagnostic Utility of Neuregulin for Acute Coronary Syndrome.
Disease markers
Yiadom, M. Y., Greenberg, J., Smith, H. M., Sawyer, D. B., Liu, D., Carlise, J., Tortora, L., Storrow, A. B.
2016; 2016: 8025271
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Abstract
The purpose of this study was to determine the diagnostic test characteristics of serum neuregulin-1β (NRG-1β) for the detection of acute coronary syndrome (ACS). We recruited emergency department patients presenting with signs and symptoms prompting an evaluation for ACS. Serum troponin and neuregulin-1β levels were compared between those who had a final discharge diagnosis of myocardial infarction (STEMI and NSTEMI) and those who did not, as well as those who more broadly had a final discharge diagnosis of ACS (STEMI, NSTEMI, and unstable angina). Of 319 study participants, 11% had evidence of myocardial infarction, and 19.7% had a final diagnosis of ACS. Patients with MI had median neuregulin levels of 0.16 ng/mL (IQR [0.16-24.54]). Compared to the median of those without MI, 1.46 ng/mL (IQR [0.16-15.02]), there was no significant difference in the distribution of results (P = 0.63). Median neuregulin levels for patients with ACS were 0.65 ng/mL (IQR [0.16-24.54]). There was no statistical significance compared to those without ACS who had a median of 1.40 ng/mL (IQR [0.16-14.19]) (P = 0.95). Neuregulin did not perform successfully as a biomarker for acute MI or ACS in the emergency department.
View details for DOI 10.1155/2016/8025271
View details for PubMedID 27110055
View details for PubMedCentralID PMC4823486
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CLOPIDOGREL USE IN ST-ELEVATION MYOCARDIAL INFARCTION (STEMI)
JOURNAL OF EMERGENCY MEDICINE
Yiadom, M. B.
2010; 39 (2): 217-218
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View details for DOI 10.1016/j.jemermed.2008.08.025
View details for Web of Science ID 000281290000017
View details for PubMedID 19168312
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Efficacy of ShotBlocker in reducing pediatric pain associated with intramuscular injections
Drago, L. A., Singh, S. B., Douglass-Bright, A., Yiadom, M., Baumann, B. M.
W B SAUNDERS CO-ELSEVIER INC. 2009: 536-543
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The aim of the study was to determine the efficacy of ShotBlocker (Bionix, Toledo, Ohio) in reducing pediatric pain with intramuscular (IM) injections.A prospective randomized controlled trial was conducted in children aged 2 months to 17 years who required an IM injection. Children were randomized to the no-intervention group or the ShotBlocker group. Demographic data and the number of IM injections were recorded. Perceived pain scores were obtained from nurses and caregivers using a 6-point Likert-type scale. Baker Wong Faces scale was used in children 36 months or older. Difficulty using the device was also rated by nurses on a 6-point scale.One hundred sixty-five children were enrolled with 80 in the no-intervention arm and 85 in the ShotBlocker arm. The mean age of children was 45 months and 56% were male. Perceived pain scores by nurses were higher for the no-intervention group (2.6 vs 1.8, P < .001) as well as by caregivers (2.6 vs 2.1, P = .04). Children aged 36 months and older (n = 64) did not report a difference in pain scores (1.5 vs 1.3, P = .6); however, in a subgroup of children 72 months or older, pain scores trended higher in the no-intervention group (1.3 vs 0.5, P = .051). Nurse-perceived difficulty of ShotBlocker use was low 1.39 (+/-1.1).Nurses and caregivers noted lower pain scores in children assigned to the ShotBlocker group. These differences were not as evident when children rated their own pain.
View details for DOI 10.1016/j.ajem.2008.04.011
View details for Web of Science ID 000266940800004
View details for PubMedID 19497458
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Pneumothorax in a blunt trauma patient
JOURNAL OF EMERGENCY MEDICINE
Yiadom, M. B., Platz, E., Brown, D. M., Nadel, E. S.
2008; 35 (2): 199-203
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View details for DOI 10.1016/j.jemermed.2008.05.014
View details for Web of Science ID 000258475700015
View details for PubMedID 18599250
OFDD HEAL Network Leadership
Publications
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Hepatitis B virus clinical and virologic characteristics in an HIV perinatal transmission study in sub-saharan Africa, HPTN 046- a post-hoc analysis.
AIDS (London, England)
Bhattacharya, D., Guo, R., Tseng, C. H., Emel, L., Sun, R., Zhang, T. H., Chiu, S. H., Stranix-Chibanda, L., Chipato, T., Ship, H., Mohtashemi, N. Z., Kintu, K., Manji, K. P., Moodley, D., Maldonado, Y., Currier, J. S., Thio, C. L.
2023
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To describe the clinical and virologic characteristics of HIV-HBV coinfection, including the predictors of high maternal HBV viral load in pregnant women with HIV in sub-Saharan Africa (SSA).HPTN 046 was a HIV perinatal transmission clinical trial evaluating infant nevirapine vs placebo. Women-infant pairs (n = 2016) were enrolled in SSA from 2007-2010; 1579 (78%) received antiretrovirals (ARV). Maternal delivery samples were retrospectively tested for hepatitis B surface antigen (HBsAg), and if positive, were tested for hepatitis B e antigen (HBeAg) and HBV viral load (VL). High HBV VL was defined as ≥106 IU/ml.Overall, 4.4% (88/2016) had HBV co-infection, with geographic variability ranging from 2.4-8.7% (p < 0.0001); 25% (22/88) were HBeAg positive with prevalence in countries ranging from 10.5-39%. Fifty-two percent (40/77) of those with HBV received ARV, the majority (97%) received 3TC as the only HBV active agent.. HBeAg positivity was associated with high maternal HBV VL, OR 37.0, 95% CI 5.4-252.4. Of those with high HBV VL, 40% (4/10) were receiving HBV active drugs (HBV-ARV).. HBV drug resistance occurred in 7.5% (3/40) receiving HBV- ARV.In SSA, HBV co-infection is common in pregnant women with HIV. HBsAg and HBeAg prevalence vary widely by country in this clinical trial cohort. HBeAg is a surrogate for high HBV viral load. HBV drug resistance occurred in 7.5% receiving HBV-ARV with lamivudine as the only HBV active agent.. These findings reinforce the importance of HBsAg screening and early treatment with with two active agents for HBV.
View details for DOI 10.1097/QAD.0000000000003752
View details for PubMedID 37861675
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Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns.
NPJ vaccines
Walter, K. S., Altamirano, J., Huang, C., Carrington, Y. J., Zhou, F., Andrews, J. R., Maldonado, Y.
2023; 8 (1): 137
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Abstract
There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from children receiving OPV and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Overall, 61% (11/18) of OPV-1, 71% (34/48) OPV-2, and 96% (54/56) OPV-3 samples with available data had evidence of a reversion at the key 5' UTR attenuating position and 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutations in the VP1 gene. Our results are consistent with previous work documenting rapid reversion to virulence of OPV and underscores the need for intensive surveillance following OPV use.
View details for DOI 10.1038/s41541-023-00740-9
View details for PubMedID 37749086
View details for PubMedCentralID 9712124
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Association of protective behaviors with SARS-CoV-2 infection: Results from a longitudinal cohort study of adults in the San Francisco Bay Area.
Annals of epidemiology
Judson, T. J., Zhang, S., Lindan, C. P., Boothroyd, D., Grumbach, K., Bollyky, J., Sample, H., Huang, B., Desai, M., Gonzales, R., Maldonado, Y., Rutherford, G.
2023
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In an effort to decrease transmission during the first years of the COVID-19 pandemic, public health officials encouraged masking, social distancing, and working from home, and restricted travel. However, many studies of the effectiveness of these measures had significant methodologic limitations. In this analysis, we used data from the TrackCOVID study, a longitudinal cohort study of a population-based sample of 3,846 adults in the San Francisco Bay Area, to evaluate the association between self-reported protective behaviors including masking, physical distancing, travel and working outside the home, and incidence of SARS-CoV-2 infection. Participants without SARS-CoV2 infection were enrolled from August-December 2020 and followed monthly with testing and surveys (median of 4 visits). A total of 118 incident infections occurred (3.0% of participants). At baseline, 80.0% reported always wearing a mask; 56.0% avoided contact with non-household members some/most of the time; 9.6% traveled outside the state; and 16.0% worked 20 or more hours per week outside the home. These behaviors did not change markedly over time. Factors associated with incident infection included being Black or Latinx, having less than a college education, and having more household residents. The only behavioral factor associated with incident infection was working outside the home (aHR 1.62, 95% CI 1.02-2.59). Focusing on protecting people who cannot work from home could help prevent infections during future waves of COVID-19, or future pandemics from respiratory viruses. This focus must be balanced with the known importance of directing resources toward those at risk of severe infections.
View details for DOI 10.1016/j.annepidem.2023.07.009
View details for PubMedID 37524216
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Electronic Nose Development and Preliminary Human Breath Testing for Rapid, Non-Invasive COVID-19 Detection.
ACS sensors
Li, J., Hannon, A., Yu, G., Idziak, L. A., Sahasrabhojanee, A., Govindarajan, P., Maldonado, Y. A., Ngo, K., Abdou, J. P., Mai, N., Ricco, A. J.
2023
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Abstract
We adapted an existing, spaceflight-proven, robust "electronic nose" (E-Nose) that uses an array of electrical resistivity-based nanosensors mimicking aspects of mammalian olfaction to conduct on-site, rapid screening for COVID-19 infection by measuring the pattern of sensor responses to volatile organic compounds (VOCs) in exhaled human breath. We built and tested multiple copies of a hand-held prototype E-Nose sensor system, composed of 64 chemically sensitive nanomaterial sensing elements tailored to COVID-19 VOC detection; data acquisition electronics; a smart tablet with software (App) for sensor control, data acquisition and display; and a sampling fixture to capture exhaled breath samples and deliver them to the sensor array inside the E-Nose. The sensing elements detect the combination of VOCs typical in breath at parts-per-billion (ppb) levels, with repeatability of 0.02% and reproducibility of 1.2%; the measurement electronics in the E-Nose provide measurement accuracy and signal-to-noise ratios comparable to benchtop instrumentation. Preliminary clinical testing at Stanford Medicine with 63 participants, their COVID-19-positive or COVID-19-negative status determined by concomitant RT-PCR, discriminated between these two categories of human breath with a 79% correct identification rate using "leave-one-out" training-and-analysis methods. Analyzing the E-Nose response in conjunction with body temperature and other non-invasive symptom screening using advanced machine learning methods, with a much larger database of responses from a wider swath of the population, is expected to provide more accurate on-the-spot answers. Additional clinical testing, design refinement, and a mass manufacturing approach are the main steps toward deploying this technology to rapidly screen for active infection in clinics and hospitals, public and commercial venues, or at home.
View details for DOI 10.1021/acssensors.3c00367
View details for PubMedID 37224474
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Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns.
medRxiv : the preprint server for health sciences
Walter, K. S., Altamirano, J., Huang, C., Carrington, Y. J., Zhou, F., Andrews, J. R., Maldonado, Y.
2023
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Abstract
There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from vaccinated children and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Alarmingly, 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutation. Our results suggest that current definitions of cVDPVs may exclude circulating virulent viruses that pose a public health risk and underscore the need for intensive surveillance following OPV use.
View details for DOI 10.1101/2023.03.16.23287381
View details for PubMedID 36993386
View details for PubMedCentralID PMC10055580
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Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era.
Lancet (London, England)
Carpiano, R. M., Callaghan, T., DiResta, R., Brewer, N. T., Clinton, C., Galvani, A. P., Lakshmanan, R., Parmet, W. E., Omer, S. B., Buttenheim, A. M., Benjamin, R. M., Caplan, A., Elharake, J. A., Flowers, L. C., Maldonado, Y. A., Mello, M. M., Opel, D. J., Salmon, D. A., Schwartz, J. L., Sharfstein, J. M., Hotez, P. J.
2023
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View details for DOI 10.1016/S0140-6736(23)00136-8
View details for PubMedID 36871571
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Evaluation of BNT162b2 Covid-19 Vaccine in Children Younger than 5 Years of Age.
The New England journal of medicine
Muñoz, F. M., Sher, L. D., Sabharwal, C., Gurtman, A., Xu, X., Kitchin, N., Lockhart, S., Riesenberg, R., Sexter, J. M., Czajka, H., Paulsen, G. C., Maldonado, Y., Walter, E. B., Talaat, K. R., Englund, J. A., Sarwar, U. N., Hansen, C., Iwamoto, M., Webber, C., Cunliffe, L., Ukkonen, B., Martínez, S. N., Pahud, B. A., Munjal, I., Domachowske, J. B., Swanson, K. A., Ma, H., Koury, K., Mather, S., Lu, C., Zou, J., Xie, X., Shi, P. Y., Cooper, D., Türeci, Ö., Şahin, U., Jansen, K. U., Gruber, W. C.
2023; 388 (7): 621-634
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Safe and effective vaccines against coronavirus disease 2019 (Covid-19) are urgently needed in young children.We conducted a phase 1 dose-finding study and are conducting an ongoing phase 2-3 safety, immunogenicity, and efficacy trial of the BNT162b2 vaccine in healthy children 6 months to 11 years of age. We present results for children 6 months to less than 2 years of age and those 2 to 4 years of age through the data-cutoff dates (April 29, 2022, for safety and immunogenicity and June 17, 2022, for efficacy). In the phase 2-3 trial, participants were randomly assigned (in a 2:1 ratio) to receive two 3-μg doses of BNT162b2 or placebo. On the basis of preliminary immunogenicity results, a third 3-μg dose (≥8 weeks after dose 2) was administered starting in January 2022, which coincided with the emergence of the B.1.1.529 (omicron) variant. Immune responses at 1 month after doses 2 and 3 in children 6 months to less than 2 years of age and those 2 to 4 years of age were immunologically bridged to responses after dose 2 in persons 16 to 25 years of age who received 30 μg of BNT162b2 in the pivotal trial.During the phase 1 dose-finding study, two doses of BNT162b2 were administered 21 days apart to 16 children 6 months to less than 2 years of age (3-μg dose) and 48 children 2 to 4 years of age (3-μg or 10-μg dose). The 3-μg dose level was selected for the phase 2-3 trial; 1178 children 6 months to less than 2 years of age and 1835 children 2 to 4 years of age received BNT162b2, and 598 and 915, respectively, received placebo. Immunobridging success criteria for the geometric mean ratio and seroresponse at 1 month after dose 3 were met in both age groups. BNT162b2 reactogenicity events were mostly mild to moderate, with no grade 4 events. Low, similar incidences of fever were reported after receipt of BNT162b2 (7% among children 6 months to <2 years of age and 5% among those 2 to 4 years of age) and placebo (6 to 7% among children 6 months to <2 years of age and 4 to 5% among those 2 to 4 years of age). The observed overall vaccine efficacy against symptomatic Covid-19 in children 6 months to 4 years of age was 73.2% (95% confidence interval, 43.8 to 87.6) from 7 days after dose 3 (on the basis of 34 cases).A three-dose primary series of 3-μg BNT162b2 was safe, immunogenic, and efficacious in children 6 months to 4 years of age. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04816643.).
View details for DOI 10.1056/NEJMoa2211031
View details for PubMedID 36791162
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Challenges in Harnessing Shared Within-Host Severe Acute Respiratory Syndrome Coronavirus 2 Variation for Transmission Inference.
Open forum infectious diseases
Walter, K. S., Kim, E., Verma, R., Altamirano, J., Leary, S., Carrington, Y. J., Jagannathan, P., Singh, U., Holubar, M., Subramanian, A., Khosla, C., Maldonado, Y., Andrews, J. R.
2023; 10 (2): ofad001
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The limited variation observed among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) consensus sequences makes it difficult to reconstruct transmission linkages in outbreak settings. Previous studies have recovered variation within individual SARS-CoV-2 infections but have not yet measured the informativeness of within-host variation for transmission inference.We performed tiled amplicon sequencing on 307 SARS-CoV-2 samples, including 130 samples from 32 individuals in 14 households and 47 longitudinally sampled individuals, from 4 prospective studies with household membership data, a proxy for transmission linkage.Consensus sequences from households had limited diversity (mean pairwise distance, 3.06 single-nucleotide polymorphisms [SNPs]; range, 0-40). Most (83.1%, 255 of 307) samples harbored at least 1 intrahost single-nucleotide variant ([iSNV] median, 117; interquartile range [IQR], 17-208), above a minor allele frequency threshold of 0.2%. Pairs in the same household shared significantly more iSNVs (mean, 1.20 iSNVs; 95% confidence interval [CI], 1.02-1.39) than did pairs in different households infected with the same viral clade (mean, 0.31 iSNVs; 95% CI, .28-.34), a signal that decreases with increasingly stringent minor allele frequency thresholds. The number of shared iSNVs was significantly associated with an increased odds of household membership (adjusted odds ratio, 1.35; 95% CI, 1.23-1.49). However, the poor concordance of iSNVs detected across sequencing replicates (24.8% and 35.0% above a 0.2% and 1% threshold) confirms technical concerns that current sequencing and bioinformatic workflows do not consistently recover low-frequency within-host variants.Shared within-host variation may augment the information in consensus sequences for predicting transmission linkages. Improving sensitivity and specificity of within-host variant identification will improve the informativeness of within-host variation.
View details for DOI 10.1093/ofid/ofad001
View details for PubMedID 36751652
View details for PubMedCentralID PMC9898879
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Lessons From a House on Fire-From Smallpox to Polio
JOURNAL OF INFECTIOUS DISEASES
Maldonado, Y. A.
2023
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View details for DOI 10.1093/infdis/jiad017
View details for Web of Science ID 000938260500001
View details for PubMedID 36691964
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Strategies to Increase Workforce Diversity in Pediatric Infectious Diseases.
Journal of the Pediatric Infectious Diseases Society
Rogo, T., Holland, S., Fassiotto, M., Maldonado, Y., Joseph, T., Ramilo, O., Byrd, K., Delair, S.
2022; 11 (Supplement_4): S148-S154
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Abstract
The number of physicians who are underrepresented in medicine within the pediatric infectious diseases workforce remains disproportionate compared to the US population. Physician workforce diversity plays an important role in reducing health care disparities. Pathways to careers in pediatric infectious diseases require that a diverse pool of students enter medicine and subsequently choose pediatric residency followed by subspecialty training. Efforts must be made to expose learners to pediatric infectious diseases earlier in the education timeline. Along with recruitment and creation of pathways, cultures of inclusivity must be created and fostered within institutions of learning along the entire spectrum of medical training.
View details for DOI 10.1093/jpids/piac094
View details for PubMedID 36477593
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Disability Identity Among Diverse Learners and Employees at an Academic Medical Center.
JAMA network open
Jerome, B., Fassiotto, M., Altamirano, J., Sutha, K., Maldonado, Y., Poullos, P.
2022; 5 (11): e2241948
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Abstract
This survey study evaluates representation of persons with disabilities across demographic characteristics at an academic medical center.
View details for DOI 10.1001/jamanetworkopen.2022.41948
View details for PubMedID 36355375
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The legacy of the COVID-19 pandemic for childhood vaccination in the USA.
Lancet (London, England)
Opel, D. J., Brewer, N. T., Buttenheim, A. M., Callaghan, T., Carpiano, R. M., Clinton, C., Elharake, J. A., Flowers, L. C., Galvani, A. P., Hotez, P. J., Schwartz, J. L., Benjamin, R. M., Caplan, A., DiResta, R., Lakshmanan, R., Maldonado, Y. A., Mello, M. M., Parmet, W. E., Salmon, D. A., Sharfstein, J. M., Omer, S. B.
2022
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View details for DOI 10.1016/S0140-6736(22)01693-2
View details for PubMedID 36309017
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Early immune markers of clinical, virological, and immunological outcomes in patients with COVID-19: a multi-omics study.
eLife
Hu, Z., van der Ploeg, K., Chakraborty, S., Arunachalam, P. S., Mori, D. A., Jacobson, K. B., Bonilla, H., Parsonnet, J., Andrews, J. R., Holubar, M., Subramanian, A., Khosla, C., Maldonado, Y., Hedlin, H., de la Parte, L., Press, K., Ty, M., Tan, G. S., Blish, C., Takahashi, S., Rodriguez-Barraquer, I., Greenhouse, B., Butte, A. J., Singh, U., Pulendran, B., Wang, T. T., Jagannathan, P.
2022; 11
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The great majority of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infections are mild and uncomplicated, but some individuals with initially mild COVID-19 progressively develop more severe symptoms. Furthermore, there is substantial heterogeneity in SARS-CoV-2-specific memory immune responses following infection. There remains a critical need to identify host immune biomarkers predictive of clinical and immunological outcomes in SARS-CoV-2-infected patients.Leveraging longitudinal samples and data from a clinical trial (N=108) in SARS-CoV-2-infected outpatients, we used host proteomics and transcriptomics to characterize the trajectory of the immune response in COVID-19 patients. We characterized the association between early immune markers and subsequent disease progression, control of viral shedding, and SARS-CoV-2-specific T cell and antibody responses measured up to 7 months after enrollment. We further compared associations between early immune markers and subsequent T cell and antibody responses following natural infection with those following mRNA vaccination. We developed machine-learning models to predict patient outcomes and validated the predictive model using data from 54 individuals enrolled in an independent clinical trial.We identify early immune signatures, including plasma RIG-I levels, early IFN signaling, and related cytokines (CXCL10, MCP1, MCP-2, and MCP-3) associated with subsequent disease progression, control of viral shedding, and the SARS-CoV-2-specific T cell and antibody response measured up to 7 months after enrollment. We found that several biomarkers for immunological outcomes are shared between individuals receiving BNT162b2 (Pfizer-BioNTech) vaccine and COVID-19 patients. Finally, we demonstrate that machine-learning models using 2-7 plasma protein markers measured early within the course of infection are able to accurately predict disease progression, T cell memory, and the antibody response post-infection in a second, independent dataset.Early immune signatures following infection can accurately predict clinical and immunological outcomes in outpatients with COVID-19 using validated machine-learning models.Support for the study was provided from National Institute of Health/National Institute of Allergy and Infectious Diseases (NIH/NIAID) (U01 AI150741-01S1 and T32-AI052073), the Stanford's Innovative Medicines Accelerator, National Institutes of Health/National Institute on Drug Abuse (NIH/NIDA) DP1DA046089, and anonymous donors to Stanford University. Peginterferon lambda provided by Eiger BioPharmaceuticals.
View details for DOI 10.7554/eLife.77943
View details for PubMedID 36239699
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Building Programs to Eradicate Toxoplasmosis Part III: Epidemiology and Risk Factors.
Current pediatrics reports
Felín, M. S., Wang, K., Raggi, C., Moreira, A., Pandey, A., Grose, A., Caballero, Z., Rengifo-Herrera, C., Ramirez, M., Moossazadeh, D., Castro, C., Montalvo, J. L., Leahy, K., Zhou, Y., Clouser, F. A., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Norero, X., Estripeaut, D., Ellis, D., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Mendivil, C., Quijada, M. R., Fernández-Pirla, S., de La Guardia, V., Wong, D., de LadrónGuevara, M., Flores, C., Borace, J., García, A., Caballero, N., de Saez, M. T., Politis, M., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebollon, A., Boyer, K., Heydemann, P., Noble, A. G., Swisher, C., Rabiah, P., Withers, S., Hull, T., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D. V., Villareal, A., Perez, A., Galvis, C. A., Montes, M. V., Perez, N. I., Ramirez, M., Chittenden, C., Wang, E., Garcia-López, L. L., Muñoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M. C., de-la-Torre, G. C., Padrieu, G., Hernandez, J. D., Celis-Giraldo, D., Acosta Dávila, J. A., Torres, E., Oquendo, M. M., Arteaga-Rivera, J. Y., Nicolae, D., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Holfels, E., Frim, D., McLone, D., Penn, R., Cohen, W., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I. L., Meier, P., Grigg, M., Gómez-Marín, J., Kosagisharaf, J. R., Llorens, X. S., Reyes, O., McLeod, R.
2022; 10 (3): 109-124
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Review comprehensive data on rates of toxoplasmosis in Panama and Colombia.Samples and data sets from Panama and Colombia, that facilitated estimates regarding seroprevalence of antibodies to Toxoplasma and risk factors, were reviewed.Screening maps, seroprevalence maps, and risk factor mathematical models were devised based on these data. Studies in Ciudad de Panamá estimated seroprevalence at between 22 and 44%. Consistent relationships were found between higher prevalence rates and factors such as poverty and proximity to water sources. Prenatal screening rates for anti-Toxoplasma antibodies were variable, despite existence of a screening law. Heat maps showed a correlation between proximity to bodies of water and overall Toxoplasma seroprevalence. Spatial epidemiological maps and mathematical models identify specific regions that could most benefit from comprehensive, preventive healthcare campaigns related to congenital toxoplasmosis and Toxoplasma infection.
View details for DOI 10.1007/s40124-022-00265-0
View details for PubMedID 37744780
View details for PubMedCentralID PMC10516319
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Gender Differences in National Institutes of Health Grant Submissions Before and During the COVID-19 Pandemic.
Journal of women's health (2002)
Roubinov, D., Haack, L. M., Folk, J. B., Rotenstein, L., Accurso, E. C., Dahiya, P., Ponce, A. N., Nava, V., Maldonado, Y., Linos, E., Mangurian, C.
2022; 31 (9): 1241-1245
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Introduction: Emerging data suggest that the COVID-19 pandemic has disproportionately impacted women in academic medicine, potentially eliminating recent gains that have been made toward gender equity. This study examined possible pandemic-related gender disparities in research grant submissions, one of the most important criteria for academic promotion and tenure evaluations. Methods: Data were collected from two major academic institutions (one private and one public) on the gender and academic rank of faculty principal investigators who submitted new grants to the National Institutes of Health (NIH) during COVID-19 (March 1st, 2020, through August 31, 2020) compared with a matched period in 2019 (March 1st, 2019, through August 31, 2019). t-Tests and chi-square analyses compared the gender distribution of individuals who submitted grants during the two periods of examination. Results: In 2019 (prepandemic), there was no significant difference in the average number of grants submitted by women compared with men faculty. In contrast, women faculty submitted significantly fewer grants in 2020 (during the pandemic) than men. Men were also significantly more likely than women to submit grants in both 2019 and 2020 compared with submitting in 2019 only, suggesting men faculty may have been more likely than their women colleagues to sustain their productivity in grant submissions during the pandemic. Discussion: Women's loss of extramural funding may compound over time, as it impedes new data collection, research progress, and academic advancement. Efforts to support women's research productivity and career trajectories are urgently needed in the following years of pandemic recovery.
View details for DOI 10.1089/jwh.2022.0182
View details for PubMedID 36112424
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Building Programs to Eradicate Toxoplasmosis Part II: Education.
Current pediatrics reports
Felín, M. S., Wang, K., Moreira, A., Grose, A., Leahy, K., Zhou, Y., Clouser, F. A., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Caballero, Z., Norero, X., Estripeaut, D., Ellis, D., Raggi, C., Castro, C., Rengifo-Herrera, C., Moossazadeh, D., Ramirez, M., Pandey, A., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Montalvo, J. L., Mendivil, C., Quijada, M. R., Fernández-Pirla, S., de La Guardia, V., Wong, D., de Guevara, M. L., Flores, C., Borace, J., García, A., Caballero, N., de Saez, M. T., Politis, M., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebellon, A., Boyer, K., Heydemann, P., Noble, A. G., Swisher, C., Rabiah, P., Withers, S., Hull, T., Frim, D., McLone, D., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D. V., Villareal, A., Perez, A., Galvis, C. A., Montes, M. V., Perez, N. I., Ramirez, M., Chittenden, C., Wang, E., Garcia-López, L. L., Muñoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M. C., de-la-Torre, G. C., Padrieu, G., Hernandez, J. D., Celis-Giraldo, D., Dávila, J. A., Torres, E., Oquendo, M. M., Arteaga-Rivera, J. Y., Nicolae, D. L., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., Holfels, E., Penn, R., Cohen, W., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I. L., Meier, P., Grigg, M., Gómez-Marín, J., Kosagisharaf, J. R., Llorens, X. S., Reyes, O., McLeod, R.
2022; 10 (3): 93-108
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Abstract
Review work to create and evaluate educational materials that could serve as a primary prevention strategy to help both providers and patients in Panama, Colombia, and the USA reduce disease burden of Toxoplasma infections.Educational programs had not been evaluated for efficacy in Panama, USA, or Colombia.Educational programs for high school students, pregnant women, medical students and professionals, scientists, and lay personnel were created. In most settings, short-term effects were evaluated. In Panama, Colombia, and USA, all materials showed short-term utility in transmitting information to learners. These educational materials can serve as a component of larger public health programs to lower disease burden from congenital toxoplasmosis. Future priorities include conducting robust longitudinal studies of whether education correlates with reduced adverse disease outcomes, modifying educational materials as new information regarding region-specific risk factors is discovered, and ensuring materials are widely accessible.
View details for DOI 10.1007/s40124-022-00267-y
View details for PubMedID 36969368
View details for PubMedCentralID PMC10035399
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Building Programs to Eradicate Toxoplasmosis Part I: Introduction and Overview.
Current pediatrics reports
Felín, M. S., Wang, K., Moreira, A., Grose, A., Leahy, K., Zhou, Y., Clouser, F. A., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Caballero, Z., Norero, X., Estripeaut, D., Ellis, D., Raggi, C., Castro, C., Moossazadeh, D., Ramirez, M., Pandey, A., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Montalvo, J. L., Mendivil, C., Quijada, M. R., Fernández-Pirla, S., de La Guardia, V., Wong, D., de Guevara, M. L., Flores, C., Borace, J., García, A., Caballero, N., Rengifo-Herrera, C., de Saez, M. T., Politis, M., Wroblewski, K., Karrison, T., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebellon, A., Boyer, K., Heydemann, P., Noble, A. G., Swisher, C., Rabiah, P., Withers, S., Hull, T., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D. V., Villareal, A., Perez, A., Galvis, C. A., Montes, M. V., Perez, N. I., Ramirez, M., Chittenden, C., Wang, E., Garcia-López, L. L., Muñoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M. C., de-la-Torre, G. C., Padrieu, G., Hernandez, J. D., Celis-Giraldo, D., Dávila, J. A., Torres, E., Oquendo, M. M., Arteaga-Rivera, J. Y., Nicolae, D. L., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Holfels, E., Frim, D., McLone, D., Penn, R., Cohen, W., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I. L., Meier, P., Grigg, M., Gómez-Marín, J., Kosagisharaf, J. R., Llorens, X. S., Reyes, O., McLeod, R.
2022; 10 (3): 57-92
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Abstract
Review building of programs to eliminate Toxoplasma infections.Morbidity and mortality from toxoplasmosis led to programs in USA, Panama, and Colombia to facilitate understanding, treatment, prevention, and regional resources, incorporating student work.Studies foundational for building recent, regional approaches/programs are reviewed. Introduction provides an overview/review of programs in Panamá, the United States, and other countries. High prevalence/risk of exposure led to laws mandating testing in gestation, reporting, and development of broad-based teaching materials about Toxoplasma. These were tested for efficacy as learning tools for high-school students, pregnant women, medical students, physicians, scientists, public health officials and general public. Digitized, free, smart phone application effectively taught pregnant women about toxoplasmosis prevention. Perinatal infection care programs, identifying true regional risk factors, and point-of-care gestational screening facilitate prevention and care. When implemented fully across all demographics, such programs present opportunities to save lives, sight, and cognition with considerable spillover benefits for individuals and societies.The online version contains supplementary material available at 10.1007/s40124-022-00269-w.
View details for DOI 10.1007/s40124-022-00269-w
View details for PubMedID 36034212
View details for PubMedCentralID PMC9395898
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Building Programs to Eradicate Toxoplasmosis Part I: Introduction and Overview
CURRENT PEDIATRICS REPORTS
Felin, M., Wang, K., Moreira, A., Grose, A., Leahy, K., Zhou, Y., Clouser, F., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Caballero, Z., Norero, X., Estripeaut, D., Ellis, D., Raggi, C., Castro, C., Moossazadeh, D., Ramirez, M., Pandey, A., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Fabrega, L., Montalvo, J., Mendivil, C., Quijada, M. R., Fernandez-Pirla, S., de La Guardia, V., Wong, D., Ladron de Guevara, M., Flores, C., Borace, J., Garcia, A., Caballero, N., Moreno de Saez, M., Politis, M., Wroblewski, K., Karrison, T., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebellon, A., Boyer, K., Heydemann, P., Noble, A., Swisher, C., Rabiah, P., Withers, S., Hull, T., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D., Villareal, A., Perez, A., Naranjo Galvis, C., Vargas Montes, M., Cardona Perez, N., Ramirez, M., Chittenden, C., Wang, E., Padrieu, G., Valencia Hernandez, J., Acosta Davila, J., Torres, E., Mejia Oquendo, M., Nicolae, D. L., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Holfels, E., Frim, D., McLone, D., Penn, R., Cohen, W., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., Britton, G., Motta, J., Ortega-Barria, E., Luz Romero, I., Meier, P., Grigg, M., Gomez-Marin, J., Rao Kosagisharaf, J., Saez Llorens, X., Reyes, O., McLeod, R.
2022
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View details for DOI 10.1007/s40124-022-00269-w
View details for Web of Science ID 000842848600001
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Building Programs to Eradicate Toxoplasmosis Part IV: Understanding and Development of Public Health Strategies and Advances "Take a Village".
Current pediatrics reports
Felin, M. S., Wang, K., Moreira, A., Grose, A., Leahy, K., Zhou, Y., Clouser, F. A., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Caballero, Z., Norero, X., Estripeaut, D., Ellis, D., Raggi, C., Castro, C., Moossazadeh, D., Ramirez, M., Pandey, A., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Montalvo, J. L., Mendivil, C., Quijada, M. R., Fernandez-Pirla, S., de La Guardia, V., Wong, D., de Guevara, M. L., Flores, C., Borace, J., Garcia, A., Caballero, N., Rengifo-Herrera, C., de Saez, M. T., Politis, M., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebellon, A., Boyer, K., Heydemann, P., Noble, A. G., Swisher, C., Rabiah, P., Withers, S., Hull, T., Frim, D., McLone, D., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D. V., Villareal, A., Perez, A., Galvis, C. A., Montes, M. V., Perez, N. I., Ramirez, M., Chittenden, C., Wang, E., Garcia-Lopez, L. L., Padrieu, G., Munoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M. C., de-la-Torre, G. C., Hernandez, J. D., Celis-Giraldo, D., Davila, J. A., Torres, E., Oquendo, M. M., Arteaga-Rivera, J. Y., Nicolae, D. L., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., Holfels, E., Frim, D., McLone, D., Penn, R., Cohen, W., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I. L., Meier, P., Grigg, M., Gomez-Marin, J., Kosagisharaf, J. R., Llorens, X. S., Reyes, O., McLeod, R.
2022: 1-30
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Abstract
Purpose of Review: Review international efforts to build a global public health initiative focused on toxoplasmosis with spillover benefits to save lives, sight, cognition and motor function benefiting maternal and child health.Recent Findings: Multiple countries' efforts to eliminate toxoplasmosis demonstrate progress and context for this review and new work.Summary: Problems with potential solutions proposed include accessibility of accurate, inexpensive diagnostic testing, pre-natal screening and facilitating tools, missed and delayed neonatal diagnosis, restricted access, high costs, delays in obtaining medicines emergently, delayed insurance pre-approvals and high medicare copays taking considerable physician time and effort, harmful shortcuts being taken in methods to prepare medicines in settings where access is restricted, reluctance to perform ventriculoperitoneal shunts promptly when needed without recognition of potential benefit, access to resources for care, especially for marginalized populations, and limited use of recent advances in management of neurologic and retinal disease which can lead to good outcomes.Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-022-00268-x.
View details for DOI 10.1007/s40124-022-00268-x
View details for PubMedID 35991908
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Building Programs to Eradicate Toxoplasmosis Part II: Education
CURRENT PEDIATRICS REPORTS
Felin, M., Wang, K., Moreira, A., Grose, A., Leahy, K., Zhou, Y., Clouser, F., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Caballero, Z., Norero, X., Estripeaut, D., Ellis, D., Raggi, C., Castro, C., Rengifo-Herrera, C., Moossazadeh, D., Ramirez, M., Pandey, A., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Montalvo, J., Mendivil, C., Quijada, M. R., Fernandez-Pirla, S., de La Guardia, V., Wong, D., de Guevara, M., Flores, C., Borace, J., Garcia, A., Caballero, N., de Saez, M., Politis, M., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebellon, A., Boyer, K., Heydemann, P., Noble, A., Swisher, C., Rabiah, P., Withers, S., Hull, T., Frim, D., McLone, D., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D., Villareal, A., Perez, A., Galvis, C., Montes, M., Perez, N., Ramirez, M., Chittenden, C., Wang, E., Garcia-Lopez, L., Munoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M., de-la-Torre, G., Padrieu, G., Hernandez, J., Celis-Giraldo, D., Davila, J., Torres, E., Oquendo, M., Arteaga-Rivera, J. Y., Nicolae, D. L., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., Holfels, E., Penn, R., Cohen, W., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I., Meier, P., Grigg, M., Gomez-Marin, J., Kosagisharaf, J., Llorens, X., Reyes, O., McLeod, R.
2022
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View details for DOI 10.1007/s40124-022-00267-y
View details for Web of Science ID 000834751600001
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Effectiveness of vaccination mandates in improving uptake of COVID-19 vaccines in the USA.
Lancet (London, England)
Mello, M. M., Opel, D. J., Benjamin, R. M., Callaghan, T., DiResta, R., Elharake, J. A., Flowers, L. C., Galvani, A. P., Salmon, D. A., Schwartz, J. L., Brewer, N. T., Buttenheim, A. M., Carpiano, R. M., Clinton, C., Hotez, P. J., Lakshmanan, R., Maldonado, Y. A., Omer, S. B., Sharfstein, J. M., Caplan, A.
2022
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View details for DOI 10.1016/S0140-6736(22)00875-3
View details for PubMedID 35817078
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Building Programs to Eradicate Toxoplasmosis Part III: Epidemiology and Risk Factors
CURRENT PEDIATRICS REPORTS
Felin, M., Wang, K., Raggi, C., Moreira, A., Pandey, A., Grose, A., Caballero, Z., Rengifo-Herrera, C., Ramirez, M., Moossazadeh, D., Castro, C., Montalvo, J., Leahy, K., Zhou, Y., Clouser, F., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Norero, X., Estripeaut, D., Ellis, D., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Mendivil, C., Quijada, M. R., Fernandez-Pirla, S., de La Guardia, V., Wong, D., de LadronGuevara, M., Flores, C., Borace, J., Garcia, A., Caballero, N., de Saez, M., Politis, M., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebollon, A., Boyer, K., Heydemann, P., Noble, A., Swisher, C., Rabiah, P., Withers, S., Hull, T., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D., Villareal, A., Perez, A., Galvis, C., Montes, M., Perez, N., Ramirez, M., Chittenden, C., Wang, E., Lorena Garcia-Lopez, L., Munoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M., de-la-Torre, G., Padrieu, G., Hernandez, J., Celis-Giraldo, D., Davila, J., Torres, E., Oquendo, M., Arteaga-Rivera, J. Y., Nicolae, D., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Holfels, E., Frim, D., McLone, D., Penn, R., Cohen, W., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I., Meier, P., Grigg, M., Gomez-Marin, J., Rao Kosagisharaf, J., Llorens, X., Reyes, O., McLeod, R.
2022
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View details for DOI 10.1007/s40124-022-00265-0
View details for Web of Science ID 000814479300001
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Global Health Needs Modernized Containment Strategies to Prepare for the Next Pandemic.
Frontiers in public health
Seetah, K., Moots, H., Pickel, D., Van Cant, M., Cianciosi, A., Mordecai, E., Cullen, M., Maldonado, Y.
2022; 10: 834451
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Abstract
COVID-19 continues to be a public health crisis, while severely impacting global financial markets causing significant economic and social hardsh