Yingjie Weng

All Publications

• Osteoarthritis risk is reduced after treatment with ticagrelor compared to clopidogrel: a propensity score matching analysis. Arthritis & rheumatology (Hoboken, N.J.) Baker, M. C., Weng, Y., William, R. H., Ahuja, N., Rohatgi, N. 2020

  Abstract

  Osteoarthritis (OA) is a common cause of joint pain and disability, and effective treatments are lacking. Extracellular adenosine has anti-inflammatory effects and can prevent and treat OA in animal models. Ticagrelor and clopidogrel are both used in patients with coronary artery disease, but only ticagrelor increases extracellular adenosine. The aim of this study was to determine whether treatment with ticagrelor was associated with a lower risk of OA.We conducted a 1:2 propensity score matching analysis using the Optum Clinformatics™ Data Mart from 2011 to 2017. We included patients who received either ticagrelor or clopidogrel for at least 90 days and excluded those with a prior diagnosis of OA or inflammatory arthritis. OA was identified using International Classification of Diseases codes. The primary outcome was the time to diagnosis of OA after treatment with ticagrelor versus clopidogrel.Our propensity score matched cohort consisted of 7,007 ticagrelor-treated patients and 14,014 clopidogrel-treated patients, with a median number of days on treatment of 287 and 284 respectively. For both groups, the mean age was 64 years, and 73% of the patients were male. Multivariate Cox-regression analysis estimated a hazard ratio of 0.71 (95% CI 0.64-0.79, p<0.001) for developing OA after treatment with ticagrelor compared to clopidogrel.Treatment with ticagrelor was associated with a 29% lower risk of developing OA compared to clopidogrel over five years of follow-up. We hypothesize that the reduction in OA seen in patients who received ticagrelor may in part be due to increased extracellular adenosine.

  View details for DOI 10.1002/art.41412

  View details for PubMedID 32564514

• Trajectory analysis for postoperative pain using electronic health records: A nonparametric method with robust linear regression and K-medians cluster analysis. Health informatics journal Weng, Y., Tian, L., Tedesco, D., Desai, K., Asch, S. M., Carroll, I., Curtin, C., McDonald, K. M., Hernandez-Boussard, T. 2019: 1460458219881339

  Abstract

  Postoperative pain scores are widely monitored and collected in the electronic health record, yet current methods fail to fully leverage the data with fast implementation. A robust linear regression was fitted to describe the association between the log-scaled pain score and time from discharge after total knee replacement. The estimated trajectories were used for a subsequent K-medians cluster analysis to categorize the longitudinal pain score patterns into distinct clusters. For each cluster, a mixture regression model estimated the association between pain score and time to discharge adjusting for confounding. The fitted regression model generated the pain trajectory pattern for given cluster. Finally, regression analyses examined the association between pain trajectories and patient outcomes. A total of 3442 surgeries were identified with a median of 22 pain scores at an academic hospital during 2009-2016. Four pain trajectory patterns were identified and one was associated with higher rates of outcomes. In conclusion, we described a novel approach with fast implementation to model patients' pain experience using electronic health records. In the era of big data science, clinical research should be learning from all available data regarding a patient's episode of care instead of focusing on the "average" patient outcomes.

  View details for DOI 10.1177/1460458219881339

  View details for PubMedID 31621460

• Initiative for prevention and early identification of delirium in medical-surgical units: Lessons learnt in the past five years. The American journal of medicine Rohatgi, N., Weng, Y., Bentley, J., Lansberg, M. G., Shepard, J., Mazur, D., Ahuja, N., Hopkins, J. 2019

  Abstract

  BACKGROUND: Delirium is an acute change in mental status affecting 10-64% of hospitalized patients, and may be preventable in 30-40% cases. In October 2013, a task force for delirium prevention and early identification in medical-surgical units was formed at our hospital. We studied if our standardized protocol prevented delirium among high-risk patients.METHODS: We studied 105,455 patient encounters between November 2013 and January 2018. Since November 2013, there has been ongoing education to decrease deliriogenic medications use. Since 2014, nurses screen all patients for presence or absence of delirium using confusion assessment method (CAM). Since 2015, nurses additionally screen all patients for risk of delirium. In 2015, a physician order set for delirium was created. Non-pharmacological measures are implemented for high-risk or CAM positive patients.RESULTS: 98.8% of patient encounters had CAM screening, and 99.6% had delirium risk screening. Since 2013, odds of opiate use decreased by 5.0% per year (P<0.001), and odds of benzodiazepines use decreased by 8.0% per year (P<0.001). There was no change in anticholinergics use. In the adjusted analysis, since 2015, odds of delirium decreased by 25.3% per year among high-risk patients (N=21,465; P<0.001). Among high-risk patients or those diagnosed with delirium (N=22,121), estimated LOS decreased by 0.13days per year (P<0.001), odds of inpatient mortality decreased by 16.0% per year (P=0.011), and odds of discharge to nursing home decreased by 17.1% per year (P<0.001).CONCLUSION: With high clinician engagement and simplified workflows, our delirium initiative has shown sustained results.

  View details for DOI 10.1016/j.amjmed.2019.05.035

  View details for PubMedID 31228413

• Can Machine Learning Methods Produce Accurate and Easy-to-use Prediction Models of 30-day Complications and Mortality After Knee or Hip Arthroplasty? CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Harris, A. S., Kuo, A. C., Weng, Y., Trickey, A. W., Bowe, T., Giori, N. J. 2019; 477 (2): 452–60

  View details for DOI 10.1097/CORR.0000000000000601

  View details for Web of Science ID 000472544900035

• Interobserver agreement of lung ultrasound findings of COVID-19. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Kumar, A., Weng, Y., Graglia, S., Chung, S., Duanmu, Y., Lalani, F., Gandhi, K., Lobo, V., Jensen, T., Nahn, J., Kugler, J. 2021

  Abstract

  BACKGROUND: Lung ultrasound (LUS) has received considerable interest in the clinical evaluation of patients with COVID-19. Previously described LUS manifestations for COVID-19 include B-lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID-19 is unknown.METHODS: This study was conducted between March and June 2020. Nine physicians (hospitalists: n = 4; emergency medicine: n = 5) from 3 medical centers independently evaluated n = 20 LUS scans (n = 180 independent observations) collected from patients with COVID-19, diagnosed via RT-PCR. These studies were randomly selected from an image database consisting of COVID-19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values (kappa) were used to calculate IRR.RESULTS: There was substantial IRR on the following items: normal LUS scan (kappa = 0.79 [95% CI: 0.72-0.87]), presence of B-lines (kappa = 0.79 [95% CI: 0.72-0.87]), ≥3 B-lines observed (kappa = 0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (kappa = 0.57 [95% CI: 0.50-0.64]), subpleural consolidation (kappa = 0.49 [95% CI: 0.42-0.56]), and presence of effusion (kappa = 0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (kappa = 0.23 [95% CI: 0.15-0.30]).DISCUSSION: Many LUS manifestations for COVID-19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID-19 may include the presence/count of B-lines or determining if a scan is normal. Clinical protocols for LUS with COVID-19 may require additional observers for the confirmation of less reliable findings such as consolidations.

  View details for DOI 10.1002/jum.15620

  View details for PubMedID 33426734

• Enhancing Social Initiations Using Naturalistic Behavioral Intervention: Outcomes from a Randomized Controlled Trial for Children with Autism. Journal of autism and developmental disorders Gengoux, G. W., Schwartzman, J. M., Millan, M. E., Schuck, R. K., Ruiz, A. A., Weng, Y., Long, J., Hardan, A. Y. 2021

  Abstract

  Deficits in social skills are common in children with Autism Spectrum Disorder (ASD), and there is an urgent need for effective social skills interventions, especially for improving interactions with typically developing peers. This study examined the effects of a naturalistic behavioral social skills intervention in improving social initiations to peers through a randomized controlled trial. Analyses of multimethod, multi-informant measures indicated that children in the active group (SIMI) demonstrated greater improvement in the types of initiations which were systematically prompted and reinforced during treatment (i.e., behavior regulation). Generalization to joint attention and social interaction initiation types, as well as collateral gains in broader social functioning on clinician- and parent-rated standardized measures were also observed.

  View details for DOI 10.1007/s10803-020-04787-8

  View details for PubMedID 33387236

• Factors Associated with Hospital-Acquired Delirium in Patients 18–65 Years Old J GEN INTERN MED Rohatgi, N., Weng, Y., Ahuja, N., Lansberg, M. G. 2021

  View details for DOI 10.1007/s11606-020-06378-w

• Characteristics of Younger and Older Adults with Hospital-Acquired Delirium: a Claims Data Study Spanning 14 years J GEN INTERN MED Rohatgi, N., Weng, Y., Ahuja, N., Lansberg, M. G. 2021

  View details for DOI 10.1007/s11606-020-06379-9

• Trends in reproductive, maternal, newborn and child health and nutrition indicators during five years of piloting and scaling-up of Ananya interventions in Bihar, India. Journal of global health Abdalla, S., Weng, Y., Mehta, K. M., Mahapatra, T., Srikantiah, S., Shah, H., Ward, V. C., Pepper, K. T., Bentley, J., Carmichael, S. L., Creanga, A., Wilhelm, J., Tarigopula, U. K., Nanda, P., Bhattacharya, D., Atmavilas, Y., Darmstadt, G. L., Ananya Study Group, Atmavilas, Y., Bentley, J., Bhattacharya, D., Borkum, E., Carmichael, S. L., Chaudhuri, I., Creanga, A., Darmstadt, G. L., Dutt, P., Delhi, N., Irani, L., Delhi, N., Krishnan, S., Mahapatra, T., Mehta, K. M., Francisco, S., Mitra, R., Munar, W., Nanda, P., Pepper, K. T., Raheel, H., Rangarajan, A., Saggurti, N., Sastry, P., Schooley, J., Shah, H., Srikantiah, S., Tarigopula, U. K., Ward, V. C., Walker, D., Weng, Y., Wilhelm, J. 2020; 10 (2): 021003

  Abstract

  Background: The Ananya program in Bihar implemented household and community-level interventions to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) in two phases: a first phase of intensive ancillary support to governmental implementation and innovation testing by non-government organisation (NGO) partners in eight focus districts (2012-2014), followed by a second phase of state-wide government-led implementation with techno-managerial assistance from NGOs (2014 onwards). This paper examines trends in RMNCHN indicators in the program's implementation districts from 2012-2017.Methods: Eight consecutive rounds of cross-sectional Community-based Household Surveys conducted by CARE India in 2012-2017 provided comparable data on a large number of indicators of frontline worker (FLW) performance, mothers' behaviours, and facility-based care and outreach service delivery across the continuum of maternal and child care. Logistic regression, considering the complex survey design and sample weights generated by that design, was used to estimate trends using survey rounds 2-5 for the first phase in the eight focus districts and rounds 6-9 for the second phase in all 38 districts statewide, as well as the overall change from round 2-9 in focus districts. To aid in contextualising the results, indicators were also compared amongst the formerly focus and the non-focus districts at the beginning of the second phase.Results: In the first phase, the levels of 34 out of 52 indicators increased significantly in the focus districts, including almost all indicators of FLW performance in antenatal and postnatal care, along with mother's birth preparedness, some breastfeeding practices, and immunisations. Between the two phases, 33 of 52 indicators declined significantly. In the second phase, the formerly focus districts experienced a rise in the levels of 14 of 50 indicators and a decline in the levels of 14 other indicators. There was a rise in the levels of 22 out of 50 indicators in the non-focus districts in the second phase, with a decline in the levels of 13 other indicators.Conclusions: Improvements in indicators were conditional on implementation support to program activities at a level of intensity that was higher than what could be achieved at scale so far. Successes during the pilot phase of intensive support suggests that RMNCHN can be improved statewide in Bihar with sufficient investments in systems performance improvements.Study registration: ClinicalTrials.gov number NCT02726230.

  View details for DOI 10.7189/jogh.10.021003

  View details for PubMedID 33427818

• Health layering of self-help groups: impacts on reproductive, maternal, newborn and child health and nutrition in Bihar, India. Journal of global health Mehta, K. M., Irani, L., Chaudhuri, I., Mahapatra, T., Schooley, J., Srikantiah, S., Abdalla, S., Ward, V., Carmichael, S. L., Bentley, J., Creanga, A., Wilhelm, J., Tarigopula, U. K., Bhattacharya, D., Atmavilas, Y., Nanda, P., Weng, Y., Pepper, K. T., Darmstadt, G. L., Ananya Study Group, Atmavilas, Y., Bhattacharya, D., Bentley, J., Borkum, E., Carmichael, S., Chaudhuri, I., Creanga, A., Darmstadt, G. L., Dutt, P., Irani, L., Mahapatra, T., Mehta, K. M., Mitra, R., Munar, W. A., Nanda, P., Pepper, K. T., Raheel, H., Rangarajan, A., Saggurti, N., Sastry, P., Shah, H., Srikantiah, S., Tarigopula, U. K., Ward, V., Weng, Y., Walker, D., Wilhelm, J. 2020; 10 (2): 021007

  Abstract

  Background: Self-help group (SHG) interventions have been widely studied in low and middle income countries. However, there is little data on specific impacts of health layering, or adding health education modules upon existing SHGs which were formed primarily for economic empowerment. We examined three SHG interventions from 2012-2017 in Bihar, India to test the hypothesis that health-layering of SHGs would lead to improved health-related behaviours of women in SHGs.Methods: A model for health layering of SHGs - Parivartan - was developed by the non-governmental organisation (NGO), Project Concern International, in 64 blocks of eight districts. Layering included health modules, community events and review mechanisms. The health layering model was adapted for use with government-led SHGs, called JEEViKA+HL, in 37 other blocks of Bihar. Scale-up of government-led SHGs without health layering (JEEViKA) occurred contemporaneously in 433 other blocks, providing a natural comparison group. Using Community-based Household Surveys (CHS, rounds 6-9) by CARE India, 62 reproductive, maternal, newborn and child health and nutrition (RMNCHN) and sanitation indicators were examined for SHGs with health layering (Pavivartan SHGs and JEEViKA+HL SHGs) compared to those without. We calculated mean, standard deviation and odds ratios of indicators using surveymeans and survey logistic regression.Results: In 2014, 64% of indicators were significantly higher in Parivartan members compared to non-members residing in the same blocks. During scale up, from 2015-17, half (50%) of indicators had significantly higher odds in health layered SHG members (Parivartan or JEEViKA+HL) in 101 blocks compared to SHG members without health layering (JEEViKA) in 433 blocks.Conclusions: Health layering of SHGs was demonstrated by an NGO-led model (Parivartan), adapted and scaled up by a government model (JEEViKA+HL), and associated with significant improvements in health compared to non-health-layered SHGs (JEEViKA). These results strengthen the evidence base for further layering of health onto the SHG platform for scale-level health change.Study registration: ClinicalTrials.gov number NCT02726230.

  View details for DOI 10.7189/jogh.10.021007

  View details for PubMedID 33425331

• Health impact of self-help groups scaled-up statewide in Bihar, India. Journal of global health Mehta, K. M., Irani, L., Chaudhuri, I., Mahapatra, T., Schooley, J., Srikantiah, S., Abdalla, S., Ward, V. C., Carmichael, S. L., Bentley, J., Creanga, A., Wilhelm, J., Tarigopula, U. K., Bhattacharya, D., Atmavilas, Y., Nanda, P., Weng, Y., Pepper, K. T., Darmstadt, G. L., Ananya Study Group, Atmavilas, Y., Bhattacharya, D., Bentley, J., Borkum, E., Carmichael, S., Chaudhuri, I., Creanga, A., Darmstadt, G. L., Dutt, P., Irani, L., Mahapatra, T., Mehta, K. M., Mitra, R., Munar, W. A., Nanda, P., Pepper, K. T., Raheel, H., Rangarajan, A., Saggurti, N., Sastry, P., Shah, H., Srikantiah, S., Ward, V., Weng, Y., Walker, D., Wilhelm, J. 2020; 10 (2): 021006

  Abstract

  Background: The objective of this study was to assess the impact of self-help groups (SHGs) and subsequent scale-up on reproductive, maternal, newborn, child health, and nutrition (RMNCHN) and sanitation outcomes among marginalised women in Bihar, India from 2014-2017.Methods: We examined RMNCHN and sanitation behaviors in women who were members of any SHGs compared to non-members, without differentiating between types of SHGs. We analysed annual surveys across 38 districts of Bihar covering 62690 women who had a live birth in the past 12 months. All analyses utilised data from Community-based Household Surveys (CHS) rounds 6-9 collected in 2014-2017 by CARE India as part of the Bihar Technical Support Program funded by the Bill & Melinda Gates Foundation. We examined 66 RMNCHN and sanitation indicators using survey logistic regression; the comparison group in all cases was age-comparable women from the geographic contexts of the SHG members but who did not belong to SHGs. We also examined links between discussion topics in SHGs and changes in relevant behaviours, and stratification of effects by parity and mother's age.Results: SHG members had higher odds compared to non-SHG members for 60% of antenatal care indicators, 22% of delivery indicators, 70% of postnatal care indicators, 50% of nutrition indicators, 100% of family planning and sanitation indicators and no immunisation indicators measured. According to delivery platform, most FLW performance indicators (80%) had increased odds, followed by maternal behaviours (57%) and facility care and outreach service delivery (22%) compared to non-SHG members. Self-report of discussions within SHGs on specific topics was associated with increased related maternal behaviours. Younger SHG members (<25 years) had attenuated health indicators compared to older group members (≥25 years), and women with more children had more positive indicators compared to women with fewer children.Conclusions: SHG membership was associated with improved RMNCHN and sanitation indicators at scale in Bihar, India. Further work is needed to understand the specific impacts of health layering upon SHGs. Working through SHGs is a promising vehicle for improving primary health care.Study registration: ClinicalTrials.gov number NCT02726230.

  View details for DOI 10.7189/jogh.10.021006

  View details for PubMedID 33425330

• Impact of mHealth interventions for reproductive, maternal, newborn and child health and nutrition at scale: BBC Media Action and the Ananya program in Bihar, India. Journal of global health Ward, V. C., Raheel, H., Weng, Y., Mehta, K. M., Dutt, P., Mitra, R., Sastry, P., Godfrey, A., Shannon, M., Chamberlain, S., Kaimal, R., Carmichael, S. L., Bentley, J., Abdalla, S., Pepper, K. T., Mahapatra, T., Srikantiah, S., Borkum, E., Rangarajan, A., Sridharan, S., Rotz, D., Nanda, P., Tarigopula, U. K., Atmavilas, Y., Bhattacharya, D., Darmstadt, G. L., Ananya Study Group, Atmavilas, Y., Bhattacharya, D., Bentley, J., Borkum, E., Carmichael, S., Chaudhuri, I., Creanga, A., Darmstadt, G. L., Dutt, P., Irani, L., Mahapatra, T., Mehta, K. M., Mitra, R., Munar, W. A., Nanda, P., Pepper, K. T., Raheel, H., Rangarajan, A., Saggurti, N., Sastry, P., Shah, H., Srikantiah, S., Tarigopula, U. K., Ward, V., Weng, Y., Walker, D., Wilhelm, J. 2020; 10 (2): 021005

  Abstract

  Background: Mobile health (mHealth) tools have potential for improving the reach and quality of health information and services through community health workers in low- and middle-income countries. This study evaluates the impact of an mHealth tool implemented at scale as part of the statewide reproductive,maternal, newborn and child health and nutrition (RMNCHN) program in Bihar, India.Methods: Three survey-based data sets were analysed to compare the health-related knowledge, attitudes and behaviours amongst childbearing women exposed to the Mobile Kunji and Dr. Anita mHealth tools during their visits with frontline workers compared with those who were unexposed.Results: An evaluation by Mathematica (2014) revealed that exposure to Mobile Kunji and Dr. Anita recordings were associated with significantly higher odds of consuming iron-folic acid tablets (odds ratio (OR)=2.3, 95% confidence interval (CI)=1.8-3.1) as well as taking a set of three measures for delivery preparedness (OR=2.8, 95% CI=1.9-4.2) and appropriate infant complementary feeding (OR=1.9, 95% CI=1.0-3.5). CARE India's Community-based Household Surveys (2012-2017) demonstrated significant improvements in early breastfeeding (OR=1.64, 95% CI=1.5-1.78) and exclusive breastfeeding (OR=1.46, 95% CI=1.33-1.62) in addition to birth preparedness practices. BBC Media Action's Usage & Engagement Survey (2014) demonstrated a positive association between exposure to Mobile Kunji and Dr. Anita and exclusive breastfeeding (58% exposed vs 43% unexposed, P<0.01) as well as maternal respondents' trust in their frontline worker.Conclusions: Significant improvements in RMNCHN-related knowledge and behaviours were observed for Bihari women who were exposed to Mobile Kunji and Dr. Anita. This analysis is unique in its rigorous evaluation across multiple data sets of mHealth interventions implemented at scale. These results can help inform global understanding of how best to use mHealth tools, for whom, and in what contexts.Study registration: ClinicalTrials.gov number NCT02726230.

  View details for DOI 10.7189/jogh.10.021005

  View details for PubMedID 33425329

• Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens. Journal of global health Ward, V. C., Weng, Y., Bentley, J., Carmichael, S. L., Mehta, K. M., Mahmood, W., Pepper, K. T., Abdalla, S., Atmavilas, Y., Mahapatra, T., Srikantiah, S., Borkum, E., Rangarajan, A., Sridharan, S., Rotz, D., Bhattacharya, D., Nanda, P., Tarigopula, U. K., Shah, H., Darmstadt, G. L., Ananya Study Group, Atmavilas, Y., Bhattacharya, D., Bentley, J., Borkum, E., Carmichael, S., Chaudhuri, I., Creanga, A., Darmstadt, G. L., Dutt, P., Irani, L., Mahapatra, T., Mehta, K. M., Mitra, R., Munar, W. A., Nanda, P., Pepper, K. T., Raheel, H., Rangarajan, A., Saggurti, N., Sastry, P., Shah, H., Srikantiah, S., Tarigopula, U. K., Ward, V., Weng, Y., Walker, D., Wilhelm, J. 2020; 10 (2): 021011

  Abstract

  Background: Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India.Methods: Utilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n=10174) and after two years of program implementation (2014, n=9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n=48349) collected by CARE India.Results: At baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized), P<0.01) and skin-to-skin care (+14.8% vs +20.4%, P<0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9, P<0.01). For the CHS data, odds ratios compared the most to the least marginalised women as referent. Results demonstrated that disparities were most significant for indicators reliant on access to care such as delivery in a facility (OR range: 0.15 to 0.48) or by a qualified doctor (OR range: 0.08 to 0.25), and seeking care for complications (OR range: 0.26 to 0.64).Conclusions: Disparities observed at baseline generally persisted throughout program implementation. The most significant disparities were observed amongst behaviours dependent upon access to care. Changes in disparities largely were due to improvements for the least marginalised women without improvements for the most marginalised. Equity-based assessments of programmatic impacts, including those of universal health approaches, must be undertaken to monitor disparities and to ensure equitable and sustainable benefits for all.Study registration: ClinicalTrials.gov number NCT02726230.

  View details for DOI 10.7189/jogh.10.021011

  View details for PubMedID 33425335

• Impact of the Ananya program on reproductive, maternal, newborn and child health and nutrition in Bihar, India: early results from a quasi-experimental study. Journal of global health Darmstadt, G. L., Weng, Y., Pepper, K. T., Ward, V. C., Mehta, K. M., Borkum, E., Bentley, J., Raheel, H., Rangarajan, A., Bhattacharya, D., Tarigopula, U. K., Nanda, P., Sridharan, S., Rotz, D., Carmichael, S. L., Abdalla, S., Munar, W., Ananya Study Group, Atmavilas, Y., Bhattacharya, D., Bentley, J., Borkum, E., Carmichael, S., Chaudhuri, I., Creanga, A., Darmstadt, G. L., Dutt, P., Irani, L., Mahapatra, T., Mehta, K. M., Mitra, R., Munar, W. A., Nanda, P., Pepper, K. T., Raheel, H., Rangarajan, A., Saggurti, N., Sastry, P., Delhi, N., Shah, H., Srikantiah, S., Tarigopula, U. K., Ward, V., Weng, Y., Walker, D., Wilhelm, J. 2020; 10 (2): 021002

  Abstract

  Background: The Government of Bihar (GoB) in India, the Bill and Melinda Gates Foundation and several non-governmental organisations launched the Ananya program aimed to support the GoB to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide. Here we summarise changes in indicators attained during the initial two-year pilot phase (2012-2013) of implementation in eight focus districts of approximately 28 million population, aimed to inform subsequent scale-up.Methods: The quasi-experimental impact evaluation included statewide household surveys at two time points during the pilot phase: January-April 2012 ("baseline") including an initial cohort of beneficiaries and January-April 2014 ("midline") with a new cohort. The two arms were: 1) eight intervention districts, and 2) a comparison arm comprised of the remaining 30 districts in Bihar where Ananya interventions were not implemented. We analysed changes in indicators across the RMNCHN continuum of care from baseline to midline in intervention and comparison districts using a difference-in-difference analysis.Results: Indicators in the two arms were similar at baseline. Overall, 40% of indicators (20 of 51) changed significantly from baseline to midline in the comparison districts unrelated to Ananya; two-thirds (n=13) of secular indicator changes were in a direction expected to promote health. Statistically significant impact attributable to the Ananya program was found for 10% (five of 51) of RMNCHN indicators. Positive impacts were most prominent for mother's behaviours in contraceptive utilisation.Conclusions: The Ananya program had limited impact in improving health-related outcomes during the first two-year period covered by this evaluation. The program's theories of change and action were not powered to observe statistically significant differences in RMNCHN indicators within two years, but rather aimed to help inform program improvements and scale-up. Evaluation of large-scale programs such as Ananya using theory-informed, equity-sensitive (including gender), mixed-methods approaches can help elucidate causality and better explain pathways through which supply- and demand-side interventions contribute to changes in behaviour among the actors involved in the production of population-level health outcomes. Evidence from Bihar indicates that deep structural constraints in health system organisation and delivery of interventions pose substantial limitations on behaviour change among health care providers and beneficiaries.Study registration: ClinicalTrials.gov number NCT02726230.

  View details for DOI 10.7189/jogh.10.021002

  View details for PubMedID 33427822

• "MAKING A LIST AND CHECKING IT TWICE": A HIGH BLOOD PRESSURE ADVISORY IN PRIMARY CARE Phadke, A., Sattler, A., Shah, S., Mahoney, M., Sharp, C., Ng, S., Kim, M., Weng, Y. I., Safaeinili, N., Brown-Johnson, C., Desai, M. SPRINGER. 2020: S702

  View details for Web of Science ID 000567143602227

• Portable Ultrasound Device Usage and Learning Outcomes Among Internal Medicine Trainees: A Parallel-Group Randomized Trial. Journal of hospital medicine Kumar, A., Weng, Y., Wang, L., Bentley, J., Almli, M., Hom, J., Witteles, R., Ahuja, N., Kugler, J. 2020; 15 (2): e1–e6

  Abstract

  BACKGROUND: Little is known about how to effectively train residents with point-of-care ultrasonography (POCUS) despite increasing usage.OBJECTIVE: This study aimed to assess whether handheld ultrasound devices (HUDs), alongside a year-long lecture series, improved trainee image interpretation skills with POCUS.METHODS: Internal medicine intern physicians (N = 149) at a single academic institution from 2016 to 2018 participated in the study. The 2017 interns (n = 47) were randomized 1:1 to receive personal HUDs (n = 24) for patient care vs no-HUDs (n = 23). All 2017 interns received a repeated lecture series regarding cardiac, thoracic, and abdominal POCUS. Interns were assessed on their ability to interpret POCUS images of normal/abnormal findings. The primary outcome was the difference in end-of-the-year assessment scores between interns randomized to receive HUDs vs not. Secondary outcomes included trainee scores after repeating lectures and confidence with POCUS. Intern scores were also compared with historical (2016, N = 50) and contemporaneous (2018, N = 52) controls who received no lectures.RESULTS: Interns randomized to HUDs did not have significantly higher image interpretation scores (median HUD score: 0.84 vs no-HUD score: 0.84; P = .86). However, HUD interns felt more confident in their abilities. The 2017 cohort had higher scores (median 0.84), compared with the 2016 historical control (median 0.71; P = .001) and 2018 contemporaneous control (median 0.48; P < .001). Assessment scores improved after first-time exposure to the lecture series, while repeated lectures did not improve scores.CONCLUSIONS: Despite feeling more confident, personalized HUDs did not improve interns' POCUS-related knowledge or interpretive ability. Repeated lecture exposure without further opportunities for deliberate practice may not be beneficial for mastering POCUS.

  View details for DOI 10.12788/jhm.3351

  View details for PubMedID 32118565

• Improving primary health care delivery in Bihar, India: Learning from piloting and statewide scale-up of Ananya. Journal of global health Darmstadt, G. L., Pepper, K. T., Ward, V. C., Srikantiah, S., Mahapatra, T., Tarigopula, U. K., Bhattacharya, D., Irani, L., Schooley, J., Chaudhuri, I., Dutt, P., Sastry, P., Mitra, R., Chamberlain, S., Monaghan, S., Nanda, P., Atmavilas, Y., Saggurti, N., Borkum, E., Rangarajan, A., Mehta, K. M., Abdalla, S., Wilhelm, J., Weng, Y., Carmichael, S. L., Raheel, H., Bentley, J., Munar, W. A., Creanga, A., Trehan, S., Walker, D., Shah, H. 2020; 10 (2): 021001

  Abstract

  In 2010, the Bill and Melinda Gates Foundation (BMGF) partnered with the Government of Bihar (GoB), India to launch the Ananya program to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) outcomes. The program sought to address supply- and demand-side barriers to the adoption, coverage, quality, equity and health impact of select RMNCHN interventions. Approaches included strengthening frontline worker service delivery; social and behavior change communications; layering of health, nutrition and sanitation into women's self-help groups (SHGs); and quality improvement in maternal and newborn care at primary health care facilities. Ananya program interventions were piloted in approximately 28 million population in eight innovation districts from 2011-2013, and then beginning in 2014, were scaled up by the GoB across the rest of the state's population of 104 million. A Bihar Technical Support Program provided techno-managerial support to governmental Health as well as Integrated Child Development Services, and the JEEViKA Technical Support Program supported health layering and scale-up of the GoB's SHG program. The level of support at the block level during statewide scale-up in 2014 onwards was approximately one-fourth that provided in the pilot phase of Ananya in 2011-2013. This paper - the first manuscript in an 11-manuscript and 2-viewpoint collection on Learning from Ananya: Lessons for primary health care performance improvement - seeks to provide a broad description of Ananya and subsequent statewide adaptation and scale-up, and capture the background and context, key objectives, interventions, delivery approaches and evaluation methods of this expansive program. Subsequent papers in this collection focus on specific intervention delivery platforms. For the analyses in this series, Stanford University held key informant interviews and worked with the technical support and evaluation grantees of the Ananya program, as well as leadership from the India Country Office of the BMGF, to analyse and synthesise data from multiple sources. Capturing lessons from the Ananya pilot program and statewide scale-up will assist program managers and policymakers to more effectively design and implement RMNCHN programs at scale through technical assistance to governments.

  View details for DOI 10.7189/jogh.10.021001

  View details for PubMedID 33414906

  View details for PubMedCentralID PMC7757841

• Direct versus indirect bypass procedure for the treatment of ischemic moyamoya disease: results of an individualized selection strategy. Journal of neurosurgery Nielsen, T. H., Abhinav, K., Sussman, E. S., Han, S. S., Weng, Y., Bell-Stephens, T., Heit, J. J., Steinberg, G. K. 2020: 1–12

  Abstract

  The only effective treatment for ischemic moyamoya disease (iMMD) is cerebral revascularization by an extracranial to intracranial bypass. The preferred revascularization method remains controversial: direct versus indirect bypass. The purpose of this study was to test the hypothesis that method choice should be personalized based on angiographic, hemodynamic, and clinical characteristics to balance the risk of perioperative major stroke against treatment efficacy.Patients with iMMD were identified retrospectively from a prospectively maintained database. Those with mild to moderate internal carotid artery or M1 segment stenosis, preserved cerebrovascular reserve, intraoperative M4 segment anterograde flow ≥ 8 ml/min, or the absence of frequent and severe transient ischemic attacks (TIAs) or stroke had been assigned to indirect bypass. The criteria for direct bypass were severe ICA or M1 segment stenosis or occlusion, impaired cerebrovascular reserve or steal phenomenon, intraoperative M4 segment retrograde flow or anterograde flow < 8 ml/min, and the presence of frequent and severe TIAs or clinical strokes. The primary study endpoint was MRI-confirmed symptomatic stroke ≤ 7 days postoperatively resulting in a decline in the modified Rankin Scale (mRS) score from preoperatively to 6 months postoperatively. As a secondary endpoint, the authors assessed 6-month postoperative DSA-demonstrated revascularization, which was classified as < 1/3, 1/3-2/3, or > 2/3 of the middle cerebral artery territory.One hundred thirty-eight patients with iMMD affecting 195 hemispheres revascularized in the period from March 2016 to June 2018 were included in this analysis. One hundred thirty-three hemispheres were revascularized with direct bypass and 62 with indirect bypass. The perioperative stroke rate was 4.7% and 6.8% in the direct and indirect groups, respectively (p = 0.36). Degree of revascularization was higher in the direct bypass group (p = 0.03). The proportion of patients improving to an mRS score 0-1 (from preoperatively to 6 months postoperatively) tended to be higher in the direct bypass group, although the difference between the two bypass groups was not statistically significant (p = 0.27).The selective use of an indirect bypass procedure for iMMD did not decrease the perioperative stroke rate. Direct bypass provided a significantly higher degree of revascularization. The authors conclude that direct bypass is the treatment of choice for iMMD.

  View details for DOI 10.3171/2020.3.JNS192847

  View details for PubMedID 32534489

• Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000-2013. Journal of patient safety Tedesco, D., Moghavem, N., Weng, Y., Fantini, M. P., Hernandez-Boussard, T. 2020

  Abstract

  Quality and safety improvement are global priorities. In the last two decades, the United States has introduced several payment reforms to improve patient safety. The Agency for Healthcare Research and Quality (AHRQ) developed tools to identify preventable inpatient adverse events using administrative data, patient safety indicators (PSIs). The aim of this study was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms.This is a retrospective, longitudinal analysis to estimate temporal changes in 13 AHRQ's PSIs. National inpatient sample from the AHRQ and estimates were weighted to represent a national sample. We analyzed PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013.Of the 13 PSIs studied, 10 had an overall decrease in rates and 3 had an increase. Joinpoint analysis showed that 12 of 13 PSIs had decreasing or stable trends in the last 5 years of the study. Central-line blood stream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013), whereas postoperative respiratory failure had the smallest decrease (-3.5 annual percent change between 2005 and 2013). With the exception of postoperative hip fracture, significant decreases in trends preceded federal payment reform initiatives.National in-hospital patient safety has significantly improved between 2000 and 2015, as measured by PSIs. In this study, improvements in PSI trends often proceeded policies targeting patient safety events, suggesting that intense public discourses targeting patient safety may drive national policy reforms and that these improved trends may be sustained by the Center for Medicare and Medicaid Services policies that followed.

  View details for DOI 10.1097/PTS.0000000000000615

  View details for PubMedID 32217926

• Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years Journal of Hospital Medicine Rohatgi, N., Weng, Y., Ahuja, N. 2020

  View details for DOI 10.12788/jhm.3363

• Community Pediatric Hospitalist Workload: Results from a National Survey. Journal of hospital medicine Alvarez, F., McDaniel, C. E., Birnie, K., Gosdin, C., Mariani, A., Paciorkowski, N., Mendez, S. S., Weng, Y., Fromme, H. B. 2019; 14: E1–E4

  Abstract

  As a newly recognized subspecialty, understanding programmatic models for pediatric hospital medicine (PHM) programs is vital to lay the groundwork for a sustainable field. Although variability has been described within university-based PHM programs, there remains no national benchmark for community-based PHM programs. In this report, we describe the workload, clinical services, employment, and perception of sustainability of 70 community-based PHM programs in 29 states through a survey of community site leaders. The median hours for a full-time hospitalist was 1,882 hours/year with those employed by community hospitals working 8% more hours/year and viewing appropriate morning pediatric census as 20% higher than those employed by university institutions. Forty-three out of 70 (63%) site leaders perceived their programs as sustainable, with no significant difference by employer structure. Future studies should further explore root causes for workload discrepancies between community and academic employed programs along with establishing potential standards for PHM program development.

  View details for DOI 10.12788/jhm.3263

  View details for PubMedID 31433774

• Can Machine Learning Methods Produce Accurate and Easy-to-use Prediction Models of 30-day Complications and Mortality After Knee or Hip Arthroplasty? Clinical orthopaedics and related research Harris, A. H., Kuo, A. C., Weng, Y., Trickey, A. W., Bowe, T., Giori, N. J. 2019

  Abstract

  BACKGROUND: Existing universal and procedure-specific surgical risk prediction models of death and major complications after elective total joint arthroplasty (TJA) have limitations including poor transparency, poor to modest accuracy, and insufficient validation to establish performance across diverse settings. Thus, the need remains for accurate and validated prediction models for use in preoperative management, informed consent, shared decision-making, and risk adjustment for reimbursement.QUESTIONS/PURPOSES: The purpose of this study was to use machine learning methods and large national databases to develop and validate (both internally and externally) parsimonious risk-prediction models for mortality and complications after TJA.METHODS: Preoperative demographic and clinical variables from all 107,792 nonemergent primary THAs and TKAs in the 2013 to 2014 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) were evaluated as predictors of 30-day death and major complications. The NSQIP database was chosen for its high-quality data on important outcomes and rich characterization of preoperative demographic and clinical predictors for demographically and geographically diverse patients. Least absolute shrinkage and selection operator (LASSO) regression, a type of machine learning that optimizes accuracy and parsimony, was used for model development. Tenfold validation was used to produce C-statistics, a measure of how well models discriminate patients who experience an outcome from those who do not. External validation, which evaluates the generalizability of the models to new data sources and patient groups, was accomplished using data from the Veterans Affairs Surgical Quality Improvement Program (VASQIP). Models previously developed from VASQIP data were also externally validated using NSQIP data to examine the generalizability of their performance with a different group of patients outside the VASQIP context.RESULTS: The models, developed using LASSO regression with diverse clinical (for example, American Society of Anesthesiologists classification, comorbidities) and demographic (for example, age, gender) inputs, had good accuracy in terms of discriminating the likelihood a patient would experience, within 30 days of arthroplasty, a renal complication (C-statistic, 0.78; 95% confidence interval [CI], 0.76-0.80), death (0.73; 95% CI, 0.70-0.76), or a cardiac complication (0.73; 95% CI, 0.71-0.75) from one who would not. By contrast, the models demonstrated poor accuracy for venous thromboembolism (C-statistic, 0.61; 95% CI, 0.60-0.62) and any complication (C-statistic, 0.64; 95% CI, 0.63-0.65). External validation of the NSQIP- derived models using VASQIP data found them to be robust in terms of predictions about mortality and cardiac complications, but not for predicting renal complications. Models previously developed with VASQIP data had poor accuracy when externally validated with NSQIP data, suggesting they should not be used outside the context of the Veterans Health Administration.CONCLUSIONS: Moderately accurate predictive models of 30-day mortality and cardiac complications after elective primary TJA were developed as well as internally and externally validated. To our knowledge, these are the most accurate and rigorously validated TJA-specific prediction models currently available (http://med.stanford.edu/s-spire/Resources/clinical-tools-.html). Methods to improve these models, including the addition of nonstandard inputs such as natural language processing of preoperative clinical progress notes or radiographs, should be pursued as should the development and validation of models to predict longer term improvements in pain and function.LEVEL OF EVIDENCE: Level III, diagnostic study.

  View details for PubMedID 30624314

• Utility of Diffusion Tensor Imaging Tractography in Evaluating Motor Examination and Functional Outcomes in Patients with Surgically Resected Deep Intracranial Cavernous Malformations: A Preliminary Model Journal of Neurological Surgery Kumar, A., Nielsen, T., Weng, Y., Han, S., Iv, M. S., Steinberg, G. K. 2019

  View details for DOI 10.1055/s-0039-1679505

• Comparison of Outcomes for Adult Inpatients With Sickle Cell Disease Cared for by Hospitalists Versus Hematologists. American journal of medical quality : the official journal of the American College of Medical Quality Slade, J., Rohatgi, N., Weng, Y., Hom, J., Ahuja, N. 2019: 1062860619892060

  View details for DOI 10.1177/1062860619892060

  View details for PubMedID 31856577

• Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India. Journal of global health Carmichael, S. L., Mehta, K., Srikantiah, S., Mahapatra, T., Chaudhuri, I., Balakrishnan, R., Chaturvedi, S., Raheel, H., Borkum, E., Trehan, S., Weng, Y., Kaimal, R., Sivasankaran, A., Sridharan, S., Rotz, D., Tarigopula, U. K., Bhattacharya, D., Atmavilas, Y., Pepper, K. T., Rangarajan, A., Darmstadt, G. L. 2019; 9 (2): 0204249

  Abstract

  mHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource - especially hard-to-reach - settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes.The Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICT-CCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups.The ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P < 0.01). The intervention also resulted in 13, 12, and 21 percentage point increases in skin-to-skin care (P < 0.01), breastfeeding immediately after delivery (P < 0.01), and age-appropriate complementary feeding (P < 0.01). FLW supervision and other RMNCHN behaviors were not significantly impacted.Important improvements in FLW home visits and RMNCHN behaviors were achieved. The ICT-CCS tool shows promise for facilitating FLW effectiveness in improving RMNCHN behaviors.

  View details for DOI 10.7189/jogh.09.020424

  View details for PubMedID 31788233

  View details for PubMedCentralID PMC6875677

• Development and validation of a predictive model for American Society of Anesthesiologists Physical Status. BMC health services research Mudumbai, S. C., Pershing, S., Bowe, T., Kamal, R. N., Sears, E. D., Finlay, A. K., Eisenberg, D., Hawn, M. T., Weng, Y., Trickey, A. W., Mariano, E. R., Harris, A. H. 2019; 19 (1): 859

  Abstract

  The American Society of Anesthesiologists Physical Status (ASA-PS) classification system was developed to categorize the fitness of patients before surgery. Increasingly, the ASA-PS has been applied to other uses including justification of inpatient admission. Our objectives were to develop and cross-validate a statistical model for predicting ASA-PS; and 2) assess the concurrent and predictive validity of the model by assessing associations between model-derived ASA-PS, observed ASA-PS, and a diverse set of 30-day outcomes.Using the 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File, we developed and internally cross-validated multinomial regression models to predict ASA-PS using preoperative NSQIP data. Accuracy was assessed with C-Statistics and calibration plots. We assessed both concurrent and predictive validity of model-derived ASA-PS relative to observed ASA-PS and 30-day outcomes. To aid further research and use of the ASA-PS model, we implemented it into an online calculator.Of the 566,797 elective procedures in the final analytic dataset, 8.9% were ASA-PS 1, 48.9% were ASA-PS 2, 39.1% were ASA-PS 3, and 3.2% were ASA-PS 4. The accuracy of the 21-variable model to predict ASA-PS was C = 0.77 +/- 0.0025. The model-derived ASA-PS had stronger association with key indicators of preoperative status including comorbidities and higher BMI (concurrent validity) compared to observed ASA-PS, but less strong associations with postoperative complications (predictive validity). The online ASA-PS calculator may be accessed at https://s-spire-clintools.shinyapps.io/ASA_PS_Estimator/ CONCLUSIONS: Model-derived ASA-PS better tracked key indicators of preoperative status compared to observed ASA-PS. The ability to have an electronically derived measure of ASA-PS can potentially be useful in research, quality measurement, and clinical applications.

  View details for DOI 10.1186/s12913-019-4640-x

  View details for PubMedID 31752856

• Effects of team-based goals and non-monetary incentives on front-line health worker performance and maternal health behaviours: a cluster randomised controlled trial in Bihar, India. BMJ global health Carmichael, S. L., Mehta, K., Raheel, H., Srikantiah, S., Chaudhuri, I., Trehan, S., Mohanty, S., Borkum, E., Mahapatra, T., Weng, Y., Kaimal, R., Sivasankaran, A., Sridharan, S., Rotz, D., Tarigopula, U. K., Bhattacharya, D., Atmavilas, Y., Munar, W., Rangarajan, A., Darmstadt, G. L., Ananya Study Group, Atmavilas, Y., Bhattacharya, D., Borkum, E., Carmichael, S. L., Chaudhuri, I., Creanga, A., Darmstadt, G. L., Dutt, P., Irani, L., Kaimal, R., Mahapatra, T., Mehta, K. M., Mitra, R., Munar, W., Pepper, K., Raheel, H., Rangarajan, A., Saggurti, N., Sastry, P., Schooley, J., Shah, H., Srikantiah, S., Kiran Tarigopula, U., Ward, V., Weng, Y., Wahid, S., Wilhelm, J. 2019; 4 (4): e001146

  Abstract

  Introduction: We evaluated the impact of a 'Team-Based Goals and Incentives' (TBGI) intervention in Bihar, India, designed to improve front-line (community health) worker (FLW) performance and health-promoting behaviours related to reproductive, maternal, newborn and child health and nutrition.Methods: This study used a cluster randomised controlled trial design and difference-in-difference analyses of improvements in maternal health-related behaviours related to the intervention's team-based goals (primary), and interactions of FLWs with each other and with maternal beneficiaries (secondary). Evaluation participants included approximately 1300 FLWs and 3600 mothers at baseline (May to June 2012) and after 2.5 years of implementation (November to December 2014) who had delivered an infant in the previous year.Results: The TBGI intervention resulted in significant increases in the frequency of antenatal home visits (15 absolute percentage points (PP), p=0.03) and receipt of iron-folic acid (IFA) tablets (7 PP, p=0.02), but non-significant changes in other health behaviours related to the trial's goals. Improvements were seen in selected attitudes related to coordination and teamwork among FLWs, and in the provision of advice to beneficiaries (ranging from 8 to 14 PP) related to IFA, cord care, breast feeding, complementary feeding and family planning.Conclusion: Results suggest that combining an integrated set of team-based coverage goals and targets, small non-cash incentives for teams who meet targets and team building to motivate FLWs resulted in improvements in FLW coordination and teamwork, and in the quality and quantity of FLW-beneficiary interactions. These improvements represent programmatically meaningful steps towards improving health behaviours and outcomes.Trial registration number: NCT03406221.

  View details for DOI 10.1136/bmjgh-2018-001146

  View details for PubMedID 31543982

• Utility of a Quantitative Approach Using Diffusion Tensor Imaging for Prognostication Regarding Motor and Functional Outcomes in Patients With Surgically Resected Deep Intracranial Cavernous Malformations. Neurosurgery Abhinav, K., Nielsen, T. H., Singh, R., Weng, Y., Han, S. S., Iv, M., Steinberg, G. K. 2019

  Abstract

  Resection of deep intracranial cavernous malformations (CMs) is associated with a higher risk of neurological deterioration and uncertainty regarding clinical outcomes.To examine diffusion tractography imaging (DTI) data evaluating the corticospinal tract (CST) in relation to motor and functional outcomes in patients with surgically resected deep CMs.Perilesional CST was characterized as disrupted, displaced, or normal. Mean fractional anisotropy (FA) values were obtained for whole ipsilateral CST and in 3 regions: subcortical (proximal), perilesional, and distally. Mean FA values in anatomically equivalent regions in the contralateral CST were obtained. Clinical and radiological data were collected independently. Multivariable regression analysis was used for statistical analysis.A total of 18 patients [brainstem (15) and thalamus/basal ganglia (3); median follow-up: 270 d] were identified over 2 yr. The CST was identified preoperatively as disrupted (6), displaced (8), and normal (4). Five of 6 patients with disruption had weakness. Higher preoperative mean FA values for distal ipsilateral CST segment were associated with better preoperative lower (P < .001), upper limb (P = .004), postoperative lower (P = .005), and upper limb (P < .001) motor examination. Preoperative mean FA values for distal ipsilateral CST segment (P = .001) and contralateral perilesional CST segment (P < .001) were negatively associated with postoperative modified Rankin scale scores.Lower preoperative mean FA values for overall and defined CST segments corresponded to worse patient pre- and postoperative motor examination and/or functional status. FA value for the distal ipsilateral CST segment has prognostic potential with respect to clinical outcomes.

  View details for DOI 10.1093/neuros/nyz259

  View details for PubMedID 31360998

• Trajectory analysis for postoperative pain using electronic health records: A nonparametric method with robust linear regression and K-medians cluster analysis Health Informatics Journal Weng, Y. 2019
• NOS3 895G&gt;T and CBR3 730G&gt;A Are Associated with Recurrence Risk in Non-Muscle-Invasive Bladder Cancer with Intravesical Instillations of THP. Chemotherapy Zhou, Q., Ding, W., Weng, Y., Ding, G., Xia, G., Xu, J., Xu, K., Ding, Q. 2018; 63 (4): 191–97

  Abstract

  To analyze the correlation between pharmacogenomic biomarkers and the efficacy of pirarubicin (THP, also named 4'-O-tetrahydropyranyl-adriamycin) and to explore potential associations of individual genetic backgrounds with the clinical outcomes of non-muscle-invasive bladder cancer (NMIBC) patients.Between July 2003 and June 2011, a total of 91 patients were treated with transurethral resection (TUR) of the bladder tumor and were histopathologically confirmed to have NMIBC. Patients received an immediate instillation and maintenance therapy with THP. All patients underwent follow-up for recurrence. We genotyped 13 single nucleotide polymorphisms (SNPs) from blood and saliva DNA samples of all patients.The associations of patients' genotypes with tumor recurrence risks were analyzed by survival analysis. A total of 16 (17.6%) of the 91 patients with NMIBC had tumor recurrences with a median follow-up of 17 months (range, 2-83 months). We confirmed the effect of the European Organization for Research and Treatment of Cancer (EORTC) risk score for predicting tumor recurrence (p = 0.002, log-rank test). We adjusted for the EORTC score and found that 2 SNPs, NOS3 895G>T (rs1799983) (p = 0.02, HR = 4.32, 95% CI, 1.30-14.39, GT+TT vs. GG) and CBR3 730G>A (rs1056892) (p = 0.04, HR = 2.57, 95% CI, 1.07-6.18, GA+AA vs. GG), were significantly associated with a higher recurrence risk after TUR and instillations of THP in NMIBC patients.Our results suggest that NOS3 895G>T and CBR3 730G>A are genetic markers that can be used to predict tumor recurrence in NMIBC patients receiving intravesical instillations of THP. The effects of those 2 SNPs are independent of the EORTC scores. Further studies with larger sample sizes and longer follow-ups are needed to confirm our results.

  View details for DOI 10.1159/000489402

  View details for PubMedID 30125887

• Effect of Medicare's Nonpayment Policy on Surgical Site Infections Following Orthopedic Procedures. Infection control and hospital epidemiology Kwong, J. Z., Weng, Y., Finnegan, M., Schaffer, R., Remington, A., Curtin, C., McDonald, K. M., Bhattacharya, J., Hernandez-Boussard, T. 2017: 1-6

  Abstract

  OBJECTIVE Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS policy's effect on rates of targeted orthopedic SSIs among the Medicare population. DESIGN We examined SSI rates following orthopedic procedures among the Medicare population before and after policy implementation compared to a similarly aged control group. Using the Nationwide Inpatient Sample database for 2000-2013, we estimated rate ratios (RRs) of orthopedic SSIs among Medicare and non-Medicare patients using a difference-in-differences approach. RESULTS Following policy implementation, SSIs significantly decreased among both the Medicare and non-Medicare populations (RR, 0.7; 95% confidence interval [CI], 0.6-0.8) and RR, 0.8l; 95% CI, 0.7-0.9), respectively. However, the estimated decrease among the Medicare population was not significantly greater than the decrease among the control population (RR, 0.9; 95% CI, 0.8-1.1). CONCLUSIONS While SSI rates decreased significantly following the implementation of the CMS nonpayment policy, this trend was not associated with policy intervention but rather larger secular trends that likely contributed to decreasing SSI rates over time. Infect Control Hosp Epidemiol 2017;1-6.

  View details for DOI 10.1017/ice.2017.86

  View details for PubMedID 28487001

• Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study) JOURNAL OF ORTHOPAEDIC TRAUMA Castillo, R. C., Raja, S. N., Frey, K. P., Vallier, H. A., Tornetta, P., Jaeblon, T., Goff, B. J., Gottschalk, A., Scharfstein, D. O., O'Toole, R. V., METRC 2017; 31: S71–S77

  Abstract

  Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.

  View details for DOI 10.1097/BOT.0000000000000793

  View details for Web of Science ID 000402085500014

  View details for PubMedID 28323806

• National Readmission Patterns of Isolated Splenic Injuries Based on Initial Management Strategy. JAMA surgery Rosenberg, G. M., Knowlton, L., Rajasingh, C., Weng, Y., Maggio, P. M., Spain, D. A., Staudenmayer, K. L. 2017; 152 (12): 1119–25

  Abstract

  Options for managing splenic injuries have evolved with a focus on nonoperative management. Long-term outcomes, such as readmissions and delayed splenectomy rate, are not well understood.To describe the natural history of isolated splenic injuries in the United States and determine whether patterns of readmission were influenced by management strategy.The Healthcare Cost and Utilization Project's Nationwide Readmission Database is an all-payer, all-ages, longitudinal administrative database that provides data on more than 35 million weighted US discharges yearly. The database was used to identify patients with isolated splenic injuries and the procedures that they received. Adult patients with isolated splenic injuries admitted from January 1 through June 30, 2013, and from January 1 through June 30, 2014, were included. Those who died during the index hospitalization or who had an additional nonsplenic injury with an Abbreviated Injury Score of 2 or greater were excluded. Univariate and mixed-effects logistic regression analysis controlling for center effect were used. Weighted numbers are reported.Initial management strategy at the time of index hospitalization, including nonprocedural management, angioembolization, and splenectomy.All-cause 6-month readmission rate. Secondary outcome was delayed splenectomy rate.A weighted sample of 3792 patients (2146 men [56.6%] and 1646 women [43.4%]; mean [SE] age, 48.5 [0.7] years) with 5155 admission events was included. During the index hospitalization, 825 (21.8%) underwent splenectomy, 293 (7.7%) underwent angioembolization, and 2673 (70.5%) had no procedure. The overall readmission rate was 21.1% (799 patients). Readmission rates did not differ based on initial management strategy (195 patients undergoing splenectomy [23.6%], 70 undergoing angioembolism [23.9%], and 534 undergoing no procedure [20%]; P = .33). Splenectomy was performed in 36 of 799 readmitted patients (4.5%) who did not have a splenectomy at their index hospitalization, leading to an overall delayed splenectomy rate of 1.2% (36 of 2967 patients). In mixed-effects logistic regression analysis controlling for patient, injury, clinical, and hospital characteristics, the choice of splenectomy (odds ratio, 0.93; 95% CI, 0.66-1.31) vs angioembolization (odds ratio, 1.19; 95% CI, 0.72-1.97) as initial management strategy was not associated with readmission.This national evaluation of the natural history of isolated splenic injuries from index admission through 6 months found that approximately 1 in 5 patients are readmitted within 6 months of discharge after an isolated splenic injury. However, the chance of readmission for splenectomy after initial nonoperative management was 1.2%. This finding suggests that the current management strategies used for isolated splenic injuries in the United States are well matched to patient need.

  View details for PubMedID 28768329

• A Dietary Intervention in Urban African Americans Results of the "Five Plus Nuts and Beans" Randomized Trial AMERICAN JOURNAL OF PREVENTIVE MEDICINE Miller, E. R., Cooper, L. A., Carson, K. A., Wang, N., Appel, L. J., Gayles, D., Charleston, J., White, K., You, N., Weng, Y., Martin-Daniels, M., Bates-Hopkins, B., Robb, I., Franz, W. K., Brown, E. L., Halbert, J. P., Albert, M. C., Dalcin, A. T., Yeh, H. 2016; 50 (1): 87-95

  Abstract

  Unhealthy diets, often low in potassium, likely contribute to racial disparities in blood pressure. We tested the effectiveness of providing weekly dietary advice, assistance with selection of higher potassium grocery items, and a $30 per week food allowance on blood pressure and other outcomes in African American adults with hypertension.We conducted an 8-week RCT with two parallel arms between May 2012 and November 2013.We randomized 123 African Americans with controlled hypertension from an urban primary care clinic in Baltimore, Maryland, and implemented the trial in partnership with a community supermarket and the Baltimore City Health Department. Mean (SD) age was 58.6 (9.5) years; 71% were female; blood pressure was 131.3 (14.7)/77.2 (10.5) mmHg; BMI was 34.5 (8.2); and 28% had diabetes.Participants randomized to the active intervention group (Dietary Approaches to Stop Hypertension [DASH]-Plus) received coach-directed dietary advice and assistance with weekly online ordering and purchasing of high-potassium foods ($30/week) delivered by a community supermarket to a neighborhood library. Participants in the control group received a printed DASH diet brochure along with a debit account of equivalent value to that of the DASH-Plus group.The primary outcome was blood pressure change. Analyses were conducted in January to October 2014.Compared with the control group, the DASH-Plus group increased self-reported consumption of fruits and vegetables (mean=1.4, 95% CI=0.7, 2.1 servings/day); estimated intake of potassium (mean=0.4, 95% CI=0.1, 0.7 grams/day); and urine potassium excretion (mean=19%, 95% CI=1%, 38%). There was no significant effect on blood pressure.A program providing dietary advice, assistance with grocery ordering, and $30/week of high-potassium foods in African American patients with controlled hypertension in a community-based clinic did not reduce BP. However, the intervention increased consumption of fruits, vegetables, and urinary excretion of potassium.

  View details for DOI 10.1016/j.amepre.2015.06.010

  View details for Web of Science ID 000366845300016

  View details for PubMedID 26321012