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Zagrodzky W, Cooper J, Joseph C, Sackett M, Silva J, Kuk R, McHugh J, Brumback B, Park S, Hayward R, Taneja T, Vu A, Liu T, Kulstad E, Kaplan A, Ramireddy A, Omotoye S. Association between proactive esophageal cooling and increased lab throughput. J Cardiovasc Electrophysiol 2024. [PMID: 38566579 DOI: 10.1111/jce.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Proactive esophageal cooling has been FDA cleared to reduce the likelihood of ablation-related esophageal injury resulting from radiofrequency (RF) cardiac ablation procedures. Data suggest that procedure times for RF pulmonary vein isolation (PVI) also decrease when proactive esophageal cooling is employed instead of luminal esophageal temperature (LET) monitoring. Reduced procedure times may allow increased electrophysiology (EP) lab throughput. We aimed to quantify the change in EP lab throughput of PVI cases after the introduction of proactive esophageal cooling. METHODS EP lab throughput data were obtained from three EP groups. We then compared EP lab throughput over equal time frames at each site before (pre-adoption) and after (post-adoption) the adoption of proactive esophageal cooling. RESULTS Over the time frame of the study, a total of 2498 PVIs were performed over a combined 74 months, with cooling adopted in September 2021, November 2021, and March 2022 at each respective site. In the pre-adoption time frame, 1026 PVIs were performed using a combination of LET monitoring with the addition of esophageal deviation when deemed necessary by the operator. In the post-adoption time frame, 1472 PVIs were performed using exclusively proactive esophageal cooling, representing a mean 43% increase in throughput (p < .0001), despite the loss of two operators during the post-adoption time frame. CONCLUSION Adoption of proactive esophageal cooling during PVI ablation procedures is associated with a significant increase in EP lab throughput, even after a reduction in total number of operating physicians in the post-adoption group.
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Affiliation(s)
| | - Julie Cooper
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Matthew Sackett
- Centra Health, Centra Lynchburg General Hospital and Centra Specialty Hospital, Lynchburg, Virginia, USA
| | - Jose Silva
- Centra Health, Centra Lynchburg General Hospital and Centra Specialty Hospital, Lynchburg, Virginia, USA
| | - Richard Kuk
- Centra Health, Centra Lynchburg General Hospital and Centra Specialty Hospital, Lynchburg, Virginia, USA
| | - Julia McHugh
- Centra Health, Centra Lynchburg General Hospital and Centra Specialty Hospital, Lynchburg, Virginia, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Shirley Park
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Robert Hayward
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Taresh Taneja
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Andrew Vu
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Taylor Liu
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Sanchez J, Woods C, Zagrodzky J, Nazari J, Singleton MJ, Schricker A, Ruppert A, Brumback B, Jenny B, Athill C, Joseph C, Shah D, Upadhyay G, Kulstad E, Cogan J, Leyton-Mange J, Cooper J, Tamirisa K, Omotoye S, Timilsina S, Perez-Verdia A, Kaplan A, Patel A, Ro A, Corsello A, Kolli A, Greet B, Willms D, Burkland D, Castillo D, Zahwe F, Nayak H, Daniels J, MacGregor J, Sackett M, Kutayli WM, Barakat M, Percell R, Akrivakis S, Hao SC, Liu T, Panico A, Ramireddy A, Dewland T, Gerstenfeld EP, Lanes DB, Sze E, Francisco G, Silva J, McHugh J, Sung K, Feldman L, Serafini N, Kawasaki R, Hongo R, Kuk R, Hayward R, Park S, Vu A, Henry C, Bailey S, Mickelsen S, Taneja T, Fisher W, Metzl M. Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2023; 9:2558-2570. [PMID: 37737773 DOI: 10.1016/j.jacep.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. OBJECTIVES The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. METHODS This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. RESULTS A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). CONCLUSIONS Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.
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Affiliation(s)
| | | | | | - Jose Nazari
- NorthShore University Health System, Evanston, Illinois, USA
| | | | - Amir Schricker
- Mills-Peninsula Medical Center, Burlingame, California, USA
| | | | | | | | | | | | - Dipak Shah
- Ascension Michigan, Detroit, Michigan, USA
| | | | - Erik Kulstad
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - John Cogan
- Memorial Healthcare System, Hollywood, Florida, USA
| | | | - Julie Cooper
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | - Apoor Patel
- Houston Methodist Hospital, Houston, Texas, USA
| | - Alex Ro
- NorthShore University Health System, Evanston, Illinois, USA
| | | | | | - Brian Greet
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Danya Willms
- Sharp Memorial Hospital, San Diego, California, USA
| | | | | | | | - Hemal Nayak
- University of Texas, San Antonio, Texas, USA
| | - James Daniels
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Matthew Sackett
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | | | | | | | | | - Steven C Hao
- Sutter Pacific Medical Foundation, San Francisco, California, USA
| | - Taylor Liu
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | | | | | - Thomas Dewland
- University of California-San Fransisco, San Fransico, California, USA
| | | | | | - Edward Sze
- MaineHealth Cardiology, Portland, Maine, USA
| | | | - Jose Silva
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Julia McHugh
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Kai Sung
- Tri-City Cardiology, Mesa, Arizona, USA
| | - Leon Feldman
- Eisenhower Medical Center, Rancho Mirage, California, USA
| | | | - Raymond Kawasaki
- Northwest Community Healthcare, Arlington Heights, Illinois, USA
| | - Richard Hongo
- California Pacific Medical Center, San Francisco, California, USA
| | - Richard Kuk
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Robert Hayward
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Shirley Park
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Andrew Vu
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | | | - Shane Bailey
- LoneStar Heart and Vascular, New Braunfels, Texas, USA
| | | | - Taresh Taneja
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Westby Fisher
- NorthShore University Health System, Evanston, Illinois, USA
| | - Mark Metzl
- NorthShore University Health System, Evanston, Illinois, USA
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Joseph C, Nazari J, Zagrodzky J, Brumback B, Sherman J, Zagrodzky W, Bailey S, Kulstad E, Metzl M. Improved 1-year outcomes after active cooling during left atrial radiofrequency ablation. J Interv Card Electrophysiol 2023; 66:1621-1629. [PMID: 36670327 PMCID: PMC10359433 DOI: 10.1007/s10840-023-01474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Active esophageal cooling during pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF) is increasingly being utilized to reduce esophageal injury and atrioesophageal fistula formation. Randomized controlled data also show trends towards increased freedom from AF when using active cooling. This study aimed to compare 1-year arrhythmia recurrence rates between patients treated with luminal esophageal temperature (LET) monitoring versus active esophageal cooling during left atrial ablation. METHOD Data from two healthcare systems (including 3 hospitals and 4 electrophysiologists) were reviewed for patient rhythm status at 1-year follow-up after receiving PVI for the treatment of AF. Results were compared between patients receiving active esophageal cooling (ensoETM, Attune Medical, Chicago, IL) and those treated with traditional LET monitoring using Kaplan-Meier estimates. RESULTS A total of 513 patients were reviewed; 253 received LET monitoring using either single or multi-sensor temperature probes; and 260 received active cooling. The mean age was 66.8 (SD ± 10) years, and 36.8% were female. Arrhythmias were 60.1% paroxysmal AF, 34.3% persistent AF, and 5.6% long-standing persistent AF, with no significant difference between groups. At 1-year follow-up, KM estimates for freedom from AF were 58.2% for LET-monitored patients and 72.2% for actively cooled patients, for an absolute increase in freedom from AF of 14% with active esophageal cooling (p = .03). Adjustment for the confounders of patient age, gender, type of AF, and operator with an inverse probability of treatment weighted Cox proportional hazards model yielded a hazard ratio of 0.6 for the effect of cooling on AF recurrence (p = 0.045). CONCLUSIONS In this first study to date of the association between esophageal protection strategy and long-term efficacy of left atrial RF ablation, a clinically and statistically significant improvement in freedom from atrial arrhythmia at 1 year was found in patients treated with active esophageal cooling when compared to patients who received LET monitoring. More rigorous prospective studies or randomized studies are required to validate the findings of the current study.
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Affiliation(s)
| | - Jose Nazari
- NorthShore University Health System, Evanston, IL, USA
| | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David's South Austin Medical Center, 901 W Ben White Blvd, Austin, TX, 78704, USA
| | - Babette Brumback
- Department of Biostatistics, College of Public Health & Health Professions, College of Medicine, University of Florida, Gainesville, USA
| | - Jacob Sherman
- Washington University in Saint Louis, 1 Brookings Dr, MO, 63130, St. Louis, USA
| | - William Zagrodzky
- Colorado College, 14 E Cache La Poudre St, Colorado Springs, CO, 80903, USA
| | - Shane Bailey
- Texas Cardiac Arrhythmia Institute, St. David's South Austin Medical Center, 901 W Ben White Blvd, Austin, TX, 78704, USA
| | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Mark Metzl
- NorthShore University Health System, Evanston, IL, USA
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Joseph C, Nazari J, Brumback B, Kulstad E, Metzl MD. INCREASED TIME TO FIRST RECURRENCE OF ARRHYTHMIA AFTER ATRIAL ABLATION WITH ACTIVE ESOPHAGEAL COOLING. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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5
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Seneadza NAH, Kwara A, Lauzardo M, Prins C, Zhou Z, Séraphin MN, Ennis N, Morano JP, Brumback B, Cook RL. Assessing risk factors for latent and active tuberculosis among persons living with HIV in Florida: A comparison of self-reports and medical records. PLoS One 2022; 17:e0271917. [PMID: 35925972 PMCID: PMC9352085 DOI: 10.1371/journal.pone.0271917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 07/10/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study examined factors associated with TB among persons living with HIV (PLWH) in Florida and the agreement between self-reported and medically documented history of tuberculosis (TB) in assessing the risk factors. METHODS Self-reported and medically documented data of 655 PLWH in Florida were analyzed. Data on sociodemographic factors such as age, race/ethnicity, place of birth, current marital status, education, employment, homelessness in the past year and 'ever been jailed' and behavioural factors such as excessive alcohol use, marijuana, injection drug use (IDU), substance and current cigarette use were obtained. Health status information such as health insurance status, adherence to HIV antiretroviral therapy (ART), most recent CD4 count, HIV viral load and comorbid conditions were also obtained. The associations between these selected factors with self-reported TB and medically documented TB diagnosis were compared using Chi-square and logistic regression analyses. Additionally, the agreement between self-reports and medical records was assessed. RESULTS TB prevalence according to self-reports and medical records was 16.6% and 7.5% respectively. Being age ≥55 years, African American and homeless in the past 12 months were statistically significantly associated with self-reported TB, while being African American homeless in the past 12 months and not on antiretroviral therapy (ART) were statistically significantly associated with medically documented TB. African Americans compared to Whites had odds ratios of 3.04 and 4.89 for self-reported and medically documented TB, respectively. There was moderate agreement between self-reported and medically documented TB (Kappa = 0.41). CONCLUSIONS TB prevalence was higher based on self-reports than medical records. There was moderate agreement between the two data sources, showing the importance of self-reports. Establishing the true prevalence of TB and associated risk factors in PLWH for developing policies may therefore require the use of self-reports and confirmation by screening tests, clinical signs and/or microbiologic data.
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Affiliation(s)
| | - Awewura Kwara
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Michael Lauzardo
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Cindy Prins
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Marie Nancy Séraphin
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, Florida, United States of America
| | - Jamie P. Morano
- University of South Florida, Morsani College of Medicine, Tampa, Florida, United States of America
| | - Babette Brumback
- Department of Biostatistics, Colleges of Public Health & Health Professions and Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States of America
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Alalwan AA, Friedman J, Park H, Segal R, Brumback B, Hartzema A. Comparative Safety of Sleeve Gastrectomy and Roux-en-Y: A Propensity Score Analysis. World J Surg 2022; 46:2715-2724. [PMID: 35840690 DOI: 10.1007/s00268-022-06664-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Use of bariatric surgery has increased dramatically in the USA. However, there are growing concerns regarding the safety outcomes of different bariatric procedures. We aim to compare the safety of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), which includes hospital readmissions, emergency room (ER) visits, gastrointestinal bleeding, and revisional surgery. METHODS A retrospective cohort analysis was conducted for adults (≥ 18 years) who received SG and RYGB in the USA. We used Truven MarketScan Commercial and Medicare supplemental claims databases from January 1, 2005, to October 1, 2015. To adjust for baseline demographic and clinical characteristics, we used stabilized inverse probability of treatment weighting using propensity score. Cox proportional hazard models was used to compare safety outcomes between SG and RYGB after bariatric surgery. RESULTS A total of 194,248 patients met inclusion criteria; 79,813 patients (41%) received SG and 114,435 patients (59%) received RYGB. The use of SG was associated with a significantly lower 30-day hospital readmission rate [adjusted hazard ratios (aHRs) 0.77; 95% confidence interval (CI), 0.74-0.81] and ER visits [aHR, 0.82; 95% CI, 0.80-0.83], and decreased risk of gastrointestinal bleeding [aHR, 0.87; 95% CI, 0.78-0.98] compared to RYGB. However, SG was associated with an increased risk of revisional surgery, compared to RYGB [aHR,1.21; 95% CI, 1.08-1.35]. CONCLUSIONS Among patients receiving bariatric surgery in a real-world setting, SG was associated with lower complication rate but a higher risk of revisional surgery compared to RYGB. Further longitudinal studies are needed to assess long-term findings.
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Affiliation(s)
- Abdullah A Alalwan
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA. .,Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Qassim, Saudi Arabia.
| | - Jeffrey Friedman
- UF Health Bariatric Surgery Center, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Haesuk Park
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Richard Segal
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL, USA
| | - Abraham Hartzema
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
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Ozrazgat-Baslanti T, Loftus TJ, Mohandas R, Wu Q, Brakenridge S, Brumback B, Efron PA, Anton S, Moore FA, Moldawer LL, Segal MS, Bihorac A. Clinical Trajectories of Acute Kidney Injury in Surgical Sepsis: A Prospective Observational Study. Ann Surg 2022; 275:1184-1193. [PMID: 33196489 PMCID: PMC8116352 DOI: 10.1097/sla.0000000000004360] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To characterize endothelial function, inflammation, and immunosuppression in surgical patients with distinct clinical trajectories of AKI and to determine the impact of persistent kidney injury and renal non-recovery on clinical outcomes, resource utilization, and long-term disability and survival. SUMMARY OF BACKGROUND DATA AKI is associated with increased healthcare costs and mortality. Trajectories that account for duration and recovery of AKI have not been described for sepsis patients, who are uniquely vulnerable to renal dysfunction. METHODS This prospective observational study included 239 sepsis patients admitted and enrolled between January 2015 and July 2017. Kidney Disease: Improving Global Outcomes (KDIGO) and Acute Disease Quality Initiative (ADQI) criteria were used to classify subjects as having no AKI, rapidly reversed AKI, persistent AKI with renal recovery, or persistent AKI without renal recovery. Serial biomarker profiles, clinical outcomes, resource utilization, and long-term physical performance status and survival were compared among AKI trajectories. RESULTS Sixty-two percent of the study population developed AKI. Only one-third of AKI episodes rapidly reversed within 48 hours; the remaining had persistent AKI, among which 57% did not have renal recovery by discharge. One-year survival and proportion of subjects fully active 1 year after sepsis was lowest among patients with persistent AKI compared with other groups. Long-term mortality hazard rates were 5-fold higher for persistent AKI without renal recovery compared with no AKI. CONCLUSIONS Among critically ill surgical sepsis patients, persistent AKI and the absence of renal recovery are associated with distinct early and sustained immunologic and endothelial biomarker signatures and decreased long-term physical function and survival.
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Affiliation(s)
- Tezcan Ozrazgat-Baslanti
- Departments of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine (Prisma), University of Florida, Gainesville, FL, USA
| | - Tyler J. Loftus
- Departments of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Rajesh Mohandas
- Departments of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Quran Wu
- Departments of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Scott Brakenridge
- Departments of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Philip A. Efron
- Departments of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephen Anton
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Frederick A. Moore
- Departments of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lyle L. Moldawer
- Departments of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mark S. Segal
- Departments of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Azra Bihorac
- Departments of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine (Prisma), University of Florida, Gainesville, FL, USA
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Williams R, Brumback B, Cook R, Cook C, Ezenwa M, Lucero R. Prevalence of HIV-related stigma in adults living with HIV & disability in Florida, 2015-2016. AIDS Care 2022; 34:47-54. [PMID: 34011205 PMCID: PMC9744242 DOI: 10.1080/09540121.2021.1929812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Using data collected from the Florida Medical Monitoring Project, we sought to compare the prevalence of overall HIV-related stigma, including its subdimensions among persons with HIV and disability(s) and persons with HIV without disability in Florida. Disability was classified as having difficulty in one or more areas: activity limitations, participation restrictions, and functional or sensory activities. HIV-related stigma was assessed using the HIV Stigma Scale, which measures (1) overall stigma (2) negative self-image, (3) personalized, and (4) anticipated stigma. Multivariate analysis indicates that the crude prevalence ratios of overall stigma, including negative self-image, personalized, and anticipated stigma among persons with HIV and disability(s) were 1.43, 1.24, 1.20, and 1.23 compared to persons with HIV without disability, respectively. After adjusting for confounders, the prevalence ratios of HIV-related stigma ranged from 1.33-1.07 among persons with HIV and disability(s) compared to persons with HIV without disability. The implications of these findings reveal that persons with HIV and disability(s) are more vulnerable to HIV-related stigma. Researchers could consider distinct stigma interventions tailored towards persons with HIV and disability(s) in Florida.
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Affiliation(s)
| | - Babette Brumback
- Department of Biostatistics, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, FL, USA
| | - Robert Cook
- Department of Epidemiology, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, FL, USA
| | - Christa Cook
- Department of Nursing Systems, University of Central Florida College of Nursing, Orlando, FL, USA
| | - Miriam Ezenwa
- Department of Biobehavioural Nursing, University of Florida College of Nursing, Gainesville, FL, USA
| | - Robert Lucero
- Center for Latin American Studies, Department of Family, Community and Health Systems Science, University of Florida College of Nursing, Gainesville, FL, USA
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Ozrazgat-Baslanti T, Loftus TJ, Ren Y, Adiyeke E, Miao S, Hashemighouchani H, Islam R, Mohandas R, Gopal S, Shenkman EA, Pardalos P, Brumback B, Segal MS, Bihorac A. Association of persistent acute kidney injury and renal recovery with mortality in hospitalised patients. BMJ Health Care Inform 2021; 28:bmjhci-2021-100458. [PMID: 34876451 PMCID: PMC8655552 DOI: 10.1136/bmjhci-2021-100458] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Acute kidney injury (AKI) affects up to one-quarter of hospitalised patients and 60% of patients in the intensive care unit (ICU). We aim to understand the baseline characteristics of patients who will develop distinct AKI trajectories, determine the impact of persistent AKI and renal non-recovery on clinical outcomes, resource use, and assess the relative importance of AKI severity, duration and recovery on survival. Methods In this retrospective, longitudinal cohort study, 156 699 patients admitted to a quaternary care hospital between January 2012 and August 2019 were staged and classified (no AKI, rapidly reversed AKI, persistent AKI with and without renal recovery). Clinical outcomes, resource use and short-term and long-term survival adjusting for AKI severity were compared among AKI trajectories in all cohort and subcohorts with and without ICU admission. Results Fifty-eight per cent (31 500/54 212) had AKI that rapidly reversed within 48 hours; among patients with persistent AKI, two-thirds (14 122/22 712) did not have renal recovery by discharge. One-year mortality was significantly higher among patients with persistent AKI (35%, 7856/22 712) than patients with rapidly reversed AKI (15%, 4714/31 500) and no AKI (7%, 22 117/301 466). Persistent AKI without renal recovery was associated with approximately fivefold increased hazard rates compared with no AKI in all cohort and ICU and non-ICU subcohorts, independent of AKI severity. Discussion Among hospitalised, ICU and non-ICU patients, persistent AKI and the absence of renal recovery are associated with reduced long-term survival, independent of AKI severity. Conclusions It is essential to identify patients at risk of developing persistent AKI and no renal recovery to guide treatment-related decisions.
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Affiliation(s)
- Tezcan Ozrazgat-Baslanti
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - Tyler J Loftus
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA.,Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Yuanfang Ren
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - Esra Adiyeke
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - Shunshun Miao
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - Haleh Hashemighouchani
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - Rubab Islam
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Rajesh Mohandas
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Saraswathi Gopal
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Panos Pardalos
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, Florida, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Mark S Segal
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, Florida, USA .,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
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10
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Wei YJJ, Schmidt S, Chen C, Fillingim RB, Reid MC, DeKosky S, Solberg L, Pahor M, Brumback B, Winterstein AG. Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia. Alzheimers Res Ther 2021; 13:78. [PMID: 33883028 PMCID: PMC8061026 DOI: 10.1186/s13195-021-00818-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 03/26/2021] [Indexed: 12/17/2022]
Abstract
Background Pain is common among individuals with Alzheimer’s disease and related dementias (ADRD), and use of opioids has been increasing over the last decade. Yet, it is unclear to what extent opioids are appropriately prescribed for patients with ADRD and whether the appropriateness of opioid prescribing differs by ADRD status. The objective of this study is to compare the quality of opioid prescribing among patients with or without ADRD who have chronic noncancer pain. Methods A nationally representative cohort study of Medicare beneficiaries aged 50 years or older who had chronic pain but who had no cancer, hospice, or palliative care from 2011 to 2015. Four indicators of potentially inappropriate opioid prescribing were measured in patients residing in communities (75,258 patients with and 435,870 patients without ADRD); five indicators were assessed in patients in nursing homes (NHs) (37,117 patients with and 5128 patients without ADRD). Each indicator was calculated as the proportion of eligible patients with inappropriate opioid prescribing in the year after a chronic pain diagnosis. Differences in proportions between ADRD and non-ADRD groups were estimated using a generalized linear model adjusting for covariates through inverse probability weighting. Results Patients with ADRD versus those without had higher concurrent use of opioids and central nervous system–active drugs (community 44.1% vs 33.3%; NH 58.8% vs 54.1%, both P < 0.001) and no opioids or scheduled pain medications for moderate or severe pain (NH 60.1% vs 52.5%, P < 0.001). The ADRD versus non-ADRD group had higher use of long-term opioids for treating neuropathic pain in communities (21.7% vs 19.5%, P = 0.003) but lower use in NHs (26.9% vs 36.0%, P < 0.001). Use of strong or high-dose opioids when naive to opioids (community 1.5% vs 2.8%; NH 2.5% vs 3.5%) and use of contraindicated opioids (community 0.08% vs 0.12%; NH 0.05% vs 0.21%) were rare for either group. Conclusion Potential inappropriate opioid prescribing in 2 areas of pain care was more common among patients with ADRD than among patients without ADRD in community or NH settings. Further studies aimed at understanding the factors and effects associated with opioid prescribing patterns that deviate from guidelines are warranted.
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Affiliation(s)
- Yu-Jung Jenny Wei
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Health Professions Nursing Pharmacy Building, Room 3321, Gainesville, FL, 32610, USA. .,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
| | - Siegfried Schmidt
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Cheng Chen
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Health Professions Nursing Pharmacy Building, Room 3321, Gainesville, FL, 32610, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, USA.,College of Dentistry, University of Florida, Gainesville, FL, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Steven DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Laurence Solberg
- NF/SG Veterans Health System, Malcom Randall VAMC, Geriatrics Research, Education, Clinical Center (GRECC), Gainesville, FL, USA.,University of Florida College of Nursing, Gainesville, FL, USA
| | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida College of Medicine, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida Colleges of Medicine and Public Health & Health Professions, Gainesville, FL, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Health Professions Nursing Pharmacy Building, Room 3321, Gainesville, FL, 32610, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.,Department of Epidemiology, University of Florida Colleges of Medicine and Public Health & Health Professions, Gainesville, FL, USA
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11
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Choi Y, Meissner HC, Hampp C, Park H, Brumback B, Winterstein AG. Calibration of Chronic Lung Disease Severity as a Risk Factor for Respiratory Syncytial Virus Hospitalization. J Pediatric Infect Dis Soc 2021; 10:317-325. [PMID: 32978942 DOI: 10.1093/jpids/piaa107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Guidelines assume children with chronic lung disease (CLD) who require medical support within 6 months before the second respiratory syncytial virus (RSV) season remains at high risk of severe RSV disease. We determined the number of days since the last treatment (DSL) when the risk of RSV hospitalization among children with CLD becomes equivalent to the risk for those not qualified for immunoprophylaxis. METHODS The study cohort was assembled using Medicaid billing records from 1999 to 2010 linked to Florida and Texas birth certificate records. We developed DSL-trend discrete time logistic regression models within a survival analysis framework, adjusting for use of immunoprophylaxis, to compare the hospitalization risk of CLD infants at 4 age points to that of term infants at 1 month of age with siblings. RESULTS The study cohort included 858 830 healthy term and 5562 preterm infants with CLD. Among 1-month-old term infants, the RSV hospitalization risk averaged across all covariate strata was 14.8 (95% confidence interval [CI], 13.5-16.1) per 1000 patient season-months. Risk for preterm CLD children reached the threshold derived from term infants when DSL was 76 (95% CI, 22-198.5), 52 (95% CI, 6.5-123), 35 (95% CI, 0-93.5), and 12 (95% CI, 0-61.5) at the respective ages of 12, 15, 17.2, and 21 months. CONCLUSIONS The 180-day threshold used to define CLD severity at season start can be shortened to 120 days, 90 days, and 60 days for children with CLD at age 15, 17.2, and 21 months, respectively.
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Affiliation(s)
- Yoonyoung Choi
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - H Cody Meissner
- Department of Pediatrics, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Christian Hampp
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Babette Brumback
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Department of Biostatistics, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, Florida, USA
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12
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Jeon N, Park H, Segal R, Brumback B, Winterstein AG. Non-steroidal anti-inflammatory drug-associated acute kidney injury: does short-term NSAID use pose a risk in hospitalized patients? Eur J Clin Pharmacol 2021; 77:1409-1417. [PMID: 33772627 DOI: 10.1007/s00228-021-03121-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/09/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE While renal risk associated with short-term use of non-steroidal anti-inflammatory drugs (NSAID) has been anecdotally documented, no conclusive evidence is available on the renal safety, especially among hospitalized patients with reduced renal function. This study is to evaluate the risk of acute kidney injury (AKI) associated with NSAID use in hospital. METHODS A retrospective matched cohort study utilizing electronic health records from two large academic tertiary-care hospitals was conducted. We defined AKI based on changes in SCr according to published AKI criteria. The hospital acquired AKI risk associated with inpatient NSAID use was assessed using a time-dependent Cox proportional hazard regression in pooled cohort as well as two sub cohorts stratified by baseline renal function. RESULTS A total of 18,794 admissions were included in the final cohort. Of 9397 admissions exposed to NSAIDs, 7914 and 1483 admissions were in the "without" and "with baseline renal impairment" cohort, with the same number of matching non-exposed admissions in each of the stratified cohort. The AKI incidences were 6 and 22 events per 1000 patient-days in "without" and "with preexisting renal impairment" cohort, respectively. The adjusted analyses suggested that NSAID use increased AKI risk in patients with preexisting renal impairment (hazard ratio [HR]: 1.38 [1.04-1.83]) but not in the patients without preexisting renal impairment (HR: 0.83 [95% CIs: 0.63-1.08]) or in the pooled cohort (HR: 1.01 [95% CIs: 0.83-1.24]). CONCLUSION Our findings suggested that NSAID use is associated with an increased risk of AKI in the hospitalized patients with preexisting renal impairment but the association is not statistically significant in those who have preserved renal function. Further randomized controlled trials are needed to validate these observational findings.
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Affiliation(s)
- Nakyung Jeon
- College of Pharmacy, Chonnam National University, Gwang-ju, South Korea
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA
| | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA. .,Center for Drug Evaluation and Safety (CoDES), University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA. .,Department of Epidemiology, College of Public Health and Health Profession & College of Medicine, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA.
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13
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Mankowski RT, Anton SD, Ghita GL, Brumback B, Darden DB, Bihorac A, Moldawer LL, Efron PA, Brakenridge SC, Moore FA. Older adults demonstrate biomarker evidence of the persistent inflammation, immunosuppression and catabolism syndrome (PICS) after sepsis. J Gerontol A Biol Sci Med Sci 2021; 77:188-196. [PMID: 33721883 DOI: 10.1093/gerona/glab080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hospital deaths after sepsis have decreased substantially and most young adult survivors rapidly recover (RAP). However, many older survivors develop chronic critical illness (CCI) with poor long-term outcomes. The etiology of CCI is multifactorial and the relative importance remains unclear. Sepsis is caused by a dysregulated immune response and biomarkers reflecting a persistent inflammation, immunosuppression and catabolism syndrome (PICS) have been observed in CCI after sepsis. Therefore, the purpose of this study was to compare serial PICS biomarkers in a) older (versus young) adults and b) older CCI (versus older RAP) patients to gain insight into underlying pathobiology of CCI in older adults. METHODS Prospective longitudinal study with young (≤ 45 years) and older (≥ 65 years) septic adults who were characterized by a) baseline predisposition, b) hospital outcomes, c) serial SOFA organ dysfunction scores over 14 days, d) Zubrod Performance status at three, six and 12-month follow-up and e) mortality over 12 months. Serial blood samples over 14 days were analyzed for selected biomarkers reflecting PICS. RESULTS Compared to the young, more older adults developed CCI (20% vs 42%) and had markedly worse serial SOFA scores, performance status and mortality over 12 months. Additionally, older (versus young) and older CCI (versus older RAP) patients had more persistent aberrations in biomarkers reflecting inflammation, immunosuppression, stress metabolism, lack of anabolism and anti-angiogenesis over 14 days after sepsis. CONCLUSION Older (versus young) and older CCI (versus older RAP) patient subgroups demonstrate early biomarker evidence of the underlying pathobiology of PICS.
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Affiliation(s)
- Robert T Mankowski
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Stephen D Anton
- Department of Neprhology, University of Florida, Gainesville, Florida, USA
| | - Gabriela L Ghita
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Babette Brumback
- Department of Surgery, University of Florida, Gainesville, Florida, USA.,Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Dijoia B Darden
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Azra Bihorac
- Department of Neprhology, University of Florida, Gainesville, Florida, USA
| | - Lyle L Moldawer
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Philip A Efron
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | | | - Frederick A Moore
- Department of Surgery, University of Florida, Gainesville, Florida, USA
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14
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Crowley SJ, Banan G, Amin M, Tanner JJ, Hizel L, Nguyen P, Brumback B, Rodriguez K, McFarland N, Bowers D, Ding M, Mareci TA, Price CC. Statistically Defined Parkinson's Disease Executive and Memory Cognitive Phenotypes: Demographic, Behavioral, and Structural Neuroimaging Comparisons. J Parkinsons Dis 2021; 11:283-297. [PMID: 33216042 DOI: 10.3233/jpd-202166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Some individuals with Parkinson's disease (PD) experience working memory and inhibitory difficulties, others learning and memory difficulties, while some only minimal to no cognitive deficits for many years. OBJECTIVE To statistically derive PD executive and memory phenotypes, and compare PD phenotypes on disease and demographic variables, vascular risk factors, and specific neuroimaging variables with known associations to executive and memory function relative to non-PD peers. METHODS Non-demented individuals with PD (n = 116) and non-PD peers (n = 62) were recruited to complete neuropsychology measures, blood draw, and structural magnetic resonance imaging. Tests representing the cognitive domains of interest (4 executive function, 3 memory) were included in a k-means cluster analysis comprised of the PD participants. Resulting clusters were compared demographic and disease-related variables, vascular risk markers, gray/white regions of interest, and white matter connectivity between known regions involved in executive and memory functions (dorsolateral prefrontal cortices to caudate nuclei; entorhinal cortices to hippocampi). RESULTS Clusters showed: 1) PD Executive, n = 25; 2) PD Memory, n = 35; 3) PD Cognitively Well; n = 56. Even after disease variable corrections, PD Executive had less subcortical gray matter, white matter, and fewer bilateral dorsolateral-prefrontal cortex to caudate nucleus connections; PD Memory showed bilaterally reduced entorhinal-hippocampal connections. PD Cognitively Well showed only reduced putamen volume and right entorhinal cortex to hippocampi connections relative to non-PD peers. Groups did not statistically differ on cortical integrity measures or cerebrovascular disease markers. CONCLUSION PD cognitive phenotypes showed different structural gray and white matter patterns. We discuss data relative to phenotype demographics, cognitive patterns, and structural brain profiles.
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Affiliation(s)
- Samuel J Crowley
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Guita Banan
- Department of Biochemistry and Molecular Biology, Gainesville, FL, USA.,McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Manish Amin
- Department of Biochemistry and Molecular Biology, Gainesville, FL, USA.,McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Loren Hizel
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Peter Nguyen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Nikolaus McFarland
- Department of Neurology, Gainesville, FL, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Mingzhou Ding
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Thomas A Mareci
- Department of Biochemistry and Molecular Biology, Gainesville, FL, USA.,McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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15
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Brakenridge SC, Wang Z, Cox M, Raymond S, Hawkins R, Darden D, Ghita G, Brumback B, Cuschieri J, Maier RV, Moore FA, Mohr AM, Efron PA, Moldawer LL. Distinct immunologic endotypes are associated with clinical trajectory after severe blunt trauma and hemorrhagic shock. J Trauma Acute Care Surg 2021; 90:257-267. [PMID: 33214489 PMCID: PMC8194286 DOI: 10.1097/ta.0000000000003029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The genomic/cytokine "storm" after severe trauma is well described. However, the differing composition, magnitude and resolution of this response, and its relationship to clinical outcomes remain unclear. METHODS This is a secondary analysis of a prospective longitudinal cohort study of severely injured trauma patients in hemorrhagic shock. Peripheral blood sampling was performed at 0.5, 1, 4, 7, 14, and 28 days after injury for measurement of circulating immune biomarkers. K-means clustering using overall mean and trajectory slope of selected immunologic biomarkers were used to identify distinct temporal immunologic endotypes. Endotypes were compared with known clinical trajectories defined as early death (<14 days), chronic critical illness (CCI) (ICU length of stay of ≥14 days with persistent organ dysfunction), and rapid recovery (RAP) (ICU length of stay of <14 days with organ recovery). RESULTS The cohort included 102 subjects enrolled across 2 level 1 trauma centers. We identified three distinct immunologic endotypes (iA, iB, and iC), each with unique associations to clinical trajectory. Endotype iA (n = 47) exhibited a moderate initial proinflammatory response followed by a return to immunologic homeostasis, with a primary clinical trajectory of RAP (n = 44, 93.6%). Endotype iB (n = 44) exhibited an early hyperinflammatory response with persistent inflammation and immunosuppression, with the highest incidence of CCI (n = 10, 22.7%). Endotype iC (n = 11) exhibited a similar hyperinflammatory response, but with rapid return to immunologic homeostasis and a predominant trajectory of RAP (n = 9, 81.8%). Patients with endotype iB had the highest severity/duration of organ dysfunction and highest incidence of nosocomial infections (50%, p = 0.001), and endotype iB was the predominant endotype of patients who developed CCI (10 of 13 patients, 76.9%; p = 0.002). CONCLUSION We identified three distinct immunologic endotypes after severe injury differing the magnitude and duration of the early response. The clinical trajectory of CCI is characterized by an endotype (iB) defined by persistent alteration in inflammation/immunosuppression and is associated with poor clinical outcomes. LEVEL OF EVIDENCE Prognostic, level III.
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Affiliation(s)
- Scott C Brakenridge
- From the Department of Surgery (S.C.B.), University of Florida Health Science Center; Department of Surgery (S.C.B., M.C., S.R., R.H., D.D., F.A.M., A.M.M., P.A.E., L.L.M.), College of Medicine, and Department of Biostatistics (B.B., Z.W., G.G.), University of Florida, Gainesville, Florida; and Department of Surgery (J.C., R.V.M.), University of Washington, Seattle, Washington
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16
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Golembiewski EH, Mainous AG, Rahmanian KP, Brumback B, Rooks BJ, Krieger JL, Goodman KW, Moseley RE, Harle CA. An Electronic Tool to Support Patient-Centered Broad Consent: A Multi-Arm Randomized Clinical Trial in Family Medicine. Ann Fam Med 2021; 19:16-23. [PMID: 33431386 PMCID: PMC7800739 DOI: 10.1370/afm.2610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Patients are frequently asked to share their personal health information. The objective of this study was to compare the effects on patient experiences of 3 electronic consent (e-consent) versions asking patients to share their health records for research. METHODS A multi-arm randomized controlled trial was conducted from November 2017 through November 2018. Adult patients (n = 734) were recruited from 4 family medicine clinics in Florida. Using a tablet computer, participants were randomized to (1) a standard e-consent (standard), (2) an e-consent containing standard information plus hyperlinks to additional interactive details (interactive), or (3) an e-consent containing standard information, interactive hyperlinks, and factual messages about data protections and researcher training (trust-enhanced). Satisfaction (1 to 5), subjective understanding (0 to 100), and other outcomes were measured immediately, at 1 week, and at 6 months. RESULTS A majority of participants (94%) consented to future uses of their health record information for research. No differences in study outcomes between versions were observed at immediate or 1-week follow-up. At 6-month follow-up, compared with the standard e-consent, participants who used the interactive e-consent reported greater satisfaction (B = 0.43; SE = 0.09; P <.001) and subjective understanding (B = 18.04; SE = 2.58; P <.001). At 6-month follow-up, compared with the interactive e-consent, participants who used the trust-enhanced e-consent reported greater satisfaction (B = 0.9; SE = 1.0; P <.001) and subjective understanding (B = 32.2; SE = 2.6, P <.001). CONCLUSIONS Patients who used e-consents with interactive research details and trust-enhancing messages reported higher satisfaction and understanding at 6-month follow-up. Research institutions should consider developing and further validating e-consents that interactively deliver information beyond that required by federal regulations, including facts that may enhance patient trust in research.
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Affiliation(s)
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida.,Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Kiarash P Rahmanian
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Benjamin J Rooks
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Janice L Krieger
- Department of Advertising, University of Florida, Gainesville, Florida
| | - Kenneth W Goodman
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ray E Moseley
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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17
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Richards VL, Zhou Z, Wang Y, Vaddiparti K, Brumback B, Cook RL. Impact of Reduction in Drinking vs. complete Cessation on the Severity and Type of Alcohol-Related Problems in Women Living with HIV. Subst Use Misuse 2021; 56:704-710. [PMID: 33682614 PMCID: PMC8900673 DOI: 10.1080/10826084.2021.1892138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women living with HIV (WLWH) often report heavy alcohol use and may experience substantial alcohol-related problems, but it is unclear whether it is necessary to completely quit drinking to reduce such problems. OBJECTIVES To assess whether complete reduction of alcohol use produced significantly greater improvement in alcohol-related problems than a partial reduction of alcohol use (reducing alcohol use to ≤7 or ≤14 drinks per week). METHODS We used data from a randomized clinical trial examining the effectiveness of Naltrexone in WLWH who reported heavy drinking (>7 drinks/week) at baseline. The primary outcome (alcohol-related problems) was measured using the Short Inventory of Problems. The primary predictor (drinking status: quit drinking, reduced drinking, continue heavy drinking) was measured using a 30-day timeline followback. RESULTS The sample consisted of 163 WLWH (50% 50 years or older, 85% Black). WLWH who reported past violence had significantly greater mean SIP scores at baseline (19.9 vs. 10.5, p<.0001). Forty-eight percent of women quit drinking by 7 months and 28% reduced drinking to ≤7 drinks/week; these women had significant reduction in alcohol-related problems compared to those who continued heavy drinking (-8.2 and -4.8 vs. -0.8, p = 0.0003). Quitting and reducing drinking were also associated with statistically significant decreases among the physical, interpersonal, intrapersonal, and social subscales of the SIP (p<.05), although a similar pattern, while not statistically significant, exists for the impulse control subscale. CONCLUSIONS While completely quitting drinking produced the greatest improvement, reducing drinking to ≤14 drinks per week can significantly reduce alcohol-related problems in WLWH.
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Affiliation(s)
| | - Zhi Zhou
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | | | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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18
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Fisk RJ, Richards VL, Leeman RF, Brumback B, Cook C, Cook RL. Negative Consequences of Alcohol Use among People Living with HIV. Subst Use Misuse 2021; 56:871-878. [PMID: 33769201 PMCID: PMC8988930 DOI: 10.1080/10826084.2021.1899232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Among people living with HIV (PLWH), alcohol use can have negative impacts beyond HIV-related outcomes. The objectives of this study are to identify the most common alcohol-related consequences among PLWH in Florida and describe factors associated with experiencing more alcohol-related consequences. Methods: Data were collected from PLWH in the Florida Cohort study who drank at least monthly in the past year (n=397). Self-reported consequences were assessed by the 15-item Short Inventory of Problems Revised (SIP-2R). Nonparametric tests and a generalized estimating equation model with inverse probability of exposure weighting were used to evaluate associations between the total SIP-2R score and socio-demographics, mental health, and substance use while controlling for alcohol use. Results: Over half (56%) endorsed at least one consequence and 29% endorsed 5 or more consequences. The most common consequences were doing something they regretted and taking foolish risks (both endorsed by 37% of participants), both in the impulse control domain. After controlling for alcohol use and other covariates, homelessness and injection drug use remained significantly associated with greater SIP-2R scores. Conclusion: PLWH who are experiencing homelessness or injecting drugs could benefit from receiving additional screening for alcohol-related consequences if they report any alcohol use.
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Affiliation(s)
- Rebecca J Fisk
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | | | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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19
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Harle CA, Golembiewski EH, Rahmanian KP, Brumback B, Krieger JL, Goodman KW, Mainous AG, Moseley RE. Does an interactive trust-enhanced electronic consent improve patient experiences when asked to share their health records for research? A randomized trial. J Am Med Inform Assoc 2020; 26:620-629. [PMID: 30938751 DOI: 10.1093/jamia/ocz015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/27/2018] [Accepted: 01/26/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In the context of patient broad consent for future research uses of their identifiable health record data, we compare the effectiveness of interactive trust-enhanced e-consent, interactive-only e-consent, and standard e-consent (no interactivity, no trust enhancement). MATERIALS AND METHODS A randomized trial was conducted involving adult participants making a scheduled primary care visit. Participants were randomized into 1 of the 3 e-consent conditions. Primary outcomes were patient-reported satisfaction with and subjective understanding of the e-consent. Secondary outcomes were objective knowledge, perceived voluntariness, trust in medical researchers, consent decision, and time spent using the application. Outcomes were assessed immediately after use of the e-consent and at 1-week follow-up. RESULTS Across all conditions, participants (N = 734) reported moderate-to-high satisfaction with consent (mean 4.3 of 5) and subjective understanding (79.1 of 100). Over 94% agreed to share their health record data. No statistically significant differences in outcomes were observed between conditions. Irrespective of condition, black participants and those with lower education reported lower satisfaction, subjective understanding, knowledge, perceived voluntariness, and trust in medical researchers, as well as spent more time consenting. CONCLUSIONS A large majority of patients were willing to share their identifiable health records for research, and they reported positive consent experiences. However, incorporating optional additional information and messages designed to enhance trust in the research process did not improve consent experiences. To improve poorer consent experiences of racial and ethnic minority participants and those with lower education, other novel consent technologies and processes may be valuable. (An Interactive Patient-Centered Consent for Research Using Medical Records; NCT03063268).
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Affiliation(s)
- Christopher A Harle
- Department of Health Policy and Management, Indiana University, Indianapolis, Indiana, USA
- Regenstrief Institute Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | | | - Kiarash P Rahmanian
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Janice L Krieger
- Department of Advertising, University of Florida, Gainesville, Florida, USA
| | - Kenneth W Goodman
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Arch G Mainous
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Ray E Moseley
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
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20
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Richards VL, Sajdeya R, Villalba K, Wang Y, Bryant V, Brumback B, Bryant K, Hahn JA, Cook RL. Secondary Analysis of a Randomized Clinical Trial of Naltrexone Among Women Living With HIV: Correlations Between Reductions in Self-Reported Alcohol Use and Changes in Phosphatidylethanol. Alcohol Clin Exp Res 2020; 45:174-180. [PMID: 33190242 DOI: 10.1111/acer.14515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Direct biomarkers such as phosphatidylethanol (PEth) have the capability to detect heavy alcohol use, but it is unclear how strongly self-reported reduction in alcohol use correlates with reduction in PEth. We sought to explore the strength of correlation between reductions in self-reported alcohol use and change in PEth among a sample of women living with HIV (WLWH) who participated in a clinical trial to reduce heavy alcohol use. We also sought to determine whether this correlation was stronger in women with lower body mass index (BMI) and women without an alcohol use disorder (AUD). METHODS 81 WLWH (mean age = 48.7, 80% Black) engaging in a randomized trial of naltrexone versus placebo with a positive baseline PEth (≥8 ng/ml), and alcohol use data at baseline, 2, and 7 months were included in this analysis. Spearman correlation coefficients were compared to measure the correlation between baseline PEth and number of drinks per week by demographic, biological, and alcohol use factors. Mini-International Neuropsychiatric Interview was used to screen for AUD. Further analyses were stratified by BMI and AUD. Spearman correlation coefficients were calculated for the change in PEth and the change in number of drinks per week over 7 months, including 3 time-points: baseline, 2, and 7 months. RESULTS At baseline, the correlation between baseline PEth and the number of drinks per week was significantly stronger for those with a BMI ≤25 compared to those with a BMI > 25 (r = 0.66; r = 0.26, respectively). Similarly, the correlation between baseline PEth and number of drinks was stronger for those who did not screen positive for AUD compared with those who did (r = 0.66; r = 0.25, respectively). When stratifying by BMI, a low-to-moderate correlation (r = 0.32, p = 0.02) was present for persons with a BMI > 25; when stratifying by AUD, a moderate correlation (r = 0.50, p < 0.01) was present for persons without an AUD between 0 and 2 months only. CONCLUSIONS In this sample of WLWH, BMI and AUD affected the strength of correlation between PEth and drinks per week. Future work examining changes in PEth over time in broader populations is needed, particularly to understand the sex differences in PEth levels.
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Affiliation(s)
- Veronica L Richards
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Ruba Sajdeya
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Karina Villalba
- Robert Stempel College of Public Health and Social Work, (KV), Florida International University, Miami, Florida
| | - Yan Wang
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Vaughn Bryant
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Babette Brumback
- Department of Biostatistics, (BB), University of Florida, Gainesville, Florida
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, (KB), Bethesda, Maryland
| | - Judith A Hahn
- Department of Medicine, (JAH), University of California, San Francisco, California
| | - Robert L Cook
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
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21
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Paige SR, Salloum RG, Krieger JL, Williams M, Xue W, Brumback B. Promoting Clinical Conversations about Lung Cancer Screening: Exploring the Role of Perceived Online Social Support. J Health Commun 2020; 25:650-659. [PMID: 33119451 PMCID: PMC8278871 DOI: 10.1080/10810730.2020.1836087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The perceived availability of online social support may contribute to patient-provider conversations about lung cancer screening. This study examines how the perceived availability of instrumental and emotional online social support is associated with patient-provider communication about lung cancer screening among adults who meet U.S. Preventive Services Taskforce (USPSTF) eligibility criteria and live with a COPD diagnosis. In April 2018, 575 adults completed an online survey after being recruited from a large southeastern academic medical center's broad research registry and website listing. Nearly half of the participants were 55-to-80 years old (41%), a current or former smoker who had quit smoking within the past 15 years (42%), and reported a smoking prevalence of 30 pack years or more (PPY; 41%). Results demonstrate that having a COPD diagnosis, identifying as male, and being a current or former tobacco smoker resulted in greater odds of having a clinical conversation about lung cancer screening. Conversely, meeting the 30 PPY smoking and 55-to-80 age thresholds lowered the odds of having these conversations. A high degree of instrumental and emotional online social support was associated with a greater incidence of annual patient-provider conversations about screening. This combination of perceived online social support was especially useful for patients with COPD.
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, University of Florida , Gainesville, FL, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida , Gainesville, FL, USA
- UF Health Cancer Center, University of Florida , Gainesville, FL, USA
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida , Gainesville, FL, USA
- UF Health Cancer Center, University of Florida , Gainesville, FL, USA
| | - Maribeth Williams
- Department of Community Health and Family Medicine, University of Florida , Gainesville, FL, USA
| | - Wei Xue
- Department of Biostatistics, University of Florida , Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida , Gainesville, FL, USA
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22
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Williams R, Cook R, Brumback B, Cook C, Ezenwa M, Spencer E, Lucero R. The relationship between individual characteristics and HIV-related stigma in adults living with HIV: medical monitoring project, Florida, 2015-2016. BMC Public Health 2020; 20:723. [PMID: 32429947 PMCID: PMC7236917 DOI: 10.1186/s12889-020-08891-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) disproportionately affects the Southern United States, accounting for approximately 46% of people living with HIV. HIV-related stigma is recognized as a barrier to testing, treatment, and prevention efforts. However, little is known about HIV-related stigma experiences in Florida. Using data collected from the Florida Medical Monitoring Project, we sought to examine individual characteristics associated with HIV-related stigma. METHODS We analyzed secondary data from the 2015-2016 Medical Monitoring Project in Florida (n = 603). Stigma was measured using the 10-item HIV Stigma Scale. Exploratory factor analysis of the HIV Stigma Scale revealed three subscales: negative self-image, anticipated, and personalized stigma. Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV Stigma Scale. RESULTS Multivariate analysis indicated that people with severe depression scores (OR: 3.13; CI: 1.38-7.13) and persons with disability (OR: 1.64; CI: 1.03-2.61) had significantly increased odds of higher overall stigma. In the subscale analyses, negative self-image was significantly associated with alcohol misuse (OR: 2.02; CI: 1.15-3.56) depression (OR: 2.81; CI: 1.38-5.72) and/or those who identify as homosexual (OR: 0.54; CI: 0.31-0.93). Anticipated stigma was significantly associated with people who had mild-moderate depression (OR: 3.03; CI: 1.20-7.65), severe depression (OR: 2.87; CI: 1.38-5.98), identified as Black (OR: 0.60; CI: 0.37-0.98), non-injection drug use (OR: 0.55; CI: 0.33-0.91), and/or people aged 50 years and older (OR: 0.28; CI: 0.09-0.82). Personalized stigma was not associated with any of the variables examined. CONCLUSIONS The implications of these findings reveal that certain individuals are more vulnerable to stigma. Researchers could consider distinct stigma interventions strategies based on the characteristics of specific individuals (i.e., targeting depression, disability, sexual orientation, avoidant coping, racial/ethnic groups, and youth) in Florida.
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Affiliation(s)
| | - Robert Cook
- Department of Epidemiology, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, FL, USA
| | - Christa Cook
- Department of Nursing Systems, College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Miriam Ezenwa
- Department of Biobehavioural Nursing, University of Florida College of Nursing, Gainesville, FL, USA
| | - Emma Spencer
- HIV/AIDS Surveillance Program, Florida Department of Health, Tallahassee, FL, USA
| | - Robert Lucero
- Center for Latin American Studies, Department of Family, Community and Health Systems Science, University of Florida College of Nursing, Gainesville, FL, USA
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23
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Mankowski RT, Anton SD, Ghita GL, Brumback B, Cox MC, Mohr AM, Leeuwenburgh C, Moldawer LL, Efron PA, Brakenridge SC, Moore FA. Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long-Term Survival. J Am Geriatr Soc 2020; 68:1962-1969. [PMID: 32294254 DOI: 10.1111/jgs.16435] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Sepsis has been called a "disease of the elderly," and as in-hospital mortality has decreased, more sepsis survivors are progressing into poorly characterized long-term outcomes. The purpose of this study was to describe the current epidemiology of sepsis in older adults compared with middle-aged and young adults. DESIGN Prospective longitudinal study with young (≤45 years), middle-aged (46-64 years), and older (≥65 years) patient groups. SETTING University tertiary medical center. PARTICIPANTS A total of 328 adult surgical intensive care unit (ICU) sepsis patients. MEASUREMENTS Patients were characterized by (1) baseline demographics and predisposition, (2) septic event, (3) hospital outcomes and discharge disposition, (4) 12-month mortality, and (5) Zubrod Performance Status, physical function (Short Physical Performance Battery and handgrip strength), and cognitive function (Hopkins Verbal Learning Test, Controlled Oral Word Association, and Mini-Mental Status Examination) at 3-, 6-, and 12-month follow-up. Loss to follow-up was due to death (in 68), consent withdrawal (in 32), and illness and scheduling difficulties: month 3 (in 51), month 6 (in 29), and month 12 (in 20). RESULTS Compared with young and middle-aged patients, older patients had (1) significantly more comorbidities at presentation (eg, chronic renal disease 6% vs 12% vs 21%), intra-abdominal infections (14% vs 25% vs 37%), septic shock (12% vs 25% vs 36%), and organ dysfunctions; (2) higher 30-day mortality (6% vs 4% vs 17%) and fewer ICU-free days (median = 25 vs 23 vs 20); (3) more progression into chronic critical illness (22% vs 34% vs 42%) with higher poor disposition discharge to non-home destinations (19% vs 40% vs 62%); (4) worse 12-month mortality (11% vs 14% vs 33%); and (5) poorer Zubrod Performance Status and objectively measured physical and cognitive functions with only slight improvement over 12-month follow-up. CONCLUSION Compared with younger patients, older sepsis survivors suffer both a higher persistent disability burden and 12-month mortality.
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Affiliation(s)
- Robert T Mankowski
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Stephen D Anton
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Gabriela L Ghita
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA.,Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Michael C Cox
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Alicia M Mohr
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Lyle L Moldawer
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Philip A Efron
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | | | - Frederick A Moore
- Department of Surgery, University of Florida, Gainesville, Florida, USA
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24
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Ibañez GE, Zhou Z, Cook CL, Slade TA, Somboonwit C, Morano J, Harman J, Bryant K, Whitehead NE, Brumback B, Algarin AB, Spencer EC, Cook RL. The Florida Cohort study: methodology, initial findings and lessons learned from a multisite cohort of people living with HIV in Florida. AIDS Care 2020; 33:516-524. [PMID: 32242455 DOI: 10.1080/09540121.2020.1748867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In 2013, Florida had the highest rate of new HIV infections and only 56% of persons living with HIV (PLWH) were virally suppressed. In response, we initiated a new HIV cohort in Florida to better understand issues affecting HIV health outcomes. This manuscript will describe the procedures of the Florida Cohort; summarize information regarding enrollment, follow-up, and findings to date; and discuss challenges and lessons learned during the establishment of a multisite cohort of PLWH. Florida Cohort participants were enrolled from eight clinics and community-based organizations geographically diverse counties across Florida. Data were obtained from participant questionnaires, medical records, and state surveillance data. From 2014-2018, 932 PLWH (44% ≥50 years, 64% male, 55% black, 20% Latinx) were enrolled. At baseline, 83% were retained in care and 75% were virally suppressed. Research findings to date have focused on outcomes such as the HIV care continuum, HIV-related comorbidities, alcohol and drug use, and mHealth interventions interest. Strengths included the diversity of the sample and the linkage of participant surveys with existing surveillance data. However, the study had several challenges during planning and follow-up. The lessons learned from this study can be helpful when initiating a new longitudinal cohort study.
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Affiliation(s)
- Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Zhi Zhou
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Christa L Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Tania A Slade
- Florida Department of Health-Seminole County, Sanford, FL, USA
| | - Charurut Somboonwit
- Division of Infectious Disease & International Medicine, University of South Florida, Tampa, FL, USA.,Florida Department of Health- Hillsborough County, Tampa, FL, USA
| | - Jaime Morano
- Division of Infectious Disease & International Medicine, University of South Florida, Tampa, FL, USA.,Florida Department of Health- Hillsborough County, Tampa, FL, USA
| | - Jeffrey Harman
- Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Nicole Ennis Whitehead
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Angel B Algarin
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Emma C Spencer
- Florida Department of Health, Bureau of Communicable Diseases, Tallahassee, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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25
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Elfasi A, Mankowski RT, Moore FA, Ghita GL, Villani K, Anton SD, Brackenridge SC, Brumback B, Efron P, Leeuwenburgh C, Moldawer LL, Simpkins AN. Abstract TMP91: Pre-Sepsis P-wave Terminal Force in Lead V1 (PTFV1) as a Predictor of Atrial Fibrillation, In-Hospital Mortality, and Cognition in Sepsis Patients. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tmp91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Enlarged P-wave terminal force in lead V1 (PTFV1) >5000 μV*ms is a long-term predictor of the left atrial abnormality such as atrial fibrillation (AF), cognitive dysfunction, and stroke at age ≤ 60. Sepsis patients are at high risk of cardiac dysfunction, AF, stroke, and impaired cognition acutely and longitudinally, but predictive value pre-sepsis PTFV1 has not been studied.
Hypothesis:
Higher PTFV1 before sepsis onset is associated with AF events, left atrial enlargement, mortality, and 1-year cognitive impairment in patients who developed sepsis.
Methods:
Patients with acute sepsis were prospectively screened and enrolled in an observational study years 2015-2019. Of the 360 consented, 287 had pre-sepsis electrocardiograms (ECG), and 272 were evaluable. PTFV1 was measured using the Mitutoyo 500-195-30CAL Absolute Digimatic Caliper. Left atrial diameter index (LADI) pre-sepsis and post enrollment were recorded (median of 2 days [interquartile range (IQR) 1-13]). Occurrence of AF was assessed on the next available ECG, 3 days [IQR 1-11] post-enrollment. Cognitive function at 1-year follow-up was assessed by the mini-mental state examination (MMSE) and the Hopkins Verbal Learning test (HVLT). Statistical significance was evaluated using linear and logistic univariate regression.
Results:
In this cohort, the median age was 63 years [IQR 53-71], 44% women. The median PTVF1, LADI at pre-sepsis and follow up were 3219 μV*ms [IQR 0 - 5487], 1.86 cm/mm
2
[IQR 1.58 - 2.14], and 1.89 cm/mm
2
[IQR 1.59 - 2.17], respectively. Pre-sepsis PTFV1 was > 5,000 μV*ms in 32%. Elevated PTFV1 at age ≥ 60 was not associated with AF (p=0.06) or in-hospital mortality (p=0.17). Similarly, high PTFV1 at age < 60 was not associated in-hospital mortality (p=0.50), and only 3 in this cohort had AF. There was no association with pre-sepsis LADI (p=0.55), follow-up LADI (p=0.70), MMSE (p=0.35), or HVLT (p=0.78) and PTFV1.
Conclusions:
Here, PTFV1 values were not associated with AF or measures of cognitive impairment. While our findings differ from other longitudinal studies, the early time interval and setting of sepsis in our study is unique. Future studies will include multivariate analysis and evaluation of long term outcome measures linked to PTFV1 such as stroke.
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Affiliation(s)
| | | | | | | | - Katelyn Villani
- Dept of Applied Physiology and Kinesiology, Univ of Florida, Gainesville, FL
| | - Stephen D Anton
- Div of Clinical Rsch, Dept of Aging and Geriatric Rsch, Univ of Florida Col, Univ of Florida, Gainesville, FL
| | - Scott C Brackenridge
- Dept of Surgery, Univ of Florida College of Medicine, Univ of Florida, Gainesville, FL
| | | | - Philip Efron
- Dept of Surgery, Univ of Florida, Gainesville, FL
| | | | | | - Alexis N Simpkins
- Div Vascular Neurology, Dept Neurology, Univ of Florida, Gainesville, FL
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26
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Choi Y, Park H, Hampp C, Brumback B, Meissner HC, Li Y, Roussos-Ross D, Zhu Y, Henriksen C, Winterstein AG. Usability of encounter data for Medicaid comprehensive managed care vs traditional Medicaid fee-for-service claims among pregnant women. Pharmacoepidemiol Drug Saf 2019; 29:30-38. [PMID: 31737976 DOI: 10.1002/pds.4923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/29/2019] [Accepted: 10/21/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The completeness of medical encounters capture among Medicaid enrollees in comprehensive managed care (CMC) has been shown to vary across states and years. CMC penetration has grown, and CMC encounter capture specific to pregnancy care is understudied. OBJECTIVES To compare the completeness of encounter data for pregnant beneficiaries in CMC versus traditional fee-for-service (FFS) in Texas and Florida between 2007 and 2010. METHODS Using Medicaid Analytic eXtract (MAX) data linked to Florida and Texas birth certificate records, for each state and study year, we compared proportions using seven themes: (a) delivery; (b) prenatal visits; (c) dispensed prescriptions during pregnancy; (d) gestational diabetes and blood glucose testing; (e) antidiabetics and diagnosis of diabetes mellitus; (f) antibiotics for urinary tract infection and outpatient encounter; and (g) bacterial vaginosis and dispensing for metronidazole or clindamycin. We considered CMC data to be acceptable if proportions were no less than 10% below the corresponding (2007 to 2010) FFS control values. RESULTS Pregnancy-related characteristics of FFS vs CMC denominators were comparable. Proportions for the seven measures among FFS controls ranged from 26% to 98%. In Texas, CMC encounter data met the thresholds for all measures between 2007 and 2010. Florida had usable CMC encounter data starting from 2009 with incomplete medical and pharmacy records in 2007 and 2008. CONCLUSIONS The quality of CMC encounter data in MAX files for pregnant women varied in Florida and Texas and improved over time. Use of pregnancy-specific measures can aid researchers in selecting states and years with acceptable encounter data quality.
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Affiliation(s)
- Yoonyoung Choi
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Christian Hampp
- Division of Epidemiology I, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Babette Brumback
- Biostatistics, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL, USA
| | - H Cody Meissner
- Tufts University School of Medicine and the Department of Pediatrics, Tufts Medical Center, Boston, MA, USA
| | - Yan Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Dikea Roussos-Ross
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yanmin Zhu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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27
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Hollen MK, Stortz JA, Darden D, Dirain ML, Nacionales DC, Hawkins RB, Cox MC, Lopez MC, Rincon JC, Ungaro R, Wang Z, Wu Q, Brumback B, Gauthier MPL, Kladde M, Leeuwenburgh C, Segal M, Bihorac A, Brakenridge S, Moore FA, Baker HV, Mohr AM, Moldawer LL, Efron PA. Myeloid-derived suppressor cell function and epigenetic expression evolves over time after surgical sepsis. Crit Care 2019; 23:355. [PMID: 31722736 PMCID: PMC6854728 DOI: 10.1186/s13054-019-2628-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/27/2019] [Indexed: 12/15/2022]
Abstract
Background Sepsis is an increasingly significant challenge throughout the world as one of the major causes of patient morbidity and mortality. Central to the host immunologic response to sepsis is the increase in circulating myeloid-derived suppressor cells (MDSCs), which have been demonstrated to be present and independently associated with poor long-term clinical outcomes. MDSCs are plastic cells and potentially modifiable, particularly through epigenetic interventions. The objective of this study was to determine how the suppressive phenotype of MDSCs evolves after sepsis in surgical ICU patients, as well as to identify epigenetic differences in MDSCs that may explain these changes. Methods Circulating MDSCs from 267 survivors of surgical sepsis were phenotyped at various intervals over 6 weeks, and highly enriched MDSCs from 23 of these samples were co-cultured with CD3/CD28-stimulated autologous T cells. microRNA expression from enriched MDSCs was also identified. Results We observed that MDSC numbers remain significantly elevated in hospitalized sepsis survivors for at least 6 weeks after their infection. However, only MDSCs obtained at and beyond 14 days post-sepsis significantly suppressed T lymphocyte proliferation and IL-2 production. These same MDSCs displayed unique epigenetic (miRNA) expression patterns compared to earlier time points. Conclusions We conclude that in sepsis survivors, immature myeloid cell numbers are increased but the immune suppressive function specific to MDSCs develops over time, and this is associated with a specific epigenome. These findings may explain the chronic and persistent immune suppression seen in these subjects.
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Affiliation(s)
- McKenzie K Hollen
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Julie A Stortz
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Dijoia Darden
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Marvin L Dirain
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Dina C Nacionales
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Russell B Hawkins
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Michael C Cox
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Maria-Cecilia Lopez
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jaimar C Rincon
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Ricardo Ungaro
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Zhongkai Wang
- Department of Biostatistics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Quran Wu
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Marie-Pierre L Gauthier
- Department of Biochemistry and Molecular Biology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael Kladde
- Department of Biochemistry and Molecular Biology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mark Segal
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Azra Bihorac
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Scott Brakenridge
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Frederick A Moore
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Henry V Baker
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alicia M Mohr
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Lyle L Moldawer
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA
| | - Philip A Efron
- Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, Gainesville, FL, 32610-0019, USA.
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Cook RL, Zhou Z, Miguez MJ, Quiros C, Espinoza L, Lewis JE, Brumback B, Bryant K. Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo. Alcohol Clin Exp Res 2019; 43:1790-1800. [PMID: 31373701 PMCID: PMC6684328 DOI: 10.1111/acer.14130] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol consumption is associated with poor health outcomes in women living with HIV (WLWH), but whether medication can help to reduce drinking in non-treatment-seeking women or whether reduction in drinking improves HIV outcomes is unclear. We conducted a randomized clinical trial (RCT) of daily oral naltrexone (50 mg) versus placebo in WLWH who met criteria for current unhealthy alcohol use. METHODS WLWH with current unhealthy alcohol use (>7 drinks/wk or >3 drinks/occasion) were randomly assigned to daily oral naltrexone 50 mg (n = 96) or placebo (n = 98) for 4 months. Drinking outcomes, including the proportion of women who reduced ( RESULTS The participants' mean age was 48 years, 86% were African American, and 94% were receiving HIV antiretroviral therapy. Among all participants, 89% and 85% completed the 4-month and 7-month follow-ups, respectively. Participants in both groups substantially reduced drinking over time. At 1 and 3 months, naltrexone was associated with a greater reduction in drinking (p < 0.05), but the proportion who reduced/quit drinking at 4 months (52% vs. 45%, p = 0.36) or 7 months (64% in both groups) was not different. HIV viral suppression at follow-up was significantly better in participants who reduced/quit drinking versus those continuing unhealthy alcohol use at 4 months (72% vs. 53%, p = 0.02) and 7 months (74% vs. 54%, p = 0.02). CONCLUSIONS Participating in an RCT to reduce drinking was associated with significant drinking reduction regardless of medication assignment, suggesting that nonmedication aspects of research study participation (e.g., repeated assessments and support from research staff) could be important interventions to help reduce drinking outside of research studies. Drinking reduction was associated with improved HIV viral suppression, providing evidence to support recommendations to avoid unhealthy alcohol use among WLWH.
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Affiliation(s)
- Robert L. Cook
- Department of Epidemiology, (RLC, ZZ), University of Florida, Gainesville
| | - Zhi Zhou
- Department of Epidemiology, (RLC, ZZ), University of Florida, Gainesville
| | - Maria Jose Miguez
- Florida, School of Integrated Science and Humanity, (MJM, CQ), Florida International University, Miami, Florida
| | - Clery Quiros
- Florida, School of Integrated Science and Humanity, (MJM, CQ), Florida International University, Miami, Florida
| | - Luis Espinoza
- Public Health & Medical Affairs, (LE), Gilead Sciences Inc., Miami, Florida
| | - John E. Lewis
- Psychiatry & Behavioral Sciences, (JEL), University of Miami School of Medicine, Miami, Florida
| | - Babette Brumback
- Biostatistics, (BB), University of Florida, Gainesville, Florida
| | - Kendall Bryant
- Alcohol and HIV/AIDS Research, (KB), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Knox CA, Hampp C, Palmsten K, Zhu Y, Setoguchi S, Brumback B, Segal R, Winterstein AG. Validation of mother‐infant linkage using Medicaid Case ID variable within the Medicaid Analytic eXtract (MAX) database. Pharmacoepidemiol Drug Saf 2019; 28:1222-1230. [DOI: 10.1002/pds.4843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/01/2019] [Accepted: 05/02/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Caitlin A. Knox
- Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of Florida Gainesville FL USA
| | - Christian Hampp
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and ResearchU.S. Food and Drug Administration Silver Spring MD USA
| | | | - Yanmin Zhu
- Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of Florida Gainesville FL USA
| | - Soko Setoguchi
- Department of MedicineRutgers Robert Wood Johnson Medical School New Brunswick NJ USA
| | - Babette Brumback
- Epidemiology Department, Colleges of Medicine and Public Health & Health ProfessionsUniversity of Florida Gainesville FL USA
| | - Richard Segal
- Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of Florida Gainesville FL USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of Florida Gainesville FL USA
- Epidemiology Department, Colleges of Medicine and Public Health & Health ProfessionsUniversity of Florida Gainesville FL USA
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Abstract
This study determined whether the Useful Field of View™ Risk Index (UFOV RI) adds value as a predictor of on-road outcomes in drivers with Parkinson's disease (PD) when considered with age, gender, and disease severity and compared with community-dwelling older drivers (Controls). A total of 101 PD drivers and 138 Controls underwent a comprehensive driving evaluation, including an on-road assessment. Logistic regression analyses determined the associations of age, gender, visual attention, and disease severity to on-road outcomes. Receiver operating characteristic curve analyses determined the optimal UFOV RI cut points to predict on-road outcomes. Above adding age and gender, the UFOV RI alone predicted on-road outcomes in PD, while the UFOV RI and age predicted on-road outcomes in Controls. Regardless of disease severity, visual attention was more impaired in PD than in Controls. The UFOV RI cut point of 3 provided the fewest misclassifications (n = 25) in PD. The UFOV RI is a valid screening predictor of on-road outcomes across PD drivers of different disease severity, but has moderate sensitivity and specificity.
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Affiliation(s)
- Sherrilene Classen
- University of Florida, Gainesville, USA.,University of Western Ontario, London, Canada
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31
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Wijayabahu AT, Zhou Z, Cook RL, Brumback B, Ennis N, Yaghjyan L. Healthy behavioral choices and cancer screening in persons living with HIV/AIDS are different by sex and years since HIV diagnosis. Cancer Causes Control 2019; 30:281-290. [PMID: 30739240 DOI: 10.1007/s10552-019-1135-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/29/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The prevalence of non-AIDS-related malignancies is on the rise among people aging with HIV population, but the evidence on healthy behaviors including cancer screening practices in this population subgroup is extremely limited. Therefore, we investigated the prevalence of healthy behaviors and sex-specific cancer screening among persons living with HIV, by sex and time since HIV diagnosis. METHODS We included 517 persons living with HIV from the Florida Cohort. Data were obtained from the baseline and follow-up questionnaires, electronic medical records, and Enhanced HIV/AIDS Reporting System. The prevalence of self-reported, age-appropriate cancer screening (anal, colorectal, prostate, breast, and cervical), and healthy behaviors (sustaining healthy body weight, refraining from smoking and alcohol and engaging in physical activity) was compared by sex and years since HIV diagnosis (≤ 13 vs. > 13 years). RESULTS In the analyses by sex, females were more likely to be obese than males (56.5% vs. 22.2%, p < 0.0001). Distribution of healthy behaviors did not differ by time since diagnosis among males and females. In the analysis of age-appropriate screening among males, 64.8% never had an anal Pap-smear, 36.2% never had a colonoscopy, and 38.9% never had prostate cancer screening. In the analysis of age-appropriate screening among females, 50.0% never had an anal Pap-smear, 46.5% never had a colonoscopy, 7.9% never had a cervical Pap-smear, and 12.7% never had a mammogram. The difference in anal Pap-smear by sex was statistically significant (p < 0.0001). Among males, the age-adjusted prevalence of never having a colonoscopy was higher in those who had HIV for ≤ 13 years (50.8% vs. 30.6%, p = 0.03). CONCLUSION The prevalence of selected healthy behaviors and cancer screening differed by sex and/or years since HIV diagnosis suggesting a need for tailored cancer prevention efforts among persons living with HIV via long-term sex-specific interventions.
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Affiliation(s)
- Akemi T Wijayabahu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100321, Gainesville, FL, 32610-0231, USA
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100321, Gainesville, FL, 32610-0231, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100321, Gainesville, FL, 32610-0231, USA
| | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, USA
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, USA
| | - Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100321, Gainesville, FL, 32610-0231, USA.
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Miller E, Apple C, Gardner A, Kannan K, Wu Q, Ghita G, Wang Z, Brumback B, Anton S, Leeuwenburgh C, Efron P, Moldawer L, Moore F, Brakenridge S, Mohr A. 1580. Crit Care Med 2019. [DOI: 10.1097/01.ccm.0000552322.25921.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE Construction and validation of a fall risk prediction model specific to inpatients receiving fall risk-increasing drugs (FRIDs) are described. METHODS In a retrospective cohort study of 75,036 admissions to 2 hospitals over a designated 22-month period that involved FRID exposure during the first 5 hospital days, factors influencing fall risk were investigated via logistic regression. The resultant risk prediction model was internally validated and its performance compared with that of a model based on Morse Fall Scale (MFS) scores. RESULTS A total of 220,904 patient-days of FRID exposure were evaluated. The three most commonly administered FRIDs were oxycodone (given on 79,697 patient-days, 36.08%), morphine (52,427, 23.73%) and hydromorphone (42,063, 19.04%). Within the 90th percentile of modeled risk scores, 144 of the 466 documented falls (30.9%) were captured by the developed risk prediction model (unbiased C statistic, 0.69), as compared with 94 falls (20.2%) captured using the MFS model (unbiased C statistic, 0.62). Strong predictors of inpatient falls included a history of falling (odds ratio [OR], 1.99; 95% confidence interval (CI), 1.42-2.80); overestimation of ability to ambulate (OR, 1.53; 95% CI, 1.12-2.09); and "comorbidity predisposition," a composite measure encompassing a history of falling and 11 past diagnoses (OR, 1.60; 95% CI, 1.30-1.97). CONCLUSION The proposed risk model for inpatient falls achieved superior predictive performance when compared with the MFS model. All risk factors were operationalized from discrete electronic health record fields, allowing full automation of real-time identification of high-risk patients.
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Affiliation(s)
- Yoonyoung Choi
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc., North Wales, PA
| | | | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Dandan Xu
- Division of Biostatistics, Office of Surveillance and Biometrics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | - Gloria Lipori
- UF Health and UF Health Sciences Center, Gainesville, FL
| | - Babette Brumback
- College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, and Department of Epidemiology, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL
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34
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Wang Y, Chen X, Hahn JA, Brumback B, Zhou Z, Miguez MJ, Cook RL. Phosphatidylethanol in Comparison to Self-Reported Alcohol Consumption Among HIV-Infected Women in a Randomized Controlled Trial of Naltrexone for Reducing Hazardous Drinking. Alcohol Clin Exp Res 2017; 42:128-134. [PMID: 29080351 DOI: 10.1111/acer.13540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/20/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biomarkers can play a key role in supplementing self-report information in alcohol research. In this study, we examined phosphatidylethanol (PEth) in comparison with self-reported alcohol use over time in a randomized controlled trial. METHODS Participants were women living with HIV enrolled in a randomized placebo-controlled trial of naltrexone for reducing hazardous drinking. Drinking behavior was measured using Timeline Followback (TLFB), and PEth as a biomarker using dried blood spots. Data collected at baseline, and months 2 and 7 were analyzed. In addition to calculated Spearman's correlations, mixed-effects modeling was used to evaluate the changes in self-reported drinking and PEth, respectively, adjusting for body mass index (BMI). RESULTS A total of 194 participants (83% black, mean age 48) were included in the analysis. PEth levels were significantly correlated with self-reported drinking via TLFB, Spearman's r = 0.21 at baseline, r = 0.29 at 2 months, and r = 0.28 at 7 months, respectively. No demographic or health factors, except for BMI, was associated with whether self-report was consistent with PEth. Mixed-effects model indicated that self-reported drinking showed significantly greater reductions in the naltrexone treatment group than the placebo group at the 2- and 7-month visits, whereas PEth measure only showed this difference at the 7-month follow-up. CONCLUSIONS The magnitude of the correlation between PEth and self-reported alcohol consumption was small. Caution is needed when using either self-report or PEth as a sole outcome measure for alcohol behavior changes in clinical trials.
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Affiliation(s)
- Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Judith A Hahn
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Zhi Zhou
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Maria J Miguez
- School of Integrated Science and Humanity, Florida International University, Miami, Florida
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida
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Khandelwal N, Brumback LC, Halpern SD, Coe NB, Brumback B, Curtis JR. Evaluating the Economic Impact of Palliative and End-of-Life Care Interventions on Intensive Care Unit Utilization and Costs from the Hospital and Healthcare System Perspective. J Palliat Med 2017; 20:1314-1320. [PMID: 28972860 PMCID: PMC5706624 DOI: 10.1089/jpm.2016.0548] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose of report: Understanding the impact of palliative care interventions on intensive care unit (ICU) costs and utilization is critical for demonstrating the value of palliative care. Performing these economic assessments, however, can be challenging. The purpose of this special report is to highlight and discuss important considerations when assessing ICU utilization and costs from the hospital perspective, with the goal of providing recommendations on methods to consider for future analyses. FINDINGS ICU length of stay (LOS) and associated costs of care are common and important outcome measures, but must be analyzed properly to yield valid conclusions. There is significant variation in costs by day of stay in the ICU with only modest differences between an ICU day at the end of a stay and the first day on the acute care floor; this variation must be appropriately accounted for analytically. Furthermore, reporting direct variable costs, in addition to total ICU costs, is needed to understand short-term and long-term impact of a reduction in LOS. Importantly, incentives for the hospital to realize savings vary depending on reimbursement policies. SUMMARY ICU utilization and costs are common outcomes in studies evaluating palliative care interventions. Accurate estimation and interpretation are key to understanding the economic implications of palliative care interventions.
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Affiliation(s)
- Nita Khandelwal
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Lyndia C. Brumback
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Scott D. Halpern
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Norma B. Coe
- Division of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - J. Randall Curtis
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
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36
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Winterstein AG, Staley B, Henriksen C, Xu D, Lipori G, Jeon N, Choi Y, Li Y, Hincapie-Castillo J, Soria-Saucedo R, Brumback B, Johns T. Development and validation of a complexity score to rank hospitalized patients at risk for preventable adverse drug events. Am J Health Syst Pharm 2017; 74:1970-1984. [DOI: 10.2146/ajhp160995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Ben Staley
- Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Dandan Xu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Gloria Lipori
- UF Health Shands Hospital, University of Florida, Gainesville, FL
| | - Nakyung Jeon
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - YoonYoung Choi
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Yan Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Juan Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Rene Soria-Saucedo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions, and College of Medicine, University of Florida, Gainesville, FL
| | - Thomas Johns
- Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL
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Jeon N, Staley B, Johns T, Lipori GP, Brumback B, Segal R, Winterstein AG. Identifying and characterizing preventable adverse drug events for prioritizing pharmacist intervention in hospitals. Am J Health Syst Pharm 2017; 74:1774-1783. [DOI: 10.2146/ajhp160387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nakyung Jeon
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Ben Staley
- Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL
| | - Thomas Johns
- Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL
| | | | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions, and Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, and Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
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38
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Cook RL, Zhou Z, Kelso-Chichetto NE, Janelle J, Morano JP, Somboonwit C, Carter W, Ibanez GE, Ennis N, Cook CL, Cohen RA, Brumback B, Bryant K. Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study. Addict Sci Clin Pract 2017; 12:22. [PMID: 28950912 PMCID: PMC5615807 DOI: 10.1186/s13722-017-0090-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/18/2017] [Indexed: 01/25/2023] Open
Abstract
Background Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence. Methods This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months. Results The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08–4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64–1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence. Conclusions Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.
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Affiliation(s)
- R L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA.
| | - Z Zhou
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
| | - N E Kelso-Chichetto
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
| | - J Janelle
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
| | - J P Morano
- Division of Infectious Diseases and International Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - C Somboonwit
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - W Carter
- Florida Department of Health, Orange County Office of Clinical Services, Disease Investigation and Research, Orlando, FL, USA
| | - G E Ibanez
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - N Ennis
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - C L Cook
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - R A Cohen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - B Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - K Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
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Hall AG, Schumacher JR, Brumback B, Harman JS, Lutz BJ, Hendry P, Carden D. Health-related quality of life among older patients following an emergency department visit and emergency department-to-home coaching intervention: A randomized controlled trial. International Journal of Care Coordination 2017. [DOI: 10.1177/2053434517733263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Many older patients experience repeated emergency department visits and hospitalizations and inadequate links to primary care. This fragmented care can result in anxiety, uncertainty, and poor health outcomes. This study compares the impact of an emergency department-to-home coaching intervention to usual, post-emergency department care on patient-reported health-related quality of life measures: information support, anxiety, and physical function. Methods This was a randomized controlled trial. Seven hundred and forty-nine chronically ill older adults presenting to emergency departments were randomized into Intervention (emergency department-to-home coaching) or Usual Care groups. Participants completed baseline, in-person and follow-up, telephone surveys. Within- and between-group differences in health-related quality of life were assessed using unweighted linear regression and propensity-weighted difference-in-difference analyses. Three Patient Reported Outcomes Measurement System measures were assessed: social health (informational support), mental health (anxiety/emotional distress), and physical health (physical functioning). Results Usual Care participants experienced statistically significant declines in informational support in unweighted (−3.13) and weighted (−2.84) analyses not observed in the Intervention group (−0.91 and −1.45, respectively). Self-reported anxiety was lowest and physical function highest at the time of emergency department visit. Patient-reported anxiety increased and physical function declined statistically significantly in Intervention participants. Conclusion Among older emergency department patients, health-related quality of life was highest at the emergency department visit and declined following the encounter. The emergency department visit per se appears to provide needed information, and in the short term, reassurance about patients’ medical conditions. The coaching intervention blunts the fall in informational support observed after usual, post-emergency department care but may heighten patients’ anxiety and awareness of chronic health conditions.
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Cook RL, Weber KM, Mai D, Thoma K, Hu X, Brumback B, Karki M, Bryant K, Rathore M, Young M, Cohen M. Acceptability and feasibility of a randomized clinical trial of oral naltrexone vs. placebo for women living with HIV infection: Study design challenges and pilot study results. Contemp Clin Trials 2017. [PMID: 28642209 DOI: 10.1016/j.cct.2017.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Women living with HIV/AIDS who drink alcohol are at increased risk for adverse health outcomes, but there is little evidence on best methods for reducing alcohol consumption in this population. We conducted a pilot study to determine the acceptability and feasibility of conducting a larger randomized clinical trial of naltrexone vs. placebo to reduce alcohol consumption in women living with HIV/AIDS. METHODS We designed the trial with input from community and scientific review. Women with HIV who reported current hazardous drinking (>7 drinks/week or ≥4 drinks per occasion) were randomly assigned to daily oral naltrexone (50mg) or placebo for 4months. We evaluated willingness to enroll, adherence to study medication, treatment side effects, and drinking and HIV-related outcomes. RESULTS From 2010 to 2012, 17 women enrolled (mean age 49years, 94% African American). Study participation was higher among women recruited from an existing HIV cohort study compared to women recruited from an outpatient HIV clinic. Participants took 73% of their study medication; 82% completed the final assessment (7-months). Among all participants, mean alcohol consumption declined substantially from baseline to month 4 (39.2 vs. 12.8 drinks/week, p<0.01) with continued reduction maintained at 7-months. Drinking reductions were similar in both naltrexone and placebo groups. CONCLUSIONS A pharmacologic alcohol intervention was acceptable and feasible in women with HIV, with reduced alcohol consumption noted in women assigned to both treatment and placebo groups. However, several recruitment challenges were identified that should be addressed to enhance recruitment in future alcohol treatment trials.
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Affiliation(s)
- Robert L Cook
- Departments of Epidemiology and Medicine, University of Florida, Gainesville, FL, United States.
| | - Kathleen M Weber
- Hektoen Institute of Medicine, Chicago, IL, United States; Cook County Health and Hospital Systems, Chicago, IL, United States
| | - Dao Mai
- Georgetown University, Washington, DC, United States
| | - Kathleen Thoma
- University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), Jacksonville, FL, United States
| | - Xingdi Hu
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Manju Karki
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Mobeen Rathore
- University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), Jacksonville, FL, United States
| | - Mary Young
- Georgetown University, Washington, DC, United States
| | - Mardge Cohen
- John H. Stroger Hospital of Cook County/Rush, Chicago, IL, United States
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Wen X, Hartzema A, Delaney JA, Brumback B, Liu X, Egerman R, Roth J, Segal R, Meador KJ. Combining adverse pregnancy and perinatal outcomes for women exposed to antiepileptic drugs during pregnancy, using a latent trait model. BMC Pregnancy Childbirth 2017; 17:10. [PMID: 28061833 PMCID: PMC5219655 DOI: 10.1186/s12884-016-1190-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Application of latent variable models in medical research are becoming increasingly popular. A latent trait model is developed to combine rare birth defect outcomes in an index of infant morbidity. Methods This study employed four statewide, retrospective 10-year data sources (1999 to 2009). The study cohort consisted of all female Florida Medicaid enrollees who delivered a live singleton infant during study period. Drug exposure was defined as any exposure to Antiepileptic drugs (AEDs) during pregnancy. Mothers with no AED exposure served as the AED unexposed group for comparison. Four adverse outcomes, birth defect (BD), abnormal condition of new born (ACNB), low birth weight (LBW), and pregnancy and obstetrical complication (PCOC), were examined and combined using a latent trait model to generate an overall severity index. Unidimentionality, local independence, internal homogeneity, and construct validity were evaluated for the combined outcome. Results The study cohort consisted of 3183 mother-infant pairs in total AED group, 226 in the valproate only subgroup, and 43,956 in the AED unexposed group. Compared to AED unexposed group, the rate of BD was higher in both the total AED group (12.8% vs. 10.5%, P < .0001), and the valproate only subgroup (19.6% vs. 10.5%, P < .0001). The combined outcome was significantly correlated with the length of hospital stay during delivery in both the total AED group (Rho = 0.24, P < .0001) and the valproate only subgroup (Rho = 0.16, P = .01). The mean score for the combined outcome in the total AED group was significantly higher (2.04 ± 0.02 vs. 1.88 ± 0.01, P < .0001) than AED unexposed group, whereas the valproate only subgroup was not. Conclusions Latent trait modeling can be an effective tool for combining adverse pregnancy and perinatal outcomes to assess prenatal exposure to AED, but evaluation of the selected components is essential to ensure the validity of the combined outcome. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1190-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuerong Wen
- Health Outcomes, College of Pharmacy, University of Rhode Island, 7 Greenhouse Rd., Kingston, RI, 02881, USA.
| | - Abraham Hartzema
- Department of Pharmaceutical Outcome and Policy, University of Florida, Gainesville, FL, USA
| | - Joseph A Delaney
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Xuefeng Liu
- Department of Biostatistics & Epidemiology, Systems, Population and Leadership, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Robert Egerman
- Department of Obstetrics & Gynecology, University of Florida, Gainesville, FL, USA
| | - Jeffrey Roth
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Rich Segal
- Department of Pharmaceutical Outcome and Policy, University of Florida, Gainesville, FL, USA
| | - Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
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Price CC, Tanner JJ, Schmalfuss IM, Brumback B, Heilman KM, Libon DJ. Dissociating Statistically-Determined Alzheimer's Disease/Vascular Dementia Neuropsychological Syndromes Using White and Gray Neuroradiological Parameters. J Alzheimers Dis 2016; 48:833-47. [PMID: 26402109 DOI: 10.3233/jad-150407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is remarkable heterogeneity in clinical Alzheimer's disease (AD) or vascular dementia (VaD). OBJECTIVES 1) To statistically examine neuropsychological data to determine dementia subgroups for individuals clinically diagnosed with AD or VaD and then 2) examine group differences in specific gray/white matter regions of interest. METHODS A k-means cluster analysis requested a 3-group solution from neuropsychological data acquired from individuals diagnosed clinically with AD/VaD. MRI measures of hippocampal, caudate, ventricular, subcortical lacunar infarction, whole brain volume, and leukoaraiosis (LA) were analyzed. Three regions of LA volumes were quantified and these included the periventricular (5 mm around the ventricles), infracortical (5 mm beneath the gray matter), and deep (between periventricular and infracortical) regions. RESULTS Cluster analysis sorted AD/VaD patients into single domain amnestic (n = 41), single-domain dysexecutive (n = 26), and multi-domain (n = 26) phenotypes. Multi-domain patients exhibited worst performance on language tests; however, multi-domain patients were equally impaired on memory tests when compared to amnestic patients. Statistically-determined groups dissociated using neuroradiological parameters: amnestic and multi-domain groups presented with smaller hippocampal volume while the dysexecutive group presented with greater deep, periventricular, and whole brain LA. Neither caudate nor lacunae volume differed by group. Caudate nucleus volume negatively correlated with total LA in the dysexecutive and multi-domain groups. CONCLUSIONS There are at least three distinct subtypes embedded within patients diagnosed clinically with AD/VaD spectrum dementia. We encourage future research to assess a) the neuroradiological substrates underlying statistically-determined AD/VaD spectrum dementia and b) how statistical modeling can be integrated into existing diagnostic criteria.
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Affiliation(s)
- Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Ilona M Schmalfuss
- Department of Radiology, University of Florida, Gainesville, Florida, USA.,Department of Radiology, North Florida/South Georgia Veteran Administration, Gainesville, Florida, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Kenneth M Heilman
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - David J Libon
- Drexel Neuroscience Institute, Drexel University, College of Medicine, Philadelphia, PA, USA
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Price CC, Tanner J, Nguyen PT, Schwab NA, Mitchell S, Slonena E, Brumback B, Okun MS, Mareci TH, Bowers D. Gray and White Matter Contributions to Cognitive Frontostriatal Deficits in Non-Demented Parkinson's Disease. PLoS One 2016; 11:e0147332. [PMID: 26784744 PMCID: PMC4718544 DOI: 10.1371/journal.pone.0147332] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 01/01/2016] [Indexed: 01/09/2023] Open
Abstract
Objective This prospective investigation examined: 1) processing speed and working memory relative to other cognitive domains in non-demented medically managed idiopathic Parkinson’s disease, and 2) the predictive role of cortical/subcortical gray thickness/volume and white matter fractional anisotropy on processing speed and working memory. Methods Participants completed a neuropsychological protocol, Unified Parkinson’s Disease Rating Scale, brain MRI, and fasting blood draw to rule out vascular contributors. Within group a priori anatomical contributors included bilateral frontal thickness, caudate nuclei volume, and prefrontal white matter fractional anisotropy. Results Idiopathic Parkinson’s disease (n = 40; Hoehn & Yahr stages 1–3) and non-Parkinson’s disease ‘control’ peers (n = 40) matched on demographics, general cognition, comorbidity, and imaging/blood vascular metrics. Cognitively, individuals with Parkinson’s disease were significantly more impaired than controls on tests of processing speed, secondary deficits on working memory, with subtle impairments in memory, abstract reasoning, and visuoperceptual/spatial abilities. Anatomically, Parkinson’s disease individuals were not statistically different in cortical gray thickness or subcortical gray volumes with the exception of the putamen. Tract Based Spatial Statistics showed reduced prefrontal fractional anisotropy for Parkinson’s disease relative to controls. Within Parkinson’s disease, prefrontal fractional anisotropy and caudate nucleus volume partially explained processing speed. For controls, only prefrontal white matter was a significant contributor to processing speed. There were no significant anatomical predictors of working memory for either group. Conclusions Caudate nuclei volume and prefrontal fractional anisotropy, not frontal gray matter thickness, showed unique and combined significance for processing speed in Parkinson’s disease. Findings underscore the relevance for examining gray-white matter interactions and also highlight clinical processing speed metrics as potential indicators of early cognitive impairment in PD.
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Affiliation(s)
- Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
- * E-mail:
| | - Jared Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America
| | - Peter T. Nguyen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America
| | - Nadine A. Schwab
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America
| | - Sandra Mitchell
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America
| | - Elizabeth Slonena
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America
| | - Michael S. Okun
- Department of Neurology, University of Florida, Gainesville, Florida, United States of America
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Thomas H. Mareci
- Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida, United States of America
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
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Bergstrand K, Mayer B, Brumback B, Zhang Y. Assessing the Relationship Between Social Vulnerability and Community Resilience to Hazards. Soc Indic Res 2015; 122:391-409. [PMID: 29276330 PMCID: PMC5739329 DOI: 10.1007/s11205-014-0698-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This article contributes to the disaster literature by measuring and connecting two concepts that are highly related but whose relationship is rarely empirically evaluated: social vulnerability and community resilience. To do so, we measure community resilience and social vulnerability in counties across the United States and find a correlation between high levels of vulnerability and low levels of resilience, indicating that the most vulnerable counties also tend to be the least resilient. We also find regional differences in the distribution of community resilience and social vulnerability, with the West being particularly vulnerable while the Southeast is prone to low levels of resilience. By looking at both social vulnerability and community resilience, we are able to map communities' social risks for harm from threats as well as their capacities for recovering and adapting in the aftermath of hazards. This provides a more complete portrait of the communities that might need the most assistance in emergency planning and response, as well as whether such interventions will need to be tailored toward reducing damage or finding the path to recovery.
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Affiliation(s)
- Kelly Bergstrand
- School of Sociology, University of Arizona, P.O. Box 210027, Tucson, AZ 85721-0027, USA
| | - Brian Mayer
- School of Sociology, University of Arizona, P.O. Box 210027, Tucson, AZ 85721-0027, USA
| | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, 228 Buckman Drive, P.O. Box 117450, Gainesville, FL 32611-7450, USA
| | - Yi Zhang
- Department of Biostatistics, Center for Statistical Sciences, Brown University, 121 S. Main Street, Box G-S121-7, Providence, RI 02912, USA
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Abstract
This article contributes to the disaster literature by measuring and connecting two concepts that are highly related but whose relationship is rarely empirically evaluated: social vulnerability and community resilience. To do so, we measure community resilience and social vulnerability in counties across the United States and find a correlation between high levels of vulnerability and low levels of resilience, indicating that the most vulnerable counties also tend to be the least resilient. We also find regional differences in the distribution of community resilience and social vulnerability, with the West being particularly vulnerable while the Southeast is prone to low levels of resilience. By looking at both social vulnerability and community resilience, we are able to map communities' social risks for harm from threats as well as their capacities for recovering and adapting in the aftermath of hazards. This provides a more complete portrait of the communities that might need the most assistance in emergency planning and response, as well as whether such interventions will need to be tailored toward reducing damage or finding the path to recovery.
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Affiliation(s)
- Kelly Bergstrand
- School of Sociology, University of Arizona, P.O. Box 210027, Tucson, AZ 85721-0027, USA
| | - Brian Mayer
- School of Sociology, University of Arizona, P.O. Box 210027, Tucson, AZ 85721-0027, USA
| | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, 228 Buckman Drive, P.O. Box 117450, Gainesville, FL 32611-7450, USA
| | - Yi Zhang
- Department of Biostatistics, Center for Statistical Sciences, Brown University, 121 S. Main Street, Box G-S121-7, Providence, RI 02912, USA
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Classen S, Brumback B, Monahan M, Malaty II, Rodriguez RL, Okun MS, McFarland NR. Driving errors in Parkinson's disease: moving closer to predicting on-road outcomes. Am J Occup Ther 2014; 68:77-85. [PMID: 24367958 DOI: 10.5014/ajot.2014.008698] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Age-related medical conditions such as Parkinson's disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age = 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age = 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), χ²(1) = 35.54, HC N = 138, PD N = 99, p < .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R² =.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t(61) = 7.004, p < .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so.
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Affiliation(s)
- Sherrilene Classen
- Sherrilene Classen, PhD, MPH, OTR/L, is Professor and Director, School of Occupational Therapy, Elborn College, Room 2555B, 1201 Western Road, Western University, London, Ontario N6G 1H1 Canada. At the time of the study, she was Director, Institute for Mobility, Activity and Participation, and Associate Professor, Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville;
| | - Babette Brumback
- Babette Brumback, PhD, is Professor and Program Director, Department of Biostatistics, University of Florida, Gainesville
| | - Miriam Monahan
- Miriam Monahan, MS OT, CDRS, is Occupational Therapist and Certified Driving Rehabilitation Specialist, Department of Occupational Therapy and Institute for Mobility, Activity and Participation, University of Florida, Gainesville
| | - Irene I Malaty
- Irene I. Malaty, MD, is Assistant Professor, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville
| | - Ramon L Rodriguez
- Ramon L. Rodriguez, MD, is Director, Movement Disorders Clinic, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville
| | - Michael S Okun
- Michael S. Okun, MD, is Co-Director, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville
| | - Nikolaus R McFarland
- Nikolaus R. McFarland, MD, PhD, is Assistant Professor, Department of Neurology, University of Florida, Gainesville
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Price CC, Mitchell SM, Brumback B, Tanner JJ, Schmalfuss I, Lamar M, Giovannetti T, Heilman KM, Libon DJ. MRI-leukoaraiosis thresholds and the phenotypic expression of dementia. Neurology 2012; 79:734-40. [PMID: 22843264 DOI: 10.1212/wnl.0b013e3182661ef6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the concept of leukoaraiosis thresholds on working memory, visuoconstruction, memory, and language in dementia. METHODS A consecutive series of 83 individuals with insidious onset/progressive dementia clinically diagnosed with Alzheimer disease (AD) or small vessel vascular dementia (VaD) completed neuropsychological measures assessing working memory, visuoconstruction, episodic memory, and language. A clinical MRI scan was used to quantify leukoaraiosis, total white matter, hippocampus, lacune, and intracranial volume. We performed analyses to detect the lowest level of leukoaraiosis associated with impairment on the neuropsychological measures. RESULTS Leukoaraiosis ranged from 0.63% to 23.74% of participants' white matter. Leukoaraiosis explained a significant amount of variance in working memory performance when it involved 3% or more of the white matter with curve estimations showing the relationship to be nonlinear in nature. Greater leukoaraiosis (13%) was implicated for impairment in visuoconstruction. Relationships between leukoaraiosis, episodic memory, and language measures were linear or flat. CONCLUSIONS Leukoaraiosis involves specific threshold points for working memory and visuoconstructional tests in AD/VaD spectrum dementia. These data underscore the need to better understand the threshold at which leukoaraiosis affects and alters the phenotypic expression in insidious onset dementia syndromes.
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Affiliation(s)
- Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, USA.
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Classen S, Wen PS, Velozo CA, Bédard M, Winter SM, Brumback B, Lanford DN. Psychometrics of the self-report safe driving behavior measure for older adults. Am J Occup Ther 2012; 66:233-41. [PMID: 22394533 DOI: 10.5014/ajot.2012.001834] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We investigated the psychometric properties of the 68-item Safe Driving Behavior Measure (SDBM) with 80 older drivers, 80 caregivers, and 2 evaluators from two sites. Using Rasch analysis, we examined unidimensionality and local dependence; rating scale; item- and person-level psychometrics; and item hierarchy of older drivers, caregivers, and driving evaluators who had completed the SDBM. The evidence suggested the SDBM is unidimensional, but pairs of items showed local dependency. Across the three rater groups, the data showed good person (≥3.4) and item (≥3.6) separation as well as good person (≥.93) and item reliability (≥.92). Cronbach's α was ≥.96, and few items were misfitting. Some of the items did not follow the hypothesized order of item difficulty. The SDBM classified the older drivers into six ability levels, but to fully calibrate the instrument it must be refined in terms of its items (e.g., item exclusion) and then tested among participants of lesser ability.
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Affiliation(s)
- Sherrilene Classen
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, PO Box 100164, Gainesville, FL 32611-0164, USA.
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Freeman MC, Greene LE, Dreibelbis R, Saboori S, Muga R, Brumback B, Rheingans R. Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial. Trop Med Int Health 2011; 17:380-91. [PMID: 22175695 DOI: 10.1111/j.1365-3156.2011.02927.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There has been increased attention to access to water, sanitation and hygiene (WASH) at schools in developing countries, but a dearth of empirical studies on the impact. We conducted a cluster-randomized trial of school-based WASH on pupil absence in Nyanza Province, Kenya, from 2007 to 2008. METHODS Public primary schools nested in three geographical strata were randomly assigned and allocated to one of three study arms [water treatment and hygiene promotion (WT & HP), additional sanitation improvement, or control] to assess the effects on pupil absence at 2-year follow-up. RESULTS We found no overall effect of the intervention on absence. However, among schools in two of the geographical areas not affected by post-election violence, those that received WT and HP showed a 58% reduction in the odds of absence for girls (OR 0.42, CI 0.21-0.85). In the same strata, sanitation improvement in combination with WT and HP resulted in a comparable drop in absence, although results were marginally significant (OR 0.47, 0.21-1.05). Boys were not impacted by the intervention. CONCLUSION School WASH improvements can improve school attendance for girls, and mechanisms for gendered impacts should be explored. Incomplete intervention compliance highlights the challenges of achieving consistent results across all settings.
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Affiliation(s)
- Matthew C Freeman
- Hubert Department of Global Health, Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Cook RL, Zhang J, Mullins J, Kauf T, Brumback B, Steingraber H, Mallison C. Factors associated with initiation and completion of human papillomavirus vaccine series among young women enrolled in Medicaid. J Adolesc Health 2010; 47:596-9. [PMID: 21094437 DOI: 10.1016/j.jadohealth.2010.09.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 09/21/2010] [Accepted: 09/21/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine age- and race-specific uptake rates of human papillomavirus (HPV) vaccine among females aged 9-20 years who participated in the Florida Medicaid during the first 2 years after approval by the Food and Drug Administration, and to identify factors associated with HPV vaccine initiation and series completion. METHODS Medicaid administrative data were used to identify claims for HPV vaccination together with individual, provider, and practice characteristics linked to each vaccination. RESULTS As of June 2008, 9.4% of females aged 11-18 years had ever received an HPV vaccination, and 1.8% had completed the three-vaccine series. In multivariate analysis, receipt of an HPV vaccination was found to be associated with age and race/ethnicity. In comparison with their white counterparts, black females were approximately half as likely to complete the three-vaccine series after initiation. CONCLUSIONS The data obtained suggest relatively slow initial uptake and completion of the HPV vaccine series in this population who are at an increased risk for cervical cancer, with racial disparities in vaccine uptake and vaccine series completion.
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Affiliation(s)
- Robert L Cook
- Department of Epidemiology and Biostatistics, University of Florida, Gainesville, Florida 32610, USA.
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