1
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Begg LR, Orriols AM, Zannikou M, Yeh C, Vadlamani P, Kanojia D, Bolin R, Dunne SF, Balakrishnan S, Camarda R, Roth D, Zielinski-Mozny NA, Yau C, Vassilopoulos A, Huang TH, Kim KYA, Horiuchi D. S100A8/A9 predicts response to PIM kinase and PD-1/PD-L1 inhibition in triple-negative breast cancer mouse models. Commun Med (Lond) 2024; 4:22. [PMID: 38378783 PMCID: PMC10879183 DOI: 10.1038/s43856-024-00444-8] [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] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Understanding why some triple-negative breast cancer (TNBC) patients respond poorly to existing therapies while others respond well remains a challenge. This study aims to understand the potential underlying mechanisms distinguishing early-stage TNBC tumors that respond to clinical intervention from non-responders, as well as to identify clinically viable therapeutic strategies, specifically for TNBC patients who may not benefit from existing therapies. METHODS We conducted retrospective bioinformatics analysis of historical gene expression datasets to identify a group of genes whose expression levels in early-stage tumors predict poor clinical outcomes in TNBC. In vitro small-molecule screening, genetic manipulation, and drug treatment in syngeneic mouse models of TNBC were utilized to investigate potential therapeutic strategies and elucidate mechanisms of drug action. RESULTS Our bioinformatics analysis reveals a robust association between increased expression of immunosuppressive cytokine S100A8/A9 in early-stage tumors and subsequent disease progression in TNBC. A targeted small-molecule screen identifies PIM kinase inhibitors as capable of decreasing S100A8/A9 expression in multiple cell types, including TNBC and immunosuppressive myeloid cells. Combining PIM inhibition and immune checkpoint blockade induces significant antitumor responses, especially in otherwise resistant S100A8/A9-high PD-1/PD-L1-positive tumors. Notably, serum S100A8/A9 levels mirror those of tumor S100A8/A9 in a syngeneic mouse model of TNBC. CONCLUSIONS Our data propose S100A8/A9 as a potential predictive and pharmacodynamic biomarker in clinical trials evaluating combination therapy targeting PIM and immune checkpoints in TNBC. This work encourages the development of S100A8/A9-based liquid biopsy tests for treatment guidance.
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Affiliation(s)
- Lauren R Begg
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Adrienne M Orriols
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Markella Zannikou
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Biostatistics Collaboration Center, Northwestern University, Chicago, IL, USA
- Rush University Medical Center, Chicago, IL, USA
| | | | - Deepak Kanojia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Mythic Therapeutics, Waltham, MA, USA
| | - Rosemary Bolin
- Center for Comparative Medicine, Northwestern University, Chicago, IL, USA
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Sara F Dunne
- High Throughput Analysis Laboratory, Northwestern University, Evanston, IL, USA
| | - Sanjeev Balakrishnan
- University of California, San Francisco, San Francisco, CA, USA
- Pulze.ai, San Francisco, CA, USA
| | - Roman Camarda
- University of California, San Francisco, San Francisco, CA, USA
- Novo Ventures US, Inc., San Francisco, CA, USA
| | - Diane Roth
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicolette A Zielinski-Mozny
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Comparative Medicine, Northwestern University, Chicago, IL, USA
| | - Christina Yau
- University of California, San Francisco, San Francisco, CA, USA
| | - Athanassios Vassilopoulos
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- AbbVie, Inc., North Chicago, IL, USA
| | - Tzu-Hsuan Huang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kwang-Youn A Kim
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Biostatistics Collaboration Center, Northwestern University, Chicago, IL, USA
| | - Dai Horiuchi
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
- Center for Human Immunobiology, Northwestern University, Chicago, IL, USA.
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Green HM, Diaz L, Carmona-Barrera V, Grobman WA, Yeh C, Williams B, Davis K, Kominiarek MA, Feinglass J, Zera C, Yee LM. Mapping the Postpartum Experience Through Obstetric Patient Navigation for Low-Income Individuals. J Womens Health (Larchmt) 2024. [PMID: 38265478 DOI: 10.1089/jwh.2023.0459] [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: 01/25/2024] Open
Abstract
Background: Although the postpartum period is an opportunity to address long-term health, fragmented care systems, inadequate attention to social needs, and a lack of structured transition to primary care threaten patient wellbeing, particularly for low-income individuals. Postpartum patient navigation is an emerging innovation to address these disparities. Methods: This mixed-methods analysis uses data from the first year of an ongoing randomized controlled trial to understand the needs of low-income postpartum individuals through 1 year of patient navigation. We designed standardized logs for navigators to record their services, tracking mode, content, intensity, and target of interactions. Navigators also completed semistructured interviews every 3 months regarding relationships with patients and care teams, care system gaps, and navigation process. Log data were categorized, quantified, and mapped temporally through 1 year postpartum. Qualitative data were analyzed using the constant comparative method. Results: Log data from 50 participants who received navigation revealed the most frequent needs related to health care access (45.4%), health and wellness (18.2%), patient-navigator relationship building (14.8%), parenting (13.6%), and social determinants of health (8.0%). Navigation activities included supporting physical and mental recovery, accomplishing health goals, connecting patients to primary and specialty care, preparing for health system utilization beyond navigation, and referring individuals to community resources. Participant needs fluctuated, yielding a dynamic timeline of the first postpartum year. Conclusion: Postpartum needs evolved throughout the year, requiring support from various teams. Navigation beyond the typical postpartum care window may be useful in mitigating health system barriers, and tracking patient needs may be useful in optimizing postpartum care. Clinical Trial Registration: Registered April 19, 2019, enrollment beginning January 21, 2020, NCT03922334, https://clinicaltrials.gov/ct2/show/NCT03922334.
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Affiliation(s)
- Hannah M Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Chen Yeh
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chloe Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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3
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Zielenbach M, Ekpe E, Oot A, Yeh C, Yee LM. Association of Antenatal Housing Instability with Perinatal Care Utilization and Outcomes. J Womens Health (Larchmt) 2024; 33:90-97. [PMID: 37944106 PMCID: PMC10794825 DOI: 10.1089/jwh.2023.0002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: Social determinants of health are important contributors to maternal and child health outcomes. Limited existing research examines the relationship between housing instability during pregnancy and perinatal care utilization. Our objective was to evaluate whether antenatal housing instability is associated with differences in perinatal care utilization and outcomes. Materials and Methods: Participants who were surveyed during their postpartum hospitalization were considered to have experienced housing instability if they answered affirmatively to at least one of six screening items. The primary outcome was adequacy of prenatal care measured by the Adequacy of Prenatal Care Utilization index. Maternal, neonatal, and postpartum outcomes, including utilization and breastfeeding, were also collected as secondary outcomes. Multivariable logistic regression models were adjusted for sociodemographic and clinical covariates. Results: In this cohort (N = 490), 11.2% (N = 55) experienced housing instability during pregnancy. Participants with unstable housing were more likely to have inadequate prenatal care (17.3% vs. 3.9%; odds ratio [OR] 5.11, 95% confidence interval [CI] 2.15-12.14, p < 0.001), but findings were not significant after adjustment (aOR 1.72, 95% CI 0.55-5.41, p = 0.35). Similarly, postpartum visit attendance was lower for individuals with unstable housing (79.6% vs. 91.2%), but there was no difference in the odds of the postpartum visit attendance after adjustment (OR 0.69, 95% CI 0.29-1.66, p = 0.14). Conclusions: There were no statistically significant association with the maternal, neonatal, and other postpartum secondary outcomes. Housing instability appears to be a risk marker that is related to other social determinants of health. Given the range of housing instability experiences, future research must account for specific types and degrees of housing instability and their potential perinatal consequences.
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Affiliation(s)
- Molly Zielenbach
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Olive View—UCLA Medical Center, David Geffen School of Medicine at the University of California Los Angeles, Sylmar, California, USA
| | - Etoroabasi Ekpe
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Antoinette Oot
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York, USA
| | - Chen Yeh
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Holder KN, Mormol JS, Bakkensen JB, Pavone ME, Goldman KN, Yeh C, Muhammad LN, Bernardi LA. Natural Cycle Frozen Embryo Transfer: Evaluating Optimal Protocols for Preparation and Timing. J Hum Reprod Sci 2023; 16:333-339. [PMID: 38322641 PMCID: PMC10841927 DOI: 10.4103/jhrs.jhrs_125_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Abstract
Background While natural cycle frozen embryo transfer (NC-FET) is becoming increasingly common, significant practice variation exists in the use of ovulation induction medications, administration of ovulation trigger, and timing of embryo transfer without consensus as to the optimal protocol. Aims The objective of this study is to evaluate the association of key aspects of the NC-FET protocol with implantation, pregnancy and live birth. Settings and Design This was a retrospective cohort study of blastocyst stage NC-FET cycles from October 2019 to July 2021 at a single academic fertility centre. Materials and Methods Protocols varied between cycles across three key parameters which were evaluated as primary predictors of cycle outcomes: (1) use of letrozole for mild ovarian stimulation/ovulation induction, (2) administration of exogenous ovulation trigger versus spontaneous luteinising hormone surge and (3) transfer timing based on ovulation trigger versus sequential progesterone monitoring. Primary outcomes included implantation rate, clinical pregnancy and ongoing pregnancy. Statistical Analysis Used Generalised estimating equations were fitted to obtain adjusted odds ratios or rate ratios as appropriate with 95% confidence intervals for each outcome across the three primary predictors. Results A total of 183 cycles from 170 unique patients were eligible for inclusion. The average implantation rate was 0.58, resulting in an overall clinical pregnancy and ongoing pregnancy rate of 59.0% and 51.4%, respectively. After adjusting for age at embryo freeze and history of a failed embryo transfer, there were no significant associations between any predictor and implantation rate, clinical pregnancy, ongoing pregnancy, or live birth. Conclusion In NC-FET, a variety of preparation and timing protocols may lead to comparable cycle outcomes, potentially allowing for flexibility on the basis of patient and physician preference. These findings warrant validation in a larger, randomised trial.
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Affiliation(s)
- Kai N. Holder
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica S. Mormol
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Jennifer B. Bakkensen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kara N. Goldman
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lutfiyya N. Muhammad
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lia A. Bernardi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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5
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Begg LR, Orriols AM, Zannikou M, Yeh C, Vadlamani P, Kanojia D, Bolin R, Dunne SF, Balakrishnan S, Camarda R, Roth D, Zielinski-Mozny NA, Yau C, Vassilopoulos A, Huang TH, Kim KYA, Horiuchi D. S100A8/A9 predicts triple-negative breast cancer response to PIM kinase and PD-1/PD-L1 inhibition. bioRxiv 2023:2023.09.21.558870. [PMID: 37790346 PMCID: PMC10542194 DOI: 10.1101/2023.09.21.558870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
It remains elusive why some triple-negative breast cancer (TNBC) patients respond poorly to existing therapies while others respond well. Our retrospective analysis of historical gene expression datasets reveals that increased expression of immunosuppressive cytokine S100A8/A9 in early-stage tumors is robustly associated with subsequent disease progression in TNBC. Although it has recently gained recognition as a potential anticancer target, S100A8/A9 has not been integrated into clinical study designs evaluating molecularly targeted therapies. Our small molecule screen has identified PIM kinase inhibitors as capable of decreasing S100A8/A9 expression in multiple cell types, including TNBC and immunosuppressive myeloid cells. Furthermore, combining PIM inhibition and immune checkpoint blockade induces significant antitumor responses, especially in otherwise resistant S100A8/A9-high PD-1/PD-L1-positive tumors. Importantly, serum S100A8/A9 levels mirror those of tumor S100A8/A9 in a syngeneic mouse model of TNBC. Thus, our data suggest that S100A8/A9 could be a predictive and pharmacodynamic biomarker in clinical trials evaluating combination therapy targeting PIM and immune checkpoints in TNBC and encourage the development of S100A8/A9-based liquid biopsy tests.
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6
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Woitowich NC, Waddimba AC, Yeh C, Muhammad LN, Warren AM, Wood CV. Evaluation of Professional Setbacks and Resilience in Biomedical Scientists During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2328027. [PMID: 37556144 PMCID: PMC10413169 DOI: 10.1001/jamanetworkopen.2023.28027] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023] Open
Abstract
This survey study evaluates whether resilience was associated with professional and career setbacks among biomedical scientists during the COVID-19 pandemic.
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Affiliation(s)
- Nicole C. Woitowich
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony C. Waddimba
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lutfiyya N. Muhammad
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ann Marie Warren
- Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, Texas
| | - Christine V. Wood
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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7
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Yeh C. Enabling Real-World Data to Accelerate the Development of Innovative Cancer Biomarkers. Glob Med Genet 2023; 10:97-100. [PMID: 37228868 PMCID: PMC10205392 DOI: 10.1055/s-0043-1768993] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The molecular diagnostics industry has historically relied on sanitized clinical trials and commoditized data sources to inform its biomarker discovery and validation process-an under-substantiated approach that was ultra-expensive, resource-consuming and did not reflect how representative a new biomarker would be in broader patient populations. In an effort to gain more accurate insight into the patient experience and bring innovative biomarkers to market more efficiently and accurately, the industry is now expanding into extended real-world data. To access the needed breadth and depth of patient-centric data, diagnostic companies must collaborate with a healthcare data analytics partner that has three key assets: (i) a broad and deep megadata with metadata, (ii) a data-rich provider network, and (iii) an outcomes-improvement engine to support the next generation of molecular diagnostics (Dx) and therapeutics (Rx) development.
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Affiliation(s)
- Chen Yeh
- OncoDxRx, Arcadia, California, United States
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8
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Yee LM, Leziak K, Jackson J, Niznik C, Saber R, Yeh C, Simon MA. SweetMama: Usability Assessment of a Novel Mobile Application Among Low-Income Pregnant People to Assist With Diabetes Management and Support. Diabetes Spectr 2023; 36:171-181. [PMID: 37193207 PMCID: PMC10182966 DOI: 10.2337/ds22-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Mobile health tools may be effective strategies to improve engagement, education, and diabetes-related health during pregnancy. We developed SweetMama, a patient-centered, interactive mobile application (app) designed to support and educate low-income pregnant people with diabetes. Our objective was to evaluate the SweetMama user experience and acceptability. Methods SweetMama is a mobile app with static and dynamic features. Static features include a customized homepage and resource library. Dynamic features include delivery of a theory-driven diabetes-specific curriculum via 1) motivational, tip, and goal-setting messages aligning with treatment and gestational age; 2) appointment reminders; and 3) ability to mark content as "favorite." In this usability assessment, low-income pregnant people with gestational or type 2 diabetes used SweetMama for 2 weeks. Participants provided qualitative feedback (via interviews) and quantitative feedback (via validated usability/satisfaction measures) on their experience. User analytic data detailed the duration and type of interactions users had with SweetMama. Results Of 24 individuals enrolled, 23 used SweetMama and 22 completed exit interviews. Participants were mostly non-Hispanic Black (46%) or Hispanic (38%) individuals. Over the 14-day period, users accessed SweetMama frequently (median number of log-ins 8 [interquartile range 6-10]), for a median of 20.5 total minutes, and engaged all features. A majority (66.7%) rated SweetMama as having moderate or high usability. Participants emphasized design and technical strengths and beneficial effects on diabetes self-management and also identified limitations of the user experience. Conclusion Pregnant people with diabetes found SweetMama to be user-friendly, informative, and engaging. Future work must study its feasibility for use throughout pregnancy and its efficacy to improve perinatal outcomes.
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Affiliation(s)
- Lynn M. Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Karolina Leziak
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jenise Jackson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Charlotte Niznik
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Chen Yeh
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melissa A. Simon
- Departments of Obstetrics and Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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9
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Green HM, Carmona-Barrera V, Diaz L, Yeh C, Williams B, Davis K, Kominiarek MA, Feinglass J, Grobman WA, Zera C, Yee LM. Implementation of postpartum navigation for low-income individuals at an urban academic medical center. PLoS One 2023; 18:e0282048. [PMID: 36821597 PMCID: PMC9949671 DOI: 10.1371/journal.pone.0282048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Patient navigation, a patient-centered intervention to promote comprehensive health care, is an emerging innovation in obstetrics to optimize postpartum care. We aimed to evaluate the implementation of a novel postpartum patient navigation program at an urban academic medical center. METHODS This mixed-methods study analyzed the implementation of a postpartum patient navigation program within an ongoing randomized control trial. This study analyzed three navigators' logs of interactions with 50 patients, care team members, and community organizations throughout patients' first year postpartum. We categorized and quantified interactions by topic addressed, care team member interacted with, and communication mode used. We also conducted semi-structured interviews with each navigator every three months (5 interviews per navigator), emphasizing navigation experiences, relationships with patients and care teams, integration in the care team, and healthcare system gaps. Interview data were analyzed using the constant comparative method to identify themes using the constructs of the Consolidated Framework for Implementation Research (CFIR). RESULTS Analysis of navigator logs revealed a high patient need level, especially in the first 3 months postpartum. CFIR-guided analysis of intervention characteristics revealed positive perceptions of navigation's utility due to its adaptability. Navigation's complexity, however, posed an early obstacle to implementation that diminished over time. Outer setting analysis indicated navigators addressed patient needs through interactions with multiple systems. Despite clinicians' initial unfamiliarity with navigation, inner setting analysis suggested ongoing communication and electronic medical record use facilitated integration into the care team. Regarding individual and process characteristics, findings emphasized how navigator self-efficacy and confidence increased with experience (individual) and was facilitated by comprehensive training and reflection (process). Overall, barriers to implementation included unfamiliarity, varied patient engagement, and innovation complexity. Facilitators included high patient need, communication with outside organizations, medical record usage, navigator characteristics (self-efficacy, communication skills, and personal growth), a comprehensive training period, consistent reflection, high relative advantage, and high adaptability to patient need. CONCLUSION Patient navigation is a promising innovation to improve postpartum care coordination and support care team efforts. The successful implementation of navigation in this study indicates that, if shown to improve patient outcomes, obstetric navigation could be a component of patient-centered postpartum care.
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Affiliation(s)
- Hannah M. Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- * E-mail:
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Chen Yeh
- Biostatistics Collaboration Center, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ka’Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Michelle A. Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States of America
| | - Chloe Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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10
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Sokol LL, Nance M, Kluger BM, Yeh C, Paulsen JS, Smith AK, Bega D. Factors Associated with the Place of Death in Huntington Disease: Analysis of Enroll-HD. J Palliat Med 2023. [PMID: 36706436 DOI: 10.1089/jpm.2022.0143] [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: 01/28/2023] Open
Abstract
Background: Most people prefer to die at home. Hospice is the standard in end-of-life care for people with Huntington disease (HD), a neurodegenerative genetic disorder that affects people in middle adulthood. Yet, we have little knowledge regarding the place of death for people with HD. Therefore, the current state of knowledge limits HD clinicians' ability to conduct high-quality goals of care conversations. Objectives: We sought to determine the factors associated with the place of death in people with HD. Design: We obtained cross-sectional data from Enroll-HD and included participants with a positive HD mutation of 36 or more CAG repeats. Results: Out of 16,120 participants in the Enroll-HD study, 536 were reported as deceased. The mean age at death was 60. The leading place of death was home (29%), followed by the hospital (23%). The adjusted odds ratio (aOR) of dying at a skilled nursing facility was significantly lower for those partnered (aOR: 0.48, confidence interval [95% CI]: 0.26-0.86). The aOR for dying on hospice compared to home was increased in a person with some college and above (aOR: 2.40, 95% CI: 1.21-4.75). Conclusions: Our data further suggest that models that predict the place of death for serious illnesses do not appear to generalize to HD. The distribution in the places of death within HD was not uniform. Our findings may assist HD clinicians in communication during goals of care conversations.
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Affiliation(s)
- Leonard L Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Martha Nance
- Struthers Parkinson's Center, Golden Valley, Minnesota, USA.,Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Chen Yeh
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane S Paulsen
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Movement Disorders, The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Mishra S, Dhuna N, Lancki N, Yeh C, Larson DN. Telehealth utilization and patient satisfaction in an ambulatory movement disorders center during the COVID-19 pandemic. J Telemed Telecare 2022:1357633X221146819. [PMID: 36575616 PMCID: PMC9805996 DOI: 10.1177/1357633x221146819] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/02/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Studies suggest that patients are satisfied with telehealth in ambulatory settings. However, tele-neurology satisfaction data are limited by a small sample size and COVID-19-era data is not specific to movement disorders clinics. In this prospective observational study, telehealth utilization during the COVID-19 pandemic was assessed, and patient satisfaction was compared between telehealth and in-person visits in an outpatient movement disorders center. METHODS Patients ≥18 years who completed an appointment at Northwestern's Movement Disorders Clinic were invited to complete a post-visit Medallia survey. The primary outcomes of the survey were likelihood to recommend (LTR) provider, LTR location, and 'spent enough time,' on a 0-10 scale. Responses were categorized into in-person vs. telehealth groups. RESULTS Telehealth utilization significantly increased from a pre-COVID timeframe rate of 0.3% (Nov 2019 to Feb 2020) to 39.5% during the COVID-19 pandemic (March 2020 through April 2021) (p-value < 0.001). During the COVID-19 pandemic, 621 patients responded to the post-visit Medallia survey (response rate = 30%), including 365 in-person and 256 telehealth visits. No significant differences were observed between in-person and telehealth encounters in LTR provider (p = 0.892), LTR location (p = 0.659), and time spent (p = 0.395). Additional subgroup multivariable analysis did not support differences in satisfaction between different age groups. DISCUSSION With its large sample size, our study demonstrates that in the setting of increased TH utilization in movement disorders clinic during the COVID-19 pandemic, patients reported similar satisfaction with telehealth compared to in-person visits. This study supports the utility of telehealth to provide specialized neurologic clinic care.
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Affiliation(s)
- Shubhendu Mishra
- Department of Neurology, Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
| | - Nikhil Dhuna
- Department of Neurology, Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
| | - Nicola Lancki
- Department of Preventive
Medicine-Biostatistics, Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventive
Medicine-Biostatistics, Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
| | - Danielle N Larson
- Department of Neurology, Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
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12
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Walton RF, Yeh C, Shannon R, Rosoklija I, Rague JT, Johnson EK, Alpern ER, Ellison JS, Routh JC, Tasian GE, Chu DI. Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020). J Pediatr Urol 2022; 18:742.e1-742.e11. [PMID: 35945144 PMCID: PMC9771899 DOI: 10.1016/j.jpurol.2022.07.005] [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: 02/15/2022] [Revised: 06/06/2022] [Accepted: 07/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Individuals with nephrolithiasis frequently present to the Emergency Department (ED). Safety and quality principles are often applied in pediatric EDs to children presenting with nephrolithiasis, such as limiting ionizing radiation exposure and opioid analgesics. However, it is unknown whether pediatric EDs apply these same principles to adult patients who present with nephrolithiasis. We hypothesized that adult patients would be associated with higher use of radiation-based imaging and opioid analgesics. OBJECTIVE To assess variations in diagnostic and treatment interventions and hospital utilization between pediatric and adult patients presenting to the pediatric ED with nephrolithiasis. STUDY DESIGN A retrospective cohort study was conducted, examining outcomes for pediatric (<18-years-old) versus adult (≥18-years-old) patients in 42 pediatric EDs from 2009 to 2020 using the Pediatric Health Information System (PHIS) database. Patients with an ICD-9/10 principal diagnosis code of nephrolithiasis with no nephrolithiasis-related visits within the prior 6 months were included. Primary outcomes were imaging, medications, and surgical interventions. Secondary outcomes were hospital admissions, 90-day ED revisits, and 90-day readmissions. Generalized linear mixed models with random effects were used to adjust for confounding and clustering. RESULTS In total, 16,117 patients with 17,837 encounters were included. Most hospitals were academic (95.2%), and a plurality were located in the South (38.1%). Most patients were <18-years-old (84.4%, median (interquartile range): 15 (12-17)-years-old), female (57.9%), and White (76.3%), and 17.1% were Hispanic/Latino. Most had no complex chronic conditions (89.2%) and no chronic disease per pediatric medical complexity algorithm (51.5%). For the primary outcome, adults, relative to pediatric patients, who presented to the pediatric ED with nephrolithiasis had higher adjusted odds of receiving computerized tomography (CT) scans (Odds Ratio [OR] 1.43 [95% Confidence Interval [CI] 1.29-1.59]) and opioid analgesics (OR 1.45 [95%CI 1.33-1.58]) (Summary Figure). Secondary outcomes showed that adults, relative to pediatric patients, had lower adjusted odds of hospital admissions, 90-day ED revisits, and 90-day readmissions. DISCUSSION Our results suggest that certain pediatric safety and quality principles, such as limiting ionizing radiation exposure and opioid analgesic prescriptions, are not being equally applied to pediatric and adult patients who present to pediatric EDs with nephrolithiasis. The mechanism of these findings remains to be elucidated. CONCLUSIONS Variations in care for individuals with nephrolithiasis reflect an opportunity for quality improvement in pediatric EDs and inform work exploring optimal care pathways for all patients presenting to the pediatric ED with nephrolithiasis.
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Affiliation(s)
- Ryan F Walton
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Chen Yeh
- Northwestern University, Department of Preventive Medicine, Division of Biostatistics, Chicago, IL, USA.
| | - Rachel Shannon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Ilina Rosoklija
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - James T Rague
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Emilie K Johnson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Elizabeth R Alpern
- Northwestern University, Department of Pediatrics, Division of Emergency Medicine, Chicago, IL, USA.
| | - Jonathan S Ellison
- Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA.
| | | | | | - David I Chu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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13
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Steinberg JR, Yeh C, Jackson J, Saber R, Niznik CM, Leziak K, Yee LM. Optimizing Engagement in an mHealth Intervention for Diabetes Support During Pregnancy: the Role of Baseline Patient Health and Behavioral Characteristics. J Diabetes Sci Technol 2022; 16:1466-1472. [PMID: 34423677 PMCID: PMC9631537 DOI: 10.1177/19322968211035441] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mobile health (mHealth) technology that addresses diabetes mellitus in pregnancy has the potential to improve maternal and child health while diminishing socioeconomic and racial disparities. Little is known about health literacy, electronic health literacy, or patient characteristics that contribute to increased mHealth use. In this pilot study, we aimed to examine patient factors associated with user engagement with a novel app for diabetes support during pregnancy. METHOD Low-income pregnant individuals with gestational or type 2 diabetes mellitus were recruited for a 2-week usability assessment of a novel mHealth smartphone application, "SweetMama," designed to improve diabetes care. This analysis of user characteristics was a pilot assessment of data from the usability study phase. Participants completed assessments of patient health literacy, electronic health literacy, diabetes self-efficacy, and activation. User metrics (eg, sessions and total duration of use) were evaluated by participant characteristics. Descriptive analyses were conducted to assess outcomes with respect to patient's clinical history, health literacy, electronic health literacy, diabetes self-efficacy, and activation. RESULTS Twenty-two diverse, low-income pregnant patients with either gestational or type 2 diabetes engaged with SweetMama for 14 days. Participants with gestational diabetes had greater mean minutes of use per session and mean total duration of use than those with type 2 diabetes. Participants with greater electronic health literacy, lower patient activation, and greater self-efficacy demonstrated greater total duration of use. No user metrics differed significantly by participant general health literacy. CONCLUSIONS Findings of this pilot study suggest engagement with a novel mHealth app for diabetes support during pregnancy varied by baseline behavioral and clinical characteristics. Results could indicate that digital health literacy better differentiates engagement patterns than general health literacy.
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Affiliation(s)
- Jecca R. Steinberg
- Department of Obstetrics and
Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventive Medicine,
Division of Biostatistics, Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - Jenise Jackson
- Department of Obstetrics and
Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
| | - Rana Saber
- Institute for Sexual and Gender
Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - Charlotte M. Niznik
- Department of Obstetrics and
Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
| | - Karolina Leziak
- Department of Obstetrics and
Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
| | - Lynn M. Yee
- Department of Obstetrics and
Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
- Lynn M. Yee, MD, MPH, Department of
Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine,
250 E. Superior Street, #5-2145, Chicago, IL 60611, USA.
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14
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Lin JS, Tan B, Yeh C, Kern R, Conley D, Welch K, Peters A, Smith S. Comparing the severity of chronic rhinosinusitis symptoms before versus during the COVID-19 pandemic. Laryngoscope Investig Otolaryngol 2022; 7:1704-1711. [PMID: 36544956 PMCID: PMC9764742 DOI: 10.1002/lio2.935] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background COVID-19 measures such as masking, social distancing, and staying indoors may mitigate chronic rhinosinusitis (CRS) symptoms. We evaluate whether these measures correlated with improved symptoms in patients with CRS. Methods This retrospective study compared SNOT-22 survey data from the Northwestern CRS Registry at the time of enrollment and at years 1-5 of follow-up. The final sample consisted of 1826 SNOT-22 surveys for 598 patients. April 10, 2020 to December 31, 2021 was considered "during the pandemic" and prior to March 11, 2020 was considered "pre-pandemic." Wilcoxon test was used to compare SNOT22 at enrollment pre-pandemic versus during pandemic. Separate linear mixed models were performed to estimate SNOT22 at 1 to 5 years after enrollment pre-pandemic versus during pandemic. Results Subjects enrolled during the pandemic had worse SNOT22 scores than those enrolled pre-pandemic (53 vs. 42, p = .0024). Total SNOT-22 scores were improved during the pandemic than before the pandemic at 1 year follow-up (18.17 vs. 12.22, p = .001). This effect persists when evaluating the nasal (7.33 vs. 5.13, p = .003), sleep (2.63 vs. 1.39, p = .008), function (1.40 vs. 0.72, p = .015), and emotion (0.77 vs. 0.17, p < .001) domains individually. There was no statistically significant difference in total SNOT-22 score at Years 2-5 of follow-up. Conclusions Patients with CRS experience a greater reduction in symptom severity in their first year of treatment during the pandemic than before the pandemic, plausibly from measures such as masking and staying indoors. Level of Evidence 4.
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Affiliation(s)
- Jasmine S. Lin
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Bruce Tan
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Chen Yeh
- Division of Biostatistics, Department of Preventative MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Robert Kern
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - David Conley
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Kevin Welch
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Anju Peters
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Stephanie Smith
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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15
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Tandon SD, McGown M, Campbell L, Smith JD, Yeh C, Brady C. Results from an effectiveness-implementation evaluation of a postpartum depression prevention intervention delivered in home visiting programs. J Affect Disord 2022; 315:113-120. [PMID: 35878827 DOI: 10.1016/j.jad.2022.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/28/2022] [Revised: 06/10/2022] [Accepted: 07/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Building on growing research examining lay health professionals delivering postpartum depression preventive interventions, we conducted a hybrid effectiveness-implementation Type 2 trial to examine implementation metrics and determine whether pregnant women receiving Mothers and Babies 1-on-1 delivered by lay home visitors exhibit greater reductions in depressive symptoms and perceived stress than women receiving usual home visiting. METHODS 1229 (672 control, 557 intervention) pregnant women were enrolled, with intervention participants receiving Mothers and Babies 1-on-1 delivered by a lay home visitor and control participants receiving usual home visiting services. Baseline and six-month follow-up assessments measured client mental health outcomes, with management information system data collected to assess intervention dosage. Surveys were administered nine months post-training to agency managers as well as home visitors who delivered any intervention content. RESULTS Intent-to-treat analyses indicated a significant reduction in perceived stress among intervention participants compared to controls, while as-treated analyses showed significant reductions in perceived stress and depressive symptoms. Although all study sites adopted the intervention, <50 % of eligible women received the intervention. Over two-thirds of home visitors made at least one fidelity-consistent adaptation, with client recruitment and retention in home visiting highlighted as challenges to delivery. LIMITATIONS Unmeasured historical events may have affected study outcomes and caution should be used generalizing to perinatal women from different racial/ethnic groups and home visiting models. CONCLUSION Mothers and Babies 1-on-1 delivered by lay home visitors leads to reductions in perceived stress and depressive symptoms, suggesting task shifting to non-mental health professionals is viable when appropriate training and supervision is provided.
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Affiliation(s)
- S Darius Tandon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America.
| | - Molly McGown
- Access Community Health Network, Chicago, IL 60609, United States of America
| | - Laura Campbell
- Oregon Health and Science University, Portland, OR 97239, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84017, United States of America
| | - Chen Yeh
- Rush University Medical Center, Department of Family and Preventive Medicine, Chicago, IL 60611, United States of America
| | - Carol Brady
- Carol Brady & Associates, LLC, Atlantic Beach, FL 32233, United States of America
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Yilmaz BD, Yeh C, Muhammad LN, Feinberg EC. HOW MANY EGGS WILL I GET AND HOW MUCH MEDICATION DO I NEED? A SART DATABASE PREDICTOR MODEL FOR EGG FREEZING. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.685] [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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17
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Yilmaz BD, Muhammad LN, Yeh C, Adeleye A, Feinberg EC. DOES RACIAL DISPARITY EXIST IN PLANNED OOCYTE CRYOPRESERVATION CYCLES? A SART DATABASE ANALYSIS OF 15,806 CYCLES. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.255] [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: 11/24/2022]
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18
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Johnson JK, Diebold A, Yeh C, Ciolino JD, Tandon SD. Examining Participant Dosage and Skill Utilization Associated with Receipt of a Perinatal Depression Preventive Intervention. Prev Sci 2022; 23:1241-1250. [DOI: 10.1007/s11121-022-01395-z] [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] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
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19
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Hsu PS, Chen D, Chien HP, Yeh C, Hong P, Lin ST, Lee JS, Lai HC. Detection of molecular residual disease (MRD) for cancer management: Lessons from longitudinal profiling of NSCLC patients undergoing chemotherapy or targeted therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15020] [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: 11/20/2022] Open
Abstract
e15020 Background: Identification of cancer patients who are at ongoing risk of relapse remains of high priority to direct effective adjuvant therapy. Plasma circulating cell-free DNA (cfDNA) analyses offer an unprecedented approach to identify patients with molecular residual disease (MRD) earlier than clinical or radiological evidence, detecting drug resistance, progression and relapse with relatively high sensitivity and specificity. Here we used longitudinal surveillance to profile cfDNA mutational landscape undergoing chemotherapy or EGFR-TKI. We demonstrated how cutting-edge NGS and digital qPCR technologies are defining new subgroups of patients with MRD for individually tailored treatment strategy. Methods: Plasma samples were collected from 8 subjects with lung adenocarcinoma, 5 patients were treated with EGFR-TKI and 3 cases by chemotherapy. Overall, 92 longitudinally collected specimens (duration of 31-143 weeks) were analyzed with a 520-gene ultra-deep NGS platform as well as a digital qPCR assay. Standard-of-care tests of CEA, CA19-9 biomarkers and CT radiography were also performed in parallel. Results: The number of somatic mutations detected ranging from 0 to 52 in a sample and correlated strongly with TMB (tumor mutational burden). The concordance of actionable EGFR mutations (L858R, T790M, Ex19Del) detected by NGS and digital qPCR assays was 100% (n = 49/49). NGS assay detected additional driver mutations in ∼20 non-EGFR genes. Majority of EGFR mutations showed directional decline in allelic fraction (AF) after treatment with EGFR-TKI. Patient progressed following EGFR-TKI were registered to undergo chemotherapy based on real-time mutational profiles and did show good responses and PFS. Longitudinal ultra-deep NGS analyses can help detect and stratify MRD, including non-druggable genetic information that could guide best clinical decision-making. Conclusions: Longitudinal ctDNA surveillance of patients treated with EGFR-TKI by a highly sensitive multi-gene NGS panel enables MRD monitoring and can potentially guide a selection of optimal adjuvant therapies earlier, and provide new surrogate endpoints for early registration of these therapies.
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Affiliation(s)
- Pei-Sung Hsu
- Division of Chest Medicine, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | - Hui-Ping Chien
- Department of Pathology and Laboratory Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | - Hung-Chih Lai
- Division of Hematology and Oncology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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20
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Henschen BL, Theodorou ME, Chapman M, Barra M, Toms A, Cameron KA, Zhou S, Yeh C, Lee J, O'Leary KJ. An Intensive Intervention to Reduce Readmissions for Frequently Hospitalized Patients: the CHAMP Randomized Controlled Trial. J Gen Intern Med 2022; 37:1877-1884. [PMID: 34472021 PMCID: PMC8409268 DOI: 10.1007/s11606-021-07048-1] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A small number of patients are disproportionally readmitted to hospitals. The Complex High Admission Management Program (CHAMP) was established as a multidisciplinary program to improve continuity of care and reduce readmissions for frequently hospitalized patients. OBJECTIVE To compare hospital utilization metrics among patients enrolled in CHAMP and usual care. DESIGN Pragmatic randomized controlled trial. PARTICIPANTS Inclusion criteria were as follows: 3 or more, 30-day inpatient readmissions in the previous year; or 2 inpatient readmissions plus either a referral or 3 observation admissions in previous 6 months. INTERVENTIONS Patients randomized to CHAMP were managed by an interdisciplinary team including social work, physicians, and pharmacists. The CHAMP team used comprehensive care planning and inpatient, outpatient, and community visits to address both medical and social needs. Control patients were randomized to usual care and contacted 18 months after initial identification if still eligible. MAIN MEASURES Primary outcome was number of 30-day inpatient readmissions 180 days following enrollment. Secondary outcomes were number of hospital admissions, total hospital days, emergency department visits, and outpatient clinic visits 180 days after enrollment. KEY RESULTS There were 75 patients enrolled in CHAMP, 76 in control. Groups were similar in demographic characteristics and baseline readmissions. At 180 days following enrollment, CHAMP patients had more inpatient 30-day readmissions [CHAMP incidence rate 1.3 (95% CI 0.9-1.8) vs. control 0.8 (95% CI 0.5-1.1), p=0.04], though both groups had fewer readmissions compared to 180 days prior to enrollment. We found no differences in secondary outcomes. CONCLUSIONS Frequently hospitalized patients experienced reductions in utilization over time. Though most outcomes showed no difference, CHAMP was associated with higher readmissions compared to a control group, possibly due to consolidation of care at a single hospital. Future research should seek to identify subsets of patients with persistently high utilization for whom tailored interventions may be beneficial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03097640; https://clinicaltrials.gov/ct2/show/NCT03097640.
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Affiliation(s)
- Bruce L Henschen
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Maria E Theodorou
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Margaret Chapman
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - McKay Barra
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Abby Toms
- Department of Social Work, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shuhan Zhou
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jungwha Lee
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Yee LM, Lu L, Soyemi E, Niznik CM, Jackson J, Leziak K, Saber R, Yeh C, Grobman WA, Simon MA. Evaluating the user experience of a novel smartphone application for low-income pregnant individuals with diabetes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.732] [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: 11/29/2022]
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22
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Verrall C, Chen J, Yeh C, Winlaw D, d'Udekem Y, Mackay M, Yang J, Cordina R. Resting Oxygen Saturations are Associated With Altered Brain White Matter Microstructure in Adolescents and Adults With a Fontan Circulation; A Diffusion Brain MRI Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.035] [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: 10/16/2022]
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Green HM, Diaz L, Carmona-Barrera V, Yeh C, Williams BR, Davis K, Feinglass JM, Kominarek MA, Grobman WA, Zera C, Yee LM. Mapping the postpartum experience through obstetric patient navigation for low-income individuals. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.673] [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: 11/01/2022]
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Salter-Volz AE, Oyasu A, Yeh C, Muhammad LN, Woitowich NC. Sex and Gender Bias in Covid-19 Clinical Case Reports. Front Glob Womens Health 2021; 2:774033. [PMID: 34881381 PMCID: PMC8647159 DOI: 10.3389/fgwh.2021.774033] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Clinical case reports circulate relevant information regarding disease presentation and describe treatment protocols, particularly for novel conditions. In the early months of the Covid-19 pandemic, case reports provided key insights into the pathophysiology and sequelae associated with Covid-19 infection and described treatment mechanisms and outcomes. However, case reports are often subject to selection bias due to their singular nature. To better understand how selection biases may have influenced Covid-19-releated case reports, we conducted a bibliometric analysis of Covid-19-releated case reports published in high impact journals from January 1 to June 1, 2020. Case reports were coded for patient sex, country of institutional affiliation, physiological system, and first and last author gender. Of 494 total case reports, 45% (n = 221) of patients were male, 30% (n = 146) were female, and 25% (n = 124) included both sexes. Ratios of male-only to female-only case reports varied by physiological system. The majority of case reports had male first (61%, n = 302) and last (70%, n = 340) authors. Case reports with male last authors were more likely to describe male patients [X2 (2, n = 465) = 6.6, p = 0.037], while case reports with female last authors were more likely to include patients of both sexes [OR = 1.918 (95% CI = 1.163–3.16)]. Despite a limited sample size, these data reflect emerging research on sex-differences in the physiological presentation and impact of Covid-19 and parallel large-scale trends in authorship patterns. Ultimately, this work highlights potential biases in the dissemination of clinical information via case reports and underscores the inextricable influences of sex and gender biases within biomedicine.
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Affiliation(s)
- Aysha E Salter-Volz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Abigail Oyasu
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lutfiyya N Muhammad
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Nicole C Woitowich
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Kassi LA, McQueen DB, Kimelman D, Confino R, Yeh C, Hutchinson A, Jain T, Boots C, Zhang J, Steinmiller J, Pavone ME. Body mass index, not race, may be associated with an alteration in early embryo morphokinetics during in vitro fertilization. J Assist Reprod Genet 2021; 38:3091-3098. [PMID: 34806132 PMCID: PMC8666401 DOI: 10.1007/s10815-021-02350-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the relationship between maternal body mass index (BMI) and embryo morphokinetics on time-lapse microscopy (TLM). DESIGN Retrospective cohort study. METHODS All IVF cycles between June 2015 and April 2017 were reviewed. Female BMI prior to egg retrieval was collected through chart review. BMI (kg/m2) classification included underweight (< 18.5), normal weight (18.5-25), overweight (25-30), and obese (≥ 30). Embryos' morphokinetic parameters were assessed with TLM and included time to syngamy, 2-cell, 3-cell, 4-cell, and 8-cell. A generalized linear mixed model was used to control for potential confounders and multiple embryos resulting from a single IVF cycle. RESULTS A total of 2150 embryos from 589 IVF cycles were reviewed and included in the analysis. Classification based on BMI was as follows: underweight (N = 56), normal weight (N = 1252), overweight (N = 502), and obese (N = 340). After adjusting for race and use of intracytoplasmic sperm injection, the mean time to the 8-cell stage in the underweight group was 4.3 (95% CI: - 8.31, - 0.21) h less than in the normal weight group (P = 0.025) and 4.6 (95% CI: - 8.8, - 0.21) h less than in the obese group (p = 0.022). No significant difference was noted between race and TLM after controlling for possible confounders. CONCLUSIONS Embryos from underweight women were demonstrated to have a faster time to the 8-cell stage than normal weight or obese women. No significant difference was noted for race. This study demonstrates that weight can be a factor contributing to embryo development as observed with TLM.
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Affiliation(s)
- Luce A Kassi
- Department of Obstetrics and Gynecology, Northwestern University, 676 N Saint Clair, Suite 2310, 250 E. Superior Street, Chicago, IL, 60611, USA
| | - Dana B McQueen
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, USA
| | - Dana Kimelman
- Centro de Esterilidad Montevideo, Uruguay, Alumni Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rafael Confino
- Department of Obstetrics and Gynecology, Northwestern University, 676 N Saint Clair, Suite 2310, 250 E. Superior Street, Chicago, IL, 60611, USA
| | - Chen Yeh
- Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anne Hutchinson
- Department of Obstetrics and Gynecology, Northwestern University, 676 N Saint Clair, Suite 2310, 250 E. Superior Street, Chicago, IL, 60611, USA
| | - Tarun Jain
- Department of Obstetrics and Gynecology, Northwestern University, 676 N Saint Clair, Suite 2310, 250 E. Superior Street, Chicago, IL, 60611, USA
| | - Christina Boots
- Department of Obstetrics and Gynecology, Northwestern University, 676 N Saint Clair, Suite 2310, 250 E. Superior Street, Chicago, IL, 60611, USA
| | - John Zhang
- Department of Obstetrics and Gynecology, Northwestern University, 676 N Saint Clair, Suite 2310, 250 E. Superior Street, Chicago, IL, 60611, USA
| | - Jaclyn Steinmiller
- Department of Obstetrics and Gynecology, Northwestern University, 676 N Saint Clair, Suite 2310, 250 E. Superior Street, Chicago, IL, 60611, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Northwestern University, 676 N Saint Clair, Suite 2310, 250 E. Superior Street, Chicago, IL, 60611, USA.
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Larson D, Yeh C, Rafferty M, Bega D. High satisfaction and improved quality of life with Rock Steady Boxing in Parkinson's disease: results of a large-scale survey. Disabil Rehabil 2021; 44:6034-6041. [PMID: 34498995 DOI: 10.1080/09638288.2021.1963854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare demographics, self-reported symptom burden, Health-Related Quality of Life (HRQL), and Self-Efficacy for Exercise (SEE) between participants and non-participants of Rock Steady Boxing (RSB), a non-contact boxing program for individuals with Parkinson's disease (PD) that focuses on agility, balance, and speed training. MATERIALS AND METHODS Adults with PD who had heard of RSB completed a 20 min, 61-question electronic survey including the Parkinson's Disease Questionnaire-39 (PDQ-39) and the Self-Efficacy for Exercise (SEE) scale. Differences between participants and never-participants were analyzed using chi-squared test, fisher's exact test and Wilcoxon test. RESULTS Of 2054 individuals enrolled in the survey, 1709 were eligible for analysis. 1333 were current participants, 166 previous-participants, and 210 never-participants. RSB participants were median age 69, 59% male, and 97% Caucasian. The majority of current participants reported that RSB improved their social life (70%), fatigue (63%), fear of falling (62%), depression (60%), and anxiety (59%). Compared to previous and never-participants, current participants had better median PDQ-39 scores (36 and 32 vs 25, p < 0.01) and SEE scores (43 and 48 vs 54, p < 0.01). CONCLUSIONS This is the largest survey of RSB use in PD. RSB participants report improvement in non-motor impairments and have significantly better HRQL and ESE compared to never-participants.IMPLICATIONS FOR REHABILITATIONParkinson's disease (PD) is a slowly progressive neurodegenerative condition that affects motor function and subsequently, quality of life.Exercise is increasingly recognized as an important treatment for motor and non-motor symptoms of PD.Rock Steady Boxing (RSB) is a specific non-contact boxing program for PD that is growing and increasing in popularity, though there is limited data on its effect on PD symptoms and quality of life.
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Affiliation(s)
- Danielle Larson
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Miriam Rafferty
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation and Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danny Bega
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Patel GB, Kudlaty EA, Guo A, Yeh C, Kim MS, Price CP, Conley D, Grammer LC, Kalhan R, Kern RC, McGrath KG, Tan BK, Rosenberg SR, Schleimer RP, Smith SS, Stevens WW, Welch KC, Peters AT. Impact of type 2 targeting biologics on acute exacerbations of chronic rhinosinusitis. Allergy Asthma Proc 2021; 42:417-424. [PMID: 34474711 DOI: 10.2500/aap.2021.42.210058] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Acute exacerbations of chronic rhinosinusitis (AECRS) are associated with significant morbidity and decreased quality of life. There are sparse data assessing the real-world impact of biologics on AECRS. Objectives: We sought to determine the impact of type 2-targeting biologics on the frequency of medication use for AECRS episodes. Methods: Antibiotic and/or systemic corticosteroid courses for AECRS were identified in a retrospective study from November 2015 to February 2020, at a single academic health system. The estimated yearly rates for antibiotic and corticosteroid courses were evaluated before and after initiation of type 2 biologics. Results: One-hundred and sixty-five patients with chronic rhinosinusitis (CRS) had received either omalizumab (n = 12), mepolizumab (n = 42), benralizumab (n = 44), dupilumab (n = 61), or reslizumab (n = 6). Seventy percent had CRS with nasal polyps, and 30% had CRS without nasal polyps. All the patients had asthma. When all the biologics were combined, the estimated yearly rate for antibiotics for AECRS decreased from 1.34 (95% confidence interval [CI], 1.12-1.59) to 0.68 (95% CI, 0.52-0.88) with biologic use (49% reduction, p < 0.001). Those with frequent AECRS (three or more courses of antibiotics in the 1 year before biologic use) had a larger degree of reduction, with an estimated yearly rate of 4.15 (95% CI, 3.79-4.55) to 1.58 (95% CI, 1.06-2.35) with biologic use (n = 27; 62% reduction; p < 0.001). Within the total cohort, the estimated yearly rate for systemic corticosteroids for AECRS decreased from 1.69 (95% CI, 1.42-2.02) to 0.68 (95% CI, 0.53-0.88) with biologic use (60% reduction; p < 0.001). Conclusion: Type 2-targeting biologics reduced medication use for AECRS. This suggested that biologics may be a therapeutic option for patients with frequent AECRS.
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Affiliation(s)
- Gayatri B. Patel
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A. Kudlaty
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amina Guo
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Margaret S. Kim
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Caroline P.E. Price
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David Conley
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leslie C. Grammer
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and
| | - Robert C. Kern
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kris G. McGrath
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bruce K. Tan
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sharon R. Rosenberg
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and
| | - Robert P. Schleimer
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephanie S. Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Whitney W. Stevens
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin C. Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anju T. Peters
- From the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Bhasin A, Smith GR, Gupta A, Zhou S, Yeh C, Lee J, O'Leary KJ. Effects of Changes to Hospitalist Admitter Staffing on Hospitalist Perception of Workload. J Gen Intern Med 2021; 36:2488-2489. [PMID: 32583339 PMCID: PMC8342638 DOI: 10.1007/s11606-020-05961-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ajay Bhasin
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine , Evanston, IL, 60208, USA.
| | - G Randy Smith
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine , Evanston, IL, 60208, USA
| | - Ashish Gupta
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine , Evanston, IL, 60208, USA
| | - Shuhan Zhou
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine , Evanston, IL, 60208, USA
| | - Chen Yeh
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Evanston, IL, 60208, USA
| | - Jungwha Lee
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Evanston, IL, 60208, USA
| | - Kevin J O'Leary
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine , Evanston, IL, 60208, USA
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29
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King NR, Lin E, Yeh C, Wong JMK, Friedman J, Traylor J, Tsai S, Chaudhari A, Milad MP. Laparoscopic Major Vascular Injuries in Gynecologic Surgery for Benign Indications: A Systematic Review. Obstet Gynecol 2021; 137:434-442. [PMID: 33543898 DOI: 10.1097/aog.0000000000004280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the incidence, location, etiology, and mortality of major vascular injuries in gynecologic laparoscopy for benign indications. DATA SOURCES A systematic review of PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and MEDLINE was conducted. METHODS OF STUDY SELECTION One thousand ninety-seven studies were screened for inclusion with 147 full-text articles reviewed. Sixty-six studies published between 1978 and 2016 met inclusion criteria, representing 197,062 surgeries. Articles that were included reported the incidence of major vascular injuries during gynecologic laparoscopy for benign indications. Exclusion criteria included surgery for gynecologic malignancy, duplicated data, case series and reports, manuscripts not in English, and studies published only as abstracts. TABULATION, INTEGRATION, AND RESULTS Injuries to the aorta, inferior vena cava, iliac (common, external, or internal), and inferior epigastric vessels were recorded, as were injuries denoted as major but not otherwise specified. A total of 179 major vascular injuries were reported with an incidence of 0.09% (95% CI 0.08-0.10). The inferior epigastric vessels were the most commonly injured vessel (0.04%, 95% CI 0.03-0.05), comprising 48% (95% CI 40-55) of all injuries. The majority of injuries occurred during abdominal entry (82%, 95% CI 76-89), and the remainder occurred during surgical dissection (18%, 95% CI 11-24). Most injuries were recognized intraoperatively (93%, 95% CI 87-100), and approximately half (55%, 95% CI 46-63) required laparotomy for repair. Only two of the 179 major vascular injuries resulted in death, for an overall mortality rate from vascular injuries of 0.001% (95% CI 0.000-0.004). CONCLUSION The incidence of major vascular injury during gynecologic laparoscopy found in this review is very low, and the vast majority of injuries did not result in death. Laparoscopy remains a safe surgical technique in relation to vascular injuries when performed for benign gynecologic disease.
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Affiliation(s)
- Nathan R King
- Department of Obstetrics and Gynecology and the Division of Biostatistics, Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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30
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Sokol LL, Bega D, Yeh C, Kluger BM, Lum HD. Disparities in Palliative Care Utilization Among Hospitalized People With Huntington Disease: A National Cross-Sectional Study. Am J Hosp Palliat Care 2021; 39:516-522. [PMID: 34291654 DOI: 10.1177/10499091211034419] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People with Huntington's disease (HD) often become institutionalized and more frequently die away from the home setting. The reasons behind differences in end-of-life care are poorly understood. Less than 5% of people with HD report utilization of palliative care (PC) or hospice services, regardless of the lack of curative therapies for this neurodegenerative disease. It is unknown what factors are associated with in-patient specialty PC consultation in this population and how PC might be related to discharge disposition. OBJECTIVES To determine what HD-specific (e.g., psychosis) and serious illness-specific factors (e.g., resuscitation preferences) are associated with PC encounters in people with HD and explore how PC encounters are associated with discharge disposition. DESIGN We analyzed factors associated with PC consultation for people with HD using discharge data from the National Inpatient Sample and the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. An anonymized, cross-sectional, and stratified sample of 20% of United States hospitalizations from 2007 through 2014 were included using ICD-9 codes. RESULTS 8521 patients with HD were admitted to the hospital. Of those, 321 (3.8%) received specialty PC. Payer type, (specifically private insurer or other insurer as compared to Medicare), income, (specifically the top quartile as compared to the bottom quartile), mortality risk, D.N.R., aspiration pneumonia, and depression were significantly associated with PC in a multivariate model. Among those who received PC, the odds ratio (OR) of discharge to a facility was 0.43 (95% CI, 0.32-0.58), whereas the OR of discharge to home with services was 2.25 (95% CI 1.57-3.23), even after adjusting for possible confounders. CONCLUSIONS Among patients with HD, economic factors, depression, and serious illness-specific factors were associated with PC, and PC was associated with discharge disposition. These findings have implications for the adaptation of inpatient PC models to meet the needs of persons with HD.
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Affiliation(s)
- Leonard L Sokol
- The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Movement Disorders, The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventive Medicine, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hillary D Lum
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.,Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Diebold A, Johnson JK, Brennan M, Ciolino JD, Petitclerc A, Wakschlag LS, Garfield CF, Yeh C, Lovejoy A, Zakieh D, Tandon SD. Testing the effects of a prenatal depression preventive intervention on parenting and young children's self-regulation and functioning (EPIC): protocol for a longitudinal observational study. BMC Public Health 2021; 21:1368. [PMID: 34246233 PMCID: PMC8271322 DOI: 10.1186/s12889-021-11385-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Perinatal depression is a pervasive public health concern that disproportionately affects low-income women and can have negative impacts on parenting and child developmental outcomes. Few interventions focus on preventing perinatal depression. Previous studies suggest that Mothers and Babies is efficacious in preventing the worsening of depressive symptoms and the onset of postpartum depression. This manuscript presents the protocol of the EPIC study (Effects of a Prenatal Depression Preventive Intervention on parenting and young children's Self-Regulation and Functioning) to test the effects of Mothers and Babies on parenting and child developmental outcomes through 54 months postpartum. EPIC is an observational study that builds on a completed cluster-randomized trial (CRT). Innovations of this study are direct observations of a subsample of mother-child dyads and the inclusion of fathers/caregivers' variables as moderators of maternal mental health. METHODS For this study, we plan to enroll 738 women with children under 30 months old, ≥18 years old, and who speak English or Spanish. Additionally, 429 fathers, partners, or other adult caregivers will be recruited through women participating in the study. Women will be recruited through the parent study (intervention and control participants) or through one of 10 home visiting programs in Illinois (control participants). Data collection will take place through maternal self-report at five time points (when the child is 30, 36, 42, 48, and 54 months), paternal self-report at three time points (when the child is 30, 42, and 54 months), and through mother-child observations at three time points (when the child is 36, 42, and 48 months). Outcome domains include maternal mental health, cognitive-behavioral and parenting skills, and child self-regulation and functioning. Moderators include the contributions of fathers/caregivers, race-ethnicity, and socioeconomic disadvantage. Power and sample size were calculated assuming a two-sided 5% type I error rate and assumed analyses on the individual level. DISCUSSION This study has several key strengths and innovations, as well as great potential significance to influence the long-term trajectories of parenting and child development via prenatal intervention. TRIAL REGISTRATION The study was retrospectively registered at ClinicalTrials.gov (Identifier: NCT04296734 ) on March 5, 2020.
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Affiliation(s)
- Alicia Diebold
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA.
| | - Jessica K Johnson
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Marianne Brennan
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Jody D Ciolino
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | | | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2100, Chicago, IL, 60611, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 St. Clair Street, Chicago, IL, 60611, USA
| | - Craig F Garfield
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2100, Chicago, IL, 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, 633 St. Clair Street, Suite 19-059, Chicago, IL, 60611, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 St. Clair Street, Chicago, IL, 60611, USA
| | - Chen Yeh
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Aiko Lovejoy
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Dana Zakieh
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - S Darius Tandon
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2100, Chicago, IL, 60611, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 St. Clair Street, Chicago, IL, 60611, USA
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Abstract
OBJECTIVES Hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity. Larger groups often assign a single hospitalist to triage pager duty which can be burdensome due to frequent interruptions and multitasking. We introduced a new role, the Triage nurse, to hold the triage pager and distribute patients. We sought to determine the effect of this Triage Nurse on the perceived workload of hospitalists and frequency of pages. METHODS We partnered with our patient throughput department to implement the Triage Nurse role who took the responsibility of tracking and distributing admissions among three admitting physicians along with coordinating report. We used the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) to measure perceived workload and accessed pager logs of admitters for 3 months before and after implementation. RESULTS Overall, 50 of an expected 67 NASA-TLX surveys (74.6%) were returned in the pre-intervention period and 64 of 92 (69.6%) were returned in the post-intervention period. We found a statistically significant reduction in the domains of physical demand, temporal demand, effort and frustration from pre- to post-intervention periods (p < 0.01). There was also a significant decrease in the performance domain (p = 0.01) with a lower number indicative of better perceived performance. There was a significant reduction in the mean number of pages received by admitting hospitalists over their 9-h shifts (81.3 + 17.3 vs 52.4 + 7.3; p < 0.01). CONCLUSION The implementation of the Triage Nurse role was associated with a significant decrease in the perceived workload of admitting hospitalists. Our findings are important because workload and interruptions can contribute to errors and burnout. Future studies should test interventions to improve hospitalist workload and evaluate their effect on patient outcomes and physician wellness.
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Affiliation(s)
- Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nita Kulkarni
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachel M Cyrus
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Biostatistics Collaboration Center, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ralph JA, Yeh C, Cowett A, Hirschhorn LR, Hammond C. Get PrEPPT (pre-exposure prophylaxis and pregnancy termination): an exploration of the values, attitudes and preferences regarding HIV and PrEP among women seeking abortion. BMJ Sex Reprod Health 2021; 47:e6. [PMID: 33122259 DOI: 10.1136/bmjsrh-2020-200623] [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] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) for the prevention of HIV transmission is under utilised by women in the US. Women seeking abortion have a higher HIV prevalence than women who continue prenatal care and could benefit from HIV risk assessment and PrEP counselling. We assessed the knowledge, attitudes, and preferences of women seeking abortion care regarding their HIV risk and knowledge of PrEP, and identified individual and system barriers to PrEP access. METHODS We performed a cross sectional descriptive study of English speaking women at a freestanding abortion clinic through an anonymous survey. Participants with indications for PrEP care included those who performed sex work, experienced a recent sexually transmitted infection, or had multiple sexual partners and inconsistent condom use. We performed descriptive statistics on response data; Wilcoxon tests were used to compare continuous variables across groups. RESULTS 64 (32.3%) participants had indications for PrEP, but only 31 (16.1%) had previous knowledge of PrEP. After the concept was explained, attitudes towards PrEP were generally positive, and 54 participants (27.8%) would consider starting PrEP in the next 6 months. Participants were most interested in receiving PrEP care from their primary care provider rather than from an abortion clinic. CONCLUSIONS Among women seeking abortion, women vulnerable to HIV infection outnumbered those with PrEP knowledge by 2 to 1. Prior knowledge of PrEP as an HIV prevention method was low, but women found PrEP acceptable. While women reported preferring to receive PrEP from a primary care provider, the abortion clinic visit may also represent an important time for HIV education and risk screening.
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Affiliation(s)
- Jessika Ann Ralph
- Obstetrics and Gynecology, Section of Family Planning, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chen Yeh
- Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Allison Cowett
- Obstetrics and Gynecology, Section of Family Planning, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa R Hirschhorn
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cassing Hammond
- Obstetrics and Gynecology, Section of Family Planning, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Smith GR, Ramalingam S, Zhou S, Yeh C, Lee J, O'Leary KJ. The Effect of Reducing Intravenous Push Opioid Use on Hospital Medicine Patients' Pain Experience during Hospitalization. Pain Med 2021; 23:669-675. [PMID: 34181019 DOI: 10.1093/pm/pnab205] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the efficacy of a program to limit the use of the IV push route for opioids on the experience of pain by inpatients and on associated safety events. DESIGN Retrospective cohort study. SETTING Two inpatient general medicine floor units at an urban tertiary care academic medical center. SUBJECTS 4752 inpatient opioid recipients. METHODS Patients on one unit were exposed to a multidisciplinary intervention to limit prescription of opioids via the IV push route, with the other unit used as a control unit. The primary study outcome was mean numeric pain score per patient during the hospital stay. Secondary measures included hospital length of stay and post-discharge patient satisfaction. Fidelity measures included percentage of patient population exposed to each opioid administration route and amount of opioid administered per route. Safety measures included patient disposition, transfer to intensive care, and incidence of naloxone administration. RESULTS The intervention was successful in decreasing both percentage of patients exposed to IV push opioids and amount of opioid administered via the IV push route, but no associated changes in other study outcomes were identified. CONCLUSIONS For treatment of acute pain in medical inpatients, no evidence of benefit or harm was identified in relation to increase or decrease in use of the IV push opioid route.
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Affiliation(s)
- G Randy Smith
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sridevi Ramalingam
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shuhan Zhou
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chen Yeh
- Biostatistics Clinical Collaborative, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jungwha Lee
- Biostatistics Clinical Collaborative, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Diebold A, Ciolino JD, Johnson JK, Yeh C, Gollan JK, Tandon SD. Comparing Fidelity Outcomes of Paraprofessional and Professional Delivery of a Perinatal Depression Preventive Intervention. Adm Policy Ment Health 2021; 47:597-605. [PMID: 32086657 PMCID: PMC7253394 DOI: 10.1007/s10488-020-01022-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mothers and Babies (MB), a perinatal depression preventive intervention, has proven effective in decreasing depressive symptoms and preventing onset of major depression. An ongoing cluster-randomized trial is comparing the effectiveness of the six-session MB group intervention led by paraprofessionals versus mental health professionals. Twenty percent of all audio-recorded intervention sessions were randomly selected for fidelity checks. Analyses assessed mean facilitator adherence and competency overall, by study arm, and by session; and, examined site, facilitator, and client-specific effects. There were no significant differences found between study arms. Findings show paraprofessionals can deliver MB with similar fidelity as mental health professionals.
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Affiliation(s)
- Alicia Diebold
- Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Suite 643, Chicago, IL, 60611, USA.
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jessica K Johnson
- Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Suite 643, Chicago, IL, 60611, USA
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jackie K Gollan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - S Darius Tandon
- Department of Medical Social Sciences, Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Dahl CM, Zhang Y, Ong JX, Yeh C, Son M, Miller ES, Roy A, Grobman WA. Patient characteristics associated with complications of external cephalic version. Am J Obstet Gynecol MFM 2021; 3:100411. [PMID: 34058425 DOI: 10.1016/j.ajogmf.2021.100411] [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: 03/22/2021] [Revised: 04/25/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient characteristics associated with external cephalic version success are well documented; however, the association between patient characteristics and the likelihood of external cephalic version complications is poorly understood. OBJECTIVE This study aimed to assess the frequency of patient characteristics associated with complications that lead to unanticipated delivery during external cephalic version. STUDY DESIGN This retrospective study included pregnant women aged at least 18 years with singleton gestations who underwent an external cephalic version attempt between 2006 and 2016 at a single quaternary care center. External cephalic version complications were defined as persistent nonreassuring fetal status, placental abruption, labor, spontaneous rupture of membranes, and umbilical cord prolapse. Complications were only considered if they led to unanticipated induction or cesarean delivery within 24 hours of external cephalic version. Patient characteristics including maternal age, height, weight, body mass index, parity, fetal sex, gestational age, estimated fetal weight, the type of fetal malpresentation, and placental location were analyzed for their association with external cephalic version complications using univariable analysis and multivariable logistic regressions. RESULTS Among the 1138 patients included in this analysis, external cephalic version complications occurred in 6.7% (n=76). These complications (not mutually exclusive) included nonreassuring fetal status (4.8%, n=55), placental abruption (1.6%, n=18), labor (1.0%, n=11), spontaneous rupture of membranes (0.6%, n=7), and cord prolapse (0.1%, n=1). Neonatal outcomes for those with complications included intensive care unit admission (10.5%, n=8), 5-minute Apgar scores <5 (1.3%, n=1), cord arterial pH <7 (6.6%, n=5), head cooling (1.3%, n=1), and anemia (6.6%, n=5). There were no perinatal deaths. In multivariable analysis, higher body mass index (adjusted odds ratio, 0.90 per kg/m2; 95% confidence interval, 0.84-0.97) and estimated fetal weight (adjusted odds ratio, 0.998 per gram; 95% confidence interval 0.998-0.999) were associated with decreased likelihood of experiencing external cephalic version complications, whereas greater gestational age at procedure (adjusted odds ratio, 1.95 per week; 95% confidence interval, 1.4-2.7) and anterior placental location (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.7) were associated with increased likelihood of experiencing external cephalic version complications. CONCLUSION In this large series, complications that led to delivery during external cephalic version occurred in 6.7% patients and were associated with body mass index, estimated fetal weight, gestational age, and placental location.
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Affiliation(s)
- Carly M Dahl
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman); Feinberg School of Medicine, Northwestern University, Chicago, IL (Dr Dahl, Mr Zhang, and Ms Ong).
| | - Yue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, IL (Dr Dahl, Mr Zhang, and Ms Ong)
| | - Janice X Ong
- Feinberg School of Medicine, Northwestern University, Chicago, IL (Dr Dahl, Mr Zhang, and Ms Ong)
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (Ms Yeh)
| | - Moeun Son
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman); Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT (Dr Son)
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman)
| | - Archana Roy
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman)
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman)
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Dieguez A, Yeh C, Rasmussen-Torvik L, Torchen LC. Peripubertal Anti-Mullerian Hormone Levels Are Associated With Hyperandrogenemia During Adolescence: The Avon Longitudinal Study of Parents and Children. J Endocr Soc 2021. [PMCID: PMC8265995 DOI: 10.1210/jendso/bvab048.1476] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is among the most common endocrine disorders in women and is associated with negative reproductive and metabolic outcomes including subfertility, pregnancy complications, metabolic syndrome, and type 2 diabetes. The diagnosis of PCOS cannot be made until reproductive maturity, when the diagnostic criteria of hyperandrogenemia and oligomenorrhea develop. However, studies have described early metabolic and reproductive characteristics of the disorder in girls at increased risk, suggesting the pathogenesis starts much earlier. Indeed, studies in animal models suggest that exposure to excessive androgen or anti-Mullerian hormone (AMH) levels during critical developmental periods can program the offspring to develop the metabolic and reproductive features of PCOS during reproductive maturity. We investigated early maternal or peripubertal factors associated with hyperandrogenemia during adolescence using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a United Kingdom birth cohort which has been ongoing since 1991. We performed linear regression to test for an association of testosterone levels at 15 years with peripubertal reproductive and metabolic phenotypes and with maternal measures of insulin sensitivity. Peripubertal phenotypes included AMH levels at 7, 9, and 11 years, and androstenedione, DHEAS, SHBG, IGF-1, fasting insulin, QUICKI, post-glucose insulin, leptin and adiponectin at age 8 years. Maternal phenotypes included fasting insulin levels and QUICKI at a post-partum visit. Unadjusted and adjusted analyses including the covariates pubertal stage, ethnicity, maternal and daughter BMI were performed. Testosterone levels at age 15 years were significantly positively associated with AMH levels at ages 7(N=299), 9(N=295), and 11(N=300) years in both the adjusted and unadjusted models (Age 7 unadjusted P<0.0001, adjusted P=0.01; Age 9 unadjusted P<0.0001, adjusted P=0.003; Age 11 unadjusted P<0.0001, adjusted P=0.02). Testosterone at age 15 years was also associated with DHEAS at age 8 years using the unadjusted (P<0.0001) but not the adjusted model. There was no significant association between any of the other peripubertal metabolic and reproductive phenotypes or the maternal metabolic phenotypes of fasting insulin and QUICKI with testosterone level at age 15 years. We have found a persistent and significant positive association of AMH levels at pre- or peri-pubertal ages with testosterone levels during adolescence, a developmental stage at which a clinical diagnosis of PCOS can be made. It remains unclear if this early elevation in AMH contributes to the pathogenesis of hyperandrogenemia or is an early marker of PCOS. Nonetheless, these findings suggest there are early differences in the reproductive phenotype in girls with hyperandrogenemia, even before the onset of puberty.
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Affiliation(s)
- Abigayil Dieguez
- Ann & Robert H Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kontrick AV, VanWagner LB, Yeh C, Courtney DM. Hepatic Steatosis: An Incidental Finding That Deserves Attention. Acad Emerg Med 2021; 28:578-581. [PMID: 33210438 DOI: 10.1111/acem.14174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Amy V. Kontrick
- From the Department of Emergency Medicine and Medical Education Northwestern University Feinberg School of Medicine Chicago ILUSA
| | - Lisa B. VanWagner
- the Department of Medicine‐Gastroenterology & Hepatology and Preventive Medicine‐Epidemiology Northwestern University Feinberg School of Medicine Chicago ILUSA
| | - Chen Yeh
- and the Division of Biostatistics Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago ILUSA
| | - D. Mark Courtney
- and the Department of Emergency Medicine UT Southwestern Medical Center Dallas TXUSA
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Mou T, Warner K, Brown O, Yeh C, Beestrum M, Kenton K, Emi Bretschneider C. Prevalence of pelvic organ prolapse among US racial populations: A systematic review and meta-analysis of population-based screening studies. Neurourol Urodyn 2021; 40:1098-1106. [PMID: 33834519 DOI: 10.1002/nau.24672] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/11/2020] [Revised: 01/13/2021] [Accepted: 03/19/2021] [Indexed: 11/08/2022]
Abstract
AIMS To determine the differences in pooled prevalence rates of symptomatic pelvic organ prolapse (POP) across different US racial/ethnic groups using existing screening-based epidemiologic studies. METHODS A systematic search of MEDLINE, EMBASE, Cochrane, and Scopus was conducted to retrieve eligible studies. We included studies that identified POP by either physical exam or questionnaire, conducted in non-gynecologic care-seeking settings, and had a representative sample of US community-dwelling women from more than one racial/ethnic group with prevalence rates reported for each population. Meta-analysis was performed with the pooled estimates calculated, and χ 2 tests were performed to examine the associations between race and POP prevalence. RESULTS Of the 2604 studies reviewed, 5 were included. One study used physical exam findings while others used questionnaires to identify POP. All but one study demonstrated statistically significant differences in POP prevalence rates based on race/ethnicity. The overall pooled POP prevalence rates were determined for each racial/ethnic group-White women: 10.76% (95% confidence interval [CI], 10.30%-11.22%); Hispanic women: 6.55% (95% CI, 5.83%-7.28%); Black women: 3.80% (95% CI, 3.22%-4.38%); and Asian American women: 3.40% (95% CI, 2.09%-4.71%). There was a significant difference in the pooled prevalence rates among these four racial/ethnic groups (p < 0.01). CONCLUSIONS Our study found that White women had the highest pooled POP prevalence rate overall, while Hispanic women had the highest pooled prevalence among minority women. Additionally, American Indians and Pacific Islanders were absent from the current prolapse epidemiologic literature.
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Affiliation(s)
- Tsung Mou
- Division of Female Pelvic Medicine and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kristina Warner
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Chen Yeh
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Molly Beestrum
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Carol Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Byrd TF, Kim JS, Yeh C, Lee J, O'Leary KJ. Technology acceptance and critical mass: Development of a consolidated model to explain the actual use of mobile health care communication tools. J Biomed Inform 2021; 117:103749. [PMID: 33766780 DOI: 10.1016/j.jbi.2021.103749] [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: 10/24/2020] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Secure mobile communication technologies are being implemented at an increasing rate across health care organizations, though providers' use of these tools can remain limited by a perceived lack of other users to communicate with. Enabling acceptance and driving provider utilization of these tools throughout an organization requires attention to the interplay between perceived peer usage (i.e. perceived critical mass) and local user needs within the social context of the care team (e.g. inpatient nursing access to the mobile app). To explain these influences, we developed and tested a consolidated model that shows how mobile health care communication technology acceptance and utilization are influenced by the moderating effects of social context on perceptions about the technology. METHODS The theoretical model and questionnaire were derived from selected technology acceptance models and frameworks. Survey respondents (n = 1254) completed items measuring perceived critical mass, perceived usefulness, perceived ease of use, personal innovativeness in information technology, behavioral intent, and actual use of a recently implemented secure mobile communication tool. Actual use was additionally measured by logged usage data. Use group was defined as whether a hospital's nurses had access to the tool (expanded use group) or not (limited use group). RESULTS The model accounted for 61% and 72% of the variance in intent to use the communication tool in the limited and expanded use groups, respectively, which in turn accounted for 53% and 33% of actual use. The total effects coefficient of perceived critical mass on behavioral intent was 0.57 in the limited use group (95% CI 0.51-0.63) and 0.70 in the expanded use group (95% CI 0.61-0.80). CONCLUSION Our model fit the data well and explained the majority of variance in acceptance of the tool amongst participants. The overall influence of perceived critical mass on intent to use the tool was similarly large in both groups. However, the strength of multiple model pathways varied unexpectedly by use group, suggesting that combining sociotechnical moderators with traditional technology acceptance models may produce greater insights than traditional technology acceptance models alone. Practically, our results suggest that healthcare institutions can drive acceptance by promoting the recruitment of early adopters though liberal access policies and making these users and the technology highly visible to others.
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Affiliation(s)
- Thomas F Byrd
- Department of Medicine (Hospital Medicine), Northwestern University Feinberg School of Medicine, USA.
| | - Jane S Kim
- Department of Medicine (Hospital Medicine), Northwestern University Feinberg School of Medicine, USA
| | - Chen Yeh
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jungwha Lee
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Department of Medicine (Hospital Medicine), Northwestern University Feinberg School of Medicine, USA
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Organ M, Tandon SD, Diebold A, Johnson JK, Yeh C, Ciolino JD. Evaluating performance of covariate-constrained randomization (CCR) techniques under misspecification of cluster-level variables in cluster-randomized trials. Contemp Clin Trials Commun 2021; 22:100754. [PMID: 33732943 PMCID: PMC7941091 DOI: 10.1016/j.conctc.2021.100754] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/12/2020] [Accepted: 02/09/2021] [Indexed: 11/27/2022] Open
Abstract
Covariate constrained randomization (CCR) is a method of controlling imbalance in important baseline covariates in cluster-randomized trials (CRT). We use simulated CRTs to investigate the performance (control of imbalance) of CCR relative to simple randomization (SR) under conditions of misspecification of the cluster-level variable used in the CCR algorithm. We use data from a Patient-Centered Outcomes Research Institute (PCORI)-funded CRT evaluating the Mothers and Babies (MB) intervention (AD-1507-31,473). CCR methodology was used in the MB study to control imbalance in, among other baseline variables, the percent minority (i.e., non-White) participants at each study site. Simulation schemes explored variation in degree of misspecification in the baseline covariate of interest, and include correct report, observed misspecification, and a range of simulated misspecification for intervals within and beyond that observed in the MB study. We also consider three within-site sample size scenarios: that observed in the MB study, small (mean 10) and large (mean 50). Simulations at every level of baseline covariate misspecification suggest that use of the CCR strategy provides between-arm imbalance that is simultaneously lower and less variable, on average, than that produced from the SR strategy. We find that the gains to using CCR over SR are nearly twice as high with accurate reporting (Δ = -5.33) compared to the observed study-level misspecification (Δ = -3.03). Although CCR still outperforms SR as the level of misspecification increases, the gains to using CCR over SR decrease; thus, every effort should still be made to obtain high-quality baseline data.
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Affiliation(s)
- Madeleine Organ
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, USA.,Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alicia Diebold
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica K Johnson
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jody D Ciolino
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Danilovich M, Achenbach C, Yeh C, Balmert L, Berzins B. High Intensity Walking Reduces Frailty and Improves Physical Function Among Older Adults Living With HIV. Innov Aging 2020. [PMCID: PMC7741018 DOI: 10.1093/geroni/igaa057.568] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Walking is a preferred mode of exercise for older adults, yet limited evidence exists on the optimal intensity to promote health gains, particularly among those with the frailty syndrome. Older adults aging with HIV have physical function impairments and higher prevalence of frailty, yet there is a paucity of evidence on therapeutic options to help these individuals maintain or improve their physical functioning. The purpose of this study was to investigate the feasibility and efficacy of a high intensity walking training (HIWT) intervention for pre-frail and frail older adults living with HIV. We enrolled n=11 older adults (>50 years of age and pre-frail or frail on the SHARE-FI). Participants underwent 16 walking sessions 2x/week consisting of 5 minute intervals of stair climbing, fast walking, weighted walking, balance tasks, and steps ups for a total of 30 minutes of high intensity (>70% of HRmax or >15 Rating of Perceived Exertion) activity. All participants were able to achieve the targeted high intensity levels throughout the sessions. We used a t-test to compare pre-post test means on a variety of physical performance measures. We found statistically significant improvements in the frailty score on the SHARE-FI, PROMIS fatigue, self-selected gait speed, Short Physical Performance Battery (SPPB), and Six Minute Walk Test. Importantly, all improvements were far above minimally clinically important differences suggesting this novel exercise approach may contribute to substantial improvements in physical function to reduce frailty in this population of older adults. Participants had no adverse events and were highly satisfied with training.
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Affiliation(s)
| | - Chad Achenbach
- Northwestern University, Chicago, Illinois, United States
| | - Chen Yeh
- Northwestern University, Chicago, United States
| | - Lauren Balmert
- Northwestern University, Chicago, Illinois, United States
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Kudlaty E, Patel GB, Prickett ML, Yeh C, Peters AT. Efficacy of type 2-targeted biologics in patients with asthma and bronchiectasis. Ann Allergy Asthma Immunol 2020; 126:302-304. [PMID: 33271296 DOI: 10.1016/j.anai.2020.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/27/2020] [Accepted: 11/23/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Elizabeth Kudlaty
- Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gayatri B Patel
- Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michelle L Prickett
- Divison of Pulmonary and Critical Care, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Wenderott JK, Flesher CG, Baker NA, Neeley CK, Varban OA, Lumeng CN, Muhammad LN, Yeh C, Green PF, O'Rourke RW. Elucidating nanoscale mechanical properties of diabetic human adipose tissue using atomic force microscopy. Sci Rep 2020; 10:20423. [PMID: 33235234 PMCID: PMC7686328 DOI: 10.1038/s41598-020-77498-w] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/11/2020] [Indexed: 01/07/2023] Open
Abstract
Obesity-related type 2 diabetes (DM) is a major public health concern. Adipose tissue metabolic dysfunction, including fibrosis, plays a central role in DM pathogenesis. Obesity is associated with changes in adipose tissue extracellular matrix (ECM), but the impact of these changes on adipose tissue mechanics and their role in metabolic disease is poorly defined. This study utilized atomic force microscopy (AFM) to quantify difference in elasticity between human DM and non-diabetic (NDM) visceral adipose tissue. The mean elastic modulus of DM adipose tissue was twice that of NDM adipose tissue (11.50 kPa vs. 4.48 kPa) to a 95% confidence level, with significant variability in elasticity of DM compared to NDM adipose tissue. Histologic and chemical measures of fibrosis revealed increased hydroxyproline content in DM adipose tissue, but no difference in Sirius Red staining between DM and NDM tissues. These findings support the hypothesis that fibrosis, evidenced by increased elastic modulus, is enhanced in DM adipose tissue, and suggest that measures of tissue mechanics may better resolve disease-specific differences in adipose tissue fibrosis compared with histologic measures. These data demonstrate the power of AFM nanoindentation to probe tissue mechanics, and delineate the impact of metabolic disease on the mechanical properties of adipose tissue.
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Affiliation(s)
- J K Wenderott
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60201, USA
| | - Carmen G Flesher
- Department of Surgery, Section of General Surgery, University of Michigan Medical School, 2210 Taubman Center-5343, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5343, USA
| | - Nicki A Baker
- Department of Surgery, Section of General Surgery, University of Michigan Medical School, 2210 Taubman Center-5343, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5343, USA
| | - Christopher K Neeley
- Department of Surgery, Section of General Surgery, University of Michigan Medical School, 2210 Taubman Center-5343, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5343, USA
| | - Oliver A Varban
- Department of Surgery, Section of General Surgery, University of Michigan Medical School, 2210 Taubman Center-5343, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5343, USA
| | - Carey N Lumeng
- Graduate Program in Immunology, University of Michigan, Ann Arbor, MI, 48109, USA
- Graduate Program in Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Lutfiyya N Muhammad
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Chen Yeh
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60201, USA
| | - Peter F Green
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, 48109, USA.
- National Renewable Energy Laboratory, Golden, CO, 80401, USA.
| | - Robert W O'Rourke
- Department of Surgery, Section of General Surgery, University of Michigan Medical School, 2210 Taubman Center-5343, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5343, USA.
- Department of Surgery, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, 48109, USA.
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Bhasin A, Nam H, Yeh C, Lee J, Liebovitz D, Achenbach C. Is BMI Higher in Younger Patients with COVID-19? Association Between BMI and COVID-19 Hospitalization by Age. Obesity (Silver Spring) 2020; 28:1811-1814. [PMID: 32610371 PMCID: PMC7361943 DOI: 10.1002/oby.22947] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Obesity has been found to be a risk factor for hospitalization with coronavirus disease (COVID-19). This study investigated whether patients hospitalized with COVID-19 differed in BMI at older versus younger ages and whether trends were independent of diabetes and hypertension. METHODS A cross-sectional analysis of patients hospitalized with moderate to severe COVID-19 at Northwestern Memorial Hospital from March 19, 2020, until April 4, 2020, was performed. Patients hospitalized with COVID-19 above and below the age of 50 were compared as well as those hospitalized without COVID-19. RESULTS Patients younger than 50 years of age hospitalized with COVID-19 without diabetes or hypertension had mean BMI greater than those older than 50 years of age, with BMI 43.1 (95% CI: 34.5-51.7) versus 30.1 (95% CI: 27.7-32.5) (P = 0.02). Furthermore, BMI appeared to inversely correlate with increasing age among patients hospitalized with COVID-19. We did not detect the same difference or trend for patients hospitalized without COVID-19. CONCLUSIONS Younger patients (age < 50 years) with COVID-19 had higher mean BMI than older patients with COVID-19, with and without diabetes and hypertension. This trend did not exist in patients without COVID-19 hospitalized during the same time period.
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Affiliation(s)
- Ajay Bhasin
- Department of MedicineDivision of Hospital MedicineNorthwestern Memorial HospitalFeinberg School of MedicineChicagoIllinoisUSA
| | - Hannah Nam
- Department of MedicineDivision of Infectious DiseasesNorthwestern Memorial HospitalFeinberg School of MedicineChicagoIllinoisUSA
| | - Chen Yeh
- Department of Preventive MedicineDivision of BiostatisticsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jungwha Lee
- Department of Preventive MedicineDivision of BiostatisticsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - David Liebovitz
- Department of MedicineDivision of General Internal Medicine and GeriatricsNorthwestern Memorial HospitalFeinberg School of MedicineChicagoIllinoisUSA
| | - Chad Achenbach
- Department of MedicineDivision of Infectious DiseasesNorthwestern Memorial HospitalFeinberg School of MedicineChicagoIllinoisUSA
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Larson D, Kwa L, Bega D, Yeh C. Influence of age of onset on Huntington's disease phenotype. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.392] [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: 10/22/2022]
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Kwa L, Larson D, Yeh C, Bega D. Influence of Age of Onset on Huntington's Disease Phenotype. Tremor Other Hyperkinet Mov (N Y) 2020; 10:21. [PMID: 32775035 PMCID: PMC7394225 DOI: 10.5334/tohm.536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 11/20/2022] Open
Abstract
Background Older patients with Huntington's disease (HD) are often thought to have a slower progressing disease course with less behavioral symptoms than younger patients. However, phenotypic differences based on age of onset have not been well characterized in a large HD population. This study will determine the difference in manifestations and disease progression between patients with young, typical, and late onset adult HD at different stages of disease. Methods Data obtained from Enroll-HD. Adults with manifest HD were included. Age groups were defined as young onset (YO: 20-29 years), typical onset (TO: 30-59 years), and late onset (LO: 60+ years). Subjects were categorized by TFC score, from Stage I (least severe) to Stage V (most severe). Motor, cognitive, and behavioral symptoms were analyzed. Descriptive statistics and Bonferroni p-value correction for pairwise comparison were calculated. Results 7,311 manifest HD participants were included (612 YO, 5,776 TO, and 923 LO). The average decline in TFC score from baseline to second visit (1.5-2.5 years) was significantly faster for YO (-1.75 points) compared to TO (-1.23 points, p = 0.0105) or LO (-0.97 points, p = 0.0017). Motor deficits were worse for LO participants at early stages of HD, and worse for YO participants at advanced stages. YO and TO participants had greater burden of behavioral symptoms at early stages of disease compared to LO. Discussion YO is predictive of a faster functional decline for adults with HD when compared to those with TO and LO. Motor and behavioral manifestations differ based on age of onset. Highlights This study compares HD manifestations while controlling for disease severity, detailing robust phenotypic differences by age of onset alone. These findings have implications for the clinical management of HD symptoms and have the possibility to improve prognostic and treatment precision.
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Affiliation(s)
- Lauren Kwa
- Northwestern University Feinberg School of Medicine, US
| | - Danielle Larson
- Northwestern University Feinberg School of Medicine, Department of Neurology, US
| | - Chen Yeh
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, US
| | - Danny Bega
- Northwestern University Feinberg School of Medicine, Department of Neurology, US
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Kominiarek MA, Yeh C, Balmert LC, Facco F, Grobman W, Simon M. Sleep Duration during Pregnancy using an Activity Tracking Device. AJP Rep 2020; 10:e309-e314. [PMID: 33094020 PMCID: PMC7571555 DOI: 10.1055/s-0040-1715172] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to describe sleep duration across gestation in women who wore an activity-tracking device (ATD) during pregnancy, and to study the association between sleep duration and adverse maternal and neonatal outcomes Study Design Women ≥ 18 years old who owned a smartphone were approached to participate in 2016 to 2017. Participants received instructions to wear and sync an ATD daily. Steps, sedentary hours, and sleep duration were wirelessly transmitted via cellular technology. We measured sleep duration for the main episode of sleep and excluded sleep times < 120 minutes. Mixed models were used to assess the trajectory of mean weekly hours of sleep by gestational age. Secondary analyses evaluated differences in pregnancy outcomes between insufficient (< 7/24 hours) and sufficient sleep (≥ 7/24 hours) groups, based on mean hours of sleep within the first 7 days of ATD use. Results The majority of 94 participants self-reported minority racial-ethnic status (33% non-Hispanic black and 51% Hispanic), had government insurance (83%), were nulliparous (61%), and had pre-pregnancy overweight or obesity (56%). The mean (standard deviation) duration of sleep was 7.2 ± 2.4 hours per 24 hours. In mixed models analyses, gestational age was statistically significantly associated with mean hours of sleep ( β = -0.02; 95% confidence interval: -0.04 to -0.01; p < 0.001). Women who had < 7 hours of sleep had greater median daily steps compared with those who had ≥ 7 hours of sleep (median: 7,122; interquartile range [IQR]: 5,167-8,338 vs. median: 5,005; IQR: 4,115-7,059; p < 0.01), but there were no significant differences in other outcomes (sedentary time, gestational weight gain, pregnancy associated hypertension, gestational diabetes, gestational age at delivery, cesarean delivery, or mean birthweight), p > 0.05 for all comparisons. Conclusion The mean sleep duration was 7.2 ± 2.4 hours among the 94 women in this cohort and decreased with advancing gestational age. Further research is required to evaluate sleep measurements with ATD in pregnant women and how sleep duration and quality is related to maternal and neonatal outcomes.
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Affiliation(s)
- Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren C Balmert
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Francesca Facco
- Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melissa Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Chhiba KD, Patel GB, Vu THT, Chen MM, Guo A, Kudlaty E, Mai Q, Yeh C, Muhammad LN, Harris KE, Bochner BS, Grammer LC, Greenberger PA, Kalhan R, Kuang FL, Saltoun CA, Schleimer RP, Stevens WW, Peters AT. Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19. J Allergy Clin Immunol 2020; 146:307-314.e4. [PMID: 32554082 PMCID: PMC7295471 DOI: 10.1016/j.jaci.2020.06.010] [Citation(s) in RCA: 206] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/23/2022]
Abstract
Background The Centers for Disease Control and Prevention advises that patients with moderate to severe asthma belong to a high-risk group that is susceptible to severe coronavirus disease 2019 (COVID-19). However, the association between asthma and COVID-19 has not been well-established. Objective The primary objective was to determine the prevalence of asthma among patients with COVID-19 in a major US health system. We assessed the clinical characteristics and comorbidities in asthmatic and nonasthmatic patients with COVID-19. We also determined the risk of hospitalization associated with asthma and/or inhaled corticosteroid use. Methods Medical records of patients with COVID-19 were searched by a computer algorithm (March 1 to April 15, 2020), and chart review was used to validate the diagnosis of asthma and medications prescribed for asthma. All patients had PCR-confirmed COVID-19. Demographic and clinical features were characterized. Regression models were used to assess the associations between asthma and corticosteroid use and the risk of COVID-19–related hospitalization. Results Of 1526 patients identified with COVID-19, 220 (14%) were classified as having asthma. Asthma was not associated with an increased risk of hospitalization (relative risk, 0.96; 95% CI, 0.77-1.19) after adjusting for age, sex, and comorbidities. The ongoing use of inhaled corticosteroids did not increase the risk of hospitalization in a similar adjusted model (relative risk, 1.39; 95% CI, 0.90-2.15). Conclusions Despite a substantial prevalence of asthma in our COVID-19 cohort, asthma was not associated with an increased risk of hospitalization. Similarly, the use of inhaled corticosteroids with or without systemic corticosteroids was not associated with COVID-19–related hospitalization.
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Affiliation(s)
- Krishan D Chhiba
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Gayatri B Patel
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Thanh Huyen T Vu
- Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Michael M Chen
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Amina Guo
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Elizabeth Kudlaty
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Quan Mai
- Department of Feinberg Information and Technology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lutfiyya N Muhammad
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kathleen E Harris
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Bruce S Bochner
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Leslie C Grammer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Paul A Greenberger
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Fei Li Kuang
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Carol A Saltoun
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Raiker N, Ramani M, Kinahan K, Yeh C, Kaye P, Didwania A, Winter J, Akhter N, Rigolin VH. CARDIOVASCULAR DISEASE IN ADULT SURVIVORS OF PEDIATRIC CANCERS: ROLE OF A MULTIDISCIPLINARY SURVIVORSHIP CLINIC IN IDENTIFICATION AND CARE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32550-x] [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: 10/24/2022]
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