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von Itzstein MS, Hullings M, Mayo H, Beg MS, Williams EL, Gerber DE. Application of Information Technology to Clinical Trial Evaluation and Enrollment: A Review. JAMA Oncol 2021; 7:1559-1566. [PMID: 34236403 DOI: 10.1001/jamaoncol.2021.1165] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance As cancer treatment has become more individualized, oncologic clinical trials have become more complex. Increasingly numerous and stringent eligibility criteria frequently include tumor molecular or genomic characteristics that may not be readily identified in medical records, rendering it difficult to best match clinical trials with clinical sites and to identify potentially eligible patients once a clinical trial has been selected and activated. Partly because of these factors, enrollment rates for cancer clinical trials remain low, creating delays and increased costs for drug development. Information technology (IT) platforms have been applied to the implementation and conduct of clinical trials to improve efficiencies in several medical fields, and these platforms have recently been introduced to oncologic studies. Observations This review summarizes cancer and noncancer studies that used IT platforms for assistance with clinical trial site selection, patient recruitment, and patient screening. The review does not address the use of IT in other aspects of clinical research, such as wearable physical activity monitors or telehealth visits. A large number of IT platforms (which may be patient facing, site or investigator facing, or sponsor facing) are now commercially available. These applications use artificial intelligence and/or natural language processing to identify and summarize protocol eligibility criteria, institutional patient populations, and individual electronic health records. Although there is an expanding body of literature examining the role of this technology, relatively few studies to date have been performed in oncologic settings. Conclusions and Relevance This review found that an increasing number and variety of IT platforms were available to assist in the planning and conduct of clinical trials. Because oncologic clinical care and clinical trial protocols are particularly complex, nuanced, and individualized, published experience with this technology in other fields may not be fully applicable to cancer settings. The extent to which these services will overcome ongoing and increasing challenges in cancer clinical research remains unclear.
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Affiliation(s)
- Mitchell S von Itzstein
- Department of Internal Medicine, Division of Hematology-Oncology, The University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas
| | - Melanie Hullings
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas
| | - Helen Mayo
- Southwestern Health Sciences Digital Library and Learning Center, The University of Texas, Dallas
| | - M Shaalan Beg
- Department of Internal Medicine, Division of Hematology-Oncology, The University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas
| | - Erin L Williams
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas
| | - David E Gerber
- Department of Internal Medicine, Division of Hematology-Oncology, The University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas.,Department of Population and Data Sciences, The University of Texas, Southwestern Medical Center, Dallas
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Bowen E, Nayfe R, Milburn N, Mayo H, Reid MC, Fraenkel L, Weiner D, Halm EA, Makris UE. Do Decision Aids Benefit Patients with Chronic Musculoskeletal Pain? A Systematic Review. Pain Med 2021; 21:951-969. [PMID: 31880805 DOI: 10.1093/pm/pnz280] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain. METHODS We performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting. RESULTS Of 477 records screened, 17 met the inclusion criteria. Chronic musculoskeletal pain conditions included osteoarthritis of the hip, knee, or trapeziometacarpal joint and back pain. Thirteen studies evaluated the use of a decision aid for deciding between surgical and nonsurgical management. The remaining four studies evaluated decision aids for nonsurgical treatment options. Outcomes included decision quality, pain, function, and surgery utilization. The effects of decision aids on decision-making outcomes were mixed. Comparing decision aids with usual care, all five studies that examined knowledge scores found improvement in patient knowledge. None of the four studies that evaluated satisfaction with the decision-making process found a difference with use of a decision aid. There was limited and inconsistent data on other decision-related outcomes. Of the eight studies that evaluated surgery utilization, seven found no difference in surgery rates with use of a decision aid. Five studies made comparisons between different types of decision aids, and there was no clearly superior format. CONCLUSIONS Decision aids may improve patients' knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes. Future efforts should focus on improving the effectiveness of decision aids and incorporating nonpharmacologic and nonsurgical management options.
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Affiliation(s)
- Emily Bowen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Rabih Nayfe
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Nathaniel Milburn
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas, Texas
| | - M C Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, New York
| | - Liana Fraenkel
- Yale University School of Medicine, New Haven, Connecticut
| | - Debra Weiner
- Geriatric Research, Education and Clinical Center, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Medicine, Psychiatry, Anesthesiology and Clinical & Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ethan A Halm
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Una E Makris
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.,Department of Medicine, VA North Texas Health Care System, Dallas, Texas, USA
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3
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Daniel CM, Davila L, Makris UE, Mayo H, Caplan L, Davis L, Solow EB. Ethnic Disparities in Atherosclerotic Cardiovascular Disease Incidence and Prevalence Among Rheumatoid Arthritis Patients in the United States: a Systematic Review. ACR Open Rheumatol 2020; 2:525-532. [PMID: 32869533 PMCID: PMC7504478 DOI: 10.1002/acr2.11170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/17/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Rheumatoid arthritis (RA) is associated with increased atherosclerotic cardiovascular disease (ASCVD). General population cohorts have shown African American individuals to have greater and Hispanic Americans to have lower cardiovascular disease prevalence when compared with non‐Hispanic white individuals; however, the reasons for these findings are not clear. This systematic review seeks to describe the incidence and prevalence of ASCVD stratified by race/ethnicity within the US RA population. Methods MEDLINE, Embase, and Cochrane databases were searched for studies that reported incidence or prevalence of ASCVD (including, but not limited to, fatal and nonfatal stroke, myocardial infarction, and cardiovascular death) in those with RA. Abstracts and full texts were screened separately for inclusion by two reviewers, with a third reviewer to resolve discrepancies. Results We screened 2625 abstracts and fully reviewed 138 manuscripts. Twenty‐one were included that cited at a minimum the percentage of non‐Hispanic whites in their population. No publication meeting entry criteria initially stratified ASCVD by race/ethnicity. The average prevalent ASCVD in RA is 46.9% (95% CI: 46.8–47) (range of prevalent ASCVD: 30%‐47%). The average incident ASCVD is 8.2% (95% CI: 8.14–8.25) (range of incident ASCVD 1%–46%). Conclusion In this systematic review, we found a paucity of data on racially/ethnically diverse RA patients and ASCVD outcomes. Future studies should report the prevalence of ASCVD in various races/ethnicities with RA in the United States. These data would help inform clinicians on how best to manage cardiovascular disease risk in RA.
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Affiliation(s)
| | - Lesley Davila
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Una E Makris
- University of Texas Southwestern Medical Center, Dallas, Texas and Medical Service VA North Texas Health Care System, Dallas, Texas
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas, Texas
| | - Liron Caplan
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado and University of Colorado, Aurora
| | | | - E Blair Solow
- University of Texas Southwestern Medical Center, Dallas, Texas
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Comish PB, Madni TD, Nakonezny PA, Mayo H, Imran JB, Kuhlenschmidt KM, Taveras LR, Vela RJ, Goldenmerry YL, Clark AT, Weis HB, Cripps MW, Wolf SE. An analysis of surgical literature trends over four decades. Am J Surg 2020; 221:53-54. [PMID: 32711859 DOI: 10.1016/j.amjsurg.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Paul B Comish
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
| | - Tarik D Madni
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Paul A Nakonezny
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Helen Mayo
- Department of Education, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan B Imran
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | | | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Ryan J Vela
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | | | - Audra T Clark
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Holly B Weis
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Arora S, Shemisa K, Vaduganathan M, Qamar A, Gupta A, Garg SK, Kumbhani DJ, Mayo H, Khalili H, Pandey A, Das SR. Premature Ticagrelor Discontinuation in Secondary Prevention of Atherosclerotic CVD: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:2454-2464. [PMID: 31097167 DOI: 10.1016/j.jacc.2019.03.470] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/03/2019] [Indexed: 01/22/2023]
Abstract
Ticagrelor is a cornerstone of modern antithrombotic therapy alongside aspirin in patients with acute coronary syndrome and after percutaneous coronary intervention. Adverse effects such as bleeding and dyspnea have been associated with premature ticagrelor discontinuation, which may limit any potential advantage of ticagrelor over clopidogrel. The randomized trials of ticagrelor captured adverse events, offering the opportunity to more precisely quantify these effects across studies. Therefore, a meta-analysis of 4 randomized clinical trials of ticagrelor conducted between January 2007 and June 2017 was performed to quantify the incidence and causes of premature ticagrelor discontinuation. Among 66,870 patients followed for a median 18 months, premature ticagrelor discontinuation was seen in 25%; bleeding was the most common cause of discontinuation followed by dyspnea. Versus the comparators, the relative risk of dyspnea-related discontinuation during follow-up was 6.4-fold higher, the relative risk of bleeding was 3.2-fold higher, and the relative risk of discontinuation due to any adverse event was 59% higher for patients receiving ticagrelor. Understanding these potential barriers to adherence to ticagrelor is crucial for informed patient-physician decision making and can inform future efforts to improve ticagrelor adherence. This review discusses the incidence, causes, and biological mechanisms of ticagrelor-related adverse effects and offers strategies to improve adherence to ticagrelor.
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Affiliation(s)
- Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kamal Shemisa
- Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Muthiah Vaduganathan
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arman Qamar
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ankur Gupta
- Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Sushil K Garg
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Houman Khalili
- Department of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Sandeep R Das
- Department of Medicine, Florida Atlantic University, Boca Raton, Florida.
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Murphy CC, Sen A, Watson B, Gupta S, Mayo H, Singal AG. A Systematic Review of Repeat Fecal Occult Blood Tests for Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2019; 29:278-287. [PMID: 31740521 DOI: 10.1158/1055-9965.epi-19-0775] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Screening with fecal occult blood tests (FOBT) reduces colorectal cancer mortality. Failure to complete repeat tests may compromise screening effectiveness. We conducted a systematic review of repeat FOBT across diverse health care settings. We searched MEDLINE, Embase, and the Cochrane Library for studies published from 1997 to 2017 and reported repeat FOBT over ≥2 screening rounds. Studies (n = 27 reported in 35 articles) measured repeat FOBT as (i) proportion of Round 1 participants completing repeat FOBT in Round 2; (ii) proportion completing two, consecutive FOBT; or (iii) proportion completing ≥3 rounds. Among those who completed FOBT in Round 1, 24.6% to 89.6% completed repeat FOBT in Round 2 [median: 82.0%; interquartile range (IQR): 73.7%-84.6%]. The proportion completing FOBT in two rounds ranged from 16.4% to 80.0% (median: 46.6%; IQR: 40.5%-50.0%), and in studies examining ≥3 rounds, repeat FOBT ranged from 0.8% to 64.1% (median: 39.2%; IQR: 19.7%-49.4%). Repeat FOBT appeared higher in mailed outreach (69.1%-89.6%) compared with opportunistic screening (24.6%-48.6%). Few studies examined correlates of repeat FOBT. In summary, we observed a wide prevalence of repeat FOBT, and prevalence generally declined in successive screening rounds. Interventions that increase and maintain participation in FOBT are needed to optimize effectiveness of this screening strategy.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas.
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Ahana Sen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Bianca Watson
- Department of Psychiatry and Behavioral Sciences, Tulane School of Medicine, New Orleans, Louisiana
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, UC San Diego, San Diego, California
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas Texas
| | - Amit G Singal
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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7
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Smith LN, Makam AN, Darden D, Mayo H, Das SR, Halm EA, Nguyen OK. Acute Myocardial Infarction Readmission Risk Prediction Models: A Systematic Review of Model Performance. Circ Cardiovasc Qual Outcomes 2019; 11:e003885. [PMID: 29321135 DOI: 10.1161/circoutcomes.117.003885] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hospitals are subject to federal financial penalties for excessive 30-day hospital readmissions for acute myocardial infarction (AMI). Prospectively identifying patients hospitalized with AMI at high risk for readmission could help prevent 30-day readmissions by enabling targeted interventions. However, the performance of AMI-specific readmission risk prediction models is unknown. METHODS AND RESULTS We systematically searched the published literature through March 2017 for studies of risk prediction models for 30-day hospital readmission among adults with AMI. We identified 11 studies of 18 unique risk prediction models across diverse settings primarily in the United States, of which 16 models were specific to AMI. The median overall observed all-cause 30-day readmission rate across studies was 16.3% (range, 10.6%-21.0%). Six models were based on administrative data; 4 on electronic health record data; 3 on clinical hospital data; and 5 on cardiac registry data. Models included 7 to 37 predictors, of which demographics, comorbidities, and utilization metrics were the most frequently included domains. Most models, including the Centers for Medicare and Medicaid Services AMI administrative model, had modest discrimination (median C statistic, 0.65; range, 0.53-0.79). Of the 16 reported AMI-specific models, only 8 models were assessed in a validation cohort, limiting generalizability. Observed risk-stratified readmission rates ranged from 3.0% among the lowest-risk individuals to 43.0% among the highest-risk individuals, suggesting good risk stratification across all models. CONCLUSIONS Current AMI-specific readmission risk prediction models have modest predictive ability and uncertain generalizability given methodological limitations. No existing models provide actionable information in real time to enable early identification and risk-stratification of patients with AMI before hospital discharge, a functionality needed to optimize the potential effectiveness of readmission reduction interventions.
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Affiliation(s)
- Lauren N Smith
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Anil N Makam
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Douglas Darden
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Helen Mayo
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Sandeep R Das
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Ethan A Halm
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Oanh Kieu Nguyen
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.).
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Abstract
BACKGROUND Over the past decade, nearly half of internal medicine residencies have implemented block clinic scheduling; however, the effects on residency-related outcomes are unknown. The authors systematically reviewed the impact of block versus traditional ambulatory scheduling on residency-related outcomes, including (1) resident satisfaction, (2) resident-perceived conflict between inpatient and outpatient responsibilities, (3) ambulatory training time, (4) continuity of care, (5) patient satisfaction, and (6) patient health outcomes. METHOD The authors reviewed the following databases: Ovid MEDLINE, Ovid MEDLINE InProcess, EBSCO CINAHL, EBSCO ERIC, and the Cochrane Library from inception through March 2017 and included studies of residency programs comparing block to traditional scheduling with at least one outcome of interest. Two authors independently extracted data on setting, participants, schedule design, and the outcomes of interest. RESULTS Of 8139 studies, 11 studies of fair to moderate methodologic quality were included in the final analysis. Overall, block scheduling was associated with marked improvements in resident satisfaction (n = 7 studies, effect size range - 0.3 to + 0.9), resident-perceived conflict between inpatient and outpatient responsibilities (n = 5, effect size range + 0.3 to + 2.6), and available ambulatory training time (n = 5). Larger improvements occurred in programs implementing short (1 week) ambulatory blocks. However, block scheduling may result in worse physician continuity (n = 4). Block scheduling had inconsistent effects on patient continuity (n = 4), satisfaction (n = 3), and health outcomes (n = 3). DISCUSSION Although block scheduling improves resident satisfaction, conflict between inpatient and outpatient responsibilities, and ambulatory training time, there may be important tradeoffs with worse care continuity.
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Affiliation(s)
- Ami L DeWaters
- Department of Internal Medicine, Pennsylvania State Hershey Medical Center, Hershey, PA, USA.
| | - Hilda Loria
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Helen Mayo
- Department of Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Alia Chisty
- Department of Internal Medicine, Temple University, Philadelphia, PA, USA
| | - Oanh K Nguyen
- Department of Medicine, University of California, San Francisco, CA, USA
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Rao S, Pandey A, Garg S, Park B, Mayo H, Després JP, Kumbhani D, de Lemos JA, Neeland IJ. Effect of Exercise and Pharmacological Interventions on Visceral Adiposity: A Systematic Review and Meta-analysis of Long-term Randomized Controlled Trials. Mayo Clin Proc 2019; 94:211-224. [PMID: 30711119 PMCID: PMC6410710 DOI: 10.1016/j.mayocp.2018.09.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/07/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the effectiveness of exercise and pharmacotherapy interventions in reducing visceral adipose tissue (VAT). PATIENTS AND METHODS A systematic search of Ovid MEDLINE, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, New York Academy of Science Grey Literature Report, and OpenGrey was combined with hand searches of existing literature. A total of 2515 titles and abstracts were reviewed. Only randomized controlled trials evaluating the effectiveness of monitored exercise or pharmacological interventions in reducing VAT by using computed tomography or magnetic resonance imaging during a sustained intervention period (≥6 months) were included. Data were independently extracted by reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed for quality and risk of bias. Separate analyses for each intervention were performed using random effect models, with pooled estimates of the change in VAT area (in centimeters squared) from baseline to follow-up reported as standardized mean difference (SMD; with 95% CI). RESULTS A total of 3602 participants from 17 randomized controlled trials were included in the final analysis. Both exercise and pharmacological interventions were associated with significant reductions in VAT: small reduction with pharmacological interventions (SMD, -0.27; 95% CI, -0.47 to -0.07; P=.02) and more substantial reductions with exercise interventions (SMD, -0.54; 95% CI, -0.63 to -0.46; P<.001). The mean absolute VAT reduction was greater in pharmacological trials than in exercise trials. Meta-regression exhibited a linear correlation between VAT and weight loss (R2=0.52 for exercise and R2=0.88 for pharmacological interventions), but VAT reduction relative to weight loss differed by intervention type. CONCLUSION Exercise interventions resulted in greater reduction in VAT relative to weight loss than did pharmacological interventions. A preferential reduction in VAT may be clinically meaningful when monitoring success of interventions because weight loss alone may underestimate benefits.
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Affiliation(s)
- Shreya Rao
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sushil Garg
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis
| | - Bryan Park
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center, Dallas
| | | | - Dharam Kumbhani
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ian J Neeland
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
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Affiliation(s)
- Charles Swan
- Institute of Medical and Veterinary ScienceAdelaideSouth Australia
| | - A. L. Tostevin
- Institute of Medical and Veterinary ScienceAdelaideSouth Australia
| | | | - Helen Mayo
- Institute of Medical and Veterinary ScienceAdelaideSouth Australia
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11
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Pandey A, Salahuddin U, Garg S, Ayers C, Kulinski J, Anand V, Mayo H, Kumbhani DJ, de Lemos J, Berry JD. Continuous Dose-Response Association Between Sedentary Time and Risk for Cardiovascular Disease: A Meta-analysis. JAMA Cardiol 2018; 1:575-83. [PMID: 27434872 DOI: 10.1001/jamacardio.2016.1567] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Prior studies suggest that higher sedentary time is associated with a greater risk for cardiovascular disease (CVD). However, the quantitative, dose-response association between sedentary time and CVD risk is not known. OBJECTIVE To determine the categorical and quantitative dose-response association between sedentary time and CVD risk. DATA SOURCES Two independent investigators searched the MEDLINE and EMBASE databases for all studies published before July 6, 2015, that evaluated the association between sedentary time and incident CVD. STUDY SELECTION Prospective cohort studies with participants 18 years or older that reported the association between sedentary time and incident CVD were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators performed the data extraction and collection using a standardized form. The study quality was assessed using the Newcastle-Ottawa Scale. The categorical dose-response association was evaluated by comparing the pooled hazard ratio (HR) for incident CVD associated with different levels of sedentary time (vs lowest sedentary time) across studies. The continuous dose-response association was assessed using random-effects generalized least squares spline models. Data were collected from April 5 to July 6, 2015. MAIN OUTCOMES AND MEASURES Incident CVD (coronary heart disease, including nonfatal myocardial infarction, stroke, and cardiovascular mortality). RESULTS Nine prospective cohort studies with 720 425 unique participants (57.1% women; 42.9% men; mean age, 54.5 years) and 25 769 unique cardiovascular events and a median follow-up of 11 years were included. In categorical analyses, compared with the lowest sedentary time category (median, 2.5 h/d), participants in the highest sedentary time category (median, 12.5 h/d) had an increased risk for CVD (HR, 1.14; 95% CI, 1.09-1.19). However, no apparent risk associated with intermediate levels of sedentary time (HR for 7.5 h/d, 1.02; 95% CI, 0.96-1.08) was found. In continuous analyses, a nonlinear association between sedentary time and incident CVD was found (P for nonlinearity < .001), with an increased risk observed for more than 10 hours of sedentary time per day (pooled HR, 1.08; 95% CI, 1.00-1.14). CONCLUSIONS AND RELEVANCE The association between sedentary time and the risk for CVD is nonlinear with an increased risk only at very high levels. These findings could have implications for guideline recommendations regarding the risks related to sedentary behavior.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Usman Salahuddin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sushil Garg
- Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas3Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | | | - Vidhu Anand
- Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis
| | - Helen Mayo
- University of Texas Southwestern Medical Center Library, Dallas
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - James de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas3Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
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Shemisa K, Pandey A, Mayo H, Kumbhani D, Das S. INCIDENCE AND ETIOLOGY OF PREMATURE TICAGRELOR DISCONTINUATION ACROSS FOUR MAJOR CLINICAL TRIALS: A META-ANALYSIS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30544-8] [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: 10/17/2022]
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Rich NE, Oji S, Mufti AR, Browning JD, Parikh ND, Odewole M, Mayo H, Singal AG. Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2018; 16:198-210.e2. [PMID: 28970148 PMCID: PMC5794571 DOI: 10.1016/j.cgh.2017.09.041] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/21/2017] [Accepted: 09/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, affecting 75-100 million Americans. However, the disease burden may not be equally distributed among races or ethnicities. We conducted a systematic review and meta-analysis to characterize racial and ethnic disparities in NAFLD prevalence, severity, and prognosis. METHODS We searched MEDLINE, EMBASE, and Cochrane databases through August 2016 for studies that reported NAFLD prevalence in population-based or high-risk cohorts, NAFLD severity including presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis, and NAFLD prognosis including development of cirrhosis complications and mortality. Pooled relative risks, according to race and ethnicity, were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. RESULTS We identified 34 studies comprising 368,569 unique patients that characterized disparities in NAFLD prevalence, severity, or prognosis. NAFLD prevalence was highest in Hispanics, intermediate in Whites, and lowest in Blacks, although differences between groups were smaller in high-risk cohorts (range 47.6%-55.5%) than population-based cohorts (range, 13.0%-22.9%). Among patients with NAFLD, risk of NASH was higher in Hispanics (relative risk, 1.09; 95% CI, 0.98-1.21) and lower in Blacks (relative risk, 0.72; 95% CI, 0.60-0.87) than Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial or ethnic groups. Data were limited and discordant on racial or ethnic disparities in outcomes of patients with NAFLD. CONCLUSIONS In a systematic review and meta-analysis, we found significant racial and ethnic disparities in NAFLD prevalence and severity in the United States, with the highest burden in Hispanics and lowest burden in Blacks. However, data are discordant on racial or ethnic differences in outcomes of patients with NAFLD.
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Affiliation(s)
- Nicole E. Rich
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Stefany Oji
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Arjmand R. Mufti
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | - Neehar D. Parikh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Mobolaji Odewole
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas TX
| | - Amit G. Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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Abstract
BACKGROUND Nephrolithiasis, or urinary stone disease, in children causes significant morbidity, and is increasing in prevalence in the North American population. Therefore, medical and dietary interventions (MDI) for recurrent urinary stones in children are poised to gain increasing importance in the clinical armamentarium. OBJECTIVES To assess the effects of medical and dietary interventions (MDI) for the prevention of idiopathic urinary stones in children aged from one to 18 years. SEARCH METHODS We searched multiple databases using search terms relevant to this review, including studies identified from the Cochrane Central Register of Controlled Trials (CENTRAL, 2017, Issue 1), MEDLINE OvidSP (1946 to 14 February 2017), Embase OvidSP (1980 to 14 February 2017), International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. Additionally, we handsearched renal-related journals and the proceedings of major renal conferences, and reviewed weekly current awareness alerts for selected renal journals. The date of the last search was 14 February 2017. There were no language restrictions. SELECTION CRITERIA Randomized controlled trials of at least one year of MDI versus control for prevention of recurrent idiopathic (non-syndromic) nephrolithiasis in children. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. Titles and abstracts were identified by search criteria and then screened for relevance, and then data extraction and risk of bias assessment were carried out. We assessed the quality of evidence using GRADE. MAIN RESULTS The search identified one study of 125 children (72 boys and 53 girls) with calcium-containing idiopathic nephrolithiasis and normal renal morphology following initial treatment with shockwave lithotripsy (SWL). Patients were randomized to oral potassium citrate 1 mEq/kg per day for 12 months versus no specific medication or preventive measure with results reported for a total of 96 patients (48 per group). This included children who were stone-free (n = 52) or had residual stone fragments (n = 44) following SWL. Primary outcomes:Medical therapy may lower rates of stone recurrence with a risk ratio (RR) of 0.19 (95% confidence interval (CI) 0.06 to 0.60; low quality evidence). This corresponds to 270 fewer stone recurrences per 1000 (133 fewer to 313 fewer) children. We downgraded the quality of evidence by two levels for very serious study limitations related to unclear allocation concealment (selection bias) and a high risk of performance, detection and attrition bias. While the data for adverse events were incomplete, they reported that six of 48 (12.5%) children receiving potassium citrate left the trial because of adverse effects. This corresponds to a RR of 13.0 (95% CI 0.75 to 224.53; very low quality evidence); an absolute effect size estimate could not be generated. We downgraded the quality of evidence for study limitations and imprecision.We found no information on retreatment rates. SECONDARY OUTCOMES We found no evidence on serum electrolytes, 24-hour urine collection parameters or time to new stone formation.We were unable to perform any preplanned secondary analyses. AUTHORS' CONCLUSIONS Oral potassium citrate supplementation may reduce recurrent calcium urinary stone formation in children following SWL; however, our confidence in this finding is limited. A substantial number of children stopped the medication due to adverse events. There is no trial evidence on retreatment rates. There is a critical need for additional well-designed trials in children with nephrolithiasis.
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Affiliation(s)
- Adam Kern
- Anne Arundel Medical CenterAnnapolisMDUSA
| | | | - Helen Mayo
- The University of Texas Southwestern Medical CenterUT Southwestern Library5323 Harry Hines BlvdDallasTXUSA75390
| | - Linda A Baker
- Children's Medical Center/University of Texas SouthwesternDepartment of Urology, Division of Pediatric UrologyDallasTXUSA75390
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Abstract
This paper is a synthesis of the available literature on occupational therapy interventions performed in the adult intensive care unit (ICU). The databases of Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and CINAHL databases were systematically searched from inception through August 2016 for studies of adults who received occupational therapy interventions in the ICU. Of 1,938 citations reviewed, 10 studies met inclusion criteria. Only one study explicitly discussed occupational therapy interventions performed and only one study specifically tested the efficacy of occupational therapy. Future research is needed to clarify the specific interventions and role of occupational therapy in the ICU and the efficacy of these interventions.
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Affiliation(s)
- Mark Weinreich
- a Department of Internal Medicine , UT Southwestern Medical Center , Dallas , TX, USA
| | - Jennifer Herman
- b Department of Physical and Occupational Therapy , UT Parkland Health and Hospital System , Dallas , TX, USA
| | - Stephanie Dickason
- b Department of Physical and Occupational Therapy , UT Parkland Health and Hospital System , Dallas , TX, USA
| | - Helen Mayo
- c Health Sciences Digital Library and Learning Center , UT Southwestern Medical Center , Dallas , TX, USA
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Abstract
We conducted a systematic literature review of the data on HIV testing, engagement in care, and treatment in incarcerated persons, and estimated the care cascade in this group. We identified 2706 titles in MEDLINE, EBSCO, and Cochrane Library databases for studies indexed to January 13, 2015, and included 92 for analysis. We summarized HIV testing results by type (blinded, opt-out, voluntary); reviewed studies on HIV care engagement, treatment, and virological suppression; and synthesized these results into an HIV care cascade before, during, and after incarceration. The HIV care cascade following diagnosis increased during incarceration and declined substantially after release, often to levels lower than before incarceration. Incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though new interventions are needed to improve postrelease care continuity.
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Affiliation(s)
- Princess A Iroh
- Princess A. Iroh and Ank E. Nijhawan are with Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas. Helen Mayo is with Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center
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Abstract
IMPORTANCE Metformin is widely viewed as the best initial pharmacological option to lower glucose concentrations in patients with type 2 diabetes mellitus. However, the drug is contraindicated in many individuals with impaired kidney function because of concerns of lactic acidosis. OBJECTIVE To assess the risk of lactic acidosis associated with metformin use in individuals with impaired kidney function. EVIDENCE ACQUISITION In July 2014, we searched the MEDLINE and Cochrane databases for English-language articles pertaining to metformin, kidney disease, and lactic acidosis in humans between 1950 and June 2014. We excluded reviews, letters, editorials, case reports, small case series, and manuscripts that did not directly pertain to the topic area or that met other exclusion criteria. Of an original 818 articles, 65 were included in this review, including pharmacokinetic/metabolic studies, large case series, retrospective studies, meta-analyses, and a clinical trial. RESULTS Although metformin is renally cleared, drug levels generally remain within the therapeutic range and lactate concentrations are not substantially increased when used in patients with mild to moderate chronic kidney disease (estimated glomerular filtration rates, 30-60 mL/min per 1.73 m2). The overall incidence of lactic acidosis in metformin users varies across studies from approximately 3 per 100,000 person-years to 10 per 100,000 person-years and is generally indistinguishable from the background rate in the overall population with diabetes. Data suggesting an increased risk of lactic acidosis in metformin-treated patients with chronic kidney disease are limited, and no randomized controlled trials have been conducted to test the safety of metformin in patients with significantly impaired kidney function. Population-based studies demonstrate that metformin may be prescribed counter to prevailing guidelines suggesting a renal risk in up to 1 in 4 patients with type 2 diabetes mellitus--use which, in most reports, has not been associated with increased rates of lactic acidosis. Observational studies suggest a potential benefit from metformin on macrovascular outcomes, even in patients with prevalent renal contraindications for its use. CONCLUSIONS AND RELEVANCE Available evidence supports cautious expansion of metformin use in patients with mild to moderate chronic kidney disease, as defined by estimated glomerular filtration rate, with appropriate dosage reductions and careful follow-up of kidney function.
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Affiliation(s)
- Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut
| | - Kasia J Lipska
- Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center, Dallas
| | - Clifford J Bailey
- School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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Affiliation(s)
- Gwen Grimsby
- Children's Medical Center/University of Texas Southwestern; Department of Urology, Division of Pediatric Urology; Dallas TX USA 75207
| | - Helen Mayo
- The University of Texas Southwestern; UT Southwestern Library; 5323 Harry Hines Blvd Dallas TX USA 75390
| | - Micah A Jacobs
- Children's Medical Center/University of Texas Southwestern; Department of Urology, Division of Pediatric Urology; Dallas TX USA 75207
| | - Linda A Baker
- Children's Medical Center/University of Texas Southwestern; Department of Urology, Division of Pediatric Urology; Dallas TX USA 75207
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Klam C, Neher JO, Mayo H, Lo V. Clinical inquiries. What is the best medical therapy for new-onset type 2 diabetes? J Fam Pract 2006; 55:998-1000. [PMID: 17090363] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Sulfonylureas, metformin, thiazolidinediones, and non-sulfonylurea secretagogues differ little in their ability to decrease glycosylated hemoglobin (Hb A1c) levels when used as initial monotherapy for diabetes mellitus type 2 (strength of recommendation [SOR]: A, based on systematic reviews); alpha-glucosidase inhibitors may also be as effective (SOR: B, based on systematic reviews with inconsistent results). Metformin is generally indicated in obese patients because it improves all-cause mortality and diabetes related outcomes (SOR: B, based on a single high-quality randomized controlled trial [RCT]). Insulin is generally not recommended as an initial agent (SOR: C, expert opinion).
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Affiliation(s)
- Cheri Klam
- Valley Family Medicine Residency, Renton, WA, USA
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Blum N, Kamens C, Mayo H, Holt J. Clinical inquiries. What treatments are safe and effective for mild to moderate hypertension in pregnancy? J Fam Pract 2004; 53:492-494. [PMID: 15189725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Nancy Blum
- Department of Family Practice and Community Medicine, University of Texas-Southwestern Medical Center, Dallas, TX, USA
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Richmond JR, Babcock CF, Mayo H, Hoekzema G. Clinical inquiries. Are beta-2-agonists or anticholinergics more effective for treating COPD? J Fam Pract 2004; 53:494-496. [PMID: 15189726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- John R Richmond
- University of Texas Southwestern Family Practice Residency Program, Dallas, TX, USA
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22
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Wilson SA, Mayo H, Fisher M. Clinical inquiries. Are tympanostomy tubes indicated for recurrent acute otitis media? J Fam Pract 2003; 52:403-406. [PMID: 12737775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Stephen A Wilson
- University of Pittsburgh Medical Center, St. Margaret Family Practice Residency, Pittsburgh, Pennsylvania, USA
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Reynolds K, Knapik J, Hoyt R, Mayo H, Bremmer J, Jones B. 1234 ASSOCIATION OF TRAINING INJURIES AND PHYSICAL FITNESS IN U. S. ARMY COMBAT ENGINEERS. Med Sci Sports Exerc 1994. [DOI: 10.1249/00005768-199405001-01236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- R A Prehn
- Oaks Psychiatric Hospital, Wilmington, North Carolina
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Just Viera JO, Maldonado C, Rodríguez Fernández H, Mayo H, Dickson R, Brito R, Jiménez C, Rodríguez Franco J, Oms J. Carciac surgery at the San Juan City Hospital 1967-1974: a critical assessment. Bol Asoc Med P R 1975; 67:132-9. [PMID: 1055585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Listgarten MA, Mayo H, Amsterdam M. Ultrastructure of the attachment device between coccal and filamentous microorganisms in "corn cob" formations of dental plaque. Arch Oral Biol 1973; 18:651-6. [PMID: 4515984 DOI: 10.1016/0003-9969(73)90105-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Affiliation(s)
- Helen Mayo
- Mothers and Babies' Health Association Adelaide
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Swan C, Tostevin AL, Mayo H, Black GHB. FURTHER OBSERVATIONS ON CONGENITAL DEFECTS IN INFANTS FOLLOWING INFECTIOUS DISEASES DURING PREGNANCY, WITH SPECIAL REFERENCE TO RUBELLA. Med J Aust 1944. [DOI: 10.5694/j.1326-5377.1944.tb51929.x] [Citation(s) in RCA: 52] [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] [Indexed: 11/17/2022]
Affiliation(s)
- Charles Swan
- Institute of Medical and Veterinary ScienceAdelaideSouth Australia
| | - A. L. Tostevin
- Institute of Medical and Veterinary ScienceAdelaideSouth Australia
| | - Helen Mayo
- Institute of Medical and Veterinary ScienceAdelaideSouth Australia
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Stephens HD, Stephen EHM, Earnshaw PA, Shugg AW, Male LG, Mayo H, McKay DG. Section of Paediatrics. Med J Aust 1937. [DOI: 10.5694/j.1326-5377.1937.tb44002.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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Helen Mayo
- Mothers' and Babies' Health Association
- Adelaide Children's Hospital
- Mareeba Babies' Hospital
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Mayo H. Observations on Ulceration of the Cartilages of Joints, and on Anchylosis. J R Soc Med 1835; 19:48-416.2. [PMID: 20895627 DOI: 10.1177/095952873501900107] [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: 11/16/2022] Open
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Mayo H. On an Acute Form of Ulceration of the Cartilages of Joints. J R Soc Med 1821; 11:104-9. [PMID: 20895402 DOI: 10.1177/09595287210110p107] [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: 11/15/2022] Open
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