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Huffman MD, Baldridge AS, Lazar D, Abbas H, Mejia J, Flowers FM, Quintana A, Jackson A, Kandula NR, Lloyd-Jones DM, Persell SD, Khan SS, Paparello JJ, Chopra A, Tripathi P, Vu MH, Chow CK, Ciolino JD. Efficacy and safety of a four-drug, quarter-dose treatment for hypertension: the QUARTET USA randomized trial. Hypertens Res 2024:10.1038/s41440-024-01658-y. [PMID: 38584159 DOI: 10.1038/s41440-024-01658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 04/09/2024]
Abstract
New approaches are needed to lower blood pressure (BP) given persistently low control rates. QUARTET USA sought to evaluate the effect of four-drug, quarter-dose BP lowering combination in patients with hypertension. QUARTET USA was a randomized (1:1), double-blinded trial conducted in federally qualified health centers among adults with hypertension. Participants received either a quadpill of candesartan 2 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg or candesartan 8 mg for 12 weeks. If BP was >130/>80 mm Hg at 6 weeks in either arm, then participants received open label add-on amlodipine 5 mg. The primary outcome was mean change in systolic blood pressure (SBP) at 12 weeks, controlling for baseline BP. Secondary outcomes included mean change in diastolic blood pressure (DBP), and safety included serious adverse events, relevant adverse drug effects, and electrolyte abnormalities. Among 62 participants randomized between August 2019-May 2022 (n = 32 intervention, n = 30 control), mean (SD) age was 52 (11.5) years, 45% were female, 73% identified as Hispanic, and 18% identified as Black. Baseline mean (SD) SBP was 138.1 (11.2) mmHg, and baseline mean (SD) DBP was 84.3 (10.5) mmHg. In a modified intention-to-treat analysis, there was no significant difference in SBP (-4.8 mm Hg [95% CI: -10.8, 1.3, p = 0.123] and a -4.9 mmHg (95% CI: -8.6, -1.3, p = 0.009) greater mean DBP change in the intervention arm compared with the control arm at 12 weeks. Adverse events did not differ significantly between arms. The quadpill had a similar SBP and greater DBP lowering effect compared with candesartan 8 mg. Trial registration number: NCT03640312.
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Affiliation(s)
- Mark D Huffman
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, MO, USA.
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Abigail S Baldridge
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, USA
| | | | - Hiba Abbas
- Access Community Health Network, Chicago, IL, USA
| | - Jairo Mejia
- Access Community Health Network, Chicago, IL, USA
| | | | | | | | - Namratha R Kandula
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephen D Persell
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James J Paparello
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Nephrology and Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aashima Chopra
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Priya Tripathi
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - My H Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Westmead, NSW, Australia
| | - Jody D Ciolino
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Northwestern University Data Analysis and Coordinating Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Sanuade OA, Jacobson TA, Quintana A, Flowers FM, Abbasi H, Vu MH, Baldridge AS, Mejia J, Lazar D, Ciolino JD, Huffman MD, Kandula NR. Process Evaluation of a Double-Blind Randomized Controlled Trial to Assess the Efficacy and Safety of a Quadruple Ultra-Low-Dose Treatment for Hypertension Within a Federally Qualified Health Center Network (QUARTET USA). J Am Heart Assoc 2024; 13:e032236. [PMID: 38156601 PMCID: PMC10863813 DOI: 10.1161/jaha.123.032236] [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: 08/17/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND This convergent parallel-design mixed-methods process evaluation of the QUARTET USA (Quadruple Ultra-Low-Dose Treatment for Hypertension USA) clinical trial (NCT03640312) explores patient and health care professional perceptions about the use of low-dose quadruple therapy (LDQT) as a novel strategy for hypertension management. METHODS AND RESULTS A survey of all 62 patients enrolled in the QUARTET USA trial was conducted. A subsample of 13 patients and 11 health care professionals, recruited via purposive sampling, took part in semistructured interviews. At enrollment, 68% of participants (mean [SD] age, 51.7 [11.5] years; 56% self-identified as Hispanic: Mexican ethnicity, 16% as Hispanic: other ethnicity, 16% as Black race, 8% as White race, and 1.6% as South Asian race) reported that their current health depended on blood pressure medications, and 48% were concerned about blood pressure medications. At trial completion, 80% were satisfied with LDQT, 96% were certain the benefits of taking LDQT outweighed the disadvantages, and 96% reported that LDQT was convenient to take. Both patients and health care professionals found LDQT acceptable because it reduced patients' perceived pill burden and facilitated medication adherence. Health care professionals stated that a perceived limitation of LDQT was the inability to titrate doses. Steps to facilitate LDQT implementation include introducing stepped-care combinations and treatment protocols, inclusion in clinical practice guidelines, and eliminating patient cost barriers. CONCLUSIONS LDQT was an acceptable strategy for hypertension treatment among patients and health care professionals involved in the QUARTET USA clinical trial. Although LDQT was generally perceived as beneficial for maintaining patients' blood pressure control and facilitating adherence, some clinicians perceived limitations in titration inflexibility, adverse effects, and costs. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03640312.
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Affiliation(s)
- Olutobi A. Sanuade
- Division of Health System Innovation and Research, Department of Population Health SciencesSpencer Fox Eccles School of Medicine at the University of UtahSalt Lake CityUT
| | | | | | | | | | - My H. Vu
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | | | | | | | | | - Mark D. Huffman
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
- Cardiovascular Division and Global Health CenterWashington University in St. LouisSt. LouisMO
- The George Institute for Global Health, University of New South WalesSydneyAustralia
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Krefman AE, Ciolino JD, Kan AK, Maki B, McHugh M, Smith JD, Bannon J, Carroll AJ, Bustamante P, Frye C, Hitsman B, Day A, Walunas TL. Rationale and design for Healthy Hearts for Michigan (HH4M): A pragmatic single-arm hybrid effectiveness-implementation study. Contemp Clin Trials Commun 2023; 35:101199. [PMID: 37671245 PMCID: PMC10475469 DOI: 10.1016/j.conctc.2023.101199] [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: 05/18/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
Background The burden of cardiovascular disease (CVD) is particularly high in several US states, which include the state of Michigan. Hypertension and smoking are two major risk factors for mortality due to CVD. Rural Michigan is disproportionally affected by CVD and by primary care shortages. The Healthy Hearts for Michigan (HH4M) study aims to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts and is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery. Methods Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M, a pragmatic, single-arm hybrid Type 2 effectiveness-implementation study during which practice facilitation was delivered at the practice level for 12 months, followed by a 3-month maintenance period. Results Fifty-four practices were enrolled over a 12-month recruitment period. At baseline, the mean proportion (standard deviation) of patients at the practice level meeting the clinical quality measures were: blood pressure, 0.72 (0.12); tobacco screening, 0.80 (0.30); tobacco cessation intervention, 0.57 (0.28); tobacco screening and cessation intervention: 0.78 (0.26). Conclusion This three-year research program will evaluate the ability of rural and medically underserved primary care practices to implement the quality improvement model by identifying drivers of and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation.
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Affiliation(s)
- Amy E. Krefman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jody D. Ciolino
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ann K. Kan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Megan McHugh
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin D. Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Jennifer Bannon
- Division of General Internal Medicine and Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Allison J. Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Patricia Bustamante
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anya Day
- Altarum Institute, Ann Arbor, MI, USA
| | - Theresa L. Walunas
- Department of Medicine, Division of General Internal Medicine and Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, USA
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Bunning BJ, Hedlin H, Chen JH, Ciolino JD, Ferstad JO, Fox E, Garcia A, Go A, Johari R, Lee J, Maahs DM, Mahaffey KW, Opsahl-Ong K, Perez M, Rochford K, Scheinker D, Spratt H, Turakhia MP, Desai M. The evolving role of data & safety monitoring boards for real-world clinical trials. J Clin Transl Sci 2023; 7:e179. [PMID: 37745930 PMCID: PMC10514684 DOI: 10.1017/cts.2023.582] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Clinical trials provide the "gold standard" evidence for advancing the practice of medicine, even as they evolve to integrate real-world data sources. Modern clinical trials are increasingly incorporating real-world data sources - data not intended for research and often collected in free-living contexts. We refer to trials that incorporate real-world data sources as real-world trials. Such trials may have the potential to enhance the generalizability of findings, facilitate pragmatic study designs, and evaluate real-world effectiveness. However, key differences in the design, conduct, and implementation of real-world vs traditional trials have ramifications in data management that can threaten their desired rigor. Methods Three examples of real-world trials that leverage different types of data sources - wearables, medical devices, and electronic health records are described. Key insights applicable to all three trials in their relationship to Data and Safety Monitoring Boards (DSMBs) are derived. Results Insight and recommendations are given on four topic areas: A. Charge of the DSMB; B. Composition of the DSMB; C. Pre-launch Activities; and D. Post-launch Activities. We recommend stronger and additional focus on data integrity. Conclusions Clinical trials can benefit from incorporating real-world data sources, potentially increasing the generalizability of findings and overall trial scale and efficiency. The data, however, present a level of informatic complexity that relies heavily on a robust data science infrastructure. The nature of monitoring the data and safety must evolve to adapt to new trial scenarios to protect the rigor of clinical trials.
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Affiliation(s)
- Bryan J. Bunning
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Jonathan H. Chen
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
| | - Jody D. Ciolino
- Department of Preventative Medicine – Biostatistics, Northwestern University, Chicago, IL, USA
| | | | - Emily Fox
- Department of Statistics, Stanford University, Stanford, CA, USA
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Ariadna Garcia
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Alan Go
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Ramesh Johari
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Justin Lee
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - David M. Maahs
- Department of Pediatrics, Stanford Medicine Children’s Hospital, Stanford, CA, USA
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA
| | - Krista Opsahl-Ong
- Department of Pediatrics, Stanford Medicine Children’s Hospital, Stanford, CA, USA
| | - Marco Perez
- Department of Medicine, Cardiovascular Medicine, Stanford Medicine, Stanford, CA, USA
| | - Kaylin Rochford
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - David Scheinker
- Systems Design and Collaborative Research, Stanford Medicine Children’s Hospital, Stanford, CA, USA
| | - Heidi Spratt
- Department of Preventative Medicine & Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Mintu P. Turakhia
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
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Ciolino JD, Kaizer AM, Bonner LB. Guidance on interim analysis methods in clinical trials. J Clin Transl Sci 2023; 7:e124. [PMID: 37313374 PMCID: PMC10260346 DOI: 10.1017/cts.2023.552] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/15/2023] Open
Abstract
Interim analyses in clinical trials can take on a multitude of forms. They are often used to guide Data and Safety Monitoring Board (DSMB) recommendations to study teams regarding recruitment targets for large, later-phase clinical trials. As collaborative biostatisticians working and teaching in multiple fields of research and across a broad array of trial phases, we note the large heterogeneity and confusion surrounding interim analyses in clinical trials. Thus, in this paper, we aim to provide a general overview and guidance on interim analyses for a nonstatistical audience. We explain each of the following types of interim analyses: efficacy, futility, safety, and sample size re-estimation, and we provide the reader with reasoning, examples, and implications for each. We emphasize that while the types of interim analyses employed may differ depending on the nature of the study, we would always recommend prespecification of the interim analytic plan to the extent possible with risk mitigation and trial integrity remaining a priority. Finally, we posit that interim analyses should be used as tools to help the DSMB make informed decisions in the context of the overarching study. They should generally not be deemed binding, and they should not be reviewed in isolation.
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Affiliation(s)
- Jody D. Ciolino
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexander M. Kaizer
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Lauren Balmert Bonner
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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McHugh M, Philbin S, Carroll AJ, Vu MH, Ciolino JD, Maki B, Day A, Smith JD, Walunas T. An Approach to Evaluating Multisector Partnerships to Support Evidence-Based Quality Improvement in Primary Care. Jt Comm J Qual Patient Saf 2023; 49:199-206. [PMID: 36739267 DOI: 10.1016/j.jcjq.2023.01.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Quality improvement (QI) interventions in primary care are increasingly designed and implemented by multisector partnerships, yet little guidance exists on how to best monitor or evaluate these partnerships. The goal of this project was to describe an approach for evaluating the development and effectiveness of a multisector partnership using data from the first year of the Healthy Hearts for Michigan (HH4M) Cooperative, a multisector partnership of nine organizations tasked with designing and implementing evidence-based QI strategies for hypertension management and tobacco cessation in 50 rural primary care practices. METHODS The researchers developed a 49-item online survey focused on factors that facilitate or hinder multisector partnerships, drawing on implementation science and partnership, engagement, and collaboration research. The team surveyed all 44 members of the HH4M Cooperative (79.5% response rate) and conducted interviews with 14 members. The interviews focused on implementation phase-specific goals, accomplishments, and challenges. Descriptive analysis was used for the survey results, and thematic analysis for the interview data. RESULTS Respondents reported strong overall performance by the Cooperative during its first year, which facilitated the successful completion of several intervention design tasks. Strengths included having a clear purpose and trust and respect among members. Areas for improvement included a need for common terminology, clarification of roles and functions, and improvement in communication across workgroups. Lack of engagement from physician practices due to capacity constraints, exacerbated by the COVID-19 pandemic, was the Cooperative's biggest challenge. CONCLUSION This multimethod approach to evaluating the development and effectiveness of a multisector partnership yielded practical, actionable feedback to program leaders.
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Burnett-Zeigler I, Zhou E, Martinez JH, Zumpf K, Lartey L, Moskowitz JT, Wisner KL, McDade T, Brown CH, Gollan J, Ciolino JD, Schauer JM, Petito LC. Comparative effectiveness of a mindfulness-based intervention (M-Body) on depressive symptoms: study protocol of a randomized controlled trial in a Federally Qualified Health Center (FQHC). Trials 2023; 24:115. [PMID: 36803835 PMCID: PMC9936464 DOI: 10.1186/s13063-022-07012-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/14/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Mindfulness-based interventions have been shown to improve psychological outcomes including stress, anxiety, and depression in general population studies. However, effectiveness has not been sufficiently examined in racially and ethnically diverse community-based settings. We will evaluate the effectiveness and implementation of a mindfulness-based intervention on depressive symptoms among predominantly Black women at a Federally Qualified Health Center in a metropolitan city. METHODS In this 2-armed, stratified, individually randomized group-treated controlled trial, 274 English-speaking participants with depressive symptoms ages 18-65 years old will be randomly assigned to (1) eight weekly, 90-min group sessions of a mindfulness-based intervention (M-Body), or (2) enhanced usual care. Exclusion criteria include suicidal ideation in 30 days prior to enrollment and regular (>4x/week) meditation practice. Study metrics will be assessed at baseline and 2, 4, and 6 months after baseline, through clinical interviews, self-report surveys, and stress biomarker data including blood pressure, heart rate, and stress related biomarkers. The primary study outcome is depressive symptom score after 6 months. DISCUSSION If M-Body is found to be an effective intervention for adults with depressive symptoms, this accessible, scalable treatment will widely increase access to mental health treatment in underserved, racial/ethnic minority communities. TRIAL REGISTRATION ClinicalTrials.gov NCT03620721. Registered on 8 August 2018.
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Affiliation(s)
- Inger Burnett-Zeigler
- Asher Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St. Clair St, Chicago, IL 60611 USA
| | - Elayne Zhou
- Asher Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St. Clair St, Chicago, IL 60611 USA
| | - Jennifer H. Martinez
- Asher Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St. Clair St, Chicago, IL 60611 USA
| | - Katelyn Zumpf
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Lynette Lartey
- Asher Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St. Clair St, Chicago, IL 60611 USA
| | - Judith T. Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Katherine L. Wisner
- Asher Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St. Clair St, Chicago, IL 60611 USA
| | - Thomas McDade
- Department of Anthropology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL USA
| | - C. Hendricks Brown
- Asher Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St. Clair St, Chicago, IL 60611 USA
| | - Jacqueline Gollan
- Asher Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St. Clair St, Chicago, IL 60611 USA
| | - Jody D. Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Jacob M. Schauer
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Lucia C. Petito
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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Stika CS, Wisner KL, George AL, Avram MJ, Zumpf K, Rasmussen-Torvik LJ, Mesches GA, Caritis SN, Venkataramanan R, Costantine MM, West HA, Clark S, Ciolino JD. Changes in Sertraline Plasma Concentrations Across Pregnancy and Postpartum. Clin Pharmacol Ther 2022; 112:1280-1290. [PMID: 36094046 DOI: 10.1002/cpt.2746] [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] [Received: 06/30/2022] [Accepted: 09/05/2022] [Indexed: 01/31/2023]
Abstract
Major depressive disorder (MDD) is a common disorder in pregnancy. Although sertraline is the most frequently prescribed antidepressant for pregnant people in the United States, limited information about its pharmacokinetics in pregnancy is available. Our objectives were to characterize plasma sertraline concentration to dose (C/D) ratios across pregnancy and postpartum and investigate the effect of pharmacogenetic variability on sertraline elimination. We performed a prospective observational cohort study in people with a singleton pregnancy ≤ 18 weeks gestation and a lifetime diagnosis of MDD at the 3 Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)-funded Obstetrical-Fetal Pharmacology Research Center sites. Subjects (N = 47) were receiving maintenance sertraline therapy and chose to continue it during pregnancy. Blood samples were obtained 24-hours postdose every 4 weeks across pregnancy and twice postpartum for measurement of plasma concentrations of sertraline and desmethylsertraline. Overall mean sertraline C/D ratios were decreased at study onset and remained consistently low until after delivery. During the last 4 weeks of pregnancy the mean sertraline C/D ratio (95% confidence interval (CI)), 0.25 (95% CI, 0.19, 0.3) ng/mL/dose (mg/day), was smaller than the mean ratio at ≥ 8 weeks after delivery, 0.32 (95% CI, 0.27, 0.37) ng/mL/dose (mg/day), a 22% difference. Mean sertraline/desmethylsertraline ratios were highest after birth, which confirmed increased sertraline elimination during pregnancy. Sertraline C/D ratios in participants with functional CYP2C19 activity did not change significantly during pregnancy, whereas ratios in participants with poor or intermediate CYP2C19 activity decreased by 51%. Exploratory pharmacogenomic analysis indicated that pregnant people with poor or intermediate CYP2C19 activity are at risk for subtherapeutic sertraline concentrations during pregnancy.
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Affiliation(s)
- Catherine S Stika
- Department of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherine L Wisner
- Department of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alfred L George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael J Avram
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katelyn Zumpf
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gabrielle A Mesches
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Steve N Caritis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee Womens Hospital, Pittsburgh, Pennsylvania, USA
| | - Raman Venkataramanan
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Holly A West
- Department of OB/GYN, University of Texas Medical Branch, Galveston, Texas, USA
| | - Shannon Clark
- Department of OB/GYN, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Baldridge AS, Huffman MD, Lazar D, Abbas H, Flowers FM, Quintana A, Jackson A, Khan SS, Chopra A, Vu M, Tripathi P, Jacobson T, Sanuade OA, Kandula NR, Persell SD, Paparello JJ, Rosul LL, Mejia J, Lloyd-Jones DM, Chow CK, Ciolino JD. Efficacy and safety of a quadruple ultra-low-dose treatment for hypertension (QUARTET USA): Rationale and design for a randomized controlled trial. Am Heart J 2022; 254:183-193. [PMID: 36116516 PMCID: PMC10236716 DOI: 10.1016/j.ahj.2022.09.004] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND Over half of patients with elevated blood pressure require multi-drug treatment to achieve blood pressure control. However, multi-drug treatment may lead to lower adherence and more adverse drug effects compared with monotherapy. OBJECTIVE The Quadruple Ultra-low-dose Treatment for Hypertension (QUARTET) USA trial was designed to evaluate whether initiating treatment with ultra-low-dose quadruple-combination therapy will lower office blood pressure more effectively, and with fewer side effects, compared with initiating standard dose monotherapy in treatment naive patients with SBP < 180 and DBP < 110 mm Hg and patients on monotherapy with SBP < 160 and DBP < 100 mm Hg. METHODS/DESIGN QUARTET USA was a prospective, randomized, double-blind trial (ClinicalTrials.gov NCT03640312) conducted in federally qualified health centers in a large city in the US. Patients were randomly assigned (1:1) to either ultra-low-dose quadruple combination therapy or standard dose monotherapy. The primary outcome was mean change from baseline in office systolic blood pressure at 12-weeks, adjusted for baseline values. Secondary outcomes included measures of blood pressure change and variability, medication adherence, and health related quality of life. Safety outcomes included occurrence of serious adverse events, relevant adverse drug effects, and electrolyte abnormalities. A process evaluation aimed to understand provider experiences of implementation and participant experiences around side effects, adherence, and trust with clinical care. DISCUSSION QUARTET USA was designed to evaluate whether a novel approach to blood pressure control would lower office blood pressure more effectively, and with fewer side effects, compared with standard dose monotherapy. QUARTET USA was conducted within a network of federally qualified healthcare centers with the aim of generating information on the safety and efficacy of ultra-low-dose quadruple-combination therapy in diverse groups that experience a high burden of hypertension.
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Affiliation(s)
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, MO; The George Institute for Global Health, Sydney, Australia
| | | | - Hiba Abbas
- Access Community Health Network, Chicago, IL
| | | | | | - Alema Jackson
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S Khan
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Aashima Chopra
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - My Vu
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Priya Tripathi
- Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Tyler Jacobson
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT
| | | | | | | | | | - Jairo Mejia
- Access Community Health Network, Chicago, IL
| | | | - Clara K Chow
- The George Institute for Global Health, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia
| | - Jody D Ciolino
- Northwestern University Feinberg School of Medicine, Chicago, IL
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10
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Olonoff M, Niaura RS, Ciecierski CC, Ciolino JD, Hitsman B. Electronic nicotine delivery systems: use, knowledge, and attitudes among diverse college students. J Am Coll Health 2022; 70:2159-2167. [PMID: 33759696 DOI: 10.1080/07448481.2020.1846044] [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] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/26/2020] [Accepted: 06/07/2020] [Indexed: 06/12/2023]
Abstract
ObjectiveThe purpose of this study was to examine Electronic Nicotine Delivery Systems (ENDS) use among nonusers in diverse college students. Participants: Participants were college students enrolled at a Hispanic-Serving University in Chicago, IL, USA in December 2017. Methods: An online survey was administered using questions about ENDS-use behaviors, device characteristics, and knowledge of their own device, and ENDS attitudes. ENDS attitudes included questions about health, susceptibility, and quit characteristics. Results: The prevalence rate of ENDS use was 7%, and 39% of ENDS users identified all device characteristics. Nonusers categorize ENDS as a healthier alternative to cigarettes and as quit devices. Finally, cigarette use, age, health factor, and social proximity are correlated with ENDS susceptibility. Conclusions: These ENDS users lack awareness of their devices and tobacco use plays a key role in ENDS susceptibility. Future studies should continue to study the role ENDS has in dependence and cigarette use.
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Affiliation(s)
- Matthew Olonoff
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Raymond S Niaura
- Department of Population Health, New York University, New York, New York, USA
| | | | - Jody D Ciolino
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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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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12
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Newcomb ME, Sarno EL, Bettin E, Conway A, Carey J, Garcia C, Hill R, Jozsa K, Swann G, Addington EL, Ciolino JD, Macapagal K, Moskowitz JT, Mustanski B, Whitton SW. Protocol for an attention-matched randomized controlled trial of 2GETHER: a relationship education and HIV prevention program for young male couples. Trials 2022; 23:514. [PMID: 35725624 PMCID: PMC9207885 DOI: 10.1186/s13063-022-06457-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial. METHODS We are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. DISCUSSION 2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03186534 .
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Affiliation(s)
- Michael E. Newcomb
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Elissa L. Sarno
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Emily Bettin
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Adam Conway
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - James Carey
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Christopher Garcia
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Ricky Hill
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA
| | - Kyle Jozsa
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA
| | - Gregory Swann
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Elizabeth L. Addington
- grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Jody D. Ciolino
- grid.16753.360000 0001 2299 3507Department of Preventive Medicine, Northwestern University, Chicago, IL USA
| | - Kathryn Macapagal
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Judith T. Moskowitz
- grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Brian Mustanski
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Sarah W. Whitton
- grid.24827.3b0000 0001 2179 9593Department of Psychology, University of Cincinnati, Cincinnati, OH USA
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13
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Dhanani M, Krishnamoorthy A, Ciolino JD, Gupta K, Strymish JM. Prophylaxis against spontaneous bacterial peritonitis: Too much or too little? Antimicrob Steward Healthc Epidemiol 2022; 2:e95. [PMID: 36483431 PMCID: PMC9726478 DOI: 10.1017/ash.2022.232] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 06/17/2023]
Abstract
Prophylaxis against spontaneous bacterial peritonitis (SBP) is recommended for select patients with cirrhosis, but long-term antibiotic therapy has risks. We evaluated concordance with guideline recommendations in 179 veterans with cirrhosis; 55% received guideline-concordant management of SBP prophylaxis. Despite stable guideline recommendations since 2012, guideline adherence remains low.
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Affiliation(s)
- Muhammad Dhanani
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Medical Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Aparna Krishnamoorthy
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jody D. Ciolino
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kalpana Gupta
- Medical Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Judith M. Strymish
- Medical Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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14
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Torres E, Zumpf KB, Ciolino JD, Clark CT, Sit DK, Miller ES, Wisner KL. C-Reactive protein concentrations in reproductive-aged women with major mood disorders. Arch Womens Ment Health 2022; 25:577-584. [PMID: 35316423 DOI: 10.1007/s00737-022-01222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
To examine associations between high sensitivity C-reactive protein (CRP) concentrations and depressive symptoms in reproductive-aged women with mood disorders. Women (N = 86) with major depressive or bipolar disorder in a specialized mood disorders program provided plasma samples which were analyzed for CRP concentrations and categorized by tertiles (T1, low; T2, middle; T3 high). Depressive symptoms were assessed with the Inventory of Depressive Symptoms. We hypothesized that CRP concentrations would be significantly associated with the following: (1) depressive symptoms; (2) pregnancy, (3) body mass index, and (4) counts of white blood cells and absolute neutrophils and percentage of segmented neutrophils. The distribution of CRP concentrations was highly skewed with a median of 2.45 mg/L and an interquartile range 0.90 - 8.17 mg/L. Elevated plasma levels of CRP were not associated with depressive symptoms, which did not differ by tertile group either before or after adjusting for BMI, pregnancy status, and their interactions. Women in T3 had 5 times greater odds of pregnancy compared to women in T1 (p = .021). However, women in T2 had 11% greater BMI on average (p = 0.023), and women in T3 had 47% greater BMI compared to those in T1 (p < 0.001). Women in T3 had higher mean white blood cell counts than those in T1 and T2, the percentage of neutrophils was higher in T2 and T3 compared to T1, and women in T3 had higher absolute neutrophil counts compared to T1. CRP concentrations varied widely and were significantly elevated in reproductive-aged women with high BMI and current pregnancy, but not with depressive symptoms in this sample of depressed women.
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Affiliation(s)
- Elizabeth Torres
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Katelynn B Zumpf
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jody D Ciolino
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Crystal T Clark
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dorothy K Sit
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily S Miller
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Kim HS, Muschong KM, Fishman IL, Schauer JM, Seitz AL, Strickland KJ, Lambert BL, McCarthy DM, Vu MH, Ciolino JD. Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial. BMJ Open 2022; 12:e061283. [PMID: 35613820 PMCID: PMC9131058 DOI: 10.1136/bmjopen-2022-061283] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Low back pain is a common problem and a substantial source of morbidity and disability worldwide. Patients frequently visit the emergency department (ED) for low back pain, but many experience persistent symptoms at 3 months despite frequent receipt of opioids. Although physical therapy interventions have been demonstrated to improve patient functioning in the outpatient setting, no randomised trial has yet to evaluate physical therapy in the ED setting. METHODS AND ANALYSIS This is a single-centre cluster-randomised trial of an embedded ED physical therapy intervention for acute low back pain. We used a covariate-constrained approach to randomise individual physicians (clusters) at an urban academic ED in Chicago, Illinois, USA, to receive, or not receive, an embedded physical therapist on their primary treatment team to evaluate all patients with low back pain. We will then enrol individual ED patients with acute low back pain and allocate them to the embedded physical therapy or usual care study arms, depending on the randomisation assignment of their treating physician. We will follow patients to a primary endpoint of 3 months and compare a primary outcome of change in PROMIS-Pain Interference score and secondary outcomes of change in modified Oswestry Disability Index score and patient-reported opioid use. Our primary approach will be a modified intention-to-treat analysis, whereby all participants who complete at least one follow-up data time point will be included in analyses, regardless of their or their physicians' adherence to their assigned study arm. ETHICS AND DISSEMINATION This trial is funded by the US Agency for Healthcare Research and Quality (R01HS027426) and was approved by the Northwestern University Institutional Review Board. All physician and patient participants will give written informed consent to study participation. Trial results will be submitted for presentation at scientific meetings and for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04921449).
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Affiliation(s)
- Howard S Kim
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kayla M Muschong
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ivy L Fishman
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jacob M Schauer
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amee L Seitz
- Department of Physical Therapy & Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kyle J Strickland
- Rehabilitation Services Department, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Bruce L Lambert
- Department of Communication Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - My H Vu
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Clark CT, Sit DK, Zumpf KB, Ciolino JD, Yang A, Fisher SD, Wisner KL. A comparison of symptoms of bipolar and unipolar depression in postpartum women. J Affect Disord 2022; 303:82-90. [PMID: 35041868 DOI: 10.1016/j.jad.2022.01.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Distinguishing postpartum women with bipolar from unipolar depression remains challenging, particularly in obstetrical and primary care settings. The post-birth period carries the highest lifetime risk for the onset or recurrence of Bipolar Disorder (BD). Characterization of differences between unipolar and bipolar depression symptom presentation and severity is critical to differentiate the two disorders. METHODS We performed a secondary analysis of a study of 10,000 women screened by phone with the Edinburgh Postnatal Depression Scale at 4-6 weeks post-birth. Screen-positive mothers completed the Structured Clinical Interview for DSM-4 and those diagnosed with BD and unipolar Major Depressive Disorder (UD) were included. Depressive symptoms were assessed with the 29-item Structured Interview Guide for the Hamilton Rating Scale for Depression (SIGH-ADS). RESULTS The sample consisted of 728 women with UD and 272 women with BD. Women with BD had significantly elevated levels of depression severity due to the higher scores on 8 of the 29 SIGH-ADS symptoms. Compared to UD, women with BD had significantly higher rates of comorbid anxiety disorders and were twice as likely to report sexual and/or physical abuse. LIMITATIONS Only women who screened positive for depression were included in this analysis. Postpartum women with unstable living situations, who were hospitalized or did not respond to contact attempts did not contribute data. CONCLUSIONS Severity of specific symptom constellations may be a useful guide for interviewing postpartum depressed women along with the presence of anxiety disorder comorbidity and physical and/or sexual abuse.
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Affiliation(s)
- Crystal T Clark
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Dorothy K Sit
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Katelyn B Zumpf
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Jody D Ciolino
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Amy Yang
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Sheehan D Fisher
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Katherine L Wisner
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States.
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17
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Mesches GA, Ciolino JD, Stika CS, Sit DK, Zumpf K, Fisher S, Clark CT, George AL, Avram MJ, Rasmussen‐Torvik LJ, Erickson DL, Caritis S, Fischer D, Venkataramanan R, Costantine M, West H, Welch E, Clark S, Wisner KL, Gollan JK. Trajectories of Depressive and Anxiety Symptoms Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor‐Treated Women. PRCP 2022; 4:32-41. [PMID: 36254188 PMCID: PMC9558923 DOI: 10.1176/appi.prcp.20210034] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Tracking perinatal mood and anxiety disorders is championed by the American Psychiatric Association and the International Marcé Society for Perinatal Mental Health. We conducted this study to examine trajectories of monthly depressive and anxiety symptoms through pregnancy and postpartum. Methods This is a prospective longitudinal observational cohort study of pregnant women interviewed at baseline (≤18th gestational week), every four weeks through delivery and at 6 and 14 weeks postpartum at three urban academic medical centers (N = 85) and a single rural health center (N = 3) from 2016 to 2020. Pregnant women had at least one prior episode of major depressive disorder, were not in a current episode, and were treated with sertraline, fluoxetine, citalopram, or escitalopram. Of 192 women screened, 88 (46%) women enrolled, and 77 (88%) women completed the postpartum follow-up. Symptom trajectories were generated with scores from the Edinburgh Postnatal Depression Scale, the Quick Inventory of Depressive Symptoms, the Generalized Anxiety Disorder Scale, 7-item, and the Patient-Reported Outcomes Measurement Information System Global Health measure. A semi-parametric, group-based mixture model (trajectory analysis) was applied. Results Three relatively stable depression trajectories emerged, described as Minimal, Mild, and Subthreshold, in each group across pregnancy. Two of the four anxiety trajectories were stable, including Asymptomatic and Minimal, while the third, termed Breakthrough, was ascending with increasing symptoms and the fourth trajectory, described as Mild, had descending symptoms. Conclusions Screening for anxiety with depression for pregnant women will yield a comprehensive view of psychiatric symptoms and treatment targets in perinatal women.
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Affiliation(s)
- Gabrielle A. Mesches
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Jody D. Ciolino
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Catherine S. Stika
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Dorothy K. Sit
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Katelyn Zumpf
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Sheehan Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Crystal T. Clark
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Alfred L. George
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Michael J. Avram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Laura J. Rasmussen‐Torvik
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Daniel L. Erickson
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Steven Caritis
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Dawn Fischer
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Raman Venkataramanan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Maged Costantine
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Holly West
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Elizabeth Welch
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Shannon Clark
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Katherine L. Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
| | - Jacqueline K. Gollan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (G. A. Mesches, D. K. Sit, S. Fisher, C. T. Clark, K. L. Wisner, J. K. Gollan); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (J. D. Ciolino, K. Zumpf, L. J. Rasmussen‐Torvik, D. L. Erickson); Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (C. S
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18
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Lauzon SD, Zhao W, Nietert PJ, Ciolino JD, Hill MD, Ramakrishnan V. Impact of minimal sufficient balance, minimization, and stratified permuted blocks on bias and power in the estimation of treatment effect in sequential clinical trials with a binary endpoint. Stat Methods Med Res 2022; 31:184-204. [PMID: 34841963 PMCID: PMC9026574 DOI: 10.1177/09622802211055856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Minimization is among the most common methods for controlling baseline covariate imbalance at the randomization phase of clinical trials. Previous studies have found that minimization does not preserve allocation randomness as well as other methods, such as minimal sufficient balance, making it more vulnerable to allocation predictability and selection bias. Additionally, minimization has been shown in simulation studies to inadequately control serious covariate imbalances when modest biased coin probabilities (≤0.65) are used. This current study extends the investigation of randomization methods to the analysis phase, comparing the impact of treatment allocation methods on power and bias in estimating treatment effects on a binary outcome using logistic regression. Power and bias in the estimation of treatment effect was found to be comparable across complete randomization, minimization, and minimal sufficient balance in unadjusted analyses. Further, minimal sufficient balance was found to have the most modest impact on power and the least bias in covariate-adjusted analyses. The minimal sufficient balance method is recommended for use in clinical trials as an alternative to minimization when covariate-adaptive subject randomization takes place.
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Affiliation(s)
| | - Wenle Zhao
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Michael D Hill
- Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
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19
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Snowber K, Ciolino JD, Clark CT, Grobman WA, Miller ES. Does implementation of collaborative care mitigate racial disparities in screening and treatment of perinatal depression? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.138] [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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20
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Brown T, Rowe TA, Lee JY, Petito LC, Chmiel R, Ciolino JD, Doctor J, Fox C, Goldstein N, Kaiser D, Linder JA, Meeker D, Peprah Y, Persell SD. Design of Behavioral Economic Applications to Geriatrics Leveraging Electronic Health Records (BEAGLE): A pragmatic cluster randomized controlled trial. Contemp Clin Trials 2022; 112:106649. [PMID: 34896294 PMCID: PMC8724916 DOI: 10.1016/j.cct.2021.106649] [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] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Overtesting and treatment of older patients is common and may lead to harms. The Choosing Wisely campaign has provided recommendations to reduce overtesting and overtreatment of older adults. Behavioral economics-informed interventions embedded within the electronic health record (EHR) have been shown to reduce overuse in several areas. Our objective is to conduct a parallel arm, pragmatic cluster-randomized trial to evaluate the effectiveness of behavioral-economics-informed clinical decision support (CDS) interventions previously piloted in primary care clinics and designed to reduce overtesting and overtreatment in older adults. METHODS/DESIGN This trial has two parallel arms: clinician education alone vs. clinician education plus behavioral-economics-informed CDS. There are three co-primary outcomes for this trial: (1) prostate-specific antigen (PSA) screening in older men, (2) urine testing for non-specific reasons in older women, and (3) overtreatment of diabetes in older adults. All eligible primary care clinics from a large regional health system were randomized using a modified constrained randomization process and their attributed clinicians were included. Clinicians were recruited to complete a survey and educational module. We randomized 60 primary care clinics with 374 primary care clinicians and achieved adequate balance between the study arms for prespecified constrained variables. Baseline annual overuse rates for the three co-primary outcomes were 25%, 23%, and 17% for the PSA, urine, and diabetes measures, respectively. DISCUSSION This trial is evaluating behavioral-economics-informed EHR-embedded interventions to reduce overuse of specific tests and treatments for older adults. The study will evaluate the effectiveness and safety of these interventions.
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Affiliation(s)
- Tiffany Brown
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Theresa A. Rowe
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ji Young Lee
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lucia C. Petito
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan Chmiel
- Northwestern Memorial HealthCare, Chicago, IL, USA
| | - Jody D. Ciolino
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason Doctor
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, USA
| | - Craig Fox
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, USA
| | - Noah Goldstein
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Jeffrey A. Linder
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniella Meeker
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, USA
| | - Yaw Peprah
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephen D. Persell
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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21
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Gollan JK, Yang A, Ciolino JD, Sit D, Wisner KL. Postpartum anhedonia: Emergent patterns in bipolar and unipolar depression. Psychiatry Res 2021; 306:114274. [PMID: 34837882 DOI: 10.1016/j.psychres.2021.114274] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022]
Abstract
The objective of this study was to identify differences in the longitudinal course anhedonia symptoms during postpartum in women diagnosed with unipolar or bipolar disorder. Female participants diagnosed with either bipolar (n = 104) or unipolar (n = 136) depression at week 20 during pregnancy were evaluated prospectively at weeks 2, 12, 26, and 52 postpartum using clinical interviews. A semi-parametric, group-based mixture model was applied to separate distinct longitudinal patterns of symptoms of anhedonia. Across time, among those who reported anhedonia, twice as many women had the diagnoses of bipolar depression relative to unipolar depression (65.03% versus 39.47%, respectively). Moreover, the rate and stability of anhedonia was higher in women with bipolar relative to unipolar depression. Across groups, anhedonia was associated with significantly higher depressive symptom severity. Anhedonia is a more stable and frequent symptom in women with postpartum bipolar relative to unipolar depressive disorder.
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Affiliation(s)
- Jacqueline K Gollan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 1000, Chicago, IL, 60611 USA.
| | - Amy Yang
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, 680N Lake Shore Drive, Suite 1400, Chicago IL 60611 USA
| | - Jody D Ciolino
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, 680N Lake Shore Drive, Suite 1400, Chicago IL 60611 USA
| | - Dorothy Sit
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 1000, Chicago, IL, 60611 USA
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 1000, Chicago, IL, 60611 USA
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22
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Miller ES, Grobman WA, Ciolino JD, Zumpf K, Sakowicz A, Gollan J, Wisner KL. Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care Program. Psychiatr Serv 2021; 72:1268-1275. [PMID: 34015950 DOI: 10.1176/appi.ps.202000563] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study evaluated whether implementation of perinatal collaborative care is associated with improvements in screening and treatment recommendations for perinatal depression by obstetric clinicians. METHODS This cohort study, conducted from January 2015 to January 2019, included all women who received prenatal care in five obstetric clinics and delivered at a single quaternary care hospital in Chicago. In January 2017, a perinatal collaborative care program (COMPASS) was implemented. Completion of depression screening and recommendations for treatment following a positive depression screen were compared before and after COMPASS implementation. Adjusted analyses included inverse probability weighting by using propensity scores to impose control over imbalance between exposure groups with respect to prespecified covariates. RESULTS A total of 7,028 women were included in these analyses: 3,227 (46%) before and 3,801 (54%) after COMPASS implementation. Women who received obstetric care after implementation were significantly more likely than those who received care before implementation to receive antenatal screening for depression (81% versus 33%; adjusted odds ratio [aOR]=8.5, 95% confidence interval [CI]=7.6-9.5). After implementation, women with a positive antenatal screen for depression were more likely to receive a treatment recommendation (61% versus 44%; aOR=2.1, 95% CI=1.2-3.7). After implementation of perinatal collaborative care, combined psychotherapy and pharmacotherapy were more frequently recommended, compared with before implementation. CONCLUSIONS Implementation of a perinatal collaborative care program was associated with improvements in perinatal depression screening and recommendations for treatment by obstetric clinicians.
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Affiliation(s)
- Emily S Miller
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - William A Grobman
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Jody D Ciolino
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Katelyn Zumpf
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Allie Sakowicz
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Jacqueline Gollan
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Katherine L Wisner
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
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23
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Ciolino JD, Spino C, Ambrosius WT, Khalatbari S, Cayetano SM, Lapidus JA, Nietert PJ, Oster RA, Perkins SM, Pollock BH, Pomann GM, Price LL, Rice TW, Tosteson TD, Lindsell CJ, Spratt H. Guidance for biostatisticians on their essential contributions to clinical and translational research protocol review. J Clin Transl Sci 2021; 5:e161. [PMID: 34527300 PMCID: PMC8427547 DOI: 10.1017/cts.2021.814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/23/2022] Open
Abstract
Rigorous scientific review of research protocols is critical to making funding decisions, and to the protection of both human and non-human research participants. Given the increasing complexity of research designs and data analysis methods, quantitative experts, such as biostatisticians, play an essential role in evaluating the rigor and reproducibility of proposed methods. However, there is a common misconception that a statistician's input is relevant only to sample size/power and statistical analysis sections of a protocol. The comprehensive nature of a biostatistical review coupled with limited guidance on key components of protocol review motived this work. Members of the Biostatistics, Epidemiology, and Research Design Special Interest Group of the Association for Clinical and Translational Science used a consensus approach to identify the elements of research protocols that a biostatistician should consider in a review, and provide specific guidance on how each element should be reviewed. We present the resulting review framework as an educational tool and guideline for biostatisticians navigating review boards and panels. We briefly describe the approach to developing the framework, and we provide a comprehensive checklist and guidance on review of each protocol element. We posit that the biostatistical reviewer, through their breadth of engagement across multiple disciplines and experience with a range of research designs, can and should contribute significantly beyond review of the statistical analysis plan and sample size justification. Through careful scientific review, we hope to prevent excess resource expenditure and risk to humans and animals on poorly planned studies.
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Affiliation(s)
- Jody D. Ciolino
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cathie Spino
- Department of Biostatistics, University of Michigan, Washington Heights, Ann Arbor, MI, USA
| | - Walter T. Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Shokoufeh Khalatbari
- Michigan Institute for Clinical & Health Research (MICHR), University of Michigan, Ann Arbor, MI, USA
| | | | - Jodi A. Lapidus
- School of Public Health, Oregon Health & Sciences University, Portland, OR, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Robert A. Oster
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, UK
| | - Susan M. Perkins
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Brad H. Pollock
- Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA, USA
| | - Gina-Maria Pomann
- Duke Biostatistics, Epidemiology and Research Design (BERD) Methods Core, Duke University, Durham, NC, USA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Todd W. Rice
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Medical Director, Vanderbilt Human Research Protections Program, Vice-President for Clinical Trials Innovation and Operations, Nashville, TN, USA
| | - Tor D. Tosteson
- Department of Biomedical Data Science, Division of Biostatistics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Heidi Spratt
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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24
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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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25
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Munoz MJ, Goelz LC, Pal GD, Karl JA, Verhagen Metman L, Sani S, Rosenow JM, Ciolino JD, Kurani AS, Corcos DM, David FJ. Increased Subthalamic Nucleus Deep Brain Stimulation Amplitude Impairs Inhibitory Control of Eye Movements in Parkinson's Disease. Neuromodulation 2021; 25:866-876. [PMID: 34139037 DOI: 10.1111/ner.13476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Bilateral subthalamic nucleus deep brain stimulation (STN DBS) in Parkinson's disease (PD) can have detrimental effects on eye movement inhibitory control. To investigate this detrimental effect of bilateral STN DBS, we examined the effects of manipulating STN DBS amplitude on inhibitory control during the antisaccade task. The prosaccade error rate during the antisaccade task, that is, directional errors, was indicative of impaired inhibitory control. We hypothesized that as stimulation amplitude increased, the prosaccade error rate would increase. MATERIALS AND METHODS Ten participants with bilateral STN DBS completed the antisaccade task on six different stimulation amplitudes (including zero amplitude) after a 12-hour overnight withdrawal from antiparkinsonian medication. RESULTS We found that the prosaccade error rate increased as stimulation amplitude increased (p < 0.01). Additionally, prosaccade error rate increased as the modeled volume of tissue activated (VTA) and STN overlap decreased, but this relationship depended on stimulation amplitude (p = 0.04). CONCLUSIONS Our findings suggest that higher stimulation amplitude settings can be modulatory for inhibitory control. Some individual variability in the effect of stimulation amplitude can be explained by active contact location and VTA-STN overlap. Higher stimulation amplitudes are more deleterious if the active contacts fall outside of the STN resulting in a smaller VTA-STN overlap. This is clinically significant as it can inform clinical optimization of STN DBS parameters. Further studies are needed to determine stimulation amplitude effects on other aspects of cognition and whether inhibitory control deficits on the antisaccade task result in a meaningful impact on the quality of life.
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Affiliation(s)
- Miranda J Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Lisa C Goelz
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Gian D Pal
- Department of Neurological Science, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Jessica A Karl
- Department of Neurological Science, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Leo Verhagen Metman
- Department of Neurological Science, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ajay S Kurani
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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26
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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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27
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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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28
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Kim HS, Ciolino JD, Lancki N, Strickland KJ, Pinto D, Stankiewicz C, Courtney DM, Lambert BL, McCarthy DM. A Prospective Observational Study of Emergency Department-Initiated Physical Therapy for Acute Low Back Pain. Phys Ther 2020; 101:6044310. [PMID: 33351942 PMCID: PMC7970627 DOI: 10.1093/ptj/pzaa219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/29/2020] [Accepted: 11/11/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Low back pain accounts for nearly 4 million emergency department (ED) visits annually and is a significant source of disability. Physical therapy has been suggested as a potentially effective nonopioid treatment for low back pain; however, no studies to our knowledge have yet evaluated the emerging resource of ED-initiated physical therapy. The study objective was to compare patient-reported outcomes in patients receiving ED-initiated physical therapy and patients receiving usual care for acute low back pain. METHODS This was a prospective observational study of ED patients receiving either physical therapy or usual care for acute low back pain from May 1, 2018, to May 24, 2019, at a single academic ED (>91,000 annual visits). The primary outcome was pain-related functioning, assessed with Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System pain interference (PROMIS-PI) scores. The secondary outcome was use of high-risk medications (opioids, benzodiazepines, and skeletal muscle relaxants). Outcomes were compared over 3 months using adjusted linear mixed and generalized estimating equation models. RESULTS For 101 participants (43 receiving ED-initiated physical therapy and 58 receiving usual care), the median age was 40.5 years and 59% were women. Baseline outcome scores in the ED-initiated physical therapy group were higher than those in the usual care group (ODI = 51.1 vs 36.0; PROMIS-PI = 67.6 vs 62.7). Patients receiving ED-initiated physical therapy had greater improvements in both ODI and PROMIS-PI scores at the 3-month follow-up (ODI = -14.4 [95% CI = -23.0 to -5.7]; PROMIS-PI = -5.1 [95% CI = -9.9 to -0.4]) and lower use of high-risk medications (odds ratio = 0.05 [95% CI = 0.01 to 0.58]). CONCLUSION In this single-center observational study, ED-initiated physical therapy for acute low back pain was associated with improvements in functioning and lower use of high-risk medications compared with usual care; the causality of these relationships remains to be explored. IMPACT ED-initiated physical therapy is a promising therapy for acute low back pain that may reduce reliance on high-risk medications while improving patient-reported outcomes. LAY SUMMARY Emergency department-initiated physical therapy for low back pain was associated with greater improvement in functioning and lower use of high-risk medications over 3 months.
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Affiliation(s)
- Howard S Kim
- Address all correspondence to Dr Kim at: , @theNNTweet
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicola Lancki
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kyle J Strickland
- Department of Rehabilitation Services, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University College of Health Sciences, Milwaukee, Wisconsin, USA,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christine Stankiewicz
- Department of Rehabilitation Services, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - D Mark Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Bruce L Lambert
- Department of Communication Studies, Center for Communication and Health, Northwestern University School of Communication, Chicago, Illinois, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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29
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Michelson KN, Charleston E, Aniciete DY, Sorce LR, Fragen P, Persell SD, Ciolino JD, Clayman ML, Rychlik K, Jones VA, Spadino P, Malakooti M, Brown M, White D. Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit: A Pilot Study. Am J Crit Care 2020; 29:271-282. [PMID: 32607571 DOI: 10.4037/ajcc2020478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience, caregiver psychological morbidity, and patient outcomes. OBJECTIVE To test the feasibility of studying and implementing a PICU communication intervention called PICU Supports, and to assess families' and health care teams' perceptions of the intervention. METHODS This study involved patients requiring more than 24 hours of PICU care. An interventionist trained in PICU-focused health care navigation, a "navigator," met with parents and the health care team to discuss communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and checked in with parents after PICU discharge. The feasibility of implementing the intervention was assessed by tracking navigator activities. Health care team and family perceptions were assessed using surveys, interviews, and focus groups. RESULTS Of 53 families approached about the study, 35 (66%) agreed to participate. The navigator met with parents on 71% and the health care team on 85% of possible weekdays, and completed 86% of the postdischarge check-ins. Family meetings were offered to 95% of eligible patients. The intervention was rated as helpful by 97% of parents, and comments during interviews were positive. CONCLUSIONS The PICU Supports intervention is feasible to implement and study and is viewed favorably by parents.
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Affiliation(s)
- Kelly N. Michelson
- About the Authors: Kelly N. Michelson is an attending physician, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, and a professor, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elizabeth Charleston
- Elizabeth Charleston is lead clinical research coordinator, Danica Y. Aniciete is a clinical research coordinator/navigator, Virginia A. Jones is a clinical research associate, and Pamela Spadino is a parent of a medically complex child, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Danica Y. Aniciete
- Elizabeth Charleston is lead clinical research coordinator, Danica Y. Aniciete is a clinical research coordinator/navigator, Virginia A. Jones is a clinical research associate, and Pamela Spadino is a parent of a medically complex child, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Lauren R. Sorce
- Lauren R. Sorce is the Founders Board nurse scientist, Department of Nursing, Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University
| | | | - Stephen D. Persell
- Stephen D. Persell is an associate professor, Division of General Internal Medicine and Geriatrics, Department of Medicine, Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University
| | - Jody D. Ciolino
- Jody D. Ciolino is an associate professor, Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Marla L. Clayman
- Marla L. Clayman is an adjunct faculty member at Northwestern University
| | - Karen Rychlik
- Karen Rychlik is a statistician, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, and an instructor, Feinberg School of Medicine, Northwestern University
| | - Virginia A. Jones
- Elizabeth Charleston is lead clinical research coordinator, Danica Y. Aniciete is a clinical research coordinator/navigator, Virginia A. Jones is a clinical research associate, and Pamela Spadino is a parent of a medically complex child, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Pamela Spadino
- Elizabeth Charleston is lead clinical research coordinator, Danica Y. Aniciete is a clinical research coordinator/navigator, Virginia A. Jones is a clinical research associate, and Pamela Spadino is a parent of a medically complex child, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Marcelo Malakooti
- Marcelo Malakooti is an atending physician and medical director, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, and an assistant professor, Department of Pediatrics, Feinberg School of Medicine, Northwestern University
| | - Melanie Brown
- Melanie Brown is an associate professor of pediatric critical care medicine, Department of Pediatrics, University of Chicago Medicine Comer Children’s Hospital, Chicago, Illinois
| | - Douglas White
- Douglas White is director, Program in Ethics and Decision Making in Critical Illness, and vice chair, professor, and Endowed Chair for Ethics, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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30
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Rowe TA, Brown T, Lee JY, Linder JA, Friedberg MW, Doctor JN, Meeker D, Ciolino JD, Persell SD. Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement. J Gen Intern Med 2020; 35:1797-1802. [PMID: 32128687 PMCID: PMC7280408 DOI: 10.1007/s11606-020-05748-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/14/2020] [Indexed: 11/29/2022]
Abstract
IMPORTANCE The extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood. OBJECTIVE To examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults. DESIGN Retrospective analysis of overall means and clinician-level variation in performance on three new measures. SUBJECTS Adults aged 65 years and older who had office visits with outpatient primary or immediate care clinicians within a single academic medical center health system between July 1, 2016, and June 30, 2017. MEASURES Two electronic clinical quality measures representing potentially inappropriate use of medical services in older adults: prostate-specific antigen testing against guidelines (PSA) in men aged 76 and older; urinalysis or urine culture for non-specific reasons in women aged 65 and older; and one intermediate outcome measure: hemoglobin A1c less than 7.0 in adults aged 75 and older with diabetes mellitus treated with insulin or oral hypoglycemic medication. RESULTS Sixty-nine clinicians and 2009 patients contributed observations to the PSA measure, 144 clinicians and 5933 patients contributed to the urinalysis/urine culture measure, and 42 clinicians and 665 patients contributed to the diabetes measure. Meaningful clinician-level performance variation was greatest for the PSA measure (intraclass correlation coefficient [ICC] = 0.27), followed by the urinalysis/urine culture measure (ICC = 0.18), and the diabetes measure (ICC = 0.024). The range of possible overuse across clinician quartiles was 8-54% for the PSA measure, 3-35% for the urinalysis/urine culture measure, and 13-49% for the diabetes measure. The odds ratios of overuse in the highest quartile compared with the lowest for the PSA, urinalysis/urine culture, and diabetes measures were 99.3 (95% CI 43 to 228), 15.7 (10 to 24), and 6.0 (3.3 to 11), respectively. CONCLUSIONS Within the same health system, rates of potential overuse in elderly patients varied greatly across clinicians, particularly for the process measures examined.
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Affiliation(s)
- Theresa A Rowe
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Tiffany Brown
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ji Young Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark W Friedberg
- RAND Corporation, Boston, MA, USA.,Blue Cross Blue Shield of Massachusetts, Boston, MA, USA.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason N Doctor
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Daniella Meeker
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jody D Ciolino
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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31
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Rowe TA, Brown T, Lee JY, Linder JA, Friedberg MW, Doctor JN, Meeker D, Ciolino JD, Persell SD. Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement. J Gen Intern Med 2020. [PMID: 32128687 DOI: 10.1007/s11606-020-05748-8/figures/3] [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] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
IMPORTANCE The extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood. OBJECTIVE To examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults. DESIGN Retrospective analysis of overall means and clinician-level variation in performance on three new measures. SUBJECTS Adults aged 65 years and older who had office visits with outpatient primary or immediate care clinicians within a single academic medical center health system between July 1, 2016, and June 30, 2017. MEASURES Two electronic clinical quality measures representing potentially inappropriate use of medical services in older adults: prostate-specific antigen testing against guidelines (PSA) in men aged 76 and older; urinalysis or urine culture for non-specific reasons in women aged 65 and older; and one intermediate outcome measure: hemoglobin A1c less than 7.0 in adults aged 75 and older with diabetes mellitus treated with insulin or oral hypoglycemic medication. RESULTS Sixty-nine clinicians and 2009 patients contributed observations to the PSA measure, 144 clinicians and 5933 patients contributed to the urinalysis/urine culture measure, and 42 clinicians and 665 patients contributed to the diabetes measure. Meaningful clinician-level performance variation was greatest for the PSA measure (intraclass correlation coefficient [ICC] = 0.27), followed by the urinalysis/urine culture measure (ICC = 0.18), and the diabetes measure (ICC = 0.024). The range of possible overuse across clinician quartiles was 8-54% for the PSA measure, 3-35% for the urinalysis/urine culture measure, and 13-49% for the diabetes measure. The odds ratios of overuse in the highest quartile compared with the lowest for the PSA, urinalysis/urine culture, and diabetes measures were 99.3 (95% CI 43 to 228), 15.7 (10 to 24), and 6.0 (3.3 to 11), respectively. CONCLUSIONS Within the same health system, rates of potential overuse in elderly patients varied greatly across clinicians, particularly for the process measures examined.
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Affiliation(s)
- Theresa A Rowe
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Tiffany Brown
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ji Young Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark W Friedberg
- RAND Corporation, Boston, MA, USA
- Blue Cross Blue Shield of Massachusetts, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason N Doctor
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Daniella Meeker
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jody D Ciolino
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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32
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Lauzon SD, Ramakrishnan V, Nietert PJ, Ciolino JD, Hill MD, Zhao W. Statistical properties of minimal sufficient balance and minimization as methods for controlling baseline covariate imbalance at the design stage of sequential clinical trials. Stat Med 2020; 39:2506-2517. [PMID: 32363614 DOI: 10.1002/sim.8552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/15/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 01/21/2023]
Abstract
When the number of baseline covariates whose imbalance needs to be controlled in a sequential randomized controlled trial is large, minimization is the most commonly used method for randomizing treatment assignments. The lack of allocation randomness associated with the minimization method has been the source of controversy, and the need to reduce even minor imbalances inherent in the minimization method has been challenged. The minimal sufficient balance (MSB) method is an alternative to the minimization method. It prevents serious imbalance from a large number of covariates while maintaining a high level of allocation randomness. In this study, the two treatment allocation methods are compared with regards to the effectiveness of balancing covariates across treatment arms and allocation randomness in equal allocation clinical trials. The MSB method proves to be equal or superior in both respects. In addition, type I error rate is preserved in analyses for both balancing methods, when using a binary endpoint.
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Affiliation(s)
- Steven D Lauzon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael D Hill
- Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Wenle Zhao
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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33
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Rasmussen-Torvik LJ, Zumpf KB, Betcher HK, Ciolino JD. Interpreting the pharmacoepidemiology literature in obstetrical studies: A guide for clinicians. Semin Perinatol 2020; 44:151225. [PMID: 32247516 PMCID: PMC7214119 DOI: 10.1016/j.semperi.2020.151225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many prescribers are knowledgeable about randomized controlled trials (RCT), but are less familiar with pharmacoepidemiology studies; that is, observational studies in which a pharmacologic agent is the exposure of interest. To date, few clinical trials include pregnant women. With the absence of RCT data, prescribers must largely rely on the pharmacoepidemiology literature to guide prescribing decisions for pregnant patients. We describe different types of pharmacoepidemiology studies and present a flowchart and table checklist to support clinicians to assess the quality of, and thus the validity of conclusions from, pharmacoepidemiology studies. We provide illustrative examples of published observational studies examining antidepressant treatment during pregnancy and fetal and infant outcomes.
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Affiliation(s)
- Laura J. Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katelyn B Zumpf
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hannah K. Betcher
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jody D. Ciolino
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Persell SD, Peprah YA, Lipiszko D, Lee JY, Li JJ, Ciolino JD, Karmali KN, Sato H. Effect of Home Blood Pressure Monitoring via a Smartphone Hypertension Coaching Application or Tracking Application on Adults With Uncontrolled Hypertension: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200255. [PMID: 32119093 PMCID: PMC7052730 DOI: 10.1001/jamanetworkopen.2020.0255] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Mobile applications (apps) may help improve hypertension self-management. OBJECTIVE To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app. DESIGN, SETTING, AND PARTICIPANTS This was a 2-group, open, randomized clinical trial. Participants with uncontrolled hypertension were recruited in 2016 and 2017 and were followed up for 6 months. Data analysis was performed from April 2019 to December 2019. INTERVENTIONS Intervention group participants received a smartphone coaching app to promote home monitoring and behavioral changes associated with hypertension self-management plus a home blood pressure monitor. Control participants received a blood pressure tracking app plus a home blood pressure monitor. MAIN OUTCOMES AND MEASURES The primary study outcome was systolic blood pressure at 6 months. Secondary outcomes included self-reported antihypertensive medication adherence, home monitoring and self-management practices, measures of self-efficacy associated with blood pressure, weight, and self-reported health behaviors. RESULTS There were 333 participants randomized, and 297 completed the follow-up assessment. Among the participants who completed the study, the mean (SD) age was 58.9 (12.8) years, 182 (61.3%) were women, and 103 (34.7%) were black. Baseline mean (SD) systolic blood pressure was 140.6 (12.2) mm Hg among intervention participants and 141.8 (13.4) mm Hg among control participants. After 6 months, the corresponding mean (SD) systolic blood pressures were 132.3 (15.0) mm Hg and 135.0 (13.9) mm Hg, with a between-group adjusted difference of -2.0 mm Hg (95% CI, -4.9 mm Hg to 0.8 mm Hg; P = .16). At 6 months, self-confidence in controlling blood pressure was greater in the intervention group (0.36 point on a 5-point scale; 95% CI, 0.18 point to 0.54 point; P < .001). There were no significant differences between the 2 groups in other secondary outcomes. The adjusted difference in self-reported physical activity was 26.7 minutes per week (95% CI, -5.4 minutes per week to 58.8 minutes per week; P = .10). Subgroup analysis raised the possibility that intervention effects differed by age. CONCLUSIONS AND RELEVANCE Among individuals with uncontrolled hypertension, those randomized to a smartphone coaching app plus home monitor had similar systolic blood pressure compared with those who received a blood pressure tracking app plus home monitor. Given the direction of the difference in systolic blood pressure between groups and the possibility for differences in treatment effects across subgroups, future studies are warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03288142.
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Affiliation(s)
- Stephen D. Persell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yaw A. Peprah
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dawid Lipiszko
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ji Young Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jim J. Li
- Omron Healthcare Co Ltd, Kyoto, Japan
| | - Jody D. Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kunal N. Karmali
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Newcomb ME, Sarno EL, Bettin E, Carey J, Ciolino JD, Hill R, Garcia CP, Macapagal K, Mustanski B, Swann G, Whitton SW. Relationship Education and HIV Prevention for Young Male Couples Administered Online via Videoconference: Protocol for a National Randomized Controlled Trial of 2GETHER. JMIR Res Protoc 2020; 9:e15883. [PMID: 32012111 PMCID: PMC7011124 DOI: 10.2196/15883] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 08/14/2019] [Revised: 10/12/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER. Objective The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions. Methods This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Results As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing. Conclusions 2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas. Trial Registration ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541 International Registered Report Identifier (IRRID) DERR1-10.2196/15883
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Affiliation(s)
- Michael E Newcomb
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Elissa L Sarno
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Emily Bettin
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - James Carey
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Ricky Hill
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Christopher P Garcia
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Brian Mustanski
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Gregory Swann
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, OH, United States
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Liss DT, Peprah YA, Brown T, Ciolino JD, Jackson K, Kho AN, Murakami L, Walunas TL, Persell SD. Using Electronic Health Records to Measure Quality Improvement Efforts: Findings from a Large Practice Facilitation Initiative. Jt Comm J Qual Patient Saf 2020; 46:11-17. [PMID: 31704159 PMCID: PMC9884429 DOI: 10.1016/j.jcjq.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Federal incentives for electronic health record (EHR) use typically require quality measure reporting over calendar year or 90-day periods. However, required reporting periods may not align with time frames of real-world quality improvement (QI) efforts. This study described primary care practices' ability to obtain measures with reporting periods aligning with a large QI initiative. METHODS Researchers conducted a substudy of a randomized trial testing practice facilitation strategies for preventive cardiovascular care. Three quality measures (aspirin for ischemic vascular disease; blood pressure control for hypertension; smoking screening/cessation) were collected quarterly over one year. The primary outcome was a binary indicator of whether a practice facilitator obtained all three measures with "rolling 12-month" reporting periods (that is, the year preceding each study quarter). RESULTS The study included 107 practices, 63 (58.9%) of which met the primary outcome of obtaining all measures with rolling 12-month reporting periods. Smaller practices were less likely to meet the primary outcome (p < 0.001). Practices used 11 different EHRs, 3 of which were unable to consistently produce rolling 12-month measures; at 33 practices (30.8%) using these 3 EHRs, facilitators met a secondary outcome of obtaining prior calendar year and rolling 3-month measures. Facilitators reported barriers to data collection such as practices lacking optional EHR features, and EHRs' inability to produce reporting periods across two calendar years. CONCLUSION EHR vendors' compliance with federal reporting requirements is not necessarily sufficient to support real-world QI work. Improvements are needed in the flexibility and usability of EHRs' quality measurement functions, particularly for smaller practices.
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Affiliation(s)
- David T. Liss
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine (NUFSM), Chicago
| | - Yaw A. Peprah
- Division of General Internal Medicine and Geriatrics, NUFSM
| | | | | | | | | | - Linda Murakami
- Quality Improvement, American Medical Association, Chicago
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Affiliation(s)
- Katherine L Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Catherine S Stika
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ciolino JD, Palac HL, Yang A, Vaca M, Belli HM. Ideal vs. real: a systematic review on handling covariates in randomized controlled trials. BMC Med Res Methodol 2019; 19:136. [PMID: 31269898 PMCID: PMC6610785 DOI: 10.1186/s12874-019-0787-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 04/11/2018] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In theory, efficient design of randomized controlled trials (RCTs) involves randomization algorithms that control baseline variable imbalance efficiently, and corresponding analysis involves pre-specified adjustment for baseline covariates. This review sought to explore techniques for handling potentially influential baseline variables in both the design and analysis phase of RCTs. METHODS We searched PubMed for articles indexed "randomized controlled trial", published in the NEJM, JAMA, BMJ, or Lancet for two time periods: 2009 and 2014 (before and after updated CONSORT guidelines). Upon screening (343), 298 articles underwent full review and data abstraction. RESULTS Typical articles reported on superiority (86%), multicenter (92%), two-armed (79%) trials; 81% of trials involved covariates in the allocation and 84% presented adjusted analysis results. The majority reported a stratified block method (69%) of allocation, and of the trials reporting adjusted analyses, 91% were pre-specified. Trials published in 2014 were more likely to report adjusted analyses (87% vs. 79%, p = 0.0100) and more likely to pre-specify adjustment in analyses (95% vs. 85%, p = 0.0045). Studies initiated in later years (2010 or later) were less likely to use an adaptive method of randomization (p = 0.0066; 7% of those beginning in 2010 or later vs. 31% of those starting before 2000) but more likely to report a pre-specified adjusted analysis (p = 0.0029; 97% for those initiated in 2010 or later vs. 69% of those started before 2000). CONCLUSION While optimal reporting procedures and pre-specification of adjusted analyses for RCTs tend to be progressively more prevalent over time, we see the opposite effect on reported use of covariate-adaptive randomization methods.
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Affiliation(s)
- Jody D Ciolino
- Department of Preventive Medicine, Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611-4402, USA.
| | | | | | | | - Hayley M Belli
- Department of Population Health, New York University Langone Health, New York, NY, USA
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Ciolino JD, Diebold A, Jensen JK, Rouleau GW, Koloms KK, Tandon D. Choosing an imbalance metric for covariate-constrained randomization in multiple-arm cluster-randomized trials. Trials 2019; 20:293. [PMID: 31138319 PMCID: PMC6537428 DOI: 10.1186/s13063-019-3324-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/12/2018] [Accepted: 03/25/2019] [Indexed: 11/16/2022] Open
Abstract
Background In cluster-randomized controlled trials (C-RCTs), covariate-constrained randomization (CCR) methods efficiently control imbalance in multiple baseline cluster-level variables, but the choice of imbalance metric to define the subset of “adequately balanced” possible allocation schemes for C-RCTs involving more than two arms and continuous variables is unclear. In an ongoing three-armed C-RCT, we chose the min(three Kruskal–Wallis [KW] test P values) > 0.30 as our metric. We use simulation studies to explore the performance of this and other metrics of baseline variable imbalance in CCR. Methods We simulated three continuous variables across three arms under varying allocation ratios and assumptions. We compared the performance of min(analysis of variance [ANOVA] P value) > 0.30, min(KW P value) > 0.30, multivariate analysis of variance (MANOVA) P value > 0.30, min(nine possible t test P values) > 0.30, and min(Wilcoxon rank-sum [WRS] P values) > 0.30. Results Pairwise comparison metrics (t test and WRS) tended to be the most conservative, providing the smallest subset of allocation schemes (10%–13%) meeting criteria for acceptable balance. Sensitivity of the min(t test P values) > 0.30 for detecting non-trivial imbalance was 100% for both hypothetical and resampled simulation scenarios. The KW criterion maintained higher sensitivity than both the MANOVA and ANOVA criteria (89% to over 99%) but was not as sensitive as pairwise criteria. Conclusions Our criterion, the KW P value > 0.30, to signify “acceptable” balance was not the most conservative, but it appropriately identified imbalance in the majority of simulations. Since all are related, CCR algorithms involving any of these imbalance metrics for continuous baseline variables will ensure robust simultaneous control over multiple continuous baseline variables, but we recommend care in determining the threshold of “acceptable” levels of (im)balance. Trial registration This trial is registered on ClinicalTrials.gov (initial post: December 1, 2016; identifier: NCT02979444). Electronic supplementary material The online version of this article (10.1186/s13063-019-3324-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jody D Ciolino
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Alicia Diebold
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica K Jensen
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gerald W Rouleau
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Chelse AB, Kurz JE, Gorman KM, Epstein LG, Balmert LC, Ciolino JD, Wainwright MS. Remote poststroke headache in children: Characteristics and association with stroke recurrence. Neurol Clin Pract 2019; 9:194-200. [PMID: 31341706 DOI: 10.1212/cpj.0000000000000652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/28/2019] [Indexed: 11/15/2022]
Abstract
Background New-onset headache after stroke is common among adult stroke survivors. However, pediatric data are limited. The primary aim of this study was to investigate the prevalence of new-headache after pediatric ischemic stroke. Secondary outcomes were to describe the characteristics of patients experiencing poststroke headache and the association between poststroke headache and stroke recurrence. Methods We conducted a single-center retrospective study on children aged 30 days to 18 years with a confirmed radiographic diagnosis of arterial ischemic stroke (AIS) from January 1, 2008, to December 31, 2016. Patients were identified from an internal database, with additional data abstracted from the electronic medical record. Poststroke headache (occurring >30 days after stroke) was identified through electronic searches of the medical record and confirmed by chart review. Results Of 115 patients with confirmed AIS, 41 (36%) experienced poststroke headache, with headache developing a median of 6 months after stroke. Fifty-one percent of patients with poststroke headache presented to the emergency department for headache evaluation; 81% of the patients had an inpatient admission for headache. Older age at stroke (odds ratio [OR] 21.5; p = 0.0001) and arteriopathy (OR 8.65; p = 0.0029) were associated with development of poststroke headache in a multivariable analysis. Seventeen patients (15%) had a recurrent stroke during the study period. Poststroke headache was associated with greater risk for stroke recurrence (p = 0.049). Conclusions Remote poststroke headache is a common morbidity among pediatric stroke survivors, particularly in older children. Headaches may increase health care utilization, including neuroimaging and hospital admissions. We identified a possible association between poststroke headache and stroke recurrence.
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Affiliation(s)
- Ana B Chelse
- Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle
| | - Jonathan E Kurz
- Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle
| | - Kathleen M Gorman
- Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle
| | - Leon G Epstein
- Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle
| | - Lauren C Balmert
- Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle
| | - Jody D Ciolino
- Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle
| | - Mark S Wainwright
- Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle
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Newmark RL, Bogen DL, Wisner KL, Isaac M, Ciolino JD, Clark CT. Risk-Benefit assessment of infant exposure to lithium through breast milk: a systematic review of the literature. Int Rev Psychiatry 2019; 31:295-304. [PMID: 31180257 DOI: 10.1080/09540261.2019.1586657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The continuation of lithium while breastfeeding is a controversial topic, and clinical recommendations vary. A systematic review was completed of available data on lithium and breastfeeding to determine the degree of lithium exposure through breast milk and assess the potential risk to the infant. Databases, including PubMed MEDLINE, Embase, PsycINFO, Web of Science, Scopus, and Cochrane CENTRAL Register of Controlled Trials databases, were searched for articles on lithium and breastfeeding from the start dates of the databases through December 2018. Articles were included if the report included at least one maternal serum/plasma and/or breast milk lithium concentration and one infant serum/plasma lithium concentration. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Twelve articles, all case reports, were selected for inclusion out of 441 articles that were found and 230 that were reviewed from the search. Data are limited on the safety of lithium continuation while breastfeeding. Among the adverse effects reported, it is difficult to differentiate poor outcomes from factors affecting infant health, concomitant medications, and gestational lithium exposure. Recommendations on whether to continue lithium while breastfeeding must be personalized to the individual woman and her infant.
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Affiliation(s)
| | - Debra L Bogen
- b Department of Pediatrics , University of Pittsburgh , Pittsburgh , PA , USA
| | - Katherine L Wisner
- c Asher Center for the Study and Treatment of Depressive Disorders, Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology , Northwestern University , Chicago , IL , USA
| | | | - Jody D Ciolino
- d Department of Preventive Medicine , Northwestern University , Chicago , IL , USA
| | - Crystal T Clark
- c Asher Center for the Study and Treatment of Depressive Disorders, Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology , Northwestern University , Chicago , IL , USA
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Fisher SD, Sit DK, Yang A, Ciolino JD, Gollan JK, Wisner KL. Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms. Depress Anxiety 2019; 36:375-383. [PMID: 30645006 PMCID: PMC6494079 DOI: 10.1002/da.22879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/19/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Postpartum depression is a heterogeneous disorder in phenotype and etiology. Characterizing the longitudinal course of depressive symptoms over the first year after birth and identifying variables that predict distinct symptom trajectories will expedite efficient mental health treatment planning. The purpose was to determine 12-month trajectories of postpartum depressive symptoms, identify characteristics that predict the trajectories, and provide a computational algorithm that predicts trajectory membership. METHODS A prospective cohort of women delivering at an academic medical center (2006-2011) was recruited from an urban women's hospital in Pittsburgh, PA. Women with a postpartum depressive disorder (n = 507) participated and completed symptom severity assessments at 4-8 weeks (intake), 3 months, 6 months, and 12 months. Women were predominantly Caucasian (71.8%), married (53.3%), and college educated (38.7%). Clinician interviews of depressive symptom severity, medical and psychiatric history, assessment of function, obstetric experience, and infant status were conducted. RESULTS Analyses resulted in identification of three distinct trajectories of depressive symptoms: (1) gradual remission (50.4%), (2) partial improvement (41.8%), and (3) chronic severe (7.8%). Key predictive characteristics of the chronic severe versus gradual remission and partial improvement trajectories included parity, education, and baseline global functioning and depression severity. We were able to predict trajectory membership with 72.8% accuracy from these characteristics. CONCLUSIONS Four maternal characteristics predicted membership in the chronic severe versus gradual remission and partial improvement trajectories with 72.8% accuracy. The trajectory groups comprise clinically relevant subgroups with the potential for tailored treatments to reduce the disease burden of postpartum depression.
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Affiliation(s)
- Sheehan D. Fisher
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine, 676 North St Clair Street,
Suite 1000, Chicago, IL, 60611 USA
| | - Dorothy K. Sit
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine, 676 North St Clair Street,
Suite 1000, Chicago, IL, 60611 USA
| | - Amy Yang
- Department of Preventive Medicine-Biostatistics,
Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite
1400, 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
| | - Jackie K. Gollan
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine, 676 North St Clair Street,
Suite 1000, Chicago, IL, 60611 USA
| | - Katherine L. Wisner
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine, 676 North St Clair Street,
Suite 1000, Chicago, IL, 60611 USA
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Danilovich MK, Diaz L, Johnson C, Holt E, Ciolino JD. Evaluating frailty in Medicaid Home and Community-based Services clients: a feasibility and comparison study between the SHARE-FI and SPPB. Pilot Feasibility Stud 2019; 5:48. [PMID: 30923629 PMCID: PMC6425588 DOI: 10.1186/s40814-019-0429-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/05/2019] [Indexed: 01/09/2023] Open
Abstract
Background Frailty assessment most commonly occurs within health care settings by health care providers. Implementing frailty assessment within non-medical settings that provide comprehensive social services for older adults may be an opportunity for population-based frailty screening and care. One such non-medical setting in which older adults receive care is Medicaid Home and Community-based Services (HCBS). Determining the feasibility of frailty screening within this non-medical setting is the first step towards population-based frailty assessment and care. The aims of this study were to (1) determine the feasibility of evaluating frailty using two different approaches (the Survey of Health Among Retired Europeans-Frailty Instrument (SHARE-FI) and Short Physical Performance Battery (SPPB)) among HCBS clients, (2) determine the agreement between the methods, and (3) explore specific frailty deficits on these measures to provide detailed knowledge on HCBS client impairments. Methods This cross-sectional study occurred in HCBS client homes throughout the Chicagoland area. A research assistant with no health care provider training conducted all frailty assessments. We used the freely available SHARE-FI calculator to generate both a categorical and continuous frailty score. We used the SPPB to capture both a categorical score with frailty categories assigned as 0-6 (frail), 7-9 (pre-frail), and 10-12 (non-frail) and continuous score. We evaluated feasibility via domains of acceptability, implementation, adaptation, and practicality. We used Cohen's kappa and Spearman's correlation to determine agreement between frailty tools. Results We enrolled n = 139 HCBS clients. Frailty assessment was feasibility via both the SHARE-FI and SPPB. The SHARE-FI was more practical given the fewer training needs, shorter administration time, and reduced equipment needs. There was a statically significant fair agreement between SHARE-FI and SPPB categorical scores with stronger agreement between SHARE-FI and SPPB continuous scores (r = - 0.448, p < .005; 95% CI, - 0.571, - 0.305). Among the five frailty criteria on the SHARE-FI, a pattern emerged of the highest frequency of positive responses to each criterion among frail clients followed by pre-frail and then non-frail. Conclusions Frailty assessment is feasible within HCBS settings conducted by a non-medical provider. Using continuous frailty scores provides stronger agreement between measures compared with categorical scores. Frailty can be feasibly measured in a non-medical setting providing initial evidence for a mechanism for population screening and care for frailty in HCBS.
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Affiliation(s)
- Margaret K Danilovich
- 1Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Suite 1100, Chicago, IL 60611 USA
| | - Laura Diaz
- 1Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Suite 1100, Chicago, IL 60611 USA
| | - Colton Johnson
- 1Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Suite 1100, Chicago, IL 60611 USA
| | - Erin Holt
- 1Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Suite 1100, Chicago, IL 60611 USA
| | - Jody D Ciolino
- 2Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Drive Suite 1400, Chicago, IL 60611 USA
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Wisner KL, Sit D, O’Shea K, Bogen DL, Clark CT, Pinheiro E, Yang A, Ciolino JD. Bipolar disorder and psychotropic medication: Impact on pregnancy and neonatal outcomes. J Affect Disord 2019; 243:220-225. [PMID: 30248632 PMCID: PMC6548542 DOI: 10.1016/j.jad.2018.09.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 04/19/2018] [Revised: 08/29/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The hypotheses were: (1) pregnant women with bipolar disorder (BD) have less favorable pregnancy outcomes than unaffected women, and (2) psychotropic treated women with BD have better outcomes than un-medicated women. METHOD This prospective study included 174 mother-infant dyads. Women had BD without psychotropic exposure (BD-NP, n = 38), BD with psychotropic treatment (BD-P, n = 49), or neither psychotropic exposure nor major mood disorder (Comp, n = 87). Maternal characteristics were completed at 20 weeks gestation and evaluated for associations with delivery and birth outcomes. We performed multiple regressions on infant outcomes with adjustment for maternal age, race, employment status, use of illicit drugs and pre-pregnancy BMI. RESULTS The BP-P, BP-NP and Comp groups varied significantly on sociodemographic characteristics. Women with BD were more likely to be less educated, unemployed, single, and use tobacco and illicit drugs than women in the Comp group. Compared to women with BD-NP, women with BD-P were more likely to be older and educated. Approximately 10% of all infants were delivered preterm. No significant differences in outcome occurred for APGAR scores < 8, NICU admissions, sex or infant length. Infants of mothers with BD-NP had significantly smaller head circumferences (HC) than the other groups, adjustment for confounding variables mitigated this association. CONCLUSIONS The overall pregnancy outcomes for women with BD were similar to those in the Comp group. The reduced HC in women with untreated BD appears due to factors related to disadvantaged sociodemographic status, a higher proportion of female births, and/or a protective effect of medication in the BD-P group.
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Affiliation(s)
- Katherine L. Wisner
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, Chicago, IL, USA,Corresponding author. (K.L. Wisner)
| | - Dorothy Sit
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, Chicago, IL, USA
| | - Kelly O’Shea
- Department of Psychiatry and Behavioral Sciences, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, Chicago, IL, USA
| | - Debra L. Bogen
- Professor of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Crystal T. Clark
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, Chicago, IL, USA
| | | | - Amy Yang
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Jody D. Ciolino
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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Jensen JK, Ciolino JD, Diebold A, Segovia M, Degillio A, Solano-Martinez J, Tandon SD. Comparing the Effectiveness of Clinicians and Paraprofessionals to Reduce Disparities in Perinatal Depression via the Mothers and Babies Course: Protocol for a Cluster-Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e11624. [PMID: 30459138 PMCID: PMC6280028 DOI: 10.2196/11624] [Citation(s) in RCA: 12] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background Postpartum depression is highly prevalent in low-income women and has significant health and mental health effects on mother and child. Home visiting (HV) programs provide services to large numbers of perinatal women in the United States and are a logical setting for delivering mental health services. Although there are interventions that reduce the risk of developing postpartum depression among low-income women, none have used nonhealth or nonmental health professionals as interventionists. Objective This study aimed to outline the protocol of a cluster randomized trial funded by the Patient-Centered Outcomes Research Institute that evaluates whether the Mothers and Babies (MB) group intervention, when led by paraprofessional home visitors, is more efficacious than usual care. It will also examine if MB, when led by home visitors, is not inferior to MB delivered by mental health professionals (MHPs). MB has previously demonstrated efficacy when delivered by MHPs, and pilot work indicated promising results using home visitors to deliver the intervention. Methods A cluster randomized trial is being conducted with 38 HV programs. Sixteen HV programs will deliver MB using MHPs, 16 will deliver MB using paraprofessional home visitors, and 6 will deliver usual HV services. The study employs a modified covariate-constrained randomization design at the site level. We anticipate recruiting 933 women aged ≥16 years enrolled in HV programs, who are 33 or more weeks’ gestation and speak either English or Spanish. Women in the 2 intervention arms will receive the 6-session MB group intervention. Baseline, postintervention, 12-week postpartum, and 24-week postpartum assessments will be conducted to assess client outcomes. The primary outcome will be the change in Quick Inventory of Depressive Symptomatology Self-Report 16 scores from baseline to 24-week follow-up. Secondary outcomes associated with core MB content will also be examined. Semistructured interviews will be conducted with home visitors and MHPs who are group facilitators and 90 study participants to gain data on intervention successes and challenges. Analyses will proceed at the participant level. Primary analyses for depressive symptoms score at 24 weeks postpartum will involve a linear mixed model, controlling for baseline symptoms and other covariates, and random effects to account for clustering. Results We have recruited 838 women through the end of August 2018. Recruitment will be completed at the end of September 2018. Conclusions There is considerable potential to disseminate MB to HV programs throughout the United States. Should our results demonstrate home visitor efficacy when compared with usual care and/ noninferiority between home visitors and MHPs in improving mental health outcomes, no additional financial resources would be required for the existing HV staff to implement MB. Should this study determine that home visitors are less effective than MHPs, we will generate more wide-scale evidence on MB effectiveness when led by MHPs. Trial Registration ClinicalTrials.gov NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444 (Archived by Webcite at http://www.webcitation.org/archive.php) International Registered Report Identifier (IRRID) PRR1-10.2196/11624
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Affiliation(s)
- Jessica K Jensen
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alicia Diebold
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Melissa Segovia
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Aria Degillio
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jesus Solano-Martinez
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - S Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Burnett-Zeigler IE, Waldron EM, Hong S, Yang A, Wisner KL, Ciolino JD. Accessibility and feasibility of using technology to support mindfulness practice, reduce stress and promote long term mental health. Complement Ther Clin Pract 2018; 33:93-99. [PMID: 30396633 DOI: 10.1016/j.ctcp.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE We evaluated the feasibility of using an activity monitor to support mindfulness practice, reduce self-reported stress and physiological indicators of stress. MATERIALS AND METHODS Adult women (N = 19) who previously participated in a mindfulness intervention wore an activity monitor for eight-weeks. The activity monitor notified them when they were stressed (based on standard deviation pulse pressure). Heart rate and pulse pressure were continuously collected via the activity monitor. Mindfulness, stress, depression and trauma symptoms were collected via self-report surveys. RESULTS There were no significant changes in self-reported stress, depression, post-traumatic stress and mindfulness from baseline to eight-weeks. Pulse pressure and standard deviation of pulse pressure increased over time. Those who were high on the non-judge mindfulness subscale had a lower standard deviation pulse pressure and spent less time stressed. CONCLUSION Those who are more mindful are less likely to have physiological signs of stress.
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Affiliation(s)
- Inger E Burnett-Zeigler
- Northwestern University, Asher Center for the Study and Treatment of Depressive Disorders, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, 676 N. Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA.
| | - Elizabeth M Waldron
- Northwestern University, Asher Center for the Study and Treatment of Depressive Disorders, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, 676 N. Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Sunghyun Hong
- Northwestern University, Asher Center for the Study and Treatment of Depressive Disorders, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, 676 N. Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Amy Yang
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Katherine L Wisner
- Northwestern University, Asher Center for the Study and Treatment of Depressive Disorders, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, 676 N. Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Jody D Ciolino
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
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47
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Palac HL, Alam N, Kaiser SM, Ciolino JD, Lattie EG, Mohr DC. A Practical Do-It-Yourself Recruitment Framework for Concurrent eHealth Clinical Trials: Simple Architecture (Part 1). J Med Internet Res 2018; 20:e11049. [PMID: 30389650 PMCID: PMC6238104 DOI: 10.2196/11049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 12/20/2022] Open
Abstract
Background The ability to identify, screen, and enroll potential research participants in an efficient and timely manner is crucial to the success of clinical trials. In the age of the internet, researchers can be confronted with large numbers of people contacting the program, overwhelming study staff and frustrating potential participants. Objective This paper describes a “do-it-yourself” recruitment support framework (DIY-RSF) that uses tools readily available in many academic research settings to support remote participant recruitment, prescreening, enrollment, and management across multiple concurrent eHealth clinical trials. Methods This work was conducted in an academic research center focused on developing and evaluating behavioral intervention technologies. A needs assessment consisting of unstructured individual and group interviews was conducted to identify barriers to recruitment and important features for the new system. Results We describe a practical and adaptable recruitment management architecture that used readily available software, such as REDCap (Research Electronic Data Capture) and standard statistical software (eg, SAS, R), to create an automated recruitment framework that supported prescreening potential participants, consent to join a research registry, triaging for management of multiple trials, capture of eligibility information for each phase of a recruitment pipeline, and staff management tools including monitoring of participant flow and task assignment/reassignment features. The DIY-RSF was launched in July 2015. As of July 2017, the DIY-RSF has supported the successful recruitment efforts for eight trials, producing 14,557 participant records in the referral tracking database and 5337 participants in the center research registry. The DIY-RSF has allowed for more efficient use of staff time and more rapid processing of potential applicants. Conclusions Using tools already supported at many academic institutions, we describe the architecture and utilization of an adaptable referral management framework to support recruitment for multiple concurrent clinical trials. The DIY-RSF can serve as a guide for leveraging common technologies to improve clinical trial recruitment procedures.
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Affiliation(s)
- Hannah L Palac
- AbbVie Inc, North Chicago, IL, United States.,Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nameyeh Alam
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susan M Kaiser
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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48
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Persell SD, Karmali KN, Stein N, Li J, Peprah YA, Lipiszko D, Ciolino JD, Sato H. Design of a randomized controlled trial comparing a mobile phone-based hypertension health coaching application to home blood pressure monitoring alone: The Smart Hypertension Control Study. Contemp Clin Trials 2018; 73:92-97. [PMID: 30172038 DOI: 10.1016/j.cct.2018.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 07/11/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hypertension is a major cause of morbidity and mortality but frequently remains uncontrolled. A smartphone application that provides coaching regarding home blood pressure monitoring and other aspects of hypertension self-care and related behavior change may be a scalable way to help manage hypertension. METHODS/DESIGN The Smart Hypertension Control Study is a prospective, randomized controlled trial to assess the effects of a hypertension personal control program (HPCP), which consists of an automated artificial intelligence smartphone application that provides individualized support and coaching to promote home monitoring and healthy behavior changes related to hypertension self-management. Enrolled adults with uncontrolled hypertension will be randomized in a 1:1 fashion to the HPCP with home blood pressure monitoring or to home monitoring alone. We plan to enroll 350 participants, with a target of 300 participants with complete six-month follow-up data. The primary study outcome will be systolic blood pressure at six months. Additional outcomes include measures of antihypertensive medication adherence, home blood pressure monitoring practices, self-management practices, weight, and self-reported health behaviors. CONCLUSION The Smart Hypertension Control Study will evaluate blood pressure and hypertension self-management behavior outcomes in participants with uncontrolled hypertension exposed to a smartphone-based hypertension health coaching application in addition to home blood pressure monitoring compared to those exposed to home blood pressure monitoring alone.
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Affiliation(s)
- Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
| | - Kunal N Karmali
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Natalie Stein
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI and Lark Technologies Inc., Mountain View, CA, United States
| | - Jim Li
- Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Yaw A Peprah
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Dawid Lipiszko
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jody D Ciolino
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Yadlapati R, Ciolino JD, Craft J, Roman S, Pandolfino JE. Trajectory assessment is useful when day-to-day esophageal acid exposure varies in prolonged wireless pH monitoring. Dis Esophagus 2018; 32:5075411. [PMID: 30124795 PMCID: PMC6403452 DOI: 10.1093/dote/doy077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acid exposure time commonly varies from day-to-day in prolonged wireless pH monitoring. Thus, diagnosis based on the number of days with abnormal acid burden may be misleading or inconclusive. We hypothesize that assessing longitudinal patterns of acid exposure may be diagnostically useful. Therefore, this study aims to describe acid exposure trajectories and evaluate agreement between identified trajectory patterns and conventional grouping. In this retrospective cohort study, we assessed patients with nonresponse to proton pump inhibitor therapy who underwent wireless pH monitoring (≥72 h) off therapy between August 2010 and September 2016. The primary outcome was esophageal acid exposure time. Subjects were grouped as 0, 1, 2, and 3+ days positive based on number of days with an acid exposure time >5.0%. Latent class group-based mixture model identified distinct longitudinal acid exposure trajectory groups. Of 212 subjects included 44%, 18%, 14%, and 24% had 0, 1, 2, 3+ days positive, respectively. Group-based modeling identified three significantly stable acid exposure trajectories: low (64%), middle (28%), and high (8%). Trajectory grouping and days positive grouping agreed substantially (weighted K 0.69; 95% CI: 0.63-0.76). Trajectory grouping identified 62% of subjects with conventionally inconclusive studies (one or two days positive) into the low trajectory. Agreement between trajectory groups when using three versus four days of monitoring was substantial (K 0.70; CI: 0.61-0.78). In summary, we found that patients with nonresponse to proton pump inhibitors follow three acid exposure trajectories over prolonged pH-monitoring periods: low, middle, and high. Compared to conventional day positive grouping, the trajectory modeling identified the majority of inconclusive days positive into the low trajectory group. Analyzing prolonged wireless pH data according to trajectories may be a complimentary method to conventional grouping, and may increase precision and accuracy in identifying acid burden.
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Affiliation(s)
- R Yadlapati
- Division of Gastroenterology and Hepatology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado,Address correspondence to: Rena Yadlapati MD, MSHS, Assistant Professor, University of Colorado, Anschutz Medical Campus, Academic Office 1 Room 7605, 12631 E. 17th Ave, Aurora, CO 80045, USA. E-mail:
| | - J D Ciolino
- Department of Preventive Medicine, Division of Biostatistics
| | - J Craft
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington, USA
| | - S Roman
- Digestive Physiology, Hospices Civils de Lyon and Lyon I University, Lyon, France
| | - J E Pandolfino
- Division of Gastroenterology & Hepatology, Northwestern University, Chicago, Illinois
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Sit DK, McGowan J, Wiltrout C, Diler RS, Dills JJ, Luther J, Yang A, Ciolino JD, Seltman H, Wisniewski SR, Terman M, Wisner KL. Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry 2018; 175:131-139. [PMID: 28969438 DOI: 10.1176/appi.ajp.2017.16101200] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients with bipolar disorder have recurrent major depression, residual mood symptoms, and limited treatment options. Building on promising pilot data, the authors conducted a 6-week randomized double-blind placebo-controlled trial to investigate the efficacy of adjunctive bright light therapy at midday for bipolar depression. The aims were to determine remission rate, depression symptom level, and rate of mood polarity switch, as well as to explore sleep quality. METHOD The study enrolled depressed adults with bipolar I or II disorder who were receiving stable dosages of antimanic medication (excluding patients with hypomania or mania, mixed symptoms, or rapid cycling). Patients were randomly assigned to treatment with either 7,000-lux bright white light or 50-lux dim red placebo light (N=23 for each group). Symptoms were assessed weekly with the Structured Interview Guide for the Hamilton Depression Scale With Atypical Depression Supplement (SIGH-ADS), the Mania Rating Scale, and the Pittsburgh Sleep Quality Index. Remission was defined as having a SIGH-ADS score of 8 or less. RESULTS At baseline, both groups had moderate depression and no hypomanic or manic symptoms. Compared with the placebo light group, the group treated with bright white light experienced a significantly higher remission rate (68.2% compared with 22.2%; adjusted odds ratio=12.6) at weeks 4-6 and significantly lower depression scores (9.2 [SD=6.6] compared with 14.9 [SD=9.2]; adjusted β=-5.91) at the endpoint visit. No mood polarity switches were observed. Sleep quality improved in both groups and did not differ significantly between them. CONCLUSIONS The data from this study provide robust evidence that supports the efficacy of midday bright light therapy for bipolar depression.
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Affiliation(s)
- Dorothy K Sit
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - James McGowan
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Christopher Wiltrout
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Rasim Somer Diler
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - John Jesse Dills
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - James Luther
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Amy Yang
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Jody D Ciolino
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Howard Seltman
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Stephen R Wisniewski
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Michael Terman
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Katherine L Wisner
- From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
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