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Bui AT, Chaudhari R, Bhati C, Wolver S, Patel S, Boyett S, Evans MC, Kamal H, Patel V, Forsgren M, Sanyal AJ, Kirkman D, Siddiqui MS. Reduced metabolic flexibility is a predictor of weight gain among liver transplant recipients. Liver Transpl 2024; 30:192-199. [PMID: 37146168 DOI: 10.1097/lvt.0000000000000169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/07/2023] [Indexed: 05/07/2023]
Abstract
Metabolic flexibility is the ability to match biofuel availability to utilization and is inversely associated with increased metabolic burden among liver transplant (LT) recipients. The present study evaluated the impact of metabolic flexibility on weight gain following LT. LT recipients were enrolled prospectively (n = 47) and followed for 6 months. Metabolic flexibility was measured using whole-room calorimetry and is expressed as a respiratory quotient (RQ). Peak RQ represents maximal carbohydrate metabolism and occurs in the post-prandial state, while trough RQ represents maximal fatty acid metabolism occurring in the fasted state. The clinical, metabolic, and laboratory characteristics of the study cohort of lost weight (n = 14) and gained weight (n = 33) were similar at baseline. Patients who lost weight were more likely to reach maximal RQ (maximal carbohydrate oxidation) early and rapidly transitioned to trough RQ (maximal fatty acid oxidation). In contrast, patients who gained weight had delayed time to peak RQ and trough RQ. In multivariate modeling, time to peak RQ (β-coefficient 0.509, p = 0.01), time from peak RQ to trough RQ (β-coefficient 0.634, p = 0.006), and interaction between time to peak RQ to trough RQ and fasting RQ (β-coefficient 0.447, p = 0.02) directly correlated with the severity of weight gain. No statistically significant relationship between peak RQ, trough RQ, and weight change was demonstrated. Inefficient transition between biofuels (carbohydrates and fatty acids) is associated with weight gain in LT recipients that is independent of clinical metabolic risk. These data offer novel insight into the physiology of obesity after LT with the potential to develop new diagnostics and therapeutics.
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Affiliation(s)
- Anh T Bui
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Rahul Chaudhari
- Division of Gastroenterology and Hepatology, VCU, Richmond, Virginia, USA
| | - Chandra Bhati
- Division of Transplant Surgery, University of Maryland, Maryland, USA
| | - Susan Wolver
- Department of Internal Medicine, VCU, Richmond, Virginia, USA
| | - Samarth Patel
- Division of Gastroenterology and Hepatology, Lehigh Valley Hospital-Cedar Crest, Pennsylvania, USA
| | - Sherry Boyett
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Marie Claire Evans
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Hiba Kamal
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Vaishali Patel
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Mikael Forsgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Arun J Sanyal
- Division of Gastroenterology and Hepatology, VCU, Richmond, Virginia, USA
| | - Danielle Kirkman
- Department of Kinesiology and Health Sciences, VCU, Richmond, Virginia, USA
| | - Mohammad Shadab Siddiqui
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
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Chavez DA, Evans MC, Bohmke NJ, Kamal H, Tran LQ, Bhati C, Wolver S, Siddiqui MS, Kirkman DL. Postoperative association between impaired renal function and vascular dysfunction in liver transplant recipients. Liver Transpl 2023; 29:340-342. [PMID: 37160055 PMCID: PMC9935544 DOI: 10.1002/lt.26572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Domenico A Chavez
- Department of Kinesiology and Health Sciences , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Marie-Claire Evans
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Natalie J Bohmke
- Department of Kinesiology and Health Sciences , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Hiba Kamal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Loan Quynh Tran
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Chandra Bhati
- Division of Transplant Surgery, Department of Surgery , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Susan Wolver
- Division of General Internal Medicine, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Mohammad S Siddiqui
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Danielle L Kirkman
- Department of Kinesiology and Health Sciences , Virginia Commonwealth University , Richmond , Virginia , USA
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Siddiqui MS, Patel S, Forsgren M, Bui AT, Shen S, Syed T, Boyett S, Chen S, Sanyal AJ, Wolver S, Kirkman D, Celi FS, Bhati CS. Differential fuel utilization in liver transplant recipients and its relationship with non-alcoholic fatty liver disease. Liver Int 2022; 42:1401-1409. [PMID: 35129295 PMCID: PMC9189602 DOI: 10.1111/liv.15178] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 02/13/2023]
Abstract
UNLABELLED Metabolic flexibility is the ability to match biofuel availability to utilization. Reduced metabolic flexibility, or lower fatty acid (FA) oxidation in the fasted state, is associated with obesity. The present study evaluated metabolic flexibility after liver transplantation (LT). METHODS Patients receiving LT for non-alcoholic steatohepatitis (NASH) (n = 35) and non-NASH (n = 10) were enrolled. NASH was chosen as these patients are at the highest risk of metabolic complications. Metabolic flexibility was measured using whole-body calorimetry and expressed as respiratory quotient (RQ), which ranges from 0.7 (pure FA oxidation) to 1.0 is (carbohydrate oxidation). RESULTS The two cohorts were similar except for a higher prevalence of obesity and diabetes in the NASH cohort. Post-prandially, RQ increased in both cohorts (i.e. greater carbohydrate utilization) but peak RQ and time at peak RQ was higher in the NASH cohort. Fasting RQ in NASH was significantly higher (0.845 vs. 0.772, p < .001), indicative of impaired FA utilization. In subgroup analysis of the NASH cohort, body mass index but not liver fat content (MRI-PDFF) was an independent predictor of fasting RQ. In NASH, fasting RQ inversely correlated with fat-free muscle volume and directly with visceral adipose tissue. CONCLUSION Reduced metabolic flexibility in patients transplanted for NASH cirrhosis may precede the development of non-alcoholic fatty liver disease after LT.
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Affiliation(s)
- Mohammad S. Siddiqui
- Division of Gastroenterology and HepatologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Samarth Patel
- Division of Gastroenterology and HepatologyVirginia Commonwealth UniversityRichmondVirginiaUSA,Division of Gastroenterology and HepatologyHunter‐Holmes McGuire VARichmondVirginiaUSA
| | - Mikael Forsgren
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Anh T. Bui
- Department of Statistical Sciences and Operations ResearchVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Steve Shen
- Division of Gastroenterology and HepatologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Taseen Syed
- Division of Gastroenterology and HepatologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Sherry Boyett
- Division of Gastroenterology and HepatologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Shanshan Chen
- Division of Endocrinology, Diabetes and MetabolismVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Arun J. Sanyal
- Division of Gastroenterology and HepatologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Susan Wolver
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Danielle Kirkman
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Francesco S. Celi
- Division of Endocrinology, Diabetes and MetabolismVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Chandra S. Bhati
- Division of Transplant SurgeryVirginia Commonwealth UniversityRichmondVirginiaUSA
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Martin LF, Chavez DA, Bohmke NJ, Miller A, Bhati C, Wolver S, Siddiqui MS, Kirkman DL. Weight Gain, Fibroblast Growth Factor‐23, and Vascular Function in Liver Transplant Recipients. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Linsey F. Martin
- Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVA
| | - Domenico A. Chavez
- Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVA
| | - Natalie J. Bohmke
- Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVA
| | - Austin Miller
- Internal Medicine, Division of General Internal MedicineVirginia Commonwealth UniversityRichmondVA
| | - Chandra Bhati
- Surgery, Division of Transplant SurgeryVirginia Commonwealth UniversityRichmondVA
| | - Susan Wolver
- Internal Medicine, Division of General Internal MedicineVirginia Commonwealth UniversityRichmondVA
| | - Mohammad S. Siddiqui
- Internal Medicine, Hepatology and NutritionVirginia Commonwealth UniversityRichmondVA
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Chavez DA, Bohmke NJ, Martin L, Miller A, Bhati C, Wolver S, Siddiqui MS, Kirkman DL. Sex Differences in Vascular Endothelial Function After Liver Transplant. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Domenico A. Chavez
- Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVA
| | - Natalie J. Bohmke
- Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVA
| | - Linsey Martin
- Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVA
| | - Austin Miller
- Internal MedicineVirginia Commonwealth UniversityRichmondVA
| | | | - Susan Wolver
- Internal MedicineVirginia Commonwealth UniversityRichmondVA
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Wolver S, Fadel K, Fieger E, Aburish Z, O'Rourke B, Chandler TM, Shimotani D, Clingempeel N, Jain S, Jain A, Puri P. Clinical Use of a Real-World Low Carbohydrate Diet Resulting in Reduction of Insulin Dose, Hemoglobin A1c, and Weight. Front Nutr 2021; 8:690855. [PMID: 34458301 PMCID: PMC8385129 DOI: 10.3389/fnut.2021.690855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/06/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: Type 2 Diabetes Mellitus (T2DM) is increasing in epidemic proportions. In addition to the morbidity and mortality, for those treated with insulin, the physical, psychological, and financial tolls are often greater. Our real-world study evaluated a Low Carbohydrate Diet (LCD) in patients with T2DM on insulin with respect to glycemic control, insulin reduction, and weight loss. Materials and Methods: A prospective cohort study was conducted via an Electronic Medical Record search for patients attending the Virginia Commonwealth University Medical Weight Loss Program from 2014 to 2020 with Type 2 Diabetes Mellitus who initially presented on insulin. Data was extracted for 1 year after enrollment. The weight loss program focuses on a LCD. Results: Of 185 participants, the mean (± SD) age was 56.1 (9.9) years. Seventy percent were female and 63% were black. Eighty-five completed 12 months (45.9%), reduced their median (25-75% interquartile range, IQR) insulin dose from 69 to 0 units (0-18, p < 0.0001), HbA1c from 8 to 6.9% (6.2-7.8, p < 0.0001), and weight from 116 to 99 kg (85-120, p < 001). Eighty six percent who completed 12 months were able to reduce or discontinue insulin, with 70.6% completely discontinuing. Among all participants who completed 3, 6, or 12 months, 97.6% were able to reduce or eliminate insulin use. Conclusion: In patients with T2DM on a LCD, it is possible to reduce and even discontinue insulin use while facilitating weight loss and achieving glycemic control. A Low Carbohydrate Diet should be offered to all patients with diabetes, especially those using insulin.
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Affiliation(s)
- Susan Wolver
- Virginia Commonwealth University, Medical Center, Richmond, VA, United States
| | - Kristen Fadel
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Ethan Fieger
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Zein Aburish
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Brennen O'Rourke
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Toni-Marie Chandler
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Dorian Shimotani
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Natasha Clingempeel
- Virginia Commonwealth University, Medical Center, Richmond, VA, United States
| | - Shuchi Jain
- Virginia Commonwealth University, Richmond, VA, United States
| | - Aashish Jain
- Independent Researcher, Richmond, VA, United States
| | - Puneet Puri
- Virginia Commonwealth University, Medical Center, Richmond, VA, United States
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Patel SS, Siddiqui MB, Chadrakumaran A, Faridnia M, Lin FP, Hernandez Roman J, Carbone S, Laurenzo J, Clinton J, Kirkman D, Wolver S, Celi F, Bhati C, Siddiqui MS. Office-Based Weight Loss Counseling Is Ineffective in Liver Transplant Recipients. Dig Dis Sci 2020; 65:639-646. [PMID: 31440999 DOI: 10.1007/s10620-019-05800-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/12/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Weight gain after liver transplantation (LT) is a predictor of major morbidity and mortality post-LT; however, there are no data regarding weight loss following LT. The current study evaluates the effectiveness of standard lifestyle intervention in LT recipients. METHODS All adult LT recipients with body mass index (BMI) ≥ 25 kg/m2 who followed up in post-LT clinic from January 2013 to January 2016 were given standard lifestyle advice based on societal recommendations which was reinforced at 24 weeks. Patients were followed for a total of 48 weeks to assess the impact of such advice on weight. Primary outcome was achieving weight loss ≥ 5% of the body weight after 48 weeks of follow-up. RESULTS A total of 151 patients with 86 (56.0%) overweight and 65 (44.0%) obese patients were enrolled in the study. The mean BMI at baseline increased from 30.2 ± 3.7 to 30.9 ± 4.3 kg/m2 at 48-week follow-up (p = 0.001). Over the course of study, 58 (38.4%) patients lost any weight and weight loss greater than 5% and 10% occurred in only 18 (11.9%) and 8 (5.3%) of the entire cohort, respectively. Higher level of education was associated with increased likelihood of weight loss (OR 9.8, 95% CI 2.6, 36.9, p = 0.001), while nonalcoholic steatohepatitis as etiology of liver disease (HR 3.7, 95% CI 1.4, 9.7, p = 0.007) was associated with weight gain. CONCLUSION The practice of office-based lifestyle intervention is ineffective in achieving clinically significant weight loss in LT recipients, and additional strategies are required to mitigate post-LT weight gain.
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Affiliation(s)
- Samarth S Patel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University (VCU), MCV Box 980342, Richmond, VA, 23298-0342, USA.
| | - Mohammad B Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University (VCU), MCV Box 980342, Richmond, VA, 23298-0342, USA
| | | | | | - Fei-Pi Lin
- School of Medicine, VCU, Richmond, VA, USA
| | | | - Salvatore Carbone
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, VCU, Richmond, VA, USA
| | | | | | - Danielle Kirkman
- Department of Kinesiology and Health Sciences, VCU, Richmond, VA, USA
| | - Susan Wolver
- Department of Internal Medicine, VCU, Richmond, VA, USA
| | - Francesco Celi
- Division of Endocrinology Diabetes and Metabolism, Department of Internal Medicine, VCU, Richmond, VA, USA
| | - Chandra Bhati
- Division of Transplant Surgery, Department of Surgery, VCU, Richmond, VA, USA
| | - Mohammad S Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University (VCU), MCV Box 980342, Richmond, VA, 23298-0342, USA
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Cole AM, Tu SP, Fernandez ME, Calo WA, Hotz J, Wolver S. Reported Use of Electronic Health Records to Implement Evidence Based Approaches to Colorectal Cancer Screening in Community Health Centers. J Health Care Poor Underserved 2017; 26:1235-45. [PMID: 26548676 DOI: 10.1353/hpu.2015.0120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Community health centers (CHCs) are critical sources of primary care for medically underserved populations. Electronic health records (EHRs) are important for implementation of evidence-based approaches for cancer control. METHODS Cross-sectional study of CHCs from the Cancer Prevention Control Research Network's community health center Clinic Characteristics Survey. Proportions of CHCs using EHR data to: 1) measure colorectal cancer screening, 2) deliver reports, and 3) provide patient reminders for colorectal cancer screening. RESULTS Only 27% of CHCs perceive EHR system's colorectal cancer screening data as very accurate. Over half (57%) of respondent CHCs with EHRs reported it is easy or very easy to do colorectal cancer screening activities using EHR systems. CONCLUSIONS Poor EHR data quality and cumbersome EHR systems may be significant barriers to implementation of evidence-based approaches to colorectal cancer screening in CHCs.
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Buckley L, Guyatt G, Fink HA, Cannon M, Grossman J, Hansen KE, Humphrey MB, Lane NE, Magrey M, Miller M, Morrison L, Rao M, Byun Robinson A, Saha S, Wolver S, Bannuru RR, Vaysbrot E, Osani M, Turgunbaev M, Miller AS, McAlindon T. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid‐Induced Osteoporosis. Arthritis Care Res (Hoboken) 2017; 69:1095-1110. [DOI: 10.1002/acr.23279] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 04/20/2017] [Indexed: 01/29/2023]
Affiliation(s)
| | | | - Howard A. Fink
- Geriatric Research Education and Clinical Center, VA Health Care SystemMinneapolis Minnesota
| | - Michael Cannon
- Arthritis Consultants of TidewaterVirginia Beach Virginia
| | | | | | | | | | - Marina Magrey
- Case Western Reserve University, MetroHealth SystemCleveland Ohio
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10
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Buckley L, Guyatt G, Fink HA, Cannon M, Grossman J, Hansen KE, Humphrey MB, Lane NE, Magrey M, Miller M, Morrison L, Rao M, Robinson AB, Saha S, Wolver S, Bannuru RR, Vaysbrot E, Osani M, Turgunbaev M, Miller AS, McAlindon T. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Rheumatol 2017; 69:1521-1537. [DOI: 10.1002/art.40137] [Citation(s) in RCA: 303] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 04/20/2017] [Indexed: 12/18/2022]
Affiliation(s)
| | | | - Howard A. Fink
- Geriatric Research Education and Clinical Center, VA Health Care System; Minneapolis Minnesota
| | - Michael Cannon
- Arthritis Consultants of Tidewater; Virginia Beach Virginia
| | | | | | | | | | - Marina Magrey
- Case Western Reserve University, MetroHealth System; Cleveland Ohio
| | | | - Lake Morrison
- Duke University Medical Center; Durham North Carolina
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Lanoye A, Stewart KE, Rybarczyk BD, Auerbach SM, Sadock E, Aggarwal A, Waller R, Wolver S, Austin K. The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization. J Clin Psychol 2016; 73:681-692. [PMID: 27505218 DOI: 10.1002/jclp.22367] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/13/2016] [Accepted: 06/21/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The integration of psychological and behavioral health services into safety net primary care clinics has been viewed as a step toward reducing disparities in mental health treatment and addressing behavioral factors in chronic diseases. Though it is posited that integrated behavioral health (IBH) reduces preventable medical costs, this premise has yet to be tested in a safety net primary care clinic. METHOD Retrospective pre- and posttreatment analysis with quasi-experimental control group was constructed using propensity score matching. Participants included 1,440 adult patients at a safety net primary care clinic, 720 of whom received IBH services, and 720 of whom received medical treatment only. RESULTS Analysis showed that rates of preventable inpatient utilization decreased significantly among IBH-treated patients compared to no change among control patients. CONCLUSION IBH was associated with decreased rates of preventable inpatient visits. IBH may present opportunities to deliver improved holistic patient care while reducing unnecessary inpatient medical utilization.
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Krist AH, Aycock RA, Etz RS, Devoe JE, Sabo RT, Williams R, Stein KL, Iwamoto G, Puro J, Deshazo J, Kashiri PL, Arkind J, Romney C, Kano M, Nelson C, Longo DR, Wolver S, Woolf SH. MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients--a randomized cluster trial. Implement Sci 2014; 9:181. [PMID: 25500097 PMCID: PMC4269965 DOI: 10.1186/s13012-014-0181-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 10/14/2014] [Accepted: 11/24/2014] [Indexed: 12/24/2022] Open
Abstract
Background Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement. Methods/design We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness. Discussion This study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians. Trial registration ClinicalTrials.gov: NCT02138448 Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0181-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia.
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