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Madlock-Brown C, Lee A, Seltzer J, Solomonides A, Mathews N, Phuong J, Weiskopf N, Adams WG, Lehmann H, Espinoza J. Racial Disparities in Diabetes Care and Outcomes for Patients with Visual Impairment: A Descriptive Analysis of the TriNetX Research Network. Res Sq 2024:rs.3.rs-3901158. [PMID: 38352357 PMCID: PMC10862972 DOI: 10.21203/rs.3.rs-3901158/v1] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Background: This research delves into the confluence of racial disparities and health inequities among individuals with disabilities, with a focus on those contending with both diabetes and visual impairment. Methods: Utilizing data from the TriNetX Research Network, which includes electronic medical records of roughly 115 million patients from 83 anonymous healthcare organizations, this study employs a directed acyclic graph (DAG) to pinpoint confounders and augment interpretation. We identified patients with visual impairments using ICD-10 codes, deliberately excluding diabetes-related ophthalmology complications. Our approach involved multiple race-stratified analyses, comparing co-morbidities like chronic pulmonary disease in visually impaired patients against their counterparts. We assessed healthcare access disparities by examining the frequency of annual visits, instances of two or more A1c measurements, and glomerular filtration rate (GFR) measurements. Additionally, we evaluated diabetes outcomes by comparing the risk ratio of uncontrolled diabetes (A1c > 9.0) and chronic kidney disease in patients with and without visual impairments. Results: The incidence of diabetes was substantially higher (nearly double) in individuals with visual impairments across White, Asian, and African American populations. Higher rates of chronic kidney disease were observed in visually impaired individuals, with a risk ratio of 1.79 for African American, 2.27 for White, and non-significant for the Asian group. A statistically significant difference in the risk ratio for uncontrolled diabetes was found only in the White cohort (0.843). White individuals without visual impairments were more likely to receive two A1c tests, a trend not significant in other racial groups. African Americans with visual impairments had a higher rate of glomerular filtration rate testing. However, White individuals with visual impairments were less likely to undergo GFR testing, indicating a disparity in kidney health monitoring. This pattern of disparity was not observed in the Asian cohort. Conclusions: This study uncovers pronounced disparities in diabetes incidence and management among individuals with visual impairments, particularly among White, Asian, and African American groups. Our DAG analysis illuminates the intricate interplay between SDoH, healthcare access, and frequency of crucial diabetes monitoring practices, highlighting visual impairment as both a medical and social issue.
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Strauss AT, Sidoti CN, Sung HC, Jain VS, Lehmann H, Purnell TS, Jackson JW, Malinsky D, Hamilton JP, Garonzik-Wang J, Gray SH, Levan ML, Hinson JS, Gurses AP, Gurakar A, Segev DL, Levin S. Artificial intelligence-based clinical decision support for liver transplant evaluation and considerations about fairness: A qualitative study. Hepatol Commun 2023; 7:e0239. [PMID: 37695082 PMCID: PMC10497243 DOI: 10.1097/hc9.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/28/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND The use of large-scale data and artificial intelligence (AI) to support complex transplantation decisions is in its infancy. Transplant candidate decision-making, which relies heavily on subjective assessment (ie, high variability), provides a ripe opportunity for AI-based clinical decision support (CDS). However, AI-CDS for transplant applications must consider important concerns regarding fairness (ie, health equity). The objective of this study was to use human-centered design methods to elicit providers' perceptions of AI-CDS for liver transplant listing decisions. METHODS In this multicenter qualitative study conducted from December 2020 to July 2021, we performed semistructured interviews with 53 multidisciplinary liver transplant providers from 2 transplant centers. We used inductive coding and constant comparison analysis of interview data. RESULTS Analysis yielded 6 themes important for the design of fair AI-CDS for liver transplant listing decisions: (1) transparency in the creators behind the AI-CDS and their motivations; (2) understanding how the AI-CDS uses data to support recommendations (ie, interpretability); (3) acknowledgment that AI-CDS could mitigate emotions and biases; (4) AI-CDS as a member of the transplant team, not a replacement; (5) identifying patient resource needs; and (6) including the patient's role in the AI-CDS. CONCLUSIONS Overall, providers interviewed were cautiously optimistic about the potential for AI-CDS to improve clinical and equitable outcomes for patients. These findings can guide multidisciplinary developers in the design and implementation of AI-CDS that deliberately considers health equity.
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Affiliation(s)
- Alexandra T. Strauss
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Carolyn N. Sidoti
- Department of Surgery, New York University, Grossman School of Medicine, New York, New York, USA
| | - Hannah C. Sung
- Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Vedant S. Jain
- Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Harold Lehmann
- Department of Medicine, Division of Biomedical Informatics & Data Science, School of Medicine, Baltimore, Maryland, USA
| | - Tanjala S. Purnell
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John W. Jackson
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Malinsky
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - James P. Hamilton
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline Garonzik-Wang
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Stephen H. Gray
- Department of Surgery, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Macey L. Levan
- Department of Surgery, New York University, Grossman School of Medicine, New York, New York, USA
| | - Jeremiah S. Hinson
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Ayse P. Gurses
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ahmet Gurakar
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Dorry L. Segev
- Department of Surgery, New York University, Grossman School of Medicine, New York, New York, USA
| | - Scott Levin
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Beckman Coulter, Brea, California, USA
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3
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Dixon BE, Staes C, Acharya J, Allen KS, Hartsell J, Cullen T, Lenert L, Rucker DW, Lehmann H. Enhancing the nation's public health information infrastructure: a report from the ACMI symposium. J Am Med Inform Assoc 2023; 30:1000-1005. [PMID: 36917089 PMCID: PMC10114045 DOI: 10.1093/jamia/ocad033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/17/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
The COVID-19 pandemic exposed multiple weaknesses in the nation's public health system. Therefore, the American College of Medical Informatics selected "Rebuilding the Nation's Public Health Informatics Infrastructure" as the theme for its annual symposium. Experts in biomedical informatics and public health discussed strategies to strengthen the US public health information infrastructure through policy, education, research, and development. This article summarizes policy recommendations for the biomedical informatics community postpandemic. First, the nation must perceive the health data infrastructure to be a matter of national security. The nation must further invest significantly more in its health data infrastructure. Investments should include the education and training of the public health workforce as informaticians in this domain are currently limited. Finally, investments should strengthen and expand health data utilities that increasingly play a critical role in exchanging information across public health and healthcare organizations.
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Affiliation(s)
- Brian E Dixon
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Catherine Staes
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Jessica Acharya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katie S Allen
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Joel Hartsell
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Theresa Cullen
- Pima County Public Health Department, Tucson, Arizona, USA
| | - Leslie Lenert
- Medical University of South Carolina, Charleston, South Carolina, USA
- Health Sciences South Carolina, Charleston, South Carolina, USA
| | - Donald W Rucker
- 1upHealth, Boston, Massachusetts, USA
- Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA
| | - Harold Lehmann
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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4
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He T, Belouali A, Patricoski J, Lehmann H, Ball R, Anagnostou V, Kreimeyer K, Botsis T. Trends and opportunities in computable clinical phenotyping: A scoping review. J Biomed Inform 2023; 140:104335. [PMID: 36933631 DOI: 10.1016/j.jbi.2023.104335] [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: 11/09/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
Identifying patient cohorts meeting the criteria of specific phenotypes is essential in biomedicine and particularly timely in precision medicine. Many research groups deliver pipelines that automatically retrieve and analyze data elements from one or more sources to automate this task and deliver high-performing computable phenotypes. We applied a systematic approach based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a thorough scoping review on computable clinical phenotyping. Five databases were searched using a query that combined the concepts of automation, clinical context, and phenotyping. Subsequently, four reviewers screened 7960 records (after removing over 4000 duplicates) and selected 139 that satisfied the inclusion criteria. This dataset was analyzed to extract information on target use cases, data-related topics, phenotyping methodologies, evaluation strategies, and portability of developed solutions. Most studies supported patient cohort selection without discussing the application to specific use cases, such as precision medicine. Electronic Health Records were the primary source in 87.1 % (N = 121) of all studies, and International Classification of Diseases codes were heavily used in 55.4 % (N = 77) of all studies, however, only 25.9 % (N = 36) of the records described compliance with a common data model. In terms of the presented methods, traditional Machine Learning (ML) was the dominant method, often combined with natural language processing and other approaches, while external validation and portability of computable phenotypes were pursued in many cases. These findings revealed that defining target use cases precisely, moving away from sole ML strategies, and evaluating the proposed solutions in the real setting are essential opportunities for future work. There is also momentum and an emerging need for computable phenotyping to support clinical and epidemiological research and precision medicine.
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Affiliation(s)
- Ting He
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Anas Belouali
- Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica Patricoski
- Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harold Lehmann
- Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Ball
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Valsamo Anagnostou
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kory Kreimeyer
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taxiarchis Botsis
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Columbus A, Goheer A, Yanek L, Zhao D, Woolf TB, Martin L, Guallar E, Lehmann H, Coughlin JW, Holzhauer K, Duan D, Hawkins M, Pokutnaya D, Clark J, McTigue KM, Lent M, Bennett W. Abstract P401: Circadian Dietary Patterns and Weight Trajectories in Adults Using the Daily24 Mobile Application. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p401] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
It is unclear whether the timing of meals relative to sleep impacts cardiometabolic risk factors (e.g., weight gain). This cohort study aimed to detect and describe the association of the timing of caloric intake and dietary patterns (e.g., skipping breakfast) with weight trajectory over 2 years among participants who used the Daily24 mobile application to record their timing of eating and sleeping.
Hypothesis:
We hypothesized that skipping breakfast or consuming 50% or more of daily calories in the latter half of the day is associated with greater weight gain over 2 years.
Methods:
We conducted a secondary data analysis from a multi-site, electronic health record-based cohort study of adults from 3 healthcare systems in PCORnet’s PaTH Clinical Research Network. Of the 1017 participants enrolled in the study, N=407 patients downloaded and used the Daily24 mobile application for at least 2 weekdays and 1 weekend day over 6 months. We calculated the median of each participant’s daily eating and sleeping intervals. Participants’ weights were extracted from electronic health records available for up to 10 years prior to until 10 months after baseline. Weight trajectories were calculated over 2 years of this data. Participants completed online surveys about demographics and behavioral characteristics at baseline and after 4 months. We constructed multivariate linear regression models with weight trajectory as the dependent variable and breakfast skipping (i.e., not eating anything within 3 hours of waking), having a medium or large meal within 3 hours of sleep, ≥50% caloric consumption in the latter half of the day (after 12 pm), and ≥90% caloric consumption after 7 pm as independent variables. Additional independent variables included age, sex, race, days of application use, and body mass index (BMI) category.
Results:
Mean (SD) baseline age was 50.8 (15.0) years, 75.7% had a BMI≥25 kg/m
2
, 78.1% were women, and 84.0% were white. The average number of recorded Daily24 application days was 55.9 (53.5), significantly greater than the 3-day minimum inclusion criterion. The mean of participants’ median intervals from first to last meal was 11.2 (2.0) hours. Although not statistically significant, consuming 50% of daily calories in the latter half of the day and skipping breakfast were associated with an increasing weight trajectory (0.03 and 0.25 kg/year; 95% CI -0.39 to 0.45 and -0.32 to 0.82, respectively).
Conclusions:
Timing of eating (e.g., skipping breakfast or eating most calories later in the day) may be associated with very small weight increases over time. Our app-based approach may not have had enough observations to establish this association. Further research is needed to understand the clinical importance of circadian dietary patterns related to cardiometabolic health.
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Affiliation(s)
| | | | | | - Di Zhao
- Johns Hopkins Univ, Baltimore, MD
| | | | | | | | | | | | | | | | | | | | | | | | - Michelle Lent
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
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6
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Miller S, Murphy Z, Gray JH, Marsteller J, Oliva-Hemker M, Maslen AT, Lehmann H, Nagy PG, Hutfless S, Gurses AP. Human-centered design of clinical decision support for anemia screening in children with inflammatory bowel disease. Appl Clin Inform 2023; 14:345-353. [PMID: 36809791 PMCID: PMC10171996 DOI: 10.1055/a-2040-0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) commonly leads to iron deficiency anemia (IDA). Rates of screening and treatment of IDA are often low. A clinical decision support system (CDSS) embedded in an electronic health record could improve adherence to evidence-based care. Rates of CDSS adoption are often low due to poor usability and fit with work processes. One solution is to use human centered design (HCD), which designs CDSS based on identified user needs and context of use and evaluates prototypes for usefulness and usability. Objectives Use HCD to design a CDSS tool called the IBD Anemia Diagnosis Tool, IADx. Methods Interviews with IBD practitioners informed creation of a process map of anemia care that was used by an interdisciplinary team that used HCD principles to create a prototype CDSS. The prototype was iteratively tested with "Think Aloud" usability evaluation with clinicians as well as semi-structured interviews, a survey, and observations. Feedback was coded and informed redesign. Results Process mapping showed that IADx should function at in-person encounters and asynchronous lab review. Clinicians desired full automation of clinical information acquisition such as lab trends and analysis such as calculation of iron deficit, less automation of clinical decision selection such as lab ordering and no automation of action implementation such as signing medication orders. Providers preferred an interruptive alert over a non-interruptive reminder. Discussion Providers preferred an interruptive alert, perhaps due to the low likelihood of noticing a non-interruptive advisory. High levels of desire for automation of information acquisition and analysis with less automation of decision selection and action may be generalizable to other CDSSs designed for chronic disease management. This underlines the ways in which CDSSs have the potential to augment rather than replace provider cognitive work.
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Affiliation(s)
- Steven Miller
- Pediatric gastroenterology, Johns Hopkins University, Baltimore, United States
| | - Zach Murphy
- Pediatric gastroenterology, Johns Hopkins University, Baltimore, United States
| | - Josh H Gray
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, United States
| | - Jill Marsteller
- Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States.,Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, United States
| | - Maria Oliva-Hemker
- Pediatric gastroenterology, Johns Hopkins University, Baltimore, United States
| | - Andrew T Maslen
- Johns Hopkins Medical Institutions, Baltimore, United States
| | - Harold Lehmann
- Division of Health Science Informatics, Johns Hopkins University, Baltimore, United States
| | - Paul G Nagy
- Biomedical Informatics, Johns Hopkins University, Ellicott City, United States
| | - Susan Hutfless
- Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, United States
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7
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Kushniruk A, Lehmann H, Alam AA, Yazdi Y, Acharya S. Development of a Digital Assistant to Support Teleconsultations Between Remote Physicians and Frontline Health Workers in India: User-Centered Design Approach. JMIR Hum Factors 2023; 10:e25361. [PMID: 36729578 PMCID: PMC9936362 DOI: 10.2196/25361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/31/2021] [Accepted: 09/10/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Many low- and middle-income countries have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with physicians in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographical barriers, these health worker-to-physician telemedicine programs have the potential to increase health care quality, expand the specialties available to patients, and reduce the time and cost required to deliver care. OBJECTIVE We aimed to identify, validate, and prioritize unmet needs in the health care space of health worker-to-physician telemedicine programs and develop and refine a solution that addresses those needs. METHODS We collected information regarding user needs through ethnographic research, direct observation, and semistructured interviews with 37 stakeholders (n=5, 14% physicians; n=1, 3% public health program manager; n=12, 32% community health workers; and n=19, 51% patients) at 2 telemedicine clinics in rural West Bengal, India. We used the Spiral-Iterative Innovation Model to design and develop a prototype solution to meet these needs. RESULTS We identified 74 unmet needs through our immersion in health worker-to-physician telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in low- and middle-income countries often requires shifting tasks such as history taking and physical examination from high-skilled remote physicians to FHWs. To meet this need, we developed a prototype digital assistant that would allow FHWs to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, physicians, and health organizations) were incorporated into the design and features of the task-shifting tool. The final prototype was shared with the health workers, physicians, and public health program managers who expressed that the tool would be useful and valuable. CONCLUSIONS The final prototype that was developed was released as an open-source digital public good and may improve the quality and efficiency of care delivery in health worker-to-physician telemedicine programs.
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Affiliation(s)
| | - Harold Lehmann
- Division of Health Sciences Informatics, Johns Hopkins University, Baltimore, MD, United States
| | | | - Youseph Yazdi
- Division of Health Sciences Informatics, Johns Hopkins University, Baltimore, MD, United States
| | - Soumyadipta Acharya
- Division of Health Sciences Informatics, Johns Hopkins University, Baltimore, MD, United States
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8
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Zhao D, Guallar E, Woolf TB, Martin L, Lehmann H, Coughlin J, Holzhauer K, Goheer AA, McTigue KM, Lent MR, Hawkins M, Clark JM, Bennett WL. Association of Eating and Sleeping Intervals With Weight Change Over Time: The Daily24 Cohort. J Am Heart Assoc 2023; 12:e026484. [PMID: 36651320 PMCID: PMC9973633 DOI: 10.1161/jaha.122.026484] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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] [Indexed: 01/19/2023]
Abstract
Background We aim to evaluate the association between meal intervals and weight trajectory among adults from a clinical cohort. Methods and Results This is a multisite prospective cohort study of adults recruited from 3 health systems. Over the 6-month study period, 547 participants downloaded and used a mobile application to record the timing of meals and sleep for at least 1 day. We obtained information on weight and comorbidities at each outpatient visit from electronic health records for up to 10 years before until 10 months after baseline. We used mixed linear regression to model weight trajectories. Mean age was 51.1 (SD 15.0) years, and body mass index was 30.8 (SD 7.8) kg/m2; 77.9% were women, and 77.5% reported White race. Mean interval from first to last meal was 11.5 (2.3) hours and was not associated with weight change. The number of meals per day was positively associated with weight change. The average difference in annual weight change (95% CI) associated with an increase of 1 daily meal was 0.28 kg (0.02-0.53). Conclusions Number of daily meals was positively associated with weight change over 6 years. Our findings did not support the use of time-restricted eating as a strategy for long-term weight loss in a general medical population.
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Affiliation(s)
- Di Zhao
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Eliseo Guallar
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Thomas B. Woolf
- Department of PhysiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - Lindsay Martin
- Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Harold Lehmann
- Division of Health Sciences InformaticsJohns Hopkins University School of MedicineBaltimoreMD
| | - Janelle Coughlin
- Division of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMD
| | - Katherine Holzhauer
- Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Attia A. Goheer
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Michelle R. Lent
- School of Professional and Applied PsychologyPhiladelphia College of Osteopathic MedicinePhiladelphiaPA
| | - Marquis Hawkins
- Department of EpidemiologyUniversity of PittsburghPittsburghPA
| | - Jeanne M. Clark
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD,Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Wendy L. Bennett
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD,Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
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9
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Nair SS, Li C, Doijad R, Nagy P, Lehmann H, Kharrazi H. A scoping review of knowledge authoring tools used for developing computerized clinical decision support systems. JAMIA Open 2021; 4:ooab106. [PMID: 34927003 PMCID: PMC8677433 DOI: 10.1093/jamiaopen/ooab106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/30/2021] [Indexed: 11/20/2022] Open
Abstract
Objective Clinical Knowledge Authoring Tools (CKATs) are integral to the computerized Clinical Decision Support (CDS) development life cycle. CKATs enable authors to generate accurate, complete, and reliable digital knowledge artifacts in a relatively efficient and affordable manner. This scoping review aims to compare knowledge authoring tools and derive the common features of CKATs. Materials and Methods We performed a keyword-based literature search, followed by a snowball search, to identify peer-reviewed publications describing the development or use of CKATs. We used PubMed and Embase search engines to perform the initial search (n = 1579). After removing duplicate articles, nonrelevant manuscripts, and not peer-reviewed publication, we identified 47 eligible studies describing 33 unique CKATs. The reviewed CKATs were further assessed, and salient characteristics were extracted and grouped as common CKAT features. Results Among the identified CKATs, 55% use an open source platform, 70% provide an application programming interface for CDS system integration, and 79% provide features to validate/test the knowledge. The majority of the reviewed CKATs describe the flow of information, offer a graphical user interface for knowledge authors, and provide intellisense coding features (94%, 97%, and 97%, respectively). The composed list of criteria for CKAT included topics such as simulating the clinical setting, validating the knowledge, standardized clinical models and vocabulary, and domain independence. None of the reviewed CKATs met all common criteria. Conclusion Our scoping review highlights the key specifications for a CKAT. The CKAT specification proposed in this review can guide CDS authors in developing more targeted CKATs.
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Affiliation(s)
- Sujith Surendran Nair
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Informatics, American College of Radiology, Virginia, USA
| | - Chenyu Li
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ritu Doijad
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Paul Nagy
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Harold Lehmann
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hadi Kharrazi
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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10
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Woolf TB, Goheer A, Holzhauer K, Martinez J, Coughlin JW, Martin L, Zhao D, Song S, Ahmad Y, Sokolinskyi K, Remayeva T, Clark JM, Bennett W, Lehmann H. Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing. JMIR Form Res 2021; 5:e26297. [PMID: 34296999 PMCID: PMC8367152 DOI: 10.2196/26297] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/12/2021] [Accepted: 04/04/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. OBJECTIVE In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. METHODS Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. RESULTS After ≥4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. CONCLUSIONS Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals.
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Affiliation(s)
- Thomas B Woolf
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Attia Goheer
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Holzhauer
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan Martinez
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lindsay Martin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shanshan Song
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yanif Ahmad
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Jeanne M Clark
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Wendy Bennett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Harold Lehmann
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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11
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Bennett WL, Bramante CT, Rothenberger SD, Kraschnewski JL, Herring SJ, Lent MR, Clark JM, Conroy MB, Lehmann H, Cappella N, Gauvey-Kern M, McCullough J, McTigue KM. Patient Recruitment Into a Multicenter Clinical Cohort Linking Electronic Health Records From 5 Health Systems: Cross-sectional Analysis. J Med Internet Res 2021; 23:e24003. [PMID: 34042604 PMCID: PMC8193474 DOI: 10.2196/24003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/04/2021] [Accepted: 04/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background There is growing interest in identifying and recruiting research participants from health systems using electronic health records (EHRs). However, few studies have described the practical aspects of the recruitment process or compared electronic recruitment methods to in-person recruitment, particularly across health systems. Objective The objective of this study was to describe the steps and efficiency of the recruitment process and participant characteristics by recruitment strategy. Methods EHR-based eligibility criteria included being an adult patient engaged in outpatient primary or bariatric surgery care at one of 5 health systems in the PaTH Clinical Research Network and having ≥2 weight measurements and 1 height measurement recorded in their EHR within the last 5 years. Recruitment strategies varied by site and included one or more of the following methods: (1) in-person recruitment by study staff from clinical sites, (2) US postal mail recruitment letters, (3) secure email, and (4) direct EHR recruitment through secure patient web portals. We used descriptive statistics to evaluate participant characteristics and proportion of patients recruited (ie, efficiency) by modality. Results The total number of eligible patients from the 5 health systems was 5,051,187. Of these, 40,048 (0.8%) were invited to enter an EHR-based cohort study and 1085 were enrolled. Recruitment efficiency was highest for in-person recruitment (33.5%), followed by electronic messaging (2.9%), including email (2.9%) and EHR patient portal messages (2.9%). Overall, 779 (65.7%) patients were enrolled through electronic messaging, which also showed greater rates of recruitment of Black patients compared with the other strategies. Conclusions We recruited a total of 1085 patients from primary care and bariatric surgery settings using 4 recruitment strategies. The recruitment efficiency was 2.9% for email and EHR patient portals, with the majority of participants recruited electronically. This study can inform the design of future research studies using EHR-based recruitment.
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Affiliation(s)
- Wendy L Bennett
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carolyn T Bramante
- University of Minnesota School of Medicine, Minneapolis, MN, United States
| | | | | | | | | | - Jeanne M Clark
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Molly B Conroy
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Harold Lehmann
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Megan Gauvey-Kern
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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12
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Zhao D, Woolf T, Martin L, Guallar E, Lehmann H, Coughlin J, Song S, Holzhauer K, Clark J, McTigue KM, Lent M, Bennett WL. Abstract 017: Meal Intervals And Weight Trajectories In Adults Using The Daily24 Mobile Application: A Prospective Cohort Study. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.017] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Small pilot and randomized controlled studies suggest that time-restricted feeding may decrease body weight. However, the role of meal timing and intervals, measured using mobile applications, has not been examined in larger population-based studies. The objective of this study is to evaluate the association between meal intervals and weight trajectories among adults from a population-based clinical cohort.
Methods:
Multi-site prospective cohort study of adults recruited from three health systems. Over the 6-month study period, 547 participants downloaded and used the Daily24 mobile application to record the timing of meals and sleep for at least one day. Intervals were calculated as the average of all available daily entries for each participant. We obtained information on weight and comorbidities at each outpatient visit from electronic health records available for up to 10 years prior to until 10 months after baseline. We used mixed linear regression to model weight trajectories.
Results:
The mean (SD) baseline (at consent) age was 51.1 (15.0) years and body mass index (BMI) 30.8 (7.8) kg/m
2
; 77.9% were women and 77.5% were White. Average time in the cohort was 5.9 years prior to and 0.3 years after baseline. The mean interval from first to last meal was 11.5 (2.3) hours. The associations between meal intervals and weight trajectories are shown in the
Table
. The number of meals per day was positively associated with weight change before baseline, and number of snacks and drinks per day was inversely associated with weight change after baseline. Each additional occasion of snacks and drinks was associated with a 3.20 kg weight decrease (95% CI 1.41 to 4.99). None of the other associations were statistically significant.
Conclusions:
Number of daily meals was positively associated with weight change in previous periods, while the number of daily snacks and drinks was inversely associated with weight trajectory. The intervals from first to last meal was not associated with weight change.
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Affiliation(s)
- Di Zhao
- Johns Hopkins Univ, Baltimore, MD
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13
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Taylor CO, Manov NF, Crew KD, Weng C, Connolly JJ, Chute CG, Ford DE, Lehmann H, Rahm AK, Kullo IJ, Caraballo PJ, Holm IA, Mathews D. Preferences for Updates on General Research Results: A Survey of Participants in Genomic Research from Two Institutions. J Pers Med 2021; 11:399. [PMID: 34065005 PMCID: PMC8151672 DOI: 10.3390/jpm11050399] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 01/11/2023] Open
Abstract
There is a need for multimodal strategies to keep research participants informed about study results. Our aim was to characterize preferences of genomic research participants from two institutions along four dimensions of general research result updates: content, timing, mechanism, and frequency. METHODS We conducted a web-based cross-sectional survey that was administered from 25 June 2018 to 5 December 2018. RESULTS 397 participants completed the survey, most of whom (96%) expressed a desire to receive research updates. Preferences with high endorsement included: update content (brief descriptions of major findings, descriptions of purpose and goals, and educational material); update timing (when the research is completed, when findings are reviewed, when findings are published, and when the study status changes); update mechanism (email with updates, and email newsletter); and update frequency (every three months). Hierarchical cluster analyses based on the four update preferences identified four profiles of participants with similar preference patterns. Very few participants in the largest profile were comfortable with budgeting less money for research activities so that researchers have money to set up services to send research result updates to study participants. CONCLUSION Future studies may benefit from exploring preferences for research result updates, as we have in our study. In addition, this work provides evidence of a need for funders to incentivize researchers to communicate results to participants.
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Affiliation(s)
- Casey Overby Taylor
- Department of Medicine, Department of Biomedical Engineering, and The Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Natalie Flaks Manov
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (N.F.M.); (D.E.F.)
| | - Katherine D. Crew
- Department of Medicine and Epidemiology, Columbia University, New York, NY 10032, USA;
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA;
| | - John J. Connolly
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Christopher G. Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Daniel E. Ford
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (N.F.M.); (D.E.F.)
| | - Harold Lehmann
- Department of Medicine, Division of Health Sciences Informatics, Johns Hopkins University, Baltimore, MD 21205, USA;
| | | | - Iftikhar J. Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | | | - Ingrid A. Holm
- Division of Genetics and Genomics, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA;
| | - Debra Mathews
- Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD 21205, USA;
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14
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Hagen A, Lehmann H, Aurich S, Bauer N, Melzer M, Moellerberndt J, Patané V, Schnabel CL, Burk J. Scalable Production of Equine Platelet Lysate for Multipotent Mesenchymal Stromal Cell Culture. Front Bioeng Biotechnol 2021; 8:613621. [PMID: 33553119 PMCID: PMC7859354 DOI: 10.3389/fbioe.2020.613621] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022] Open
Abstract
Translation of multipotent mesenchymal stromal cell (MSC)-based therapies is advancing in human and veterinary medicine. One critical issue is the in vitro culture of MSC before clinical use. Using fetal bovine serum (FBS) as supplement to the basal medium is still the gold standard for cultivation of many cell types including equine MSC. Alternatives are being explored, with substantial success using platelet lysate-supplemented media for human MSC. However, progress lags behind in the veterinary field. The aim of this study was to establish a scalable protocol for equine platelet lysate (ePL) production and to test the ePL in equine MSC culture. Whole blood was harvested into blood collection bags from 20 healthy horses. After checking sample materials for pathogen contamination, samples from 19 animals were included. Platelet concentrates were prepared using a buffy coat method. Platelets, platelet-derived growth factor BB, and transforming growth factor β1 concentrations were increased in the concentrates compared with whole blood or serum (p < 0.05), while white blood cells were reduced (p < 0.05). The concentrates were lysed using freeze/thaw cycles, which eliminated the cells while growth factor concentrations were maintained. Donor age negatively correlated with platelet and growth factor concentrations after processing (p < 0.05). Finally, all lysates were pooled and the ePL was evaluated as culture medium supplement in comparison with FBS, using adipose-derived MSC from four unrelated donor horses. MSC proliferated well in 10% FBS as well as in 10% ePL. However, using 5 or 2.5% ePL entailed highly inconsistent proliferation or loss of proliferation, with significant differences in generation times and confluencies (p < 0.05). MSC expressed the surface antigens CD90, CD44, and CD29, but CD73 and CD105 detection was low in all culture media. Adipogenic and osteogenic differentiation led to similar results in MSC from different culture media. The buffy coat method is useful to produce equine platelet concentrate with increased platelet and reduced white blood cell content in large scales. The ePL obtained supports MSC expansion similar as FBS when used at the same concentration (10%). Further investigations into equine MSC functionality in culture with ePL should follow.
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Affiliation(s)
- A Hagen
- Equine Clinic (Surgery, Orthopedics), Justus-Liebig-University Giessen, Giessen, Germany
| | - H Lehmann
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - S Aurich
- Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-University Giessen, Giessen, Germany
| | - N Bauer
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University Giessen, Giessen, Germany
| | - M Melzer
- Equine Clinic (Surgery, Orthopedics), Justus-Liebig-University Giessen, Giessen, Germany
| | - J Moellerberndt
- Equine Clinic (Surgery, Orthopedics), Justus-Liebig-University Giessen, Giessen, Germany
| | - V Patané
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University Giessen, Giessen, Germany
| | - C L Schnabel
- Faculty of Veterinary Medicine, Institute of Immunology, Leipzig University, Leipzig, Germany
| | - J Burk
- Equine Clinic (Surgery, Orthopedics), Justus-Liebig-University Giessen, Giessen, Germany
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15
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Messino PJ, Kharrazi H, Kim JM, Lehmann H. A method for measuring the effect of certified electronic health record technology on childhood immunization status scores among Medicaid managed care network providers. J Biomed Inform 2020; 110:103567. [PMID: 32927058 PMCID: PMC7486207 DOI: 10.1016/j.jbi.2020.103567] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 08/05/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To provide a methodology for estimating the effect of U.S.-based Certified Electronic Health Records Technology (CEHRT) implemented by primary care physicians (PCPs) on a Healthcare Effectiveness Data and Information Set (HEDIS) measure for childhood immunization delivery. MATERIALS AND METHODS This study integrates multiple health care administrative data sources from 2010 through 2014, analyzed through an interrupted time series design and a hierarchical Bayesian model. We compared managed care physicians using CEHRT to propensity-score matched comparisons from network physicians who did not adopt CEHRT. Inclusion criteria for physicians using CEHRT included attesting to the Childhood Immunization Status clinical quality measure in addition to meeting "Meaningful Use" (MU) during calendar year 2013. We used a first-presence patient attribution approach to develop provider-specific immunization scores. RESULTS We evaluated 147 providers using CEHRT, with 147 propensity-score matched providers selected from a pool of 1253 PCPs practicing in Maryland. The estimate for change in odds of increasing immunization rates due to CEHRT was 1.2 (95% credible set, 0.88-1.73). DISCUSSION We created a method for estimating immunization quality scores using Bayesian modeling. Our approach required linking separate administrative data sets, constructing a propensity-score matched cohort, and using first-presence, claims-based childhood visit information for patient attribution. In the absence of integrated data sets and precise and accurate patient attribution, this is a reusable method for researchers and health system administrators to estimate the impact of health information technology on individual, provider-level, process-based, though outcomes-focused, quality measures. CONCLUSION This research has provided evidence for using Bayesian analysis of propensity-score matched provider populations to estimate the impact of CEHRT on outcomes-based quality measures such as childhood immunization delivery.
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Affiliation(s)
| | - Hadi Kharrazi
- Johns Hopkins School of Public Health, Center for Population Health IT, Baltimore, MD, USA; Johns Hopkins School of Medicine, Division of Health Sciences Informatics, Baltimore, MD, USA
| | - Julia M Kim
- Johns Hopkins School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - Harold Lehmann
- Johns Hopkins School of Medicine, Division of Health Sciences Informatics, Baltimore, MD, USA
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16
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Goheer A, Holzhauer K, Martinez J, Woolf T, Coughlin JW, Martin L, Zhao D, Lehmann H, Clark JM, Bennett WL. What influences the "when" of eating and sleeping?A qualitative interview study. Appetite 2020; 156:104980. [PMID: 32980457 DOI: 10.1016/j.appet.2020.104980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
Timing of eating relative to sleep and endogenous circadian rhythm impacts weight and cardiometabolic health. We used qualitative methods to explore what influences the "when" of eating and sleeping. We conducted 37 one-on-one semi-structured interviews among participants with a body mass index (BMI) ≥ 25 kg/m2 recruited from three internal medicine clinics affiliated with an urban academic hospital. Participants (70.3% Female; 51.4% White; Age range: 21-83 years old) completed measures of social jetlag, physical activity, eating habits, and mobile application use and participated in interviews following a guide developed by the study team. Responses were recorded, transcribed and coded sequentially by two trained researchers using editing-style analysis to identify themes. We identified two main themes, each with subthemes: 1) influences on the "when" of eating and sleeping, with subthemes including social jetlag and being overscheduled, and 2) contextualizing beliefs and perceptions about the "when" of eating and sleeping, with subthemes including perceived recommendations for timing of eating and sleeping, and alignment of behaviors with perceived recommendations. Many participants noted being more flexible in their eating and sleeping times on work-free vs work days. The themes this study identified should be considered when designing interventions that influence the timing of eating and sleeping for weight management.
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Affiliation(s)
- Attia Goheer
- The Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA.
| | - Katherine Holzhauer
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
| | - Jonathan Martinez
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
| | - Thomas Woolf
- The Johns Hopkins University School of Medicine, Department of Physiology, Baltimore, MD, USA.
| | - Janelle W Coughlin
- The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore MD, USA.
| | - Lindsay Martin
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
| | - Di Zhao
- The Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Division of Cardiovascular and Clinical Epidemiology, Baltimore, MD, USA.
| | - Harold Lehmann
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of Health Sciences Informatics, Baltimore MD, USA.
| | - Jeanne M Clark
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
| | - Wendy L Bennett
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
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17
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Spiker J, Kreimeyer K, Dang O, Boxwell D, Chan V, Cheng C, Gish P, Lardieri A, Wu E, De S, Naidoo J, Lehmann H, Rosner GL, Ball R, Botsis T. Information Visualization Platform for Postmarket Surveillance Decision Support. Drug Saf 2020; 43:905-915. [DOI: 10.1007/s40264-020-00945-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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18
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Perry H, Lehmann H, Mantovani E, Thilaganathan B, Khalil A. Are maternal hemodynamic indices markers of fetal growth restriction in pregnancies with a small-for-gestational-age fetus? Ultrasound Obstet Gynecol 2020; 55:210-216. [PMID: 31381215 DOI: 10.1002/uog.20419] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 05/24/2019] [Accepted: 07/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Pregnancies complicated by fetal growth restriction (FGR) have a worse outcome than those with a small-for-gestational-age (SGA) fetus. There is increasing evidence of a maternal cardiovascular role in the pathophysiology of FGR. We aimed to compare maternal hemodynamic indices between pregnancies complicated by FGR and those delivering a SGA neonate, using a non-invasive device. METHODS This was a prospective study of normotensive pregnancies complicated by FGR (defined as estimated fetal weight (EFW) < 3rd centile or Doppler evidence of impaired placental-fetal blood flow), those with a SGA fetus (defined as EFW < 10th centile) and control pregnancies with an appropriately grown fetus. Assessment of maternal hemodynamics (heart rate (HR), cardiac output (CO), mean arterial pressure (MAP), systemic vascular resistance (SVR) and stroke volume) was performed using a non-invasive device (USCOM-1A®). Uterine artery (UtA) pulsatility index (PI) was measured using transabdominal ultrasound. Hemodynamic variables that are affected by gestational age and maternal characteristics were corrected for using device-specific reference ranges. Comparison between groups was performed using the chi-square test or the Mann-Whitney U-test, as appropriate. RESULTS A total of 102 FGR, 64 SGA and 401 control pregnancies, with a median gestational age of 36 weeks, were included in the analysis. Women with a pregnancy complicated by FGR and those with a SGA fetus were shorter and weighed less than did controls. Compared with controls, the FGR group had significantly lower median maternal HR (80 beats per min (bpm) vs 85 bpm; P = 0.001) and CO multiples of the median (MoM; 0.91 vs 0.98; P = 0.003), and higher median maternal MAP (90 mmHg vs 87 mmHg; P = 0.040), SVR MoM (1.2 vs 1.0; P < 0.001) and UtA-PI MoM (1.1 vs 0.96; P < 0.001), but there was no significant difference in stroke volume MoM (1.0 vs 0.98; P = 0.647). Compared with the SGA group, the FGR group had a significantly lower median HR (80 bpm vs 87 bpm; P = 0.022), and higher median maternal MAP (90 mmHg vs 85 mmHg; P = 0.025), SVR MoM (1.2 vs 1.0; P = 0.002) and UtA-PI MoM (1.1 vs 0.98; P = 0.005), but there was no significant difference in CO MoM (0.91 vs 0.96; P = 0.092) or stroke volume MoM (1.0 vs 1.0; P = 0.806). There were no significant differences in adjusted maternal hemodynamic indices between the SGA group and controls. CONCLUSION Pregnancies complicated by FGR presented with impaired maternal hemodynamic function, as evidenced by lower HR and CO, as well as higher MAP, SVR and UtA resistance. Pregnancies delivering a SGA neonate, without evidence of FGR, had normal maternal hemodynamic function. Maternal hemodynamic indices may therefore be of value in distinguishing FGR from SGA pregnancies. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - H Lehmann
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - E Mantovani
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - B Thilaganathan
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
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19
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Miller SD, Stablein P, Syed J, Smothers V, Marx E, Greene P, Lehmann H, Nagy PG. Evaluation of a Training Program to Improve Organizational Capacity for Health Systems Analytics. Appl Clin Inform 2019; 10:634-642. [PMID: 31461754 DOI: 10.1055/s-0039-1694965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The Leadership in Analytics and Data Science (LEADS) course was evaluated for effectiveness. LEADS was a 6-month program for working biomedical and health informatics (BMHI) professionals designed to improve analytics skills, knowledge of enterprise applications, data stewardship, and to foster an analytics community of practice through lectures, hands-on skill building workshops, networking events, and small group projects. METHODS The effectiveness of the LEADS course was evaluated using the Kirkpatrick Model by assessing pre- and postcourse knowledge, analytics capabilities, goals, practice, class lecture reaction, and change in the size of participant professional networks. Differences in pre- and postcourse responses were analyzed with a Wilcoxon signed rank test to determine significance, and effect sizes were computed using a z-statistic. RESULTS Twenty-nine students completed the course with 96% of respondents reporting that they were "very" or "extremely" likely to recommend the course. Participants reported improvement in several analytics capabilities including Epic data warehousing (p = 0.017), institutional review board policy (p = 0.005), and data stewardship (p = 0.007). Changes in practice patterns mirrored those in self-reported capability. On average, the participant professional network doubled. CONCLUSION LEADS was the first course targeted to working BMHI professional at a large academic medical center to have a formal effectiveness evaluation be published in the literature. The course achieved the goals of expansion of BMHI knowledge, skills, and professional networks. The LEADS course provides a template for continuing education of working BMHI professionals.
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Affiliation(s)
- Steven D Miller
- Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University, Baltimore, Maryland, United States
| | - Phillip Stablein
- Casemix Information Management, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Jay Syed
- Technology Innovation Center, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Valerie Smothers
- Department of Emerging Technologies, Johns Hopkins University, Baltimore, Maryland, United States
| | - Emily Marx
- Technology Innovation Center, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Peter Greene
- Department of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Harold Lehmann
- Department of Health Science Informatics, Johns Hopkins University, Baltimore, Maryland, United States
| | - Paul G Nagy
- Department of Radiology, Technology Innovation Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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20
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Trent M, Recto M, Qian Q, Butz A, Frick KD, Ellen JM, Lehmann H. Please Be Careful with Me: Discrepancies between Adolescent Expectations and Clinician Perspectives on the Management of Pelvic Inflammatory Disease. J Pediatr Adolesc Gynecol 2019; 32:363-367. [PMID: 30974212 PMCID: PMC6742537 DOI: 10.1016/j.jpag.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/10/2018] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To compare clinician perspectives for the treatment of pelvic inflammatory disease (PID) with those of adolescent patients and parents. DESIGN Cross-sectional study. SETTING Urban academic pediatric and adolescent medicine practices and school-based health clinics in a large urban community with a high prevalence of sexually transmitted infections and a national sample of adolescent-serving clinicians. PARTICIPANTS Female patients aged 12-19 years, parents raising an adolescent older than the age of 12 years in the urban community, and clinicians who serve adolescents recruited from regional and national listservs. INTERVENTIONS None. MAIN OUTCOME MEASURES Visual analogue scale scores on a scale of 0-10 corresponding to preferences on patient disposition in 17 clinical scenarios for a hypothetical patient with PID. RESULTS Compared with adolescents, clinicians were significantly more likely to endorse hospitalizations when patients presented with severe or complicated illness (β = 0.9; standard error [SE], 0.22; P < .001), possible surgical emergency (β = 0.83; SE, 0.2; P < .001), concurrent pregnancy (β = 0.59; SE, 0.3; P = .046), or failure of outpatient treatment (β = 0.58; SE, 0.29; P = .045). Compared with clinicians, adolescents were significantly more likely to endorse hospitalizations when patients presented at a young age (β = 1.36; SE, 0.38; P < .001), were homeless (β = 0.88; SE, 0.32; P = .007), were afraid to inform a partner (β = 1.66; SE, 0.40; P < .001), or had unaware parents (β = 2.86; SE, 0.39; P < .001). CONCLUSION Clinicians were more likely to recommend hospitalization when doing so adhered to national guidelines on PID treatment. Adolescents opted for hospitalization more often than clinicians in scenarios in which patients exhibited social vulnerability. Clinicians should engage with adolescents in shared disposition planning and use a more nuanced approach to PID management for adolescents who might not be able to tolerate an outpatient regimen.
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Affiliation(s)
- Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Michelle Recto
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Qiang Qian
- HaoHan Technologies, LLC, Clarksville, Maryland
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kevin D Frick
- Vice Dean for Education, Carey School of Business, Baltimore, Maryland
| | - Jonathan M Ellen
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Harold Lehmann
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Perry H, Lehmann H, Mantovani E, Thilaganathan B, Khalil A. Correlation between central and uterine hemodynamics in hypertensive disorders of pregnancy. Ultrasound Obstet Gynecol 2019; 54:58-63. [PMID: 30084237 DOI: 10.1002/uog.19197] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Pregnancies affected by a hypertensive disorder (HDP) have increased uterine artery pulsatility index (UtA-PI) compared with that in healthy pregnancies. Women with HDP are also known to have lower cardiac output and increased systemic vascular resistance. The aim of this study was to investigate the relationship between central and uterine hemodynamics in HDP and uncomplicated pregnancy. METHODS This was a prospective study of HDP and normotensive control singleton pregnancies presenting at a tertiary referral hospital between January 2012 and December 2017. Paired measurements of maternal hemodynamics, using a non-invasive device (USCOM-1A®), and UtA-PI were performed in the third trimester. HDP pregnancies were divided into preterm (onset < 37 weeks' gestation) and term (onset ≥ 37 weeks). Spearman's rank coefficient was used to assess the correlation between the central and uteroplacental hemodynamics. Regression analysis was performed to assess the association of UtA-PI with independent variables. RESULTS We included 231 women with HDP (152 with preterm and 79 with term HDP) and 378 controls with normotensive pregnancy. Compared with controls, women with preterm HDP had significantly lower cardiac output (median (interquartile range (IQR)), 6.0 (5.1-7.2) vs 6.6 (5.8-7.5) L/min; P < 0.001) and significantly higher systemic vascular resistance (median (IQR), 1394 (1189-1670) vs 1063 (915-1222) dynes × s/cm5 ; P < 0.001) and UtA-PI (median (IQR), 1.0 (0.75-1.4) vs 0.67 (0.58-0.83); P < 0.001). Conversely, in women with term HDP, there were no significant differences in heart rate, cardiac output or UtA-PI compared with controls (all P > 0.05), while systemic vascular resistance was significantly higher (median (IQR), 1315 (1099-1527) vs 1063 (915-1222) dynes × s/cm5 ; P < 0.001). On multiple regression analysis, heart rate, mean arterial pressure and stroke volume were associated significantly with mean UtA-PI (all P < 0.001). CONCLUSIONS Differences observed between HDP and normotensive pregnancies in third-trimester UtA resistance are mirrored in the central maternal hemodynamic parameters. Late pregnancy differences in the uteroplacental circulation in preterm and term HDP are an index of maternal cardiovascular function rather than being related to inadequate spiral artery remodeling and impaired placentation. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - H Lehmann
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - E Mantovani
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - B Thilaganathan
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
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Gleason KT, Dennison Himmelfarb CR, Ford DE, Lehmann H, Samuel L, Jain S, Naccarelli G, Aggarwal V, Nazarian S. Association of sex and atrial fibrillation therapies with patient-reported outcomes. Heart 2019; 105:1642-1648. [PMID: 31118198 DOI: 10.1136/heartjnl-2019-314881] [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: 02/08/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Women report higher atrial fibrillation (AF) symptom severity and receive less AF therapies than their male counterparts. It is understudied if differences in AF therapies received explains sex differences in AF symptom severity. We investigate the impact of sex and AF therapies on patient-reported outcomes. METHODS Participants were recruited (n=953) across four academic medical centres with an AF diagnosis and age ≥18 years. Patient-reported outcomes (AF symptom severity, AF-related quality of life, functional status and emotional status) were determined by biannual surveys. We performed multiple linear regressions on propensity-matched cohorts to determine the association of AF therapies and sex on patient-reported outcomes. RESULTS Our study population (n=953) was 65% male (n=616), 93% white (n=890) and 72 (±10) years old. Individuals receiving rate control therapy reported comparatively lower AF-related quality of life (-7.22, 95% CI -11.51 to -2.92) and poorer functional status (-3.69, 95% CI -5.27 to -2.12). Individuals receiving rhythm control strategies did not report significantly different patient-reported outcomes. Women were more likely to report poorer functional status (-2.63, 95% CI -3.86 to -1.40) and poorer AF-related quality of life, higher anxiety (2.33, 95% CI 1.07 to 3.59), higher symptoms of depression (1.48, 95% CI 0.31 to 2.65) and AF symptom severity (0.29, 95% CI 0.07 to 0.52). CONCLUSIONS Female sex was associated with comparatively poorer AF symptom severity and quality of life, and this association remained after accounting for AF therapies received. Receiving rate control medication alone was associated with comparatively poorer AF-related quality of life and functional status.
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Affiliation(s)
| | | | | | - Harold Lehmann
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sandeep Jain
- Heart and Vascular Institute, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gerald Naccarelli
- Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Vikas Aggarwal
- Division of Cardiology, Department of Internal Medicine, University of Michigan Health System, Ann Harbor, Michigan, USA
| | - Saman Nazarian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gleason KT, Dennison Himmelfarb CR, Ford DE, Lehmann H, Samuel L, Han HR, Jain SK, Naccarelli GV, Aggarwal V, Nazarian S. Association of sex, age and education level with patient reported outcomes in atrial fibrillation. BMC Cardiovasc Disord 2019; 19:85. [PMID: 30953478 PMCID: PMC6451250 DOI: 10.1186/s12872-019-1059-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/12/2018] [Accepted: 03/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In atrial fibrillation (AF), there are known sex and sociodemographic disparities in clinical outcomes such as stroke. We investigate whether disparities also exist with respect to patient-reported outcomes. We explored the association of sex, age, and education level with patient-reported outcomes (AF-related quality of life, symptom severity, and emotional and functional status). METHODS The PaTH AF cohort study recruited participants (N = 953) with an AF diagnosis and age ≥ 18 years across 4 academic medical centers. We performed longitudinal multiple regression with random effects to determine if individual characteristics were associated with patient-reported outcomes. RESULTS Women reported poorer functional status (β - 2.23, 95% CI: -3.52, - 0.94) and AF-related quality of life (β - 4.12, 95% CI: -8.10, - 0.14), and higher symptoms of anxiety (β 2.08, 95% CI: 0.76, 3.40), depression (β 1.44, 95% CI: 0.25, 2.63), and AF (β 0.29, 95% CI: 0.08, 0.50). Individuals < 60 years were significantly (p < 0.05) more likely to report higher symptoms of depression, anxiety, and AF, and poorer AF-related quality of life. Lack of college education was associated with reporting higher symptoms of AF (β 0.42, 95% CI: 0.17, 0.68), anxiety (β 1.86, 95% CI: 0.26, 3.45), and depression (β 1.11, 95% CI: 0.15, 2.38), and lower AF-related quality of life (β - 4.41, 95% CI: -8.25, - 0.57) and functional status. CONCLUSION Women, younger adults, and individuals with lower levels of education reported comparatively poor patient-reported outcomes. These findings highlight the importance of understanding why individuals experience AF differently based on certain characteristics.
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Affiliation(s)
- Kelly T Gleason
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA.
| | | | - Daniel E Ford
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Harold Lehmann
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Hae Ra Han
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Sandeep K Jain
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gerald V Naccarelli
- Penn State Milton S. Hershey Medical Center, State College, Hershey, PA, USA
| | - Vikas Aggarwal
- University of Michigan Health System/Frankel Cardiovascular Center, Ann Harbor, MI, USA
| | - Saman Nazarian
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Miller SD, Cuffari C, Akhuemonkhan E, Guerrerio AL, Lehmann H, Hutfless S. Anemia Screening, Prevalence, and Treatment in Pediatric Inflammatory Bowel Disease in the United States, 2010-2014. Pediatr Gastroenterol Hepatol Nutr 2019; 22:152-161. [PMID: 30899691 PMCID: PMC6416389 DOI: 10.5223/pghn.2019.22.2.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/04/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE We examined the prevalence of anemia, annual screening for anemia, and treatment of anemia with iron among children with inflammatory bowel disease (IBD). METHODS A retrospective study of U.S. pediatric patients with IBD was performed in the MarketScan commercial claims database from 2010-2014. Children (ages 1-21) with at least two inpatient or outpatient encounters for IBD who had available lab and pharmacy data were included in the cohort. Anemia was defined using World Health Organization criteria. We used logistic regression to determine differences in screening, incident anemia, and treatment based on age at first IBD encounter and sex. RESULTS The cohort (n=2,446) included 1,560 Crohn's disease (CD) and 886 ulcerative colitis (UC). Approximately, 85% of CD and 81% of UC were screened for anemia. Among those screened, 51% with CD and 43% with UC had anemia. Only 24% of anemia patients with CD and 20% with UC were tested for iron deficiency; 85% were iron deficient. Intravenous (IV) iron was used to treat 4% of CD and 4% UC patients overall and 8% of those with anemia. CONCLUSION At least 80% of children with IBD were screened for anemia, although most did not receive follow-up tests for iron deficiency. The 43%-50% prevalence of anemia was consistent with prior studies. Under-treatment with IV iron points to a potential target for quality improvement.
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Affiliation(s)
- Steven D Miller
- Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carmelo Cuffari
- Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eboselume Akhuemonkhan
- Department of Allopathic Internal Medicine Residency, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Anthony L Guerrerio
- Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harold Lehmann
- Division of Health Science Informatics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Hutfless
- Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Gastroenterology and Hepatology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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25
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Petersen C, Berner ES, Embi PJ, Fultz Hollis K, Goodman KW, Koppel R, Lehmann CU, Lehmann H, Maulden SA, McGregor KA, Solomonides A, Subbian V, Terrazas E, Winkelstein P. AMIA's code of professional and ethical conduct 2018. J Am Med Inform Assoc 2018; 25:1579-1582. [PMID: 30329055 PMCID: PMC7646920 DOI: 10.1093/jamia/ocy092] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/08/2018] [Accepted: 06/18/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Carolyn Petersen
- Global Business Solutions, Mayo Clinic, Rochester, Minnesota, USA
| | - Eta S Berner
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter J Embi
- The Regenstrief Institute, Indianapolis, Indiana, USA
| | - Kate Fultz Hollis
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kenneth W Goodman
- Department of Philosophy, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Health Informatics, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Electrical and Computer Engineering, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Anesthesiology, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- School of Nursing and Health Studies, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ross Koppel
- Department of Sociology, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christoph U Lehmann
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Harold Lehmann
- Division of Health Services Informatics, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kyle A McGregor
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Anthony Solomonides
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Vignesh Subbian
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona, USA
- Department of Systems & Industrial Engineering, The University of Arizona, Tucson, Arizona, USA
| | | | - Peter Winkelstein
- Institute for Healthcare Informatics, Center of Excellence in Bioinformatics and Life Sciences, University at Buffalo, Buffalo, New York, USA
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Faensen A, Lehmann H, Metze B, Berns M, Hinkson L, Henrich W, Bührer C, Bamberg C. Differential association of prenatal blood flow patterns with death and neurodevelopmental retardation in preterm infants with intrauterine growth restriction. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671137] [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: 10/28/2022] Open
Affiliation(s)
- A Faensen
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - H Lehmann
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - B Metze
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - M Berns
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - L Hinkson
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - W Henrich
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - C Bührer
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - C Bamberg
- UKE, Geburtsmedizin, Hamburg, Deutschland
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27
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Overby CL, Thompkins P, Lehmann H, Chute CG, Sheffield JS. Value of Genetics-informed Drug Dosing Guidance in Pregnant Women: A Needs Assessment with Obstetric Healthcare Providers at Johns Hopkins. AMIA Annu Symp Proc 2018; 2017:1342-1351. [PMID: 29854203 PMCID: PMC5977707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In order to better understand the potential value of genetics-informed drug dose guidance to obstetric healthcare providers at Johns Hopkins we administered a web-based needs assessment survey. The survey included questions about: 1) experience with adjusting drug doses during pregnancy; 2) comfort prescribing medications to pregnant women with chronic conditions; 3) awareness and use of genetics-informed dosing guidance; and 4) perceived value of access to services to provide genetics-informed dosing guidance. Among thirty-one respondents, 81% indicated an interest in access to genetics-informed drug dose guidance, particularly a mobile or electronic health record (EHR) application. It was indicated, however, that genetics is one of many characteristics that influence dose adjustments during pregnancy. This study motivates future research to help obstetric healthcare providers tailor drug dose to individual patients based upon models integrating multiple patient characteristics, including genetics.
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Affiliation(s)
- Casey L Overby
- Division of General Internal Medicine
- Institute for Clinical & Translational Research
- Division of Health Sciences Informatics
| | | | | | - Christopher G Chute
- Division of General Internal Medicine
- Institute for Clinical & Translational Research
- Division of Health Sciences Informatics
| | - Jeanne S Sheffield
- Division of Maternal & Fetal Medicine; Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
Summary
Objective: To develop a heuristic framework for students to organize and apply the many concepts of informatics for rapid use.
Method: Organization of curriculum material and recurrent refinement by student feedback. An Informatics Stack was developed based on several existing informatics and software-development frameworks comprising several levels of abstraction, from what a system is supposed to accomplish (4 levels) to how it accomplishes it (5 levels). At each level, there are specific concerns, types of interoperability, ethical and legal issues, testing and evaluation approaches and methods, and relevant scientific disciplines, and privacy (upper 5 levels), confidentiality (middle 3 levels), and security (lower 4 levels ) concerns whose levels overlap. An 8-week Introduction to Informatics course was taught for 6 years to masters students of informatics and of public health, based on the Stack, with a Final Project continually filled in during the course, where students applied the Stack to existing reports describing health information systems and their deployments.
Results: Student feedback from 538 students working in 116 groups over 6 years shows near-universal appreciation that the Stack helped to organize their review of the report. Each student, from a wide variety of backgrounds, identified some level of the Stack as something they might have otherwise missed, and all levels were invoked by some student. Attributes identified by the students as missing from the Stack concerned the practicalities of system development.
Conclusion: The Stack is a broadly-encompassing heuristic whose application can be learned and applied by students from a wide variety of backgrounds in an 8-week course.
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Affiliation(s)
- Harold Lehmann
- Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Correspondence to Harold Lehmann Johns Hopkins School of MedicineDivision of Health Sciences Informatics2024 E Monument St1–201Baltimore, MD 21205USA
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29
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van Schaik IN, Bril V, van Geloven N, Hartung HP, Lewis RA, Sobue G, Lawo JP, Praus M, Mielke O, Durn BL, Cornblath DR, Merkies ISJ, Sabet A, George K, Roberts L, Carne R, Blum S, Henderson R, Van Damme P, Demeestere J, Larue S, D'Amour C, Bril V, Breiner A, Kunc P, Valis M, Sussova J, Kalous T, Talab R, Bednar M, Toomsoo T, Rubanovits I, Gross-Paju K, Sorro U, Saarela M, Auranen M, Pouget J, Attarian S, Le Masson G, Wielanek-Bachelet A, Desnuelle C, Delmont E, Clavelou P, Aufauvre D, Schmidt J, Zschuentssch J, Sommer C, Kramer D, Hoffmann O, Goerlitz C, Haas J, Chatzopoulos M, Yoon R, Gold R, Berlit P, Jaspert-Grehl A, Liebetanz D, Kutschenko A, Stangel M, Trebst C, Baum P, Bergh F, Klehmet J, Meisel A, Klostermann F, Oechtering J, Lehmann H, Schroeter M, Hagenacker T, Mueller D, Sperfeld A, Bethke F, Drory V, Algom A, Yarnitsky D, Murinson B, Di Muzio A, Ciccocioppo F, Sorbi S, Mata S, Schenone A, Grandis M, Lauria G, Cazzato D, Antonini G, Morino S, Cocito D, Zibetti M, Yokota T, Ohkubo T, Kanda T, Kawai M, Kaida K, Onoue H, Kuwabara S, Mori M, Iijima M, Ohyama K, Baba M, Tomiyama M, Nishiyama K, Akutsu T, Yokoyama K, Kanai K, van Schaik I, Eftimov F, Notermans N, Visser N, Faber C, Hoeijmakers J, Rejdak K, Chyrchel-Paszkiewicz U, Casanovas Pons C, Alberti Aguiló M, Gamez J, Figueras M, Marquez Infante C, Benitez Rivero S, Lunn M, Morrow J, Gosal D, Lavin T, Melamed I, Testori A, Ajroud-Driss S, Menichella D, Simpson E, Chi-Ho Lai E, Dimachkie M, Barohn R, Beydoun S, Johl H, Lange D, Shtilbans A, Muley S, Ladha S, Freimer M, Kissel J, Latov N, Chin R, Ubogu E, Mumfrey S, Rao T, MacDonald P, Sharma K, Gonzalez G, Allen J, Walk D, Hobson-Webb L, Gable K. Subcutaneous immunoglobulin for maintenance treatment in chronic inflammatory demyelinating polyneuropathy (PATH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 2018; 17:35-46. [DOI: 10.1016/s1474-4422(17)30378-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Lehmann H, Musk G, Laurence M, Bech-Gleerup K, Collins T, Hyndman T, Tuke J, Johnson C. Lidocaine or meloxicam analgesia decrease nociception as indicated by cardiovascular responses of halothane-anaesthetized Bos indicus bull calves during surgical castration. Vet Anaesth Analg 2017. [DOI: 10.1016/j.vaa.2016.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Balke M, Wunderlich G, Brunn A, Fink G, Lehmann H. Chronische inflammatorische demyelinisierende Polyneuropathie. Fortschr Neurol Psychiatr 2016; 84:756-769. [DOI: 10.1055/s-0042-120226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Balke
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
| | - G. Wunderlich
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
| | - A. Brunn
- Institut für Neuropathologie, Universitätsklinikum Köln
| | - G. Fink
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
| | - H. Lehmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
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Gordon-Smith EC, Dacie JV, Blecher TE, French EA, Wiltshirre BG, Lehmann H. Haemoglobin Nottingham, Beta FG 5 (98) Valgly: A New Unstable Haemoglobin Producing Severe Haemolysis. Proc R Soc Med 2016. [DOI: 10.1177/003591577306600607] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - J V Dacie
- Royal Postgraduate Medical School, London W12
| | | | | | | | - H Lehmann
- MRC Abnormal Heemoglobin Unit, Cambridge
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Abstract
An abnormal haemoglobin, which on paper electrophoresis has the mobility of Hb J, has been found in two brothers and, in the heterozygous state at least, is not associated with serious clinical abnormality. The structure of this hitherto unreported haemoglobin is α 120 (H3) Ala → Glu and it is named Haemoglobin J Birmingham.
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Geber C, Boehmerle W, Lehmann H, Hagenacker T. Diagnostik und Therapie Chemotherapie-induzierter Polyneuropathien: Update 2016. Akt Neurol 2016. [DOI: 10.1055/s-0035-1569271] [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: 10/22/2022]
Affiliation(s)
- C. Geber
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz, Mainz
| | - W. Boehmerle
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, Berlin
| | - H. Lehmann
- Klinik und Poliklinik für Neurologie, Uniklinik Köln, Köln
| | - T. Hagenacker
- Klinik für Neurologie, Universitätsklinikum Essen, Essen
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Windschall D, Trauzeddel R, Berendes R, Ganser G, Krumrey-Langkammerer M, Schoof P, Niewerth M, Trauzeddel R, Lehmann H. Bildgebung in der pädiatrischen Rheumatologie: Ergebnisse einer Umfrage unter deutschen Kinderrheumatologen. AKTUEL RHEUMATOL 2015. [DOI: 10.1055/s-0035-1555793] [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: 10/23/2022]
Affiliation(s)
- D. Windschall
- Klinik für Kinder- und Jugendmedizin, Asklepios Klinik Weißenfels, Weißenfels
| | - R. Trauzeddel
- Pädiatrische Rheumatologie, Helios Klinik Berlin-Buch, Berlin
| | - R. Berendes
- Pädiatrische Rheumatologie, Kinderkrankenhaus St. Marien, Landshut
| | - G. Ganser
- Kinderrheumatologie, St. Josef-Stift, Sendenhorst, Sendenhorst
| | - M. Krumrey-Langkammerer
- Pädiatrische Rheumatologie, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Garmisch-Partenkirchen
| | - P. Schoof
- Pädiatrische Rheumatologie, Kinderarztpraxis Schoof München, München
| | - M. Niewerth
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum, Berlin
| | | | - H. Lehmann
- Department of Pediatrics, University of Giessen, Giesssen
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Abstract
Phytovigilance consists in supervision of side effects and drug interactions consequential to use of herbal medicinal products, herbal food supplements, herbal cosmetics and/or medicinal plants. It includes thus pharmacovigilance applied to phytotherapy, nutrivigilance and cosmetovigilance but also addictovigilance in case of plants, which lead to drug addiction, and toxicovigilance in case of toxic plants. Becoming necessary owing to (acute or chronic) toxicity risks or to drug interactions risks (of pharmacocinetical or pharmacodynamical kind)--as far as it concerns interactions between several associated plants or between a plant and a chemical or biotechnological allopathic medicine--phytovigilance represents moreover a legal obligation. Pharmacovigilance--in case of herbal medicinal products--is indeed becoming mandatory according to title IX of the European directive 2001/83/EC, whereas nutrivigilance is imposed by the European Food Safety Agency (EFSA).
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Affiliation(s)
- H Lehmann
- EA 4487, centre de recherches en droit et perspectives du droit, faculté des sciences pharmaceutiques et biologiques, université Lille 2, 3, rue du Professeur-Laguesse, BP 53, 59006 Lille, France.
| | - J-Y Pabst
- EA 7307, centre d'études internationales et européennes (CEIE), faculté de pharmacie, université de Strasbourg, 74, route du Rhin, 67400 Illkirch, France
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Deisher A, Anderson S, Cusma J, Herman M, Johnson S, Lehmann H, Packer D, Parker K, Song L, Takami M, Kruse J. WE-EF-BRA-03: Catheter- Free Ablation with External Photon Radiation: Treatment Planning, Delivery Considerations, and Correlation of Effects with Delivered Dose. Med Phys 2015. [DOI: 10.1118/1.4925982] [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: 11/07/2022] Open
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Walter U, Nöcker G, Pawils S, Robra BP, Trojan A, Franz M, Grossmann B, Schmidt TA, Lehmann H, Bauer U, Göpel E, Janz A, Kuhn J, Naegele G, Müller-Kohlenberg H, Plaumann M, Stender KP, Stolzenberg R, Süß W, Trenker M, Wanek V, Wildner M. [Memorandum on sustainable reinforcement of prevention and health promotion: challenges at the federal, state and local level]. Gesundheitswesen 2015; 77:382-8. [PMID: 26018541 DOI: 10.1055/s-0035-1549949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Research-based evidence and practice-based experience are core requirements for the effective implementation of preventive interventions. The knowledge gained in the Prevention Research Funding Initiative of the German Federal Ministry of Education and Research (2004-2013) was therefore amalgamated, reflected and consolidated in the Cooperation for Sustainable Prevention Research (KNP) meta-project. In annual strategy meetings, researchers and practitioners from the field and other experts developed 3 memoranda providing recommendations for the further development of research and practice in the field of prevention and health promotion. Memorandum III is primarily aimed at decision-makers in politics and administration at the federal, state and local level, in civil society and in the workplace. Its recommendations show that structuring efforts are urgently needed to achieve sustainable policy, particularly in the fields of health, education, employment and social affairs. Memorandum III brings together the knowledge extracted and problems identified in research projects. More so than its 2 predecessors, Memorandum III abstracts knowledge from the individual projects and attempts to derive guidance for action and decision-making, as shown by the 7 recommendations that appear to useful for consensus-building in practice and research. Value judgments are inevitable. Prevention and health promotion are an investment in the future: of social health, social capital and social peace. Improvement of the framework conditions is needed to achieve the harmonized awareness and the sustained effectiveness of these structure-building efforts in different policy areas, spheres of life, fields of action, and groups of actors. This includes the implementation of an overall national strategy as well as the expansion of sources of funding, extension of the legal framework, overarching coordination, and the establishment of a National Center of Excellence to develop and safeguard prevention and health promotion. The memorandum is intended to stimulate a discourse resulting in structure-building and stabilizing measures designed to ensure the sustainability of prevention and health promotion.
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Affiliation(s)
- U Walter
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover
| | - G Nöcker
- Bundeszentrale für gesundheitliche Aufklärung, Köln
| | - S Pawils
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - B-P Robra
- Institut für Sozialmedizin und Gesundheitsökonomie, Otto-von-Guericke-Universität Magdeburg
| | - A Trojan
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf
| | - M Franz
- Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Düsseldorf
| | - B Grossmann
- Bundesvereinigung für Prävention und Gesundheitsförderung e.V., Bonn
| | - T-A Schmidt
- Referat 402 Gesundheitsförderung, Arzneimittel, Medizinprodukte, Biotechnologie, Niedersächsisches Ministerium für Soziales, Gesundheit und Gleichstellung, Hannover
| | | | - U Bauer
- Zentrum für Prävention und Intervention im Kindes- und Jugendalter, Fakultät für Erziehungswissenschaft, Universität Bielefeld
| | - E Göpel
- Kooperationsverbund Hochschulen für Gesundheit e.V., Berlin
| | - A Janz
- Stadt Kassel, Deutscher Städtetag Gesundheitsausschuss
| | - J Kuhn
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
| | - G Naegele
- Forschungsgesellschaft für Gerontologie e.V., Institut für Gerontologie an der Technischen Universität Dortmund
| | | | - M Plaumann
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover
| | - K-P Stender
- Behörde für Gesundheit und Verbraucherschutz, Freie und Hansestadt Hamburg
| | - R Stolzenberg
- Charité - Universitätsmedizin Berlin, Berlin School of Public Health
| | - W Süß
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf
| | - M Trenker
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover
| | - V Wanek
- Spitzenverband der Gesetzlichen Krankenversicherung, Berlin
| | - M Wildner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim/Pettenkofer School of Public Health
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Orlova A, Lehmann H. Informatics Education for HIM Professionals in the Era of Interoperable Standards-Based HIEs. J AHIMA 2015; 86:48-51. [PMID: 26901975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Maceroni C, Lehmann H, Da Silva R, Montalbán J. Pulsations in close binaries: challenges and opportunities. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/201510104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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DeBaun MR, Gordon M, McKinstry RC, Noetzel MJ, White DA, Sarnaik SA, Meier ER, Howard TH, Majumdar S, Inusa BPD, Telfer PT, Kirby-Allen M, McCavit TL, Kamdem A, Airewele G, Woods GM, Berman B, Panepinto JA, Fuh BR, Kwiatkowski JL, King AA, Fixler JM, Rhodes MM, Thompson AA, Heiny ME, Redding-Lallinger RC, Kirkham FJ, Dixon N, Gonzalez CE, Kalinyak KA, Quinn CT, Strouse JJ, Miller JP, Lehmann H, Kraut MA, Ball WS, Hirtz D, Casella JF. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. N Engl J Med 2014; 371:699-710. [PMID: 25140956 PMCID: PMC4195437 DOI: 10.1056/nejmoa1401731] [Citation(s) in RCA: 350] [Impact Index Per Article: 35.0] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Silent cerebral infarcts are the most common neurologic injury in children with sickle cell anemia and are associated with the recurrence of an infarct (stroke or silent cerebral infarct). We tested the hypothesis that the incidence of the recurrence of an infarct would be lower among children who underwent regular blood-transfusion therapy than among those who received standard care. METHODS In this randomized, single-blind clinical trial, we randomly assigned children with sickle cell anemia to receive regular blood transfusions (transfusion group) or standard care (observation group). Participants were between 5 and 15 years of age, with no history of stroke and with one or more silent cerebral infarcts on magnetic resonance imaging and a neurologic examination showing no abnormalities corresponding to these lesions. The primary end point was the recurrence of an infarct, defined as a stroke or a new or enlarged silent cerebral infarct. RESULTS A total of 196 children (mean age, 10 years) were randomly assigned to the observation or transfusion group and were followed for a median of 3 years. In the transfusion group, 6 of 99 children (6%) had an end-point event (1 had a stroke, and 5 had new or enlarged silent cerebral infarcts). In the observation group, 14 of 97 children (14%) had an end-point event (7 had strokes, and 7 had new or enlarged silent cerebral infarcts). The incidence of the primary end point in the transfusion and observation groups was 2.0 and 4.8 events, respectively, per 100 years at risk, corresponding to an incidence rate ratio of 0.41 (95% confidence interval, 0.12 to 0.99; P=0.04). CONCLUSIONS Regular blood-transfusion therapy significantly reduced the incidence of the recurrence of cerebral infarct in children with sickle cell anemia. (Funded by the National Institute of Neurological Disorders and Stroke and others; Silent Cerebral Infarct Multi-Center Clinical Trial ClinicalTrials.gov number, NCT00072761, and Current Controlled Trials number, ISRCTN52713285.).
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Affiliation(s)
- Michael R DeBaun
- From the Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University School of Medicine, Nashville (M.R.D.); Department of Ophthalmology and Visual Sciences, Division of Biostatistics (M.G.), Departments of Radiology and Pediatrics (R.C.M.), Neurology and Pediatrics (M.J.N.), and Psychology (D.A.W.), the Program in Occupational Therapy and Department of Pediatrics Hematology-Oncology (A.A.K.), and the Division of Biostatistics and Department of Internal Medicine (J.P.M.), Washington University School of Medicine, St. Louis; Department of Pediatrics, Division of Hematology-Oncology, Wayne State University, Detroit (S.A.S.); Center for Cancer and Blood Disorders, Children's National Medical Center, Department of Pediatrics, George Washington University Medical Center (E.R.M.), and Department of Pediatrics, Division of Hematology-Oncology, Georgetown University Hospital (C.E.G.) - all in Washington, DC; Department of Pediatrics, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham (T.H.H.); Department of Pediatrics, Division of Hematology-Oncology, University of Mississippi Medical Center, Jackson (S.M.); Department of Paediatrics, Evelina Children's Hospital, St. Thomas' Hospital NHS Trust (B.P.D.I.), Department of Pediatric Hematology, Royal London Hospital, Barts Health NHS Trust (P.T.T.), and the Neurosciences Unit, Institute of Child Health, University College London (F.J.K.) - all in London; Hospital for Sick Children, Department of Paediatrics, Haematology-Oncology, University of Toronto, Toronto (M.K.-A.); Division of Hematology-Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas (T.L.M.C.); Département Pédiatrie, Hôpital Intercommunal de Creteil, Creteil, France (A.K.); Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston (G.A.); Department of Pediatrics, Hematology-Oncology, Univer
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Amin W, Tsui FR, Borromeo C, Chuang CH, Espino JU, Ford D, Hwang W, Kapoor W, Lehmann H, Martich GD, Morton S, Paranjape A, Shirey W, Sorensen A, Becich MJ, Hess R. PaTH: towards a learning health system in the Mid-Atlantic region. J Am Med Inform Assoc 2014; 21:633-6. [PMID: 24821745 PMCID: PMC4078296 DOI: 10.1136/amiajnl-2014-002759] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/19/2014] [Accepted: 03/25/2014] [Indexed: 12/02/2022] Open
Abstract
The PaTH (University of Pittsburgh/UPMC, Penn State College of Medicine, Temple University Hospital, and Johns Hopkins University) clinical data research network initiative is a collaborative effort among four academic health centers in the Mid-Atlantic region. PaTH will provide robust infrastructure to conduct research, explore clinical outcomes, link with biospecimens, and improve methods for sharing and analyzing data across our diverse populations. Our disease foci are idiopathic pulmonary fibrosis, atrial fibrillation, and obesity. The four network sites have extensive experience in using data from electronic health records and have devised robust methods for patient outreach and recruitment. The network will adopt best practices by using the open-source data-sharing tool, Informatics for Integrating Biology and the Bedside (i2b2), at each site to enhance data sharing using centrally defined common data elements, and will use the Shared Health Research Information Network (SHRINE) for distributed queries across the network.
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Affiliation(s)
- Waqas Amin
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fuchiang Rich Tsui
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charles Borromeo
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cynthia H Chuang
- Department of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jeremy U Espino
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel Ford
- Department of Medicine, Division of Health Science Informatics, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Wenke Hwang
- Department of Public Health Sciences, Division of Health Services Research, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Wishwa Kapoor
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harold Lehmann
- Department of Medicine, Division of Health Science Informatics, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - G Daniel Martich
- Department of Critical Care Medicine, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sally Morton
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anuradha Paranjape
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - William Shirey
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Aaron Sorensen
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael J Becich
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rachel Hess
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Lehmann H. Elektronenrückstreuraten leichter Elemente in Molièrescher Näherung / Electron Backscattering Rates of Light Elements in Molière Approximation. ACTA ACUST UNITED AC 2014. [DOI: 10.1515/zna-1978-0820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electron backscattering rates of light elements (atomic number Z = 6, 13, 29) are evaluated for electron energies of E = 20···60 keV. The scattering amplitude in Moliere approximation is expanded as a series. The series elements are calculated in closed form with the aid of substitute functions. By comparison with the first Born approximation this yields correction factors of 1···1,25.
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Affiliation(s)
- H. Lehmann
- Optisches Institut der Technischen Universität Berlin
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Abstract
Abstract
The Moliere approximation of the scattering amplitude is, following earlier statements, a high-energy and small-angle approximation. Recent investigations show that there is no intrinsic small-angle restriction, the restriction being due to special derivations. A method is given, to obtain the scattering amplitude in the Moliere approximation without small-angle assumption. This enables to evaluate electron backscattering rates with the aid of the Moliere scattering amplitude.
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Affiliation(s)
- H. Lehmann
- Optisches Institut der Technischen Universität Berlin
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Jäger KM, Johansson C, Kunz U, Lehmann H. Sub-Cellular Element Analysis of a Cyanobacterium (Nostocsp.) in Symbiosis withGunnera manicataby ESI and EELS. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/j.1438-8677.1997.tb00622.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stelzer R, Lehmann H, Kramer D, Lüttge U. X-Ray Microprobe Analyses of Vacuoles of Spruce Needle Mesophyll, Endodermis and Transfusion Parenchyma Cells at Different Seasons of the Year*. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/j.1438-8677.1990.tb00183.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hersh WR, Cimino J, Payne PRO, Embi P, Logan J, Weiner M, Bernstam EV, Lehmann H, Hripcsak G, Hartzog T, Saltz J. Recommendations for the use of operational electronic health record data in comparative effectiveness research. EGEMS (Wash DC) 2013; 1:1018. [PMID: 25848563 PMCID: PMC4371471 DOI: 10.13063/2327-9214.1018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
There is an increasing amount of clinical data in operational electronic health record (EHR) systems. Such data provide substantial opportunities for their re-use for many purposes, including comparative effectiveness research (CER). In a previous paper, we identified a number of caveats related to the use of such data, noting that they may be inaccurate, incomplete, transformed in ways that undermine their meaning, unrecoverable for research, of unknown provenance, of insufficient granularity, or incompatible with research protocols. In this paper, we provide recommendations for overcoming these caveats with the goal of leveraging such data to benefit CER and other health care activities. These recommendations include adaptation of “best evidence” approaches to use of data; processes to evaluate availability, completeness, quality, and transformability of data; creation of tools to manage data and their attributes; determination of metrics for assessing whether data are “research grade”; development of methods for comparative validation of data; construction of a methodology database for methods involving use of clinical data; standardized reporting methods for data and their attributes; appropriate use of informatics expertise; and a research agenda to determine biases inherent in operational data and to assess informatics approaches to their improvement.
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Affiliation(s)
| | | | | | - Peter Embi
- The Ohio State University Wexner Medical Center
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Rogers AJ, Chu JH, Darvishi K, Ionita-Laza I, Lehmann H, Mills R, Lee C, Raby BA. Copy number variation prevalence in known asthma genes and their impact on asthma susceptibility. Clin Exp Allergy 2013; 43:455-62. [PMID: 23517041 DOI: 10.1111/cea.12060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/11/2012] [Accepted: 10/22/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Genetic studies have identified numerous genes reproducibly associated with asthma, yet these studies have focussed almost entirely on single nucleotide polymorphisms (SNPs), and virtually ignored another highly prevalent form of genetic variation: Copy Number Variants (CNVs). OBJECTIVE To survey the prevalence of CNVs in genes previously associated with asthma, and to assess whether CNVs represent the functional asthma-susceptibility variants at these loci. METHODS We genotyped 383 asthmatic trios participating in the Childhood Asthma Management Program (CAMP) using a competitive genomic hybridization (CGH) array designed to interrogate 20 092 CNVs. To ensure comprehensive assessment of all potential asthma candidate genes, we purposely used liberal asthma gene inclusion criteria, resulting in consideration of 270 candidate genes previously implicated in asthma. We performed statistical testing using FBAT-CNV. RESULTS Copy number variation in asthma candidate genes was prevalent, with 21% of tested genes residing near or within one of 69 CNVs. In six instances, the complete candidate gene sequence resides within the CNV boundaries. On average, asthmatic probands carried six asthma-candidate CNVs (range 1-29). However, the vast majority of identified CNVs were of rare frequency (< 5%) and were not statistically associated with asthma. Modest evidence for association with asthma was observed for 2 CNVs near NOS1 and SERPINA3. Linkage disequilibrium analysis suggests that CNV effects are unlikely to explain previously detected SNP associations with asthma. CONCLUSIONS AND CLINICAL RELEVANCE Although a substantial proportion of asthma-susceptibility genes harbour polymorphic CNVs, the majority of these variants do not confer increased asthma risk. The lack of linkage disequilibrium (LD) between CNVs and asthma-associated SNPs suggests that these CNVs are unlikely to represent the functional variant responsible for most known asthma associations.
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Affiliation(s)
- A J Rogers
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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