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Waite MR, Heslin K, Cook J, Kim A, Simpson M. Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center. J Subst Use Addict Treat 2023; 147:208933. [PMID: 36805798 DOI: 10.1016/j.josat.2022.208933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Substance use disorder is often a chronic condition, and its treatment requires patient access to a continuum of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient programs. Ideally, patients complete treatment at the most suitable level for their immediate individual needs, then transition to the next appropriate level. In practice, however, attrition rates are high, as many patients discharge before successfully completing a treatment program or struggle to transition to follow-up care after program discharge. Previous studies analyzed up to two programs at a time in single-center datasets, meaning no studies have assessed patient attrition and follow-up behavior across all five levels of substance use treatment programs in parallel. METHODS To address this major gap, this retrospective study collected patient demographics, enrollment, discharge, and outcomes data across five substance use treatment levels at a large Midwestern psychiatric hospital from 2017 to 2019. Data analyses used descriptive statistics and regression analyses. RESULTS Analyses found several differences in treatment engagement based on patient-level variables. Inpatients were more likely to identify as Black or female compared to lower-acuity programs. Patients were less likely to step down in care if they were younger, Black, had Medicare coverage were discharging from inpatient treatment, or had specific behavioral health diagnoses. Patients were more likely to relapse if they were male or did not engage in follow-up SUD treatment. CONCLUSIONS Future studies should assess mechanisms by which these variables influence treatment access, develop programmatic interventions that encourage appropriate transitions between programs, and determine best practices for increasing access to treatment.
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Affiliation(s)
- Mindy R Waite
- Advocate Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Jonathan Cook
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Aengela Kim
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; Chicago Medical School, Rosalind Franklin University, 3333 Green Bay Rd, North Chicago, IL 60064, USA.
| | - Michelle Simpson
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; AAH Ed Howe Center for Health Care Transformation, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
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Khan A, Heslin K, Simpson M, Malone ML. Can Variables From the Electronic Health Record Identify Delirium at Bedside? J Patient Cent Res Rev 2022; 9:174-180. [DOI: 10.17294/2330-0698.1890] [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: 11/04/2022] Open
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Mundt D, Klumph M, Heslin K, Askar W. Vitamin D Level Testing in an Urban Midwest Clinic: To Test or Not to Test? J Patient Cent Res Rev 2022; 9:122-127. [DOI: 10.17294/2330-0698.1854] [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: 11/04/2022] Open
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William HM, Heslin K, Kram JJF, Toberna CP, Baumgardner DJ. Association of Natural Waterways and Legionella pneumophila Infection in Eastern Wisconsin: A Case-Control Study. J Patient Cent Res Rev 2022; 9:128-131. [PMID: 35600231 PMCID: PMC9022710 DOI: 10.17294/2330-0698.1872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Preliminary research has suggested possible associations between natural waterways and Legionella infection, and we previously explored these associations in eastern Wisconsin using positive L. pneumophila serogroup 1 urine antigen tests (LUAT) as diagnostic. This case-control study was a secondary analysis of home address data from patients who underwent LUAT at a single eastern Wisconsin health system from 2013 to 2017. Only zip codes within the health system's catchment area that registered ≥3 positive cases and ≥50 completed tests, as well as geographically adjacent zip codes with ≥2 positive cases and ≥50 tests, were included. A 1:3 ratio of cases to randomly selected controls was used. Home addresses were geocoded and mapped using ArcGIS software (Esri); nearest waterway and distance to home was identified. Distance to nearest waterway according to ArcGIS was verified/corrected using Google Maps incognito. Distances were analyzed using chi-squared and 2-sample t-tests. Overall, mean distance to nearest waterway did not differ between cases (2958 ± 2049 ft) and controls (2856 ± 2018 ft; P=0.701). However, in a subset of nonurban zip codes, cases were closer to nearest waterway than controls (1165 ± 905 ft vs 2113 ± 1710 ft; P=0.019). No association was found between cases and type of waterway. Further research is needed to investigate associations and differences between natural and built environmental water sources in relation to legionellosis.
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Affiliation(s)
- Hannah M. William
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
- Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI
| | - Jessica J. F. Kram
- Center for Urban Population Health, Milwaukee, WI
- Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Caroline P. Toberna
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
- Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI
| | - Dennis J. Baumgardner
- Center for Urban Population Health, Milwaukee, WI
- Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Dilworth T, Kram J, Baumgardner D, Heslin K. Assessing the impact of Geo-demographic factors on antibiotic prescribing for adults with acute, uncomplicated bronchitis. Ann Fam Med 2022; 20:2678. [PMID: 35834726 PMCID: PMC10548927 DOI: 10.1370/afm.20.s1.2678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Context Acute bronchitis is a common reason patients seek primary care and has predominately viral causes. Yet, antibiotics are often prescribed despite limited evidence of clinical benefit. Interventions targeting antibiotic prescribing for acute bronchitis have reduced prescribing, but rates continued to remain higher than expected. There is also a paucity of data describing variability in antibiotic prescribing and its determinants; specifically, non-clinical, patient-level factors. Identifying non-clinical determinants of antibiotic prescribing for bronchitis could inform better care for these patients in primary care. Objective To assess the impact of geo-demographic factors on antibiotic prescribing for ambulatory adults with acute, uncomplicated bronchitis. Study design Cohort study. Setting Ambulatory clinics, urgent cares and emergency departments within a large, single U.S. health-system. Population studied Adult patients with a primary diagnosis of bronchitis in 2019. Outcome measures Predictors of antibiotic prescribing. Results There were 63,051 unique patients (mean age 48±18 years); 62.7% were female and 78.7% were non-Hispanic Caucasians. Of providers, 66.7% were physicians. Patients who were older (aOR 1.02, 95% CI 1.02-1.02), male (1.06, 1.03-1.10), black (1.21, 1.14-1.29), smoked (1.16, 1.12-1.20), had a nurse practitioner v. physician provider (1.11, 1.06-1.16) or a physician assistant v. physician provider (1.06, 1.01-1.11) were more likely to receive antibiotics. Patients who were Hispanic (0.87, 0.82-0.94), or Asian (0.85, 0.75-0.96) were less likely to receive antibiotics. Additionally, patients who had Medicare (0.78, 0.74-0.82), Medicaid (0.73, 0.69-0.77) or Exchange insurance (0.90, 0.82-0.98) or lived in a U.S. Census Block group with larger number of households without vehicles (0.66, 0.52-0.85) were less likely to receive antibiotics. Those living in an area with more owner-occupied housing were more likely to receive antibiotics (1.39, 1.25-1.53). The distance between a patient's residence and the encounter location did not impact the likelihood of antibiotic prescribing. Conclusions This study identified antibiotic prescribing disparities for adults with acute bronchitis at the level of the patient, prescriber and the patient residential area. Interventions targeting antibiotic prescribing in this population should consider the role these factors have in prescribing decisions.
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Reimer S, Pearce N, Marek A, Heslin K, Moreno AP. The Impact of Incarceration on Health and Health Care Utilization: a System Perspective. J Health Care Poor Underserved 2021; 32:1403-1414. [PMID: 34421039 DOI: 10.1353/hpu.2021.0140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previously incarcerated individuals report high rates of chronic disease and reduced health care access. We characterized the impact of recent incarceration in jail or prison on chronic disease burden and health care utilization. METHODS AND FINDINGS Incarceration data over 10 years were matched to health system data and patients were classified by recent incarceration status. Each cohort was stratified by gender and neighborhood socioeconomic status for utilization analysis. Main outcomes were chronic disease incidence and health care utilization. Incarceration had a significant but small effect on chronic disease incidence. Incarceration had a moderate to large effect on emergency department and behavioral health utilization, with additional differences seen by gender and socioeconomic status. CONCLUSION Incarceration's impact on quantity and type of health care utilization varies with socioeconomic status and gender. Future work should evaluate the impact of length or number of cycles of incarceration on health or health care utilization.
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Tadesse EA, Heslin K, Hendawi M, Peterson L, Wolf FM, Brown TD, Thompson MA. Genomic markers associated with hyperprogression in patients with lung cancer treated with immune checkpoint inhibitors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9105 Background: Immune checkpoint inhibitor (ICI) therapy has become a mainstay of non-small cell lung cancer (NSCLC) treatment. However, not all patients (pts) benefit with a subset paradoxically experiencing accelerated tumor growth while on ICI. Hyperprogression (HP) refers to accelerated tumor growth on ICI with worsening clinical status. Various gene alterations may be associated with HP including MDM2/MDM4 amplifications, EGFR alterations, and STK11/LKB1 mutations. Kato et al. (doi: 10.1158/1078-0432.CCR-16-3133 ) showed HP in 6/6 pts with MDM2/MDM4 amplification and in 2/10 pts with EGFR alterations. This report describes HP in pts with NSCLC treated with ICIs in a large health system. Methods: Pts with NSCLC treated with ICIs from Jan 2012 to Jan 2021 at Advocate Aurora Health were reviewed after IRB approval. Pts with NSCLC histology (ICD diagnosis codes and/or manual chart review), ICI treatment, and molecular testing were identified via the real world data integrated within the Syapse Learning Health Network platform. Additional chart review to ascertain HP was performed, and molecular results were analyzed. HP criteria include: 1) time-to-treatment failure < 2 months (from start to discontinuation of ICI for any reason), 2) > 50% increase in tumor burden by RECIST, 3) spread of the disease to a new organ between baseline and first radiologic evaluation or clinical deterioration, and 4) ECOG PS ≥ 2 during the first 2 months of treatment. Based on the number of criteria fulfilled, HP = > 3, Progression = 1-2, and non-progressor = 0. Pts with and without HP were compared using Chi-squared and Fisher Exact tests. T-tests were performed for continuous variables. Results: Out of 7,078 NSCLC pts, 1,389 (20%) were treated with ICI including atezolizumab (40 pts, 3%), durvalumab (17 pts, 1%), nivolumab (167 pts, 12%), pembrolizumab (190 pts, 14%), and multiple ICIs (12 pts, 1%). Of those pts treated with ICIs, molecular testing was performed in 427 (31%). 98 of 427 pts (23%)had HP and an additional 86 pts (20%) had progressive disease without meeting the definition of HP. Biomarker associations with HP are shown in the table. By tumor gene alterations, HP was seen in pts with: EGFR (20/60), STK11/LKB1 (16/25); and MDM2/4 (4/7). Conclusions: EGFR, STK11/LKB1, and MDM2/4 gene alterations were all statistically significantly associated with HP. Clinical and molecular predictors of HP need to be explored in order to optimize selection of pts for ICI therapy.[Table: see text]
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Tjoe JA, Heslin K, Perez Moreno AC, Thomas S, Kram JJF. Factors Associated With Breast Cancer Surgery Delay Within a Coordinated Multihospital Community Health System: When Does Surgical Delay Impact Outcome? Clin Breast Cancer 2021; 22:e91-e100. [PMID: 34119430 DOI: 10.1016/j.clbc.2021.04.012] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multiple factors influence the time elapsed between diagnosis of breast cancer and surgical extirpation of the primary tumor. The disease-free interval between resection of primary breast cancer and first evidence of recurrence is predictive of mortality. We aimed to determine patient, disease, and treatment factors associated with a delay in time to surgery (TTS) and identify the point when prolonged TTS negatively impacts disease-free survival. PATIENTS AND METHODS Cancer registry and electronic medical record data for patients with breast cancer who underwent surgery as first course of treatment during 2006-2016 were retrospectively reviewed. Patients undergoing surgery in ≤30 vs. 31-60 vs. >60 days of initial diagnosis were compared. Kaplan-Meier survival analyses with Cox proportional hazards were performed to evaluate impact of time from breast cancer diagnosis to definitive therapeutic surgery on breast cancer recurrence or death (all-cause). RESULTS Overall, 4462 patients were analyzed, 43.4% of whom underwent surgery beyond 30 days. The following factors were associated with TTS >30 days: age <50, non-Hispanic White race/ethnicity, commercial or health exchange/Medicaid insurance, diagnosis of noninvasive disease (i.e., ductal carcinoma in situ), had breast magnetic resonance imaging before definitive surgery, underwent total mastectomy (especially if immediate reconstruction, particularly if autologous, was performed), and did not receive adjuvant therapies (P < .001 for all). After adjusting for relevant variables, significant predictors of recurrence/death included a TTS >60 days, increased patient age, higher breast cancer stage, and triple-negative biomarker expression. CONCLUSION Risk of recurrence or death is not compromised until TTS exceeds 60 days after initial breast cancer diagnosis.
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Affiliation(s)
- Judy A Tjoe
- Department of Surgical Breast Oncology, Aurora Sinai Medical Center, Milwaukee, WI; Translational Oncology Research Quest for Understanding and Exploration (TORQUE), Milwaukee, WI; Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI; Department of Surgery, University of Wisconsin and School of Medicine and Public Health, Madison WI.
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI; Aurora University of Wisconsin Medical Group, Advocate Aurora Health, Milwaukee, WI; Center for Urban Population Health, Milwaukee, WI
| | - Ana C Perez Moreno
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Shanita Thomas
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Jessica J F Kram
- Aurora University of Wisconsin Medical Group, Advocate Aurora Health, Milwaukee, WI; Center for Urban Population Health, Milwaukee, WI
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Burek GA, Waite MR, Heslin K, Liewen AK, Yaqub TM, Larsen SE. Low-dose clonidine in veterans with Posttraumatic stress disorder. J Psychiatr Res 2021; 137:480-485. [PMID: 33798975 DOI: 10.1016/j.jpsychires.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 01/21/2023]
Abstract
Posttraumatic stress disorder (PTSD) symptoms of hyperarousal are mediated through sympathetic nervous system hyperactivity. PTSD symptoms, including distressing thoughts and memories, flashbacks, hyperarousal, and sleep disturbances, have been linked with elevated norepinephrine levels in the cerebrospinal fluid. Clonidine, an alpha2-adrenergic agonist, reduces the release of norepinephrine and has been suggested as a treatment for PTSD. However, literature for use of clonidine in PTSD is limited. The objective of this study was to evaluate clinical records of patients with PTSD treated with clonidine to assess reported efficacy and safety. A cohort of veterans with PTSD treated with clonidine at a midwestern VA hospital between July 2015 and January 2018 were studied retrospectively. Medical records of 79 patients with moderate to severe PTSD symptoms were reviewed by three independent clinicians using the Clinical Global Impressions (CGI) scale to quantify symptom severity (CGI-S) before starting clonidine and subjects' change in symptoms (CGI-I) after starting clonidine. Data on adverse events were also collected. Subgroup analyses were conducted on the impact of comorbid diagnoses, concurrent medications, and substance use. Mean CGI-S score at baseline was 4.8 (5 = markedly ill). After treatment with low-dose clonidine, 72% of patients experienced improvement, and 49% scored "much improved" or "very much improved." Adverse effects were reported by 18 out of 79 subjects. In this retrospective analysis of veterans prescribed clonidine for PTSD, CGI-I scores suggested improvement in PTSD symptoms, and minimal side effects were reported. In addition, some comorbid diagnoses and concurrent medications were correlated with variations in outcomes.
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Affiliation(s)
- Gregory A Burek
- Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
| | - Mindy R Waite
- Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI, 53233, USA
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI, 53233, USA
| | - Amanda K Liewen
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Tareq M Yaqub
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA; Department of Child and Adolescent Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Sadie E Larsen
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA; Milwaukee VA Medical Center, 5000 W National Ave., Milwaukee, WI, 53295, USA
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Macias Tejada JA, Klumph M, Heslin K, Khan A, Malone ML. Prevalence of high-risk medications in patients enrolled in the Hospital Elder Life Program. J Am Geriatr Soc 2021; 69:1941-1947. [PMID: 33769554 DOI: 10.1111/jgs.17133] [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: 12/30/2020] [Accepted: 02/28/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The study aimed to assess the prevalence of newly prescribed antipsychotic/benzodiazepine medication, as well as 30-day readmissions, among Hospital Elder Life Program (HELP)-enrolled patients. DESIGN Retrospective case-control study. SETTING HELP intervention took place in eight hospital units. The standard care group was selected from eight additional hospital units. PARTICIPANTS Hospitalized patients, aged 65 years and older, enrolled in HELP during between January 1, 2017 to December 31, 2018 were included in the HELP cohort. Patients hospitalized in eight additional units during the same time frame were part of the standard care group. MEASUREMENTS Antipsychotic/benzodiazepine medications were pulled from the electronic health record. History of chronic mental illnesses were classified by ICD10 codes. Basic descriptive statistics were used to analyze patient characteristics and comorbidities. Chi-squared and t-tests were performed to detect statistical differences as appropriate. RESULTS There were 1411 patients in the HELP group and 10,807 patients in the standard care group. The HELP group was likely to be older, female and to have a shorten length of stay (all p ≤ 0.02). Our study demonstrated that approximately 8.9% (n = 125) of patients enrolled in HELP received an order for antipsychotics during their hospital admission, while 31.5% (n = 3400) from the standard care group (p < 0.001). The difference in benzodiazepine prescription in patients enrolled in HELP was also less when comparing the two groups (22.8% HELP vs 25.6% standard care; p = 0.02). CONCLUSIONS Patients enrolled in the HELP group were less likely to receive a prescription for antipsychotics or benzodiazepines. The majority of patients enrolled in HELP were discharged to a more independent environment (home or assisted living) and there was a relatively low 30-day readmission rate among HELP patients.
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Affiliation(s)
- Jonny A Macias Tejada
- Advocate Aurora Health, Milwaukee, Wisconsin, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marianne Klumph
- Advocate Aurora Health, Milwaukee, Wisconsin, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kayla Heslin
- Advocate Aurora Health, Milwaukee, Wisconsin, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Advocate Aurora Health Research Institute, Milwaukee, Wisconsin, USA
| | - Ariba Khan
- Advocate Aurora Health, Milwaukee, Wisconsin, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael L Malone
- Advocate Aurora Health, Milwaukee, Wisconsin, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Ostroot MK, Heslin K, Kram JJF, Tjoe JA, Dorton B. Breast cancer recurrence risk after hormonal contraceptive use in survivors of reproductive age. Eur J Obstet Gynecol Reprod Biol 2020; 258:174-178. [PMID: 33444811 DOI: 10.1016/j.ejogrb.2020.12.035] [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: 11/25/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the risk of recurrence with hormonal contraceptive use in breast cancer survivors of reproductive age. STUDY DESIGN In this retrospective study, women ages 18-51 years who were diagnosed with primary stage 0-3 breast cancer between 2006-2016 and subsequently entered remission were included. Patients with missing information within the cancer registry or electronic medical record and those with a history of hysterectomy and/or sterilization procedure prior to diagnosis were excluded. Hormonal contraception use was defined as being prescribed an oral contraceptive pill (OCP), patch, vaginal ring, medroxyprogesterone injection, etonogestrel implant, or levonorgestrel-releasing intrauterine device (IUD). Women were separated into two groups, hormonal contraceptive users and non-users. Basic descriptive and inferential statistics were used to compare groups as appropriate. The primary outcome reviewed was local or distant breast cancer recurrence. Secondary outcomes included all-cause mortality and pregnancy. RESULTS Following exclusions, 1370 women remained in the cohort. Ninety-seven women (7.08 %) received a prescription for a form of hormonal contraception. When comparing groups, hormonal contraceptive users were more likely to be between 18-40 years of age (46.39 % vs. 17.99 % non-users;P < 0.01) and never smokers (68.04 % vs. 38.57 % non-users; P < 0.01). Patients did not differ between groups based on any other demographic or cancer-related characteristic, including tumor hormone receptor expression. Overall, 92 patients (6.72 %) experienced local or distant recurrence during the study period. Recurrence did not differ between groups (6.19 % users vs. 6.76 % non-users; P = 0.83). All-cause mortality and pregnancy rates also did not differ between hormonal contraceptive users and non-users. CONCLUSION The study shows no increased risk of recurrence associated with hormonal contraceptive use after breast cancer diagnosis and remission.
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Affiliation(s)
- Molly K Ostroot
- Department of Obstetrics and Gynecology, Advocate Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, United States.
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health Care, Milwaukee, WI, United States; Aurora University of Wiscons in Medical Group and Center for Urban Population Health, Advocate Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, United States
| | - Jessica J F Kram
- Aurora University of Wiscons in Medical Group and Center for Urban Population Health, Advocate Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, United States
| | - Judy A Tjoe
- Advocate Aurora Research Institute, Advocate Aurora Health Care, Milwaukee, WI, United States; Department of Surgical Breast Oncology, Advocate Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, United States; Translational Oncology Research Quest for Understanding and Exploration (TORQUE), Advocate Aurora Health Care, Milwaukee, WI, United States
| | - Benjamin Dorton
- Department of Obstetrics and Gynecology, Advocate Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, United States
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Khan A, Heslin K, Simpson M, Malone M. Electronic Health Record Data Can be Used at the Bedside to Identify Older Hospitalized Patients With Delirium. Innov Aging 2020. [PMCID: PMC7741756 DOI: 10.1093/geroni/igaa057.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Delirium is a serious condition that is often underrecognized. Several delirium predictive rules can assist in early detection. The coupling of prediction rules with features of the EHR are in their infancy but hold potential. This study aimed to determine variables within the EHR that can be used to identify older hospitalized patients with delirium. This is a prospective study among patients >=65 years admitted to the hospital. Researchers screened daily for delirium using the 3-D CAM. Predictive variables were extracted from the EHR. Basic descriptive statistics were conducted. Chi-squared and Fischer’s exact tests were used to compare differences among those diagnosed with or without delirium as appropriate; binary logistic regression was used for multivariate modeling. Among 408 participants, mean age was 75 years, 61% were female, and 83% were black. The overall rate of delirium was 16.7% (prevalent delirium 10.5%; incident delirium 6.1%). There was no statistical difference in 30-day mortality (2.9% vs. 2.7%) or 30-day readmission (13.2% vs. 14.7%) rates between those with and without delirium (both P>0.05). Even so, patients with delirium were older, more likely to have a diagnosis of infection and/or cognitive impairment, as well as increased severity of illness (all P’s <0.05). Moreover, patients with delirium had a lower Braden score and higher Morse fall score (both P’s <0.01). In multivariate analysis, cognitive impairment (OR 5.49; 95% CI 2.77-10.87) and lower Braden scores (OR 1.29; 95% CI 1.18-1.41) remained significant predictors of delirium. Further research is needed to develop an automated EHR prediction model.
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Affiliation(s)
- Ariba Khan
- Advocate Aurora Health Care, Milwaukee, Wisconsin, United States
| | - Kayla Heslin
- Aurora Research Institute, Milwaukee, United States
| | | | - Michael Malone
- Advocate Aurora Health, Milwaukee, Wisconsin, United States
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Horter DA, Heslin K, Forgie M, Malloy E, Kram JJF. Dancing During Labor: Are Women Down to Boogie? J Patient Cent Res Rev 2020; 7:349-354. [PMID: 33163556 DOI: 10.17294/2330-0698.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recent social media trends have demonstrated increased interest in dancing during the final weeks of pregnancy and labor. However, there is limited evidence about dancing during labor and its impact on labor pain and duration as well as patient satisfaction. Before conducting a prospective study, given that enrollment is often challenging, our feasibility study aimed to assess the willingness of pregnant women to participate in a future study evaluating low-impact dance during labor. We anonymously surveyed a convenience sample of English-speaking/reading pregnant women who presented for prenatal care at 1 of 3 clinics from June 2019 to July 2019. Questions related to women's interest in dancing during labor and limited demographic information were collected and analyzed. Overall, 88.6% of pregnant women who completed the survey expressed interest in participating in a future study on low-impact dance during labor, with Caucasian patients and those ≥35 years of age being less interested in future participation (P<0.05 for both). Interest in participating was not influenced by any other demographic characteristic, pregnancy history, or current activity level. Given sufficient interest among pregnant women in participating in a study aimed at evaluating the potential benefits of low-impact dance during labor, enrollment numbers may be easier to achieve than previously expected.
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Affiliation(s)
- Drew A Horter
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI.,Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI.,Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Marie Forgie
- Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI.,Obstetrics and Gynecology, Aurora Sinai Medical Center, Milwaukee, WI
| | - Emily Malloy
- Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI.,Midwifery and Wellness Center, Aurora Sinai Medical Center, Milwaukee, WI
| | - Jessica J F Kram
- Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
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14
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Mironov NR, Kram JJF, Heslin K, Michelson ELD. Retrospective review of cesarean hysterectomy outcomes utilizing uterine intravascular interventions in a large, community-based healthcare setting. Eur J Obstet Gynecol Reprod Biol 2020; 255:237-241. [PMID: 33160153 DOI: 10.1016/j.ejogrb.2020.10.056] [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: 08/06/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore outcomes of women with planned cesarean hysterectomies, with or without use of internal iliac intravascular occlusive balloon catheter or uterine artery embolization (UAE). STUDY DESIGN We retrospectively reviewed adult women who underwent a planned cesarean hysterectomy, 2004-2019. All planned cases were included, regardless of indication. Planned surgeries were divided into three groups: balloon placement, UAE, or no intervention. Patients with balloon placement were further subdivided into: balloons placed but not deployed or balloons placed and deployed intraoperatively. Hemorrhage was defined as estimated blood loss (EBL) ≥1,500 mL. An adverse outcome was defined as one or more of the following: intensive care unit admission, thromboembolism, ureteral stent placement, amputation, or reoperation. Basic descriptive and inferential statistics were used to explore differences among groups and adverse outcomes. RESULTS A total of 34 patients underwent planned cesarean hysterectomy. Ten patients (29.4%) had balloons placed, nine (26.5%) had UAE, and 15 (44.1%) had no intervention. Risk of hemorrhage was clinically higher among those with balloon placement (80% vs. 33% UAE vs. 60% no intervention; P = 0.14), with mean EBL (3,605.0 mL vs. 1,488.9 mL vs. 2,289.3 mL; P = 0.05) and mean transfusion requirements (9.3 units vs. 2.8 vs. 4.4; P = 0.01) being significantly higher. Adverse outcomes were also significantly higher among those with balloon placement (80.0% vs. 66.7% UAE vs. 20.0% no intervention; P ≤ 0.01). Of the ten patients with balloons placed, four were deployed. Among those with balloons placed and deployed, mean EBL (5,250.0 mL vs. 2,508.3 mL balloons placed but not deployed vs. 2,289.3 mL no intervention; P=0.04) and mean transfusion requirements (11 units vs. 7.5 units balloons placed but not deployed vs. 4.4 units no intervention; P = 0.05) were significantly higher. Adverse outcomes were also significantly higher among those who had balloons placed and deployed (100.0% vs. 66.7% balloons placed but not deployed vs. 20.0% no intervention; P ≤ 0.01). CONCLUSIONS Balloon placement, regardless of deployment, may not be beneficial to women undergoing a planned cesarean hysterectomy. Although UAE was also associated with adverse outcomes, it may be a better option for reducing intraoperative blood loss among patients with a planned cesarean hysterectomy.
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Affiliation(s)
- Natalie R Mironov
- Des Moines University College of Osteopathic Medicine, United States, Des Moines, IA, United States; Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States
| | - Jessica J F Kram
- Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States
| | - Kayla Heslin
- Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States; Advocate Aurora Research Institute, Advocate Aurora Health, United States, Milwaukee, WI, United States
| | - Elizabeth L Dickson Michelson
- Department of Oncology, Advocate Aurora Health, Aurora West Allis Medical Center, United States, West Allis, WI, United States.
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15
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Tadesse EA, Heslin K, Hendawi M, Hirsch J, Idyro C, Thompson MA. Molecular alterations with hyperprogression in lung cancer patients treated with immune checkpoint inhibitors in a large health system. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15082] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15082 Background: Immune checkpoint inhibitor (ICI) therapy has become a mainstay of lung cancer treatment. However, not all NSCLC patients (pts) benefit, a subset paradoxically experience accelerated tumor growth while on immunotherapy. Hyperprogression (HP) refers to accelerated tumor growth on ICI with worsening clinical status. Various molecular alterations may be associated with HP including MDM2/MDM4 amplifications, EGFR aberrations, and STK11/LKB1 mutations. Kato et al. ( http://ow.ly/2n8a30nQpZv ) showed HP in 6/6 pts with MDM2/MDM4 amplification and in 2/10 pts with EGFR alterations. Methods: Lung cancer pts treated with ICI from Jan 2017 to Jan 2019 at Aurora Health Care were reviewed after IRB approved. Pts with NSCLC histology (ICD diagnosis codes and / or manual chart review), ICI treatment, and molecular testing were identified via the real world data (RWD) integrated in the Syapse platform. Additional chart review to ascertain HP was performed, and molecular results obtained via Syapse molecular lab integrations were analyzed. Pts had various forms of real world biomarker testing including oligo NGS panels. HP is defined as: 1) time-to-treatment failure (TTF) < 2 months (time from the start of treatment with ICI to ICI discontinuation for any reason, including progression, patient preference, toxicity, or death), 2) > 50% increase in tumor burden by RECIST, 3) spread of the disease to a new organ between baseline and first radiologic evaluation or clinical deterioration, and 4) ECOG PS ≥2 during the first 2 months of treatment. HP > = 3, Progression 1-2, non-progressor 0 criteria fulfilled.Pts with and without HP were compared using Chi-squared and Fisher Exact tests. T-tests were performed for continuous variables. Results: Out of 1536 lung cancer patients 350 (22.8%) were treated with ICI including: atezolizumab (35), durvalumab (6), nivolumab (177), pembrolizumab (145). Some pts were treated with more than one ICI. 64/350 (18.2%) pts had HP. 79/350 (22.5%) pts had progressive disease without meeting the definition of HP. Biomarker associations with HP are shown in the table. Conclusions: Only the STK11/LKB1 mutation was associated with HP (P = < 0.0001) with 5 of 6 STK11 pts treated with ICI showing HP. Other potential HP biomarkers will be assessed prospectively as larger panels are utilized. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Michael A. Thompson
- Aurora Cancer Care, Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
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16
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Abstract
Over the past 30 years, medical interventions in pregnancy and childbirth have increased. Some pregnant women seek less invasive and nonpharmacological options to manage discomforts during labor. While exercise during pregnancy is recommended, less is known about exercise, specifically dancing, during labor. While anecdotal evidence is supportive, little is known about the implications of exercise and dance during the first stage of labor for pain reduction and labor progression. Some movements common in dance, such as expanding hip circles that loosen and relax muscles of the pelvic floor, may be beneficial to women during labor. Available evidence suggests that dancing during the first stage of labor may decrease duration and intensity of pain and increase patient satisfaction, but further study is warranted. Ultimately, before assessing the implications of dance during labor, a feasibility study should be conducted to determine pregnant women's willingness to participate in a prospective or randomized controlled trial.
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Affiliation(s)
- Caroline P Toberna
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Drew Horter
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Kayla Heslin
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Marie M Forgie
- Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Obstetrics and Gynecology, Aurora Sinai Medical Center, Milwaukee, WI.,Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Emily Malloy
- Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Midwifery and Wellness Center, Aurora Sinai Medical Center, Milwaukee, WI.,Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jessica J F Kram
- Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
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17
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Toberna CP, William HM, Kram JJF, Heslin K, Baumgardner DJ. Epidemiologic Survey of Legionella Urine Antigen Testing Within a Large Wisconsin-Based Health Care System. J Patient Cent Res Rev 2020; 7:165-175. [PMID: 32377550 DOI: 10.17294/2330-0698.1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Legionella pneumophila pneumonia is a life-threatening, environmentally acquired infection identifiable via Legionella urine antigen tests (LUAT). We aimed to identify cumulative incidence, demographic distribution, and undetected disease outbreaks of Legionella pneumonia via positive LUAT in a single eastern Wisconsin health system, with a focus on urban Milwaukee County. Methods A multilevel descriptive ecologic study was conducted utilizing electronic medical record data from a large integrated health care system of patients who underwent LUAT from 2013 to 2017. A random sample inclusive of all positive tests was reviewed to investigate geodemographic differences among patients testing positive versus negative. Statistical comparisons used chi-squared or 2-sample t-tests; stepwise regression followed by binary logistic regression was used for multivariable analysis. Positive cases identified by LUAT were mapped to locate hotspots; positive cases versus total tests performed also were mapped by zip code. Results Of all LUAT performed (n=21,599), 0.68% were positive. Among those in the random sample (n=11,652), positive cases by LUAT were more prevalent in the June-November time period (86.2%) and younger patients (59.4 vs 67.7 years) and were disproportionately male (70.3% vs 29.7%) (P<0.0001 for each). Cumulative incidence was higher among nonwhite race/ethnicity (1.91% vs 1.01%, P<0.0001) but did not remain significant on multivariable analysis. Overall, 5507 tests were performed in Milwaukee County zip codes, yielding 82 positive cases by LUAT (60.7% of all positive cases in the random sample). A potential small 2016 outbreak was identified. Conclusions Cumulative incidence of a positive LUAT was less than 1%. LUAT testing, if done in real time by cooperative health systems, may complement public health detection of Legionella pneumonia outbreaks.
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Affiliation(s)
- Caroline P Toberna
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Hannah M William
- Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Jessica J F Kram
- Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kayla Heslin
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Dennis J Baumgardner
- Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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18
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Dickson Michelson EL, Kram JJF, Heslin K, Baugh D, Bamra V, Hu J, Shukla A, Kamelle SA. Can Magnetic Resonance Imaging Predict Pathologic Findings for Endometrioid Endometrial Cancer? J Patient Cent Res Rev 2020; 7:206-212. [PMID: 32377553 DOI: 10.17294/2330-0698.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This pilot study aimed to assess the feasibility of precisely measuring tumor diameter and myometrial invasion in patients with endometrioid endometrial cancer (EEC) using preoperative contrast-enhanced magnetic resonance imaging (MRI). Adult patients with confirmed diagnosis of complex hyperplasia with atypia or EEC were included. Three radiologists separately measured tumor diameter and myometrial invasion. Basic descriptive statistics were used to describe patient characteristics and to compare radiology- and pathology-measured tumor diameter and myometrial invasion. Using the pathology results for tumor diameter as the gold standard for comparison, at least 1 radiologist was able to predict largest tumor diameter within 5 mm for 41.7% of patients. Similarly, based on pathology results for myometrial invasion, at least 1 radiologist was able to predict myometrial invasion within 5% for 50% of patients. All radiologists were able to predict superficial (<50%) or deep (≥50%) myometrial invasion for 75% of patients, with greater sensitivity, specificity, and accuracy for deep myometrial invasion. Given variation among radiologic measurements, it is difficult to recommend preoperative MRI as a basis for measuring tumor diameter and myometrial invasion. Even so, the ability to predict superficial versus deep myometrial invasion may benefit patients with EEC for whom surgery is not a viable option or for those seeking fertility-sparing treatment options.
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Affiliation(s)
| | - Jessica J F Kram
- Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Kayla Heslin
- Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - David Baugh
- Radiology, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Vikram Bamra
- Radiology, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Jiahao Hu
- Radiology, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Abhishek Shukla
- Pathology, Aurora St. Luke's Medical Center, Aurora Health Care, Milwaukee, WI
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Heslin K, Coutellier L. Npas4 deficiency and prenatal stress interact to affect social recognition in mice. Genes Brain Behav 2018; 17:e12448. [PMID: 29227584 DOI: 10.1111/gbb.12448] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 01/21/2023]
Abstract
Neurodevelopmental disorders such as autism spectrum disorders and schizophrenia have an expansive array of reported genetic and environmental contributing factors. However, none of these factors alone can account for a substantial proportion of cases of either disorder. Instead, many gene-by-environment interactions are responsible for neurodevelopmental disturbances that lead to these disorders. The current experiment used heterozygous knock-out mice to examine a potential interaction between 2 factors commonly linked to neurodevelopmental disorders and cognitive deficit: imbalanced excitatory/inhibitory signaling in the cortex and prenatal stress (PNS) exposure. Both of these factors have been linked to disrupt GABAergic signaling in the prefrontal cortex (PFC), a common feature of neurodevelopmental disorders. The neuronal PAS domain protein 4 (Npas4) gene is instrumental in regulation of the excitatory/inhibitory balance in the cortex and hippocampus in response to activation. Npas4 heterozygous and wild-type male and female mice were exposed to either PNS or standard gestation, then evaluated during adulthood in social and anxiety behavioral measures. The combination of PNS and Npas4 deficiency in male mice impaired social recognition. This behavioral deficit was associated with decreased parvalbumin and cFos protein expression in the infralimbic region of the PFC following social stimulation in Npas4 heterozygous males. In contrast, females displayed fewer behavioral effects and molecular changes in PFC in response to PNS and decreased Npas4.
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Affiliation(s)
- K Heslin
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - L Coutellier
- Department of Psychology, The Ohio State University, Columbus, Ohio.,Department of Neuroscience, The Ohio State University, Columbus, Ohio
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20
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Jackson L, Shaheen M, Heslin K, Pan D. Racial/Ethnic Differences in the Prevalence of Childhood Caries and Parental Perception of Need for Dental Treatment and Preventive Services. Ann Epidemiol 2009. [DOI: 10.1016/j.annepidem.2009.07.063] [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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Andersen R, Bozzette S, Shapiro M, St Clair P, Morton S, Crystal S, Goldman D, Wenger N, Gifford A, Leibowitz A, Asch S, Berry S, Nakazono T, Heslin K, Cunningham W. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study. Health Serv Res 2000; 35:389-416. [PMID: 10857469 PMCID: PMC1089126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To employ the behavioral model of health services use in examining the extent to which predisposing, enabling, and need factors explain the treatment of the HIV-positive population in the United States with highly active antiretroviral therapy (HAART). DATA SOURCE A national probability sample of 2,776 adults under treatment for human immunodeficiency virus (HIV) infection. STUDY DESIGN The article uses data from the baseline and six-month follow-up surveys. The key independent variables describe vulnerable population groups including women, drug users, ethnic minorities, and the less educated. The dependent variable is whether or not a respondent received HAART by December 1996. DATA COLLECTION All interviews were conducted using computer-assisted personal interview instruments designed for this study. Ninety-two percent of the baseline interviews were conducted in person and the remainder over the telephone. PRINCIPAL FINDINGS A multistage logit regression shows that the predisposing factors that have previously described vulnerable groups in the general population with limited access to medical care also define HIV-positive groups who are less likely to gain early access to HAART including women, injection drug users, African Americans, and the least educated (odds ratios, controlling for need, ranged from 0.35 to 0.59). CONCLUSIONS Those HIV-positive persons with the greatest need (defined by a low CD4 count) are most likely to have early access to HAART, which suggests equitable access. However, some predisposing and enabling variables continue to be important as well, suggesting inequitable access, especially for African Americans and lower-income groups. Policymakers and clinicians need to be sensitized to the continued problems of African Americans and other vulnerable populations in gaining access to such potentially beneficial therapies. Higher income, anonymous test sites, and same-day appointments are important enabling resources.
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Affiliation(s)
- R Andersen
- Department of Health Services, University of California at Los Angeles 90095-1772, USA
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22
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Heslin K, Bramwell L. The supportive role of the staff nurse in the hospital palliative care situation. J Palliat Care 1989; 5:20-6. [PMID: 2477518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The supportive comforting role of the nurse is complex. Comprehensive supportive role behaviours need to be described for nurses in the hospital setting in order to identify actual role competencies, enhance the definition of professional practice, and evaluate clinical competence. As a first step in definition of this supportive role, an exploratory study was conducted with five registered nurses on a four bed palliative primary nursing unit in a hospital setting. Their supportive role behaviours were elicited in order to answer the following research question: What supportive nursing interventions are identified and described by staff nurses to promote physical, psychological, and spiritual comfort for palliative care patients? A model of supportive nursing care in the palliative care setting was generated from study findings and presented for testing through further research.
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Heslin K. Nursing unit changes from team to total patient care. Dimens Health Serv 1987; 64:27-9. [PMID: 3609521] [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: 01/06/2023]
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