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Cohen MA, Tavares J. Are Wealthy Older Adults who use Medicaid Opportunistically Accessing the Program? J Aging Soc Policy 2024; 36:347-363. [PMID: 36165772 DOI: 10.1080/08959420.2022.2127597] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/12/2022] [Indexed: 10/14/2022]
Abstract
Medicaid is the largest payer of long-term services and supports (LTSS) and millions of older Americans rely on this means-tested program, especially during late life. There has been longstanding concern that wealthy older adults may be accessing the program by opportunistically divesting assets in order to qualify for coverage rather than by having high medical or LTSS expenses on which they spend down their resources to eligibility levels. Few current studies analyze this question longitudinally. Thus, questions remain about whether states need to tighten asset eligibility rules to prevent opportunistic asset divestiture. This analysis explores robust longitudinal data to determine the extent to which older, wealthier Americans accessing Medicaid do so by engaging in opportunistic asset transfer. Our findings demonstrate that this may occur among a relatively small proportion of wealthy people, and that tightening Medicaid eligibility criteria would likely have only a very modest impact on program expenditures.
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Affiliation(s)
- Marc A Cohen
- Professor, Gerontology Department, University of Massachusetts Boston, Co-Director, LeadingAge LTSS Center @umass Boston and Research Director, Center for Consumer Engagement in Health Innovation, Community Catalyst, Boston, MA, USA
| | - Jane Tavares
- Research fellow, LeadingAge LTSS Center @umass Boston, and Associate Lecturer, Gerontology Department, University of Massachusetts Boston, Boston, MA, USA
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Cohen MA, Tavares J. How Medicaid Financial Eligibility Rules Exclude Financially and Medically Vulnerable Older Adults. J Aging Soc Policy 2024; 36:364-379. [PMID: 36992556 DOI: 10.1080/08959420.2023.2195784] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/09/2022] [Indexed: 03/31/2023]
Abstract
Millions of older Americans rely on Medicaid because it is the largest payer of long-term services and supports. To qualify for the program, low-income individuals age 65 and over must meet income standards based on the dated Federal Poverty Level as well as asset tests that are often viewed as quite stringent. There has long been concern that current eligibility standards exclude many adults with significant health and financial vulnerabilities. We use updated household socio-demographic and financial information to simulate the impacts of five alternative financial eligibility standards on the number and profile of older adults that would gain Medicaid coverage. The study clearly demonstrates that a large number of financially- and health-vulnerable older adults are excluded from the Medicaid program under current policy. The study highlights the implications for policymakers of updating Medicaid financial eligibility standards to assure that Medicaid benefits are targeted to vulnerable older adults who need them.
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Affiliation(s)
- Marc A Cohen
- Gerontology Institute, UMass Boston, Co-Director, LeadingAge LTSS Center @UMass Boston and Research Director, The Center for Community Engagement in Health Innovation, Community Catalyst, Boston, MA, USA
| | - Jane Tavares
- Research Fellow, LeadingAge LTSS Center @UMass Boston, Boston, MA, USA
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Smythe T, Kuper H. The association between disability and all-cause mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e756-e770. [PMID: 38614629 DOI: 10.1016/s2214-109x(24)00042-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND There are 1·3 billion people with disabilities globally. On average, they have poorer health than their non-disabled peers, but the extent of increased risk of premature mortality is unknown. We aimed to systematically review the association between disability and mortality in low-income and middle-income countries (LMICs). METHODS We searched MEDLINE, Global Health, PsycINFO, and EMBASE from Jan 1, 1990 to Nov 14, 2022. Longitudinal epidemiological studies in any language with a comparator group that measured the association between disability and all-cause mortality in people of any age were eligible for inclusion. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. We used a random-effects meta-analysis to calculate the pooled hazard ratio (HR) for all-cause mortality by disability status. We then conducted meta-analyses separately for different impairment and age groups. FINDINGS We identified 6146 unique articles, of which 70 studies (81 cohorts) were included in the systematic review, from 22 countries. There was variability in the methods used to assess and report disability and mortality. The meta-analysis included 54 studies, representing 62 cohorts (comprising 270 571 people with disabilities). Pooled HRs for all-cause mortality were 2·02 (95% CI 1·77-2·30) for people with disabilities versus those without disabilities, with high heterogeneity between studies (τ2=0·23, I2=98%). This association varied by impairment type: from 1·36 (1·17-1·57) for visual impairment to 3·95 (1·60-9·74) for multiple impairments. The association was highest for children younger than 18 years (4·46, [3·01-6·59]) and lower in people aged 15-49 years (2·45 [1·21-4·97]) and people older than 60 years (1·97 [1·65-2·36]). INTERPRETATION People with disabilities had a two-fold higher mortality rate than people without disabilities in LMICs. Interventions are needed to improve the health of people with disabilities and reduce their higher mortality rate. FUNDING UK National Institute for Health and Care Research; and UK Foreign, Commonwealth and Development Office.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Lee TH, Streed CG. Gender Eligibility Descriptions for Clinical Trials. JAMA 2024; 331:1415-1416. [PMID: 38526485 DOI: 10.1001/jama.2024.0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Tzu-Hao Lee
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Carl G Streed
- GenderCare Center, Boston Medical Center, Boston, Massachusetts
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Mohan S, Tse T. Gender Eligibility Descriptions for Clinical Trials-Reply. JAMA 2024; 331:1416-1417. [PMID: 38526481 DOI: 10.1001/jama.2024.0692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Swapna Mohan
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Tony Tse
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
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Idnay B, Liu J, Fang Y, Hernandez A, Kaw S, Etwaru A, Juarez Padilla J, Ramírez SO, Marder K, Weng C, Schnall R. Sociotechnical feasibility of natural language processing-driven tools in clinical trial eligibility prescreening for Alzheimer's disease and related dementias. J Am Med Inform Assoc 2024; 31:1062-1073. [PMID: 38447587 PMCID: PMC11031244 DOI: 10.1093/jamia/ocae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) affect over 55 million globally. Current clinical trials suffer from low recruitment rates, a challenge potentially addressable via natural language processing (NLP) technologies for researchers to effectively identify eligible clinical trial participants. OBJECTIVE This study investigates the sociotechnical feasibility of NLP-driven tools for ADRD research prescreening and analyzes the tools' cognitive complexity's effect on usability to identify cognitive support strategies. METHODS A randomized experiment was conducted with 60 clinical research staff using three prescreening tools (Criteria2Query, Informatics for Integrating Biology and the Bedside [i2b2], and Leaf). Cognitive task analysis was employed to analyze the usability of each tool using the Health Information Technology Usability Evaluation Scale. Data analysis involved calculating descriptive statistics, interrater agreement via intraclass correlation coefficient, cognitive complexity, and Generalized Estimating Equations models. RESULTS Leaf scored highest for usability followed by Criteria2Query and i2b2. Cognitive complexity was found to be affected by age, computer literacy, and number of criteria, but was not significantly associated with usability. DISCUSSION Adopting NLP for ADRD prescreening demands careful task delegation, comprehensive training, precise translation of eligibility criteria, and increased research accessibility. The study highlights the relevance of these factors in enhancing NLP-driven tools' usability and efficacy in clinical research prescreening. CONCLUSION User-modifiable NLP-driven prescreening tools were favorably received, with system type, evaluation sequence, and user's computer literacy influencing usability more than cognitive complexity. The study emphasizes NLP's potential in improving recruitment for clinical trials, endorsing a mixed-methods approach for future system evaluation and enhancements.
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Affiliation(s)
- Betina Idnay
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Jianfang Liu
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Yilu Fang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Alex Hernandez
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Shivani Kaw
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Alicia Etwaru
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Janeth Juarez Padilla
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Sergio Ozoria Ramírez
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- New York University Steinhardt School of Culture, Education, and Human Development, New York, NY 10003, United States
| | - Karen Marder
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- Mailman School of Public Health, Columbia University, New York, NY 10032, United States
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Power-deFur LA. Special Education Assessment: Practices That Support Eligibility and Intervention. Lang Speech Hear Serv Sch 2024; 55:336-348. [PMID: 38113137 DOI: 10.1044/2023_lshss-23-00077] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
PURPOSE Federal special education requirements specify that information districts must gather and review during the process of finding a student eligible for special education and developing a student's Individualized Education Program (IEP). The purpose of this tutorial is to describe the federal requirements related to evaluation and assessment and to apply best practices in assessment to those expectations, thereby enhancing teams' ability to identify students' strengths and needs, determine eligibility for services, and create high-quality IEPs. METHOD This tutorial includes a detailed review of the Individuals with Disabilities Education Act (IDEA) statute and regulations and the U.S. Department of Education guidance related to evaluation, assessment, and IEP development. The tutorial also reflects on an analysis of existing data regarding the identification of students with speech-language impairment in one state and a narrative review of the current literature related to assessment and its role in intervention planning. RESULTS The results indicate that the IDEA requires rigorous evaluation and assessment practices to determine eligibility (evaluation) and identify students' unique strengths and needs for intervention (assessment). By adhering to these requirements and employing evidence-based assessment practices, speech-language pathologists (SLPs) can be assured that they are gathering accurate and useful information. This information is fundamental to developing an IEP that will support students' acquisition of the knowledge and skills needed to progress in the general curriculum. CONCLUSIONS This tutorial reviews federal requirements related to assessment and links these with best practices in assessment, to facilitate compliance with federal evaluation requirements and IEP development in a manner that meets the needs of all students. SLPs can rely on the IDEA for guidance in completing their special education evaluations and assessments, using this as a framework for employing evidence-based assessment practices.
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Abstract
PURPOSE This review of federal statutes, regulations, administrative directions, and case law related to special education, disabilities, and school nutrition is designed to provide speech-language pathologists (SLPs) with information essential for determining eligibility children with pediatric feeding disorder (PFD). Despite the absence of mention of dysphagia or PFD in federal statutes and regulations, special education, disability, and school food service requirements provide direction for serving children with health care needs, which include children with dysphagia. The federal requirements, court cases, and policy interpretations are detailed to provide guidance to SLPs and their school teams when working with children with PFDs. METHOD Federal statutes and regulations, administrative directions, and case law were reviewed. This review details the application of federal statutes and regulations for children with PFDs. Furthermore, administrative direction and case law identify the importance of attending to the safety of children with dysphagia. RESULTS As a result of this review, sections of the various federal statutes and regulations that support provision of services to children with PFD are identified. In addition, information from case law and administrative reviews further highlights the importance of attending to the rights and needs of children with PFD. CONCLUSIONS The rights of all children with disabilities are established through statutes, regulations, and case law, and children with PFDs benefit from these rights. These requirements can guide SLPs in working with school teams, so that children with dysphagia can be found eligible for and receive school-based services for dysphagia.
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Woods AD, Ireland MC, Murphy KA, Lancaster HS. Go Beyond Compliance: Use Individualized Education Programs to Answer Strategic Questions and Improve Programs. Lang Speech Hear Serv Sch 2024; 55:249-258. [PMID: 37956879 DOI: 10.1044/2023_lshss-23-00084] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
PURPOSE The most significant document to ensure effective and compliant design, implementation, monitoring, and enforcement of a program of special education services in the United States is the Individualized Education Program (IEP). Although IEPs have been used to document procedural compliance with the Individuals with Disabilities Education Act (IDEA) for individual students, IEPs also provide extensive data that can and should be used by a variety of stakeholders including speech-language pathologists (SLPs), school administrators, and state education agencies to design targeted professional development and collectively improve programs, processes, and outcomes in special education. METHOD We summarize existing literature on the use of IEP data and describe opportunities to use IEP data to analyze individual student service patterns and SLP practice patterns. Aggregated IEP data also provide a robust view of district-wide and state trends in eligibility rates and least restrictive environment settings. Information on current and potential IEP data uses, reflection questions for substantive compliance, and lessons learned from a large-scale analysis of IEP data are provided. These lessons include potential software adjustments to enhance usability as a data source for substantive compliance; program improvement; and monitoring individual, school-wide, and district-wide outcomes. CONCLUSIONS IEP data are a rich data source of information that may be used to (a) identify trends; (b) assist schools, districts, and states with ensuring substantive compliance with IDEA; (c) examine service equity and efficacy; (d) identify professional development needs; and (e) identify promising practices and provide opportunities to use real-time data to improve models and address public policy.
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Affiliation(s)
- Adrienne D Woods
- Center for Learning and Development, Education, SRI International, Arlington, VA
| | - Marie C Ireland
- School of Arts and Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Kimberly A Murphy
- School of Communication Sciences and Disorders, Old Dominion University, Norfolk, VA
| | - Hope Sparks Lancaster
- Center for Childhood Deafness, Language, and Learning, Boys Town National Research Hospital, NE
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Fernandez J, Albaugh J, Markley L, Indurlal P, Wilfong L. HSR24-136: The Impact of Prescription Drug Plan (Part D) Enrollment for Medicare Beneficiaries on Eligibility for Episodic Value-Based Care Model Participation and Total Cost of Care (TCOC) at a Community Oncology Network. J Natl Compr Canc Netw 2024; 22:HSR24-136. [PMID: 38579765 DOI: 10.6004/jnccn.2023.7284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
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Gaw CE, Metzger KB, Pfeiffer MR, Yerys BE, Boyd RC, Corwin DJ, Curry AE. Driver's Licensure and Driving Outcomes Among Youths With Mood Disorders. JAMA Netw Open 2024; 7:e245543. [PMID: 38587843 PMCID: PMC11002704 DOI: 10.1001/jamanetworkopen.2024.5543] [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: 11/06/2023] [Accepted: 02/09/2024] [Indexed: 04/09/2024] Open
Abstract
Importance Mood disorders are prevalent among adolescents and young adults, and their onset often coincides with driving eligibility. The understanding of how mood disorders are associated with youth driving outcomes is limited. Objective To examine the association between the presence of a mood disorder and rates of licensing, crashes, violations, and suspensions among adolescents and young adults. Design, Setting, and Participants This cohort study was conducted among New Jersey residents who were born 1987 to 2000, age eligible to acquire a driver's license from 2004 to 2017, and patients of the Children's Hospital of Philadelphia network within 2 years of licensure eligibility at age 17 years. The presence of a current (ie, ≤2 years of driving eligibility) mood disorder was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Rates of licensure and driving outcomes among youths who were licensed were compared among 1879 youths with and 84 294 youths without a current mood disorder from 2004 to 2017. Data were analyzed from June 2022 to July 2023. Main Outcomes and Measures Acquisition of a driver's license and first involvement as a driver in a police-reported crash and rates of other adverse driving outcomes were assessed. Survival analysis was used to estimate adjusted hazard ratios (aHRs) for licensing and driving outcomes. Adjusted rate ratios (aRRs) were estimated for driving outcomes 12 and 48 months after licensure. Results Among 86 173 youths (median [IQR] age at the end of the study, 22.8 [19.7-26.5] years; 42 894 female [49.8%]), there were 1879 youths with and 84 294 youths without a mood disorder. A greater proportion of youths with mood disorders were female (1226 female [65.2%]) compared with those without mood disorders (41 668 female [49.4%]). At 48 months after licensure eligibility, 75.5% (95% CI, 73.3%-77.7%) and 83.8% (95% CI, 83.5%-84.1%) of youths with and without mood disorders, respectively, had acquired a license. Youths with mood disorders were 30% less likely to acquire a license than those without a mood disorder (aHR, 0.70 [95% CI, 0.66-0.74]). Licensed youths with mood disorders had higher overall crash rates than those without mood disorders over the first 48 months of driving (137.8 vs 104.8 crashes per 10 000 driver-months; aRR, 1.19 [95% CI, 1.08-1.31]); licensed youths with mood disorders also had higher rates of moving violations (aRR, 1.25 [95% CI, 1.13-1.38]) and license suspensions (aRR, 1.95 [95% CI, 1.53-2.49]). Conclusions and Relevance This study found that youths with mood disorders were less likely to be licensed and had higher rates of adverse driving outcomes than youths without mood disorders. These findings suggest that opportunities may exist to enhance driving mobility in this population and elucidate the mechanisms by which mood disorders are associated with crash risk.
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Affiliation(s)
- Christopher E. Gaw
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Kristina B. Metzger
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa R. Pfeiffer
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin E. Yerys
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rhonda C. Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel J. Corwin
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison E. Curry
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Singer PM, Skinner D, Wright B. What the Evolution of 1332 Waivers Tells Us about Their Innovative Potential. J Health Polit Policy Law 2024; 49:269-288. [PMID: 37801019 DOI: 10.1215/03616878-10989687] [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] [Indexed: 10/07/2023]
Abstract
Section 1332 of the Affordable Care Act (ACA) provides states unprecedented flexibility to alter federal health policy. The authors analyze state waiver activity from 2019 to 2023, applying a comparative approach to understand waivers proposed by Georgia, Colorado, Washington, Oregon, and Nevada. Much of the waiver activity during this period focused on reinsurance programs. During the Trump administration, the most innovative waiver application was from Georgia, which sought to restructure and decentralize its individual market, moving away from the framework established by the ACA. While the Biden administration suspended Georgia's efforts, Democratic-led states have focused implementing waiver programs supporting and expanding on the ACA. This has included adopting public-option insurance plans offered by private insurers and expanding eligibility for qualified health plans for previously ineligible groups. The authors' analysis offers insights into contemporary health politics, policy durability, and the role of the administrative presidency.
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Van Boxtel W, Jerković-Ćosić K, Schoonmade LJ, Chinapaw MJM. Health literacy in the context of child health promotion: a scoping review of conceptualizations and descriptions. BMC Public Health 2024; 24:808. [PMID: 38486202 PMCID: PMC10941366 DOI: 10.1186/s12889-024-17955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Increasing health literacy (HL) in children could be an opportunity for a more health literate future generation. The aim of this scoping review is to provide an overview of how HL is conceptualized and described in the context of health promotion in 9-12-year-old children. METHODS A systematic and comprehensive search for 'health literacy' and 'children' and 'measure' was performed in accordance with PRISMA ScR in PubMed, Embase.com and via Ebsco in CINAHL, APA PsycInfo and ERIC. Two reviewers independently screened titles and abstracts and evaluated full-text publications regarding eligibility. Data was extracted systematically, and the extracted descriptions of HL were analyzed qualitatively using deductive analysis based on previously published HL definitions. RESULTS The search provided 5,401 original titles, of which 26 eligible publications were included. We found a wide variation of descriptions of learning outcomes as well as competencies for HL. Most HL descriptions could be linked to commonly used definitions of HL in the literature, and some combined several HL dimensions. The descriptions varied between HL dimensions and were not always relevant to health promotion. The educational setting plays a prominent role in HL regarding health promotion. CONCLUSION The description of HL is truly diverse and complex encompassing a wide range of topics. We recommend adopting a comprehensive and integrated approach to describe HL dimensions, particularly in the context of health promotion for children. By considering the diverse dimensions of HL and its integration within educational programs, children can learn HL skills and competencies from an early age.
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Affiliation(s)
- Wieke Van Boxtel
- Research group Innovation in Preventive Healthcare, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, The Netherlands.
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands.
- Health Behaviour and Chronic Diseases, Methodology, Amsterdam Public Health, Amsterdam, The Netherlands.
| | - Katarina Jerković-Ćosić
- Research group Innovation in Preventive Healthcare, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1007 MB, The Netherlands
| | - Mai J M Chinapaw
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviour and Chronic Diseases, Methodology, Amsterdam Public Health, Amsterdam, The Netherlands
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Kavanagh NM, Campbell AL, McIntyre A. Medicare Eligibility and Reported Support for Proposals to Expand Medicare. JAMA 2024; 331:882-884. [PMID: 38345789 PMCID: PMC10862260 DOI: 10.1001/jama.2024.0379] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
This study estimates the association between Medicare eligibility and support for recent proposals to expand program participation and benefits.
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Affiliation(s)
- Nolan M. Kavanagh
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts
| | - Andrea L. Campbell
- Department of Political Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Bertochi GFA, Tasinafo Júnior MF, Santos IA, Sasaki JE, Mota GR, Jordão GG, Puggina EF. The use of wearable resistance and weighted vest for sprint performance and kinematics: a systematic review and meta-analysis. Sci Rep 2024; 14:5453. [PMID: 38443408 PMCID: PMC10915135 DOI: 10.1038/s41598-024-54282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/10/2024] [Indexed: 03/07/2024] Open
Abstract
Wearable resistance (WR) and weighted vests (WV) can be used in almost all training conditions to enhance sprint performance; however, positioning and additional mass are different in WV and WR strategies, affecting performance and kinematics differently. We aimed to systematically review the literature, searching for intervention studies that reported the acute or chronic kinematic and performance impact of WV and WR and comparing them. We analyzed Pubmed, Embase, Scopus, and SPORTDiscuss databases for longitudinal and cross-over studies investigating sprint performance or kinematics using an inverse-variance with a random-effect method for meta-analysis. After the eligibility assessment, 25 studies were included in the meta-analysis. Cross-over WR and WV studies found significantly higher sprint times and higher ground contact times (CT) compared to unloaded (UL) conditions. However, WR presented a lower step frequency (SF) compared to UL, whereas WV presented a lower step length (SL). Only one study investigated the chronic adaptations for WR, indicating a superiority of the WR group on sprint time compared to the control group. However, no difference was found chronically for WV regarding sprint time, CT, and flight time (FT). Our findings suggest that using WV and WR in field sports demonstrates overload sprint gesture through kinematic changes, however, WR can be more suitable for SF-reliant athletes and WV for SL-reliant athletes. Although promising for chronic performance improvement, coaches and athletes should carefully consider WV and WR use since there is no supporting evidence that WV or WR will impact sprint performance, CT, and FT.
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Affiliation(s)
- Gabriel Felipe Arantes Bertochi
- Graduate Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil.
| | | | - Izabela A Santos
- Graduate Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Jeffer Eidi Sasaki
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Gustavo R Mota
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Gabriela Gregorutti Jordão
- Institute of Health Sciences, Department of Nutrition, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Enrico Fuini Puggina
- Graduate Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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16
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Reis LADOD, Miranda SS, Fonseca BRD, Pereira M, Natividade MDS, Aragão E, Lara TP, Nery JS. Association between racial iniquities and oral health status: a systematic review. Cien Saude Colet 2024; 29:e04882023. [PMID: 38451644 DOI: 10.1590/1413-81232024293.04882023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/28/2023] [Indexed: 03/08/2024] Open
Abstract
The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.
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Affiliation(s)
- Laila Araújo de Oliveira Dos Reis
- Faculdade de Odontologia, Universidade Federal da Bahia (UFBA). R. Augusto Viana s/n, Palácio da Reitoria, Canela. 40110-909 Salvador BA Brasil.
| | | | - Bruna Rebouças da Fonseca
- Faculdade de Odontologia, Universidade Federal da Bahia (UFBA). R. Augusto Viana s/n, Palácio da Reitoria, Canela. 40110-909 Salvador BA Brasil.
| | | | | | - Erika Aragão
- Instituto de Saúde Coletiva, UFBA. Salvador BA Brasil
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17
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Wilson ML, Godfrey EM, Glass S, Zhang Y. Reproductive Planning: Short-Acting Reversible Contraceptives. FP Essent 2024; 538:13-24. [PMID: 38498325] [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: 03/20/2024]
Abstract
Short-acting reversible contraceptives (SARCs) are prescribed routinely by primary care clinicians. SARCs are among the most commonly prescribed contraceptive methods and include combined hormonal oral contraceptive pills, the combined hormonal transdermal patch, the combined hormonal vaginal ring, progestin-only pills, and the 3-month depot medroxyprogesterone acetate injection. To ensure safe prescribing and reduce barriers to receiving SARC methods, family physicians should be familiar with two evidence-based national contraceptive guidelines, the U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) and the U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR). SARCs have benefits in addition to pregnancy prevention; as such, these methods may be chosen for reasons other than contraception.
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Affiliation(s)
- Megan L Wilson
- Department of Family Medicine - University of Washington, Seattle
| | - Emily M Godfrey
- Departments of Family Medicine and Obstetrics and Gynecology - University of Washington, Seattle
| | - Samantha Glass
- Department of Family Medicine and Community Health - Institute for Family Health-Harlem Family Medicine Residency, New York
| | - Ying Zhang
- Reproductive Health and Advocacy Fellowship - Department of Family Medicine - University of Washington, Seattle
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18
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Loh FE, Stuart BC, Hunt RJ, Negari M. Medicare Part D low-income subsidies expanded in January 2024, but more needs to be done to ensure that eligible beneficiaries enroll. J Manag Care Spec Pharm 2024; 30:279-289. [PMID: 38324387 DOI: 10.18553/jmcp.2024.23174] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND The Inflation Reduction Act of 2022 extended full low-income subsidies (LIS) to a small group of Medicare Part D recipients with limited assets and incomes between 135% and 150% of the Federal Poverty Level beginning in January 2024. This policy may result in small enrollment gains among beneficiaries eligible for the new benefits, but the biggest problem with the current LIS program is underenrollment across all eligibility groups. Prior research has shown that underenrollment has been a persistent problem since the LIS program began in 2006, yet little has been done to correct the situation. OBJECTIVE To identify individual-level factors associated with failure to enroll among low-income beneficiaries eligible for both full subsidies and partial subsidies under the LIS program. METHODS We used 2019 Medicare Current Beneficiary Survey data for the study. The Medicare Current Beneficiary Survey is uniquely suited for this work because it contains administrative data on LIS enrollment plus extensive survey information on financial resources necessary to establish program eligibility. We conducted descriptive and multivariate analyses to identify factors associated with failure to enroll when eligible for either full or partial subsidies. Explanatory variables included sociodemographic characteristics, economic resources, work status, health variables, and source of prescription coverage (for nonsubsidized beneficiaries). RESULTS In 2019, 73% of beneficiaries eligible for full subsidies under pre-Inflation Reduction Act LIS provisions were enrolled, compared with only 25% eligible for partial subsidies. The number of those estimated to be eligible for full subsidies but not enrolled (N = 3.9 million) was more than double that of those eligible but not enrolled for partial subsidies (N = 1.5 million). Factors associated with failure to enroll (older age, male sex, White race, married, higher education, higher income and assets, and excellent/very good health status) were similar for both groups. In multivariate analyses, the single strongest predictor of failure to enroll was receipt of income from work (odds ratio = 5.50; P < 0.001). Among the nonenrolled, 64% eligible for full subsidies and 75% eligible for partial subsidies maintained unsubsidized Part D coverage. CONCLUSIONS Significant numbers of low-income Medicare beneficiaries are eligible for Part D subsidies but fail to enroll. Common characteristics distinguishing nonenrollees from enrollees include older age with higher proportions of White individuals, married individuals, higher income and assets, and better overall health. Two promising targets for increasing LIS enrollment are evidence of work income and unsubsidized Part D coverage.
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Affiliation(s)
- F Ellen Loh
- Department of Social, Behavioral and Administrative Sciences, Touro College of Pharmacy, New York, NY
| | - Bruce C Stuart
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore
| | - Rebecca J Hunt
- Department of Policy and Research, Pharmaceutical Research and Manufacturers of America, Washington DC
| | - Meiti Negari
- Department of Policy and Research, Pharmaceutical Research and Manufacturers of America, Washington DC
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19
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Zhang X, Wang J. The effects of medication therapy management on medication utilization among Medicare beneficiaries with HIV/AIDS. J Am Pharm Assoc (2003) 2024; 64:463-470.e2. [PMID: 38182001 PMCID: PMC10942721 DOI: 10.1016/j.japh.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/27/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Medicare Part D plans are required to provide medication therapy management (MTM) programs to eligible beneficiaries to optimize medication utilization. MTM programs' effects on medication utilization among older persons living with HIV/AIDS (PLWHs) remain unclear. OBJECTIVE This study examined the effects of the Medicare MTM programs on medication utilization among PLWHs. METHODS This study analyzed 2017 Medicare databases linked to the Area Health Resources Files. Recipients and nonrecipients of the MTM services were compared on their medication utilization: adherence to antiretroviral medications, drug-drug interactions (DDI), and concurrent use of opioids and benzodiazepines. The intervention group comprised recipients of the MTM services, and the control group was nonrecipients meeting the eligibility criteria. A propensity score with a ratio of 1:2 between the intervention and control groups was used to identify study groups with balanced characteristics. A logistic regression was used to control for patient/community characteristics. RESULTS After matching, the intervention and comparison groups comprised 3298 and 6596 beneficiaries for the antiretroviral adherence measure, 809 and 1618 for the DDI measure, and 691 and 1382 for the concurrent use of opioids and benzodiazepines measure. The intervention was associated with higher odds of adherence to antiretroviral medications (adjusted odds ratio = 1.15, 95% CI = 1.04-1.26), and no concurrent use of opioids and benzodiazepines (adjusted odds ratio = 1.255, 95% CI = 1.005-1.568). The study groups did not differ on no DDI (adjusted odds ratio = 0.95, 95% CI = 0.74-1.20). CONCLUSIONS Medicare MTM programs effectively improved medication utilization among PLWHs. Future studies should explore the long-term effects of the program.
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Gordon SH, Chen L, DeLew N, Sommers BD. COVID-19 Medicaid Continuous Enrollment Provision Yielded Gains In Postpartum Continuity Of Coverage. Health Aff (Millwood) 2024; 43:336-343. [PMID: 38437599 DOI: 10.1377/hlthaff.2023.00580] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
The Medicaid continuous enrollment provision mandated by the Families First Coronavirus Response Act of 2020 effectively prohibited the termination of enrollees from Medicaid during the COVID-19 public health emergency, including people enrolled in Medicaid during pregnancy. Using data from the Transformed Medicaid Statistical Information System, we found that the rate of continuous Medicaid enrollment during the twelve months postpartum increased from 59.3 percent for births during March-December 2018 to 90.7 percent for births during March-December 2020, when the public health emergency was in effect. This corresponds to approximately 430,000 fewer people losing Medicaid coverage after pregnancy and an average of more than 2.5 months of additional postpartum enrollment. These findings indicate that states that have extended or that plan to extend pregnancy-related Medicaid eligibility in the postpartum year are likely to experience significant gains in continuity of coverage.
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Affiliation(s)
- Sarah H Gordon
- Sarah H. Gordon , Department of Health and Human Services, Washington, D.C.; and Boston University, Boston, Massachusetts
| | - Lucy Chen
- Lucy Chen, Harvard University, Boston, Massachusetts
| | - Nancy DeLew
- Nancy DeLew, Department of Health and Human Services
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21
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Stolz L, Doldi PM, Kresoja KP, Bombace S, Koell B, Kassar M, Kirchner J, Weckbach LT, Ludwig S, Stocker TJ, Glaser H, Schöber AR, Massberg S, Näbauer M, Rudolph V, Kalbacher D, Praz F, Lurz P, Hausleiter J. Applying the TRILUMINATE Eligibility Criteria to Real-World Patients Receiving Tricuspid Valve Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2024; 17:535-548. [PMID: 37987997 DOI: 10.1016/j.jcin.2023.11.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND According to the TRILUMINATE (Clinical Trial to Evaluate Cardiovascular Outcomes in Patients Treated With the Tricuspid Valve Repair System) trial, transcatheter tricuspid edge-to-edge repair (T-TEER) improves quality of life beyond medical treatment, while no effects on heart failure hospitalization (HFH) and survival were observed at 1 year. However, the generalizability of the TRILUMINATE trial to real-world conditions remains a subject of discussion. OBJECTIVES The aim of this study was to apply the clinical TRILUMINATE inclusion and exclusion criteria to a real-world T-TEER patient group and evaluate symptomatic and survival outcome in TRILUMINATE-eligible and TRILUMINATE-ineligible patients. METHODS Clinical TRILUMINATE inclusion and exclusion criteria were applied to a cohort of patients who underwent T-TEER at 5 European centers from 2016 to 2022. Study patients were compared regarding baseline characteristics, survival, HFH, and symptomatic outcomes as measured by NYHA functional class, a quality-of-life questionnaire and 6-minute walk distance. RESULTS Of 962 patients, 54.8% were classified as TRILUMINATE eligible, presenting with superior left ventricular function and fewer comorbidities compared with the ineligible population. Tricuspid regurgitation reduction, improvement in NYHA functional class, quality of life, and exercise capacity were comparable in both groups. However, the 1-year survival and HFH rates significantly differed (tricuspid regurgitation ≤2+ at discharge, 82% vs 85%; survival, 85% vs 75%; HFH, 14% vs 22% for eligible vs ineligible patients). CONCLUSIONS The observed differences in survival and HFH outcomes suggest a limited generalizability of TRILUMINATE to real-world conditions and indicate the need for additional studies evaluating the outcomes after T-TEER in less selected patient populations.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Sara Bombace
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site/Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Johannes Kirchner
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site/Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Hannah Glaser
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Anne R Schöber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
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22
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Ipsen JA, Sandal LF, Chang NHS, Schiøttz-Christensen B, Søgaard K, Hansen A. Interest in mHealth Among Patients With Low Back Pain: Cross-Sectional Study. JMIR Hum Factors 2024; 11:e48729. [PMID: 38345837 PMCID: PMC10897794 DOI: 10.2196/48729] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/12/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Digitally supported self-management tailored to an individual's need, in addition to usual care, may reduce pain-related disability compared to usual care alone, and patients with low back pain (LBP) using mobile health (mHealth) solutions express positive experiences. Hence, implementing mHealth solutions designed to support self-management is desirable from a clinical and patient perspective. Easily accessible mHealth solutions that can support the self-management of patients with LBP are available, but interest may be subgroup specific. Understanding the characteristics and preferences of patients with LBP labeled as interested may help to reach relevant LBP patient groups and inform the development and implementation of effective interventions with mHealth for patients with LBP. OBJECTIVE This study aims to explore the proportion of patients with LBP labeled as interested in testing an mHealth solution designed to support self-management in addition to usual care and to assess how these patients differ from those who were labeled as not interested. METHODS This exploratory cross-sectional study analyzed demographic and patient-reported outcomes from the SpineData registry, a Danish registry of patients with LBP in an outpatient setting. Between February and December 2019, the SpineData registry was used to assess the preliminary eligibility of patients for a clinical trial (selfBACK). Patients were labeled as interested or uninterested depending on if they responded to an invitation to be tested for eligibility for the trial Outcomes were selected from the International Classification of Functioning core set of LBP using a clinical approach. Associations were assessed in a backward selection process, and the proportion of variance explained was assessed with pseudo-R2 statistic. RESULTS This study included 843 patients, with 181 (21%) individuals labeled as interested in participating in the selfBACK trial. Notably, the cohort labeled as interested differed from their uninterested counterparts in two key aspects: age (36-65 years: 116/181, 64.1% vs 347/662, 52.4%; P=.003) and smoking status (smokers: 22/181, 12.5% vs 174/662, 26.6%; P<.001). Those aged 36-65 years had higher odds of being labeled as interested compared to individuals aged 18-35 years (odds ratio [OR] 0.43, 95% CI 0.26-0.71) and those 65 years or older (OR 0.77, 95% CI 0.53-1.15). Nevertheless, age accounted for only a modest proportion of variance (R2=0.014). Smokers demonstrated lower odds of being labeled as interested (OR 0.39, 95% CI 0.24-0.64), with smoking status explaining a similarly small proportion of variance (R2=0.019). Collectively, age and smoking status accounted for 3.3% of the variance. CONCLUSIONS Our investigation revealed that 181 (21%) individuals with LBP invited to participate in the mHealth solution trial for self-management expressed interest. Generally, the characteristics of those labeled as interested and uninterested were comparable. Of note, patients aged 36-65 years had a higher frequency of being labeled as interested compared to their younger and older counterparts.
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Affiliation(s)
- Jonas Ammundsen Ipsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Louise Fleng Sandal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Natalie Hong Siu Chang
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Medical Research, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
| | | | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Hansen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Medical Research, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
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23
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Park S, Marcondes FO. The effect of Medicare eligibility on diagnosis of chronic conditions. Am J Manag Care 2024; 30:96-100. [PMID: 38381545 DOI: 10.37765/ajmc.2024.89497] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES The near-universal access to Medicare coverage at age 65 years improves access to care. However, little is known about whether Medicare eligibility promotes the diagnosis of chronic diseases. We examined the effects of Medicare eligibility at age 65 years on the diagnosis of chronic conditions. STUDY DESIGN Using data from the 2007-2019 Medical Expenditure Panel Survey, we employed a regression discontinuity design. METHODS Our sample includes 43,620 individuals aged 59 to 71 years. Our primary outcomes were diagnoses of 19 chronic conditions. Using a regression discontinuity design, we exploited the discontinuity in eligibility for Medicare at age 65 years and compared individuals just before and after age 65 years. RESULTS Medicare eligibility at age 65 years led to significant increases in having any coverage or Medicare coverage: 8.8 percentage points (95% CI, 8.4-9.2) and 78.1 percentage points (95% CI, 74.9-81.4), respectively. However, there were no or small changes in the diagnosis of chronic conditions at age 65 years. Specifically, there were no significant changes in the diagnoses of 17 chronic conditions, and the changes were minor in magnitude. Significant changes were observed only in the diagnosis of stroke and cancer, at -0.6 percentage points (95% CI, -1.0 to -0.2) and -1.7 percentage points (95% CI, -2.8 to -0.6), respectively. CONCLUSIONS Our findings suggest that Medicare coverage did not necessarily lead to increased diagnosis of chronic conditions. Further research is necessary to explore the underlying mechanisms behind this observation.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, and BK21 FOUR R&E Center for Learning Health Systems, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Republic of Korea, 02841.
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24
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Churchill TW, O’Kelly AC, Montembeau SC, Kim JH, Guseh JS, Wasfy MM, Dickert NW, Baggish AL. Risk tolerance and eligibility decision-making strategies among young competitive athletes: novel insights into the emerging practice of shared decision making. Eur J Prev Cardiol 2024; 31:e1-e3. [PMID: 37494730 PMCID: PMC10811746 DOI: 10.1093/eurjpc/zwad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Timothy W. Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey 5B, 55 Fruit St., Boston, MA 02114, USA
| | - Anna C. O’Kelly
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Sarah C. Montembeau
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Jonathan H. Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA 30307, USA
| | - James S. Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey 5B, 55 Fruit St., Boston, MA 02114, USA
| | - Meagan M. Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey 5B, 55 Fruit St., Boston, MA 02114, USA
| | - Neal W. Dickert
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey 5B, 55 Fruit St., Boston, MA 02114, USA
- Department of Cardiology, Lausanne University Hospital and Institute for Sport Science, CH-1015 Lausanne, Switzerland
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25
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Do NV, Elbers DC, Fillmore NR, Ajjarapu S, Bergstrom SJ, Bihn J, Corrigan JK, Dhond R, Dipietro S, Dolgin A, Feldman TC, Goryachev SD, Huhmann LB, La J, Marcantonio PA, McGrath KM, Miller SJ, Nguyen VQ, Schneeloch GR, Sung FC, Swinnerton KN, Tarren AH, Tosi HM, Valley D, Vo AD, Yildirim C, Zheng C, Zwolinski R, Sarosy GA, Loose D, Shannon C, Brophy MT. Matching Patients to Accelerate Clinical Trials (MPACT): Enabling Technology for Oncology Clinical Trial Workflow. Stud Health Technol Inform 2024; 310:1086-1090. [PMID: 38269982 DOI: 10.3233/shti231132] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Clinical trial enrollment is impeded by the significant time burden placed on research coordinators screening eligible patients. With 50,000 new cancer cases every year, the Veterans Health Administration (VHA) has made increased access for Veterans to high-quality clinical trials a priority. To aid in this effort, we worked with research coordinators to build the MPACT (Matching Patients to Accelerate Clinical Trials) platform with a goal of improving efficiency in the screening process. MPACT supports both a trial prescreening workflow and a screening workflow, employing Natural Language Processing and Data Science methods to produce reliable phenotypes of trial eligibility criteria. MPACT also has a functionality to track a patient's eligibility status over time. Qualitative feedback has been promising with users reporting a reduction in time spent on identifying eligible patients.
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Affiliation(s)
- Nhan V Do
- VA Boston Healthcare System, Boston MA, USA
- Boston University School of Medicine, Boston MA, USA
| | - Danne C Elbers
- VA Boston Healthcare System, Boston MA, USA
- Harvard Medical School, Boston MA, USA
| | - Nathanael R Fillmore
- VA Boston Healthcare System, Boston MA, USA
- Harvard Medical School, Boston MA, USA
| | | | | | - John Bihn
- VA Boston Healthcare System, Boston MA, USA
| | | | - Rupali Dhond
- VA Boston Healthcare System, Boston MA, USA
- Boston University School of Medicine, Boston MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mary T Brophy
- VA Boston Healthcare System, Boston MA, USA
- Boston University School of Medicine, Boston MA, USA
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Janssen AB, Kavisha S, Johnson A, Marinic A, Teede H, Shaw T. Implementation of Artificial Intelligence Applications in Australian Healthcare Organisations: Environmental Scan Findings. Stud Health Technol Inform 2024; 310:1136-1140. [PMID: 38269992 DOI: 10.3233/shti231142] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Artificial Intelligence (AI) has great potential to improve healthcare, but implementation into routine practice remains a challenge. This study scoped the extent to which AI and Natural Language Processing (NLP) is being implemented into routine practice in Australian healthcare organisations. An environmental scan of publicly available data was undertaken to identify AI applications. Publicly available data consisted of news posts from Australian public healthcare organisations and conference proceedings from key research organisations. Two researchers reviewed and analysed posts related to AI applications to create a list of potential implementation case studies. The final list of AI applications was reviewed by a governance committee in order to identify any missing applications. One application was identified by the governance committee and subsequently added. The environmental scan identified eighteen AI applications, of which eleven met all eligibility criteria. Only one application included NLP. Twelve applications were included when the application identified by the governance committee was added to the list. Implementation of AI applications is spread across four broad categories of use: 1) Decision Support, 2) Monitoring Treatment Effectiveness, 3) Personalised Care and 4) Risk Prediction.
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Affiliation(s)
- Anna B Janssen
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Shah Kavisha
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
| | - Anna Marinic
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
- Monash Centre for Health Research Implementation, School of Public Health, Monash University, Melbourne, VIC, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Gao G, Martin CL, Vaughan C, Markland A, Kelly U, Pathak N, Wallace J, Burningham Z. End Users' Perceived Engagement with Clinical Dashboards: A Rapid Review. Stud Health Technol Inform 2024; 310:1091-1095. [PMID: 38269983 DOI: 10.3233/shti231133] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Clinical dashboards are an emerging and fast-evolving technology used to support frontline clinicians' practice. Understanding end users' perceived engagement with clinical dashboards is essential to co-design, implementation, and adoption. There is a lack of literature exploring the integration of dashboards into clinical workflow. This rapid review explores clinical end users' perceived engagement with dashboards that support workflow. We conducted a literature search in PubMed and CINAHL. Four articles met our eligibility criteria. Findings reveal variations in taxonomy and measures used to evaluate clinicians' perceived engagement. There are also a variety of reported barriers and facilitators to adoption. Standardized frameworks and vocabulary are needed to facilitate a common understanding of clinical end users' perceived engagement with dashboards.
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Affiliation(s)
- Grace Gao
- VA Quality Scholar Program, Atlanta VA Health Care System, Atlanta, GA, USA
| | | | - Camille Vaughan
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, USA
- Emory University, Atlanta, GA, USA
| | - Alayne Markland
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, USA
- University of Birmingham, Birmingham, AL, USA
| | | | - Neha Pathak
- VA Quality Scholar Program, Atlanta VA Health Care System, Atlanta, GA, USA
| | - Joseph Wallace
- VA Quality Scholar Program, Atlanta VA Health Care System, Atlanta, GA, USA
| | - Zachary Burningham
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
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Cholin LK, Ramos EF, Yahr J, Schold JD, Poggio ED, Delvalle CL, Huml AM. Psychosocial characteristics of potential and actual living kidney donors. BMC Nephrol 2024; 25:31. [PMID: 38267875 PMCID: PMC10807153 DOI: 10.1186/s12882-023-03375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
The psychosocial assessment is an essential component of the living kidney donor (LKD) evaluation. However, it remains uncertain how specific psychosocial factors impact LKD eligibility. We performed a retrospective chart review of LKD candidates who initiated the evaluation process and who had completed a required, in-person licensed social work (LSW) visit. LSW notes were reviewed for frequency of psychosocial factors that may impact the success of LKD candidate approval by the selection committee. 325 LKD candidates were included in the study: 104 not-approved and 221 approved. Not-approved LKD candidates were more likely to receive a negative family reaction to wanting to donate than approved LKD candidates (8.7% vs 1.4%, p < 0.01). On multivariate analysis, Black race, history of psychiatric illness, highest level of education being high school, and high psychosocial risk score assignment were all associated with a lower odds ratio of being approved. The majority of not-approved LKD candidates were disqualified for medical reasons (N = 76, 73.1%). In conclusion, psychosocial factors impact donation even after LKD candidates make it to an in-person evaluation.
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Affiliation(s)
- Liza K Cholin
- Department of Nephrology, The Ohio State University Wexner Medical Center, 300 W 10Th Ave, Columbus, OH, #1150, USA.
| | - Everly F Ramos
- Department of Internal Medicine, Cleveland Clinic, Cleveland, USA
| | - Jordana Yahr
- Department of Internal Medicine, Cleveland Clinic, Cleveland, USA
| | - Jesse D Schold
- Department of Surgery and Transplant, University of CO Anschutz Medical Campus, Aurora, CO,, USA
| | - Emilio D Poggio
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | | | - Anne M Huml
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Transplantation, Cleveland Clinic, Cleveland, OH, USA
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Shahmirzalou P, Rasekhi A, Jafari Khaledi M, Khayamzadeh M. Comparison performance of the Bayesian Approach with the Weibull and Birnbaum-Saunders distributions in imputation of time-to-event censors. PLoS One 2024; 19:e0295977. [PMID: 38252651 PMCID: PMC10802968 DOI: 10.1371/journal.pone.0295977] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/02/2023] [Indexed: 01/24/2024] Open
Abstract
Almost all survival data is censored, and censor imputation is necessary. This study aimed to investigate the performance of the Bayesian Approach (BA) in the imputation of censored records in simulated and Breast Cancer (BC) data. Due to the difference in the distribution of time to event in survival analysis, two well-known the Weibull and Birnbaum-Saunders (BS) distributions have been used to test the performance of the BA. For each of the censored, 10,000 times were simulated using the BA in R and BUGS software, and their median or mean was imputed instead of each censor. The eligibility of both imputation methods was investigated using different curves, different censoring percentages, and sample sizes, as well as the Deviance Information Criteria (DIC), Effective Sample Size, and the Geweke diagnostic in simulated and especially real BC data. The BC data, which contains 220 patients who were identified and followed up between 2015 and 2023, was made accessible on February 1, 2023. The Kaplan-Meier, the BA, and other survival curves were drawn for the observed times. Findings indicated that the performance of the BA under the Weibull and BS distributions in simulated data is similar. The DIC index in the BC data under the BS distribution (1510) is less than the Weibull distribution (1698). Therefore, the BS distribution is preferred over the Weibull for imputation of censoring times in real BC data.
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Affiliation(s)
- Parviz Shahmirzalou
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Aliakbar Rasekhi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Maryam Khayamzadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ireland MC, McLeod SL, Verdon S. Eligibility Determinations for Speech and Language Services in U.S. Public Schools: Experiences and Tensions. Lang Speech Hear Serv Sch 2024; 55:181-198. [PMID: 38101324 DOI: 10.1044/2023_lshss-23-00039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
PURPOSE The purpose of this study was to examine school speech-language pathologists' (SLPs) experiences regarding students' eligibility for services in public schools within the United States. METHOD Fifteen school SLPs participated in online focus groups to examine the complex nature of SLPs' participation within decision-making teams and describe practice experiences in U.S. schools. SLPs worked in one to 10+ schools serving students from pre-K through 12th grade. Data were analyzed using Cultural-Historical Activity Theory (CHAT; Engeström, 2015). RESULTS School SLPs' practice is impacted by rules, community, and division of labor in schools. Participants discussed the following: culture of the work setting, interaction between team members, desire to assist families and children, knowledge of regulations, evaluation practices, and the impact of poverty, and cultural and linguistic differences. Nine major tensions were identified: need for greater SLP empowerment and advocacy, documentation of educational impact, complexities of students learning English as an additional language, concerns about evaluation data for decision making, SLPs' concerns regarding outcomes of eligibility decision making, overuse of speech-language impairment for students who do not qualify, parents' involvement in decision making, disagreement between team members, and administrations' adherence to rules. CONCLUSIONS Within the schools, the CHAT framework was useful to identify tensions and opportunities for change at the individual and institutional levels, impacting team decision making for eligibility, SLPs' provision of services, and student outcomes. Acknowledgment of tensions and opportunities for change regarding students' eligibility for services may guide public policy; preservice training; and individual, local, and national advocacy.
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Affiliation(s)
- Marie C Ireland
- School of Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | | | - Sarah Verdon
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
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Jones S, Brown TJ, Watson P, Homer C, Freeman C, Bakhai C, Ells L. Commercial provider staff experiences of the NHS low calorie diet programme pilot: a qualitative exploration of key barriers and facilitators. BMC Health Serv Res 2024; 24:53. [PMID: 38200539 PMCID: PMC10782528 DOI: 10.1186/s12913-023-10501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The National Health Service Type 2 Diabetes Path to Remission programme in England (known as the NHS Low Calorie Diet programme when piloted) was established to support people living with excess weight and Type 2 Diabetes to lose weight and improve their glycaemic control. A mixed method evaluation was commissioned to provide an enhanced understanding of the long-term cost effectiveness of the pilot programme, its implementation, equity and transferability across broad and diverse populations. This study provided key insights on implementation and equity from the service providers' perspective. METHODS Thirteen focus groups were conducted with commercial providers of the programme, during the initial pilot rollout. Participants were purposively sampled across all provider organisations and staff roles involved in implementing and delivering the programme. Normalisation Process Theory (NPT) was used to design the topic schedule, with the addition of topics on equity and person-centredness. Data were thematically analysed using NPT constructs with additional inductively created codes. Codes were summarised, and analytical themes generated. RESULTS The programme was found to fulfil the requirements for normalisation from the providers' perspective. However, barriers were identified in engaging GP practices and receiving sufficient referrals, as well as supporting service users through challenges to remain compliant. There was variation in communication and training between provider sites. Areas for learning and improvement included adapting systems and processes and closing the gap where needs of service users are not fully met. CONCLUSIONS The evaluation of the pilot programme demonstrated that it was workable when supported by effective primary care engagement, comprehensive training, and effective internal and external communication. However, limitations were identified in relation to programme specifications e.g. eligibility criteria, service specification and local commissioning decisions e.g. pattern of roll out, incentivisation of general practice. A person-centred approach to care is fundamental and should include cultural adaptation(s), and the assessment and signposting to additional support and services where required.
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Affiliation(s)
- Susan Jones
- School of Health & Life Sciences, Teesside University, Centuria Building, Middlesbrough, North Yorkshire, TS1 3BX, UK
| | - Tamara J Brown
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK.
| | - Patricia Watson
- School of Health & Life Sciences, Teesside University, Centuria Building, Middlesbrough, North Yorkshire, TS1 3BX, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Olympic Legacy Park, 2 Old Hall Road, Sheffield, S9 3TU, UK
| | - Charlotte Freeman
- Public Health Team, Calderdale Council, Princess Buildings, Princess Street, Halifax, West Yorkshire, HX1 1TP, UK
| | - Chirag Bakhai
- Larkside Practice, Churchfield Medical Centre, 322 Crawley Green Road, Luton, Bedfordshire, LU2 9SB, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK
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Shriver SP, Arafat W, Potteiger C, Butler DL, Beg MS, Hullings M, Semy S, Lister Z, Khosama L, Armstrong S, Hadley D, Pappa J, Fleury ME. Feasibility of institution-agnostic, EHR-integrated regional clinical trial matching. Cancer 2024; 130:60-67. [PMID: 37851512 DOI: 10.1002/cncr.35022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND A lack of onsite clinical trials is the largest barrier to participation of cancer patients in trials. Development of an automated process for regional trial eligibility screening first requires identification of patient electronic health record data that allows effective trial screening, and evidence that searching for trials regionally has a positive impact compared with site-specific searching. METHODS To assess a screening framework that would support an automated regional search tool, a set of patient clinical variables was analyzed for prescreening clinical trials. The variables were used to assess regional compared with site-specific screening throughout the United States. RESULTS Eight core variables from patient electronic health records were identified that yielded likely matches in a prescreen process. Assessment of the screening framework was performed using these variables to search for trials locally and regionally for an 84-patient cohort. The likelihood that a trial returned in this prescreen was a provisional trial match was 45.7%. Expanding the search radius to 20 miles led to a net 91% increase in matches across cancers within the tested cohort. In a U.S. regional analysis, for sparsely populated areas, searching a 100-mile radius using the prescreening framework was needed, whereas for urban areas a 20-mile radius was sufficient. CONCLUSION A clinical trial screening framework was assessed that uses limited patient data to efficiently and effectively identify prescreen matches for clinical trials. This framework improves trial matching rates when searching regionally compared with locally, although the applicability of this framework may vary geographically depending on oncology practice density. PLAIN LANGUAGE SUMMARY Clinical trials provide cancer patients the opportunity to participate in research and development of new drugs and treatment approaches. It can be difficult to find available clinical trials for which a patient is eligible. This article describes an approach to clinical trial matching using limited patient data to search for trials regionally, beyond just the patient's local care site. Feasibility testing shows that this process can lead to a net 91% increase in the number of potential clinical trial matches available within 20 miles of a patient. Based on these findings, a software tool based on this model is being developed that will automatically send limited, deidentified information from patient medical records to services that can identify possible clinical trials within a given region.
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Affiliation(s)
- Sharon P Shriver
- American Cancer Society Cancer Action Network, Washington, District of Columbia, USA
| | - Waddah Arafat
- University of Texas Southwestern Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | | | - Dorothy L Butler
- American Cancer Society Cancer Action Network, Washington, District of Columbia, USA
| | - Muhammad S Beg
- University of Texas Southwestern Simmons Comprehensive Cancer Center, Dallas, Texas, USA
- Science37, Culver City, California, USA
| | - Melanie Hullings
- University of Texas Southwestern Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Salim Semy
- MITRE Corporation, Bedford, Massachusetts, USA
| | - Zach Lister
- MITRE Corporation, Bedford, Massachusetts, USA
| | - Leticia Khosama
- University of Texas Southwestern Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Susan Armstrong
- University of Texas Southwestern Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | | | | | - Mark E Fleury
- American Cancer Society Cancer Action Network, Washington, District of Columbia, USA
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Tammemägi MC. Time to quit using quit time as a lung cancer screening eligibility criterion. Cancer 2024; 130:182-185. [PMID: 37658650 DOI: 10.1002/cncr.34999] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Multiple lines of reasoning and evidence, including those provided in the study by Meza and colleagues in this issue, have converged to indicate that using the ≤15 quit‐years rule for determining lung cancer screening eligibility should be abandoned.
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Sequist LV, Warner ET, Yang CFJ. Improving Eligibility Criteria for Lung Cancer Screening-Promises, Challenges, and Unmet Needs. JAMA Oncol 2023; 9:1649-1650. [PMID: 37883100 DOI: 10.1001/jamaoncol.2023.4410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Lecia V Sequist
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Erica T Warner
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston
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Chiddarwar V, de Zoete RMJ, Dickson C, Lathlean T. Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis. Br J Sports Med 2023; 57:1498-1508. [PMID: 37451706 DOI: 10.1136/bjsports-2022-106422] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD). DESIGN Systematic review and meta-analysis. DATA SOURCES Systematic literature search (MEDLINE, Web of Science, Scopus, Google Scholar). ELIGIBILITY Studies focused on EBI or EBI as a part of postoperative care for adults with an ASD, written in English, and published after 1990. We excluded diagnostic, assessment-based studies on individuals experiencing recurrent shoulder dislocations, concomitant shoulder injury, animal or cadaveric studies. Primary outcomes were dislocation RTA. Secondary outcomes were self-reported outcome measures, strength and range of motion. Random-effects meta-analysis was used to estimate the effect of EBI (SMD; Hedges' g, RR). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence. RESULTS Sixty studies were included (n=3598); seven were meta-analysed (n=345). The mean age of participants in the included studies was 26.71±9.19 and 56% of those included were male. Of the 60 studies included in the systematic review, 29 were fair quality (48.3%), 15 studies were good quality (25%) and 16 studies were poor quality (26.7%), (k=0.66). Individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability than individuals who underwent EBI in conjunction with surgery (RR 2.03, 95% CI 1.03 to 3.97). Individuals who underwent EBI with surgery appeared 1.81 times more likely to RTA than those who underwent EBI alone, although results were not statistically significant (RR 1.81, 95% CI 0.96 to 3.43). CONCLUSIONS Surgery combined with EBI is more effective in reducing the risk of recurrence and possibly increasing RTA than EBI alone after traumatic ASD.
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Affiliation(s)
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Timothy Lathlean
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
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Fox A, Howell FM, Weber E, Janevic T. Left Behind: Medicaid Immigrant Exclusions and Access to Maternal Health Care Across the Reproductive-Perinatal Continuum. Med Care Res Rev 2023; 80:582-595. [PMID: 37191341 DOI: 10.1177/10775587231170066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 05/17/2023]
Abstract
Noncitizen immigrants are often excluded from accessing critical safety-net programs, such as Medicaid. Access to health care plays a central role in current policy debates on maternal health. Yet, immigrant exclusions are rarely considered in maternal health policy research. Through open-ended interviews with 31 policymakers, researchers, and program administrators, we examined state variations in approaches to providing care for pregnant, post, and intrapartum immigrant women. We found four themes: (a) a patchwork safety-net exists that provides some access to immigrants ineligible for Medicaid; (b) patchwork coverage leads to patchwork care, which can contribute to maternal health inequities; (c) immigrant Medicaid policy is assembled along a hierarchy of deservingness based on documentation status; (d) Trump-era public charge rules and political climate may have a substantial chilling effect on benefit uptake regardless of eligibility. We discuss implications for efforts to expand Medicaid postpartum and address the maternal health crisis.
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Affiliation(s)
- Ashley Fox
- University at Albany-State University of New York, USA
| | | | - Ellerie Weber
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Teresa Janevic
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Burton A, Mohan S, Puplampu-Dove Y, Tse T. Characterizing Gender Eligibility Descriptions for Clinical Trials Registered on ClinicalTrials.gov. JAMA 2023; 330:2019-2021. [PMID: 37948067 PMCID: PMC10638663 DOI: 10.1001/jama.2023.19517] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/11/2023] [Indexed: 11/12/2023]
Abstract
This cross-sectional, exploratory study uses ClinicalTrials.gov data from trials initiated on or after January 18, 2017, to characterize the use of a new free-text “gender eligibility description” data field; reports the frequency of gender identity terms used; and assesses the correct or incorrect use of the field.
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Affiliation(s)
- Amanda Burton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Swapna Mohan
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | | | - Tony Tse
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
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Goodon H, Czyrnyj C, Comaskey B, Gawaziuk J, Logsetty S, Spiwak R. Social determinants of alcohol-related traumatic injury in young adults: a scoping review protocol. BMJ Open 2023; 13:e074653. [PMID: 37989375 PMCID: PMC10668285 DOI: 10.1136/bmjopen-2023-074653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/02/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Limited research examines alcohol-related injury in the context of social determinants of health (SDoH) to guide effective intervention and prevention programmes. SDoH are non-medical factors that impact health such as income, housing and childhood environment. This scoping review aims to explore the role SDoH in childhood have in alcohol-related injury in young adults. METHODS AND ANALYSIS The scoping review process will be guided by the methodology framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews Guidelines (PRISMA-ScR). The PubMed and SCOPUS databases will be systematically searched. Studies of various designs and methodologies (published in English since 1 January 2000) that examine certain SDoH of interest in relation to alcohol-related injury in adults aged 18-25 years old will be considered for inclusion in this review. Two reviewers will screen all articles identified from the databases independently. Titles and abstracts will be reviewed based on the initial search and included if eligibility criteria are met. Duplicate articles will be removed and full texts will be examined to create a final list of included studies. Any disagreements on the inclusion of any articles will be resolved through discussion and consultation with a third reviewer if necessary. ETHICS AND DISSEMINATION As this research does not involve human subjects, ethics approval is not required. The results of this study will be summarised quantitatively through numerical counts and qualitatively through a narrative synthesis. The results from this review will address an important literature gap and inform the development of targeted prevention programmes for alcohol-related injury. REGISTRATION NUMBER This protocol is registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/MYEXA).
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Affiliation(s)
- Hunter Goodon
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cameron Czyrnyj
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brenda Comaskey
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin Gawaziuk
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarvesh Logsetty
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rae Spiwak
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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Malone-Moses M, Zhang M, El-Mufti L, Russo R. Letter to the Editor: Performance of an Integrated Palliative Care Program for Beneficiaries Dually Eligible for Medicare and Medicaid: Member Experience Survey. J Palliat Med 2023; 26:1446-1447. [PMID: 37643303 DOI: 10.1089/jpm.2023.0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
| | - Mary Zhang
- Commonwealth Care Alliance, Boston, Massachusetts, USA
| | | | - Rachel Russo
- Commonwealth Care Alliance, Boston, Massachusetts, USA
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Daw JR, Underhill K, Liu C, Allen HL. The Health And Social Needs Of Medicaid Beneficiaries In The Postpartum Year: Evidence From A Multistate Survey. Health Aff (Millwood) 2023; 42:1575-1585. [PMID: 37931190 DOI: 10.1377/hlthaff.2023.00541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
As of September 2023, thirty-seven states and Washington, D.C., had adopted the option in the American Rescue Plan Act of 2021 to extend pregnancy Medicaid eligibility to one year postpartum. To inform state initiatives to support this newly covered population, we conducted a representative survey of postpartum people in six states and New York City from January 2021 to March 2022. Compared with respondents who had commercial insurance at the time of childbirth, Medicaid respondents were less likely to have a usual source of care and reported less use of primary, specialty, and dental care in the postpartum year. Depression symptoms and social concerns such as food insecurity, intimate partner violence, and financial strain were significantly higher in the Medicaid population. Rates of anxiety symptoms, delaying or not getting needed care, and unsatisfactory child care were similar in both populations. Our findings suggest that postpartum Medicaid extensions should be coupled with state initiatives to address beneficiaries' health and social needs. National investments in data collection on postpartum people will be critical to support evidence-based policy making to improve maternal health and well-being.
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Affiliation(s)
- Jamie R Daw
- Jamie R. Daw , Columbia University, New York, New York
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Sullivan SS, Mann CM, Wittenberg E. Communication Openings: A Novel Approach for Serious Illness Communication in Homecare. J Gerontol Nurs 2023; 49:33-41. [PMID: 37906048 DOI: 10.3928/00989134-20231011-02] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Serious illness communication in homecare about hospice and/or palliative care transitions is lacking due to clinical culture. The purpose of the current study was to understand communication openings using COMFORT™, a palliative care communication model used to train nurses. Qualitative, focus group interviews with 31 homecare nurses were conducted. Data were transcribed verbatim and thematically analyzed using NVivo software, followed by hand-sorting. Four themes for communication openings for initiating discussions about potential hospice and/or palliative care transitions were identified: Organizational Openings (homecare appropriateness, eligibility requirements, and staffing); Patient Openings (patient physical decline, psychosocial changes, safety concerns, and denying/stopping care); Caregiver Openings (caregiver physical changes and patient readiness); and Nurse Openings (need for hospice, checking for prognosis understanding, increasing interprofessional care needs, and providing end-of-life care). This study extends the concept of communication openings in the COMFORT model. Further development of communication openings as part of COMFORT communication is needed in educational and intervention research. [Journal of Gerontological Nursing, 49(11), 33-41.].
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Gibson AB, Hendricks WD, Arnow K, Tran LD, Wagner TH, Knowlton LM. State-Level Variability in Hospital Presumptive Eligibility Programs. JAMA Netw Open 2023; 6:e2345244. [PMID: 38015508 PMCID: PMC10685880 DOI: 10.1001/jamanetworkopen.2023.45244] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
This cross-sectional study examines state-level variability in hospital presumptive eligibility programs to understand discrepancies in access by Medicaid expansion status.
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Affiliation(s)
- Alexander B. Gibson
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford, California
| | - Wesley D. Hendricks
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford, California
| | - Katherine Arnow
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford, California
| | - Linda D. Tran
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford, California
| | - Todd H. Wagner
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford, California
| | - Lisa Marie Knowlton
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford, California
- Section of Trauma, Surgical Critical Care and Acute Care Surgery, Stanford University School of Medicine, Stanford, California
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Cassidy B, Letchuman S. A Prescription for Americans Dually Eligible for Medicare and Medicaid. JAMA 2023; 330:1221-1222. [PMID: 37713190 DOI: 10.1001/jama.2023.16686] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
This Viewpoint discusses the lack of coordination of care that individuals who are eligible for both Medicare and Medicaid services face.
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Affiliation(s)
| | - Sunjay Letchuman
- Office of US Senator Bill Cassidy, Washington, DC
- Icahn School of Medicine at Mount Sinai, New York, New York
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Shafer PR, Katchmar A, Callori S, Alam R, Patel R, Choi S, Auty S. Medicaid policy data for evaluating eligibility and programmatic changes. BMC Res Notes 2023; 16:250. [PMID: 37789360 PMCID: PMC10546693 DOI: 10.1186/s13104-023-06525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance coverage to more than 90 million Americans as of early 2023. There is substantial variation in eligibility criteria, application procedures, premiums, and other programmatic characteristics across states and over time. Analyzing changes in Medicaid policies is important for state and federal agencies and other stakeholders, but such analysis requires data on historical programmatic characteristics that are often not available in a form ready for quantitative analysis. Our objective is to fill this gap by synthesizing existing qualitative policy data to create a new data resource that facilitates Medicaid policy research. DATA DESCRIPTION Our source data were the 50-state surveys of Medicaid and CHIP eligibility, enrollment, and cost-sharing policies, and budgets conducted near annually by KFF since 2000, which we coded through 2020. These reports are a rich source of point-in-time information but not operationalized for quantitative analysis. Through a review of the measures captured in the KFF surveys, we developed five Medicaid policy domains with 122 measures in total, each coded by state-quarter-1) eligibility (28 measures), 2) enrollment and renewal processes (39 measures), 3) premiums (16 measures), 4) cost-sharing (26 measures), and 5) managed care (13 measures).
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Affiliation(s)
- Paul R Shafer
- Department of Health Law, Policy, and Management School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA.
| | - Amanda Katchmar
- Department of Health Law, Policy, and Management School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - Steven Callori
- Alix School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Raisa Alam
- Health Management Associates, 31 Saint James Avenue Suite 920, Boston, MA, 02116, USA
| | - Roshni Patel
- James E. Rogers College of Law, University of Arizona, 1201 East Speedway Boulevard, Tucson, AZ, 85721, USA
| | - Sugy Choi
- Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Avenue, New York, NY, 10016, USA
| | - Samantha Auty
- Department of Health Law, Policy, and Management School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
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Broderick JP, Silva GS, Selim M, Kasner SE, Aziz Y, Sutherland J, Jauch EC, Adeoye OM, Hill MD, Mistry EA, Lyden PD, Mocco J, Smith EM, Hernandez-Jimenez M, Deljkich E, Kamel H. Enhancing Enrollment in Acute Stroke Trials: Current State and Consensus Recommendations. Stroke 2023; 54:2698-2707. [PMID: 37694403 PMCID: PMC10542906 DOI: 10.1161/strokeaha.123.044149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The Stroke Treatment Academic Industry Roundtable (STAIR) convened a session and workshop regarding enrollment in acute stroke trials during the STAIR XII meeting on March 22, 2023. This forum brought together stroke physicians and researchers, members of the National Institute of Neurological Disorders and Stroke, industry representatives, and members of the US Food and Drug Administration to discuss the current status and opportunities for improving enrollment in acute stroke trials. The workshop identified the most relevant issues impacting enrollment in acute stroke trials and addressed potential action items for each. Focus areas included emergency consent in the United States and other countries; careful consideration of eligibility criteria to maximize enrollment and representativeness; investigator, study coordinator, and pharmacist availability outside of business hours; trial enthusiasm/equipoise; site start-up including contractual issues; site champions; incorporation of study procedures into standard workflow as much as possible; centralized enrollment at remote sites by study teams using telemedicine; global trials; and coenrollment in trials when feasible. In conclusion, enrollment of participants is the lifeblood of acute stroke trials and is the rate-limiting step for testing an exciting array of new approaches to improve patient outcomes. In particular, efforts should be undertaken to broaden the medical community's understanding and implementation of emergency consent procedures and to adopt designs and processes that are easily incorporated into standard workflow and that improve trials' efficiencies and execution. Research and actions to improve enrollment in ongoing and future trials will improve stroke outcomes more broadly than any single therapy under consideration.
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Affiliation(s)
- Joseph P. Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
| | - Gisele Sampaio Silva
- Federal University of São Paulo, Clinical Trialist/Neurology ,Albert Einstein Hospital, São Paulo, Brazil
| | - Magdy Selim
- Dept. of Neurology, Division of Stroke & Cerebrovascular Disease. Harvard Medical School / Beth Israel Deaconess Med. Ctr
| | - Scott E. Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Yasmin Aziz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
| | | | - Edward C. Jauch
- Chair, Department of Research and Evaluation Sciences, University of North Carolina at MAHEC
| | - Opeolu M. Adeoye
- Department of Emergency Medicine, Washington University School of Medicine, Emergency Physician-in-Chief, Barnes-Jewish Hospital, St. Louis, MO
| | - Michael D. Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada
| | - Eva A. Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
| | - Patrick D. Lyden
- Professor of Physiology and Neuroscience, Professor of Neurology, Zilkha Neurogenetic Institute, Keck School of Medicine of USC
| | - J Mocco
- Department of Neurological Surgery, Mount Sinai Health System. Mount Sinai Health System. New York, New York, United States
| | | | - Macarena Hernandez-Jimenez
- Scientific Director, aptaTargets S.L., Av. Cardenal Herrera Oria 298, Madrid, Spain. Pharmacology and Toxicology Department, Complutense University, Av. Complutense s/n, Madrid, Spain
| | | | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, NY
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Rosendaal N, Hayes SL, Wang X(J, Teno JM, Thomas KS, Gozalo PL, Belanger E. Likelihood of assisted living residents aging in place as a factor of dual Medicare-Medicaid eligibility at the end of life. J Am Geriatr Soc 2023; 71:3310-3313. [PMID: 37235504 PMCID: PMC10592546 DOI: 10.1111/jgs.18427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Nicole Rosendaal
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Susan L. Hayes
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Xiao (Joyce) Wang
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Joan M. Teno
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kali S. Thomas
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
- U.S. Department of Veterans Affairs Medical Center, Providence RI
| | - Pedro L. Gozalo
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
- U.S. Department of Veterans Affairs Medical Center, Providence RI
| | - Emmanuelle Belanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
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Marks SJ, Davoodi NM, Felton R, Rothberg A, Goldberg EM. The Effect of COVID-19 on Dual-Eligible Beneficiaries: A Scoping Review. J Am Med Dir Assoc 2023; 24:1565-1572. [PMID: 37696498 PMCID: PMC10576100 DOI: 10.1016/j.jamda.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To examine the impact of COVID-19 on clinical health outcomes and health-related social needs among Medicaid-Medicare dual-eligible beneficiaries. DESIGN Scoping review. SETTING AND PARTICIPANTS Dual eligibles during COVID-19. METHODS We performed a comprehensive scoping review including observational studies, clinical trials, and original empirical research studies of PubMed and CINAHL. We generated a list of terms related to programs that both serve dual eligibles and address our desired outcomes. With the assistance of a medical librarian, we identified relevant abstracts published during COVID-19 meeting our inclusion criteria. We performed full-text reviews of relevant abstracts and selected the final studies. We extracted the study population, design, and major findings, then conducted thematic analysis. RESULTS 1100 articles were identified, with 439 deemed relevant. On full text-review, 15 articles met inclusion criteria representing more than 86 million Medicare beneficiaries. No studies were specific only to dual eligibles. Topic areas included in this review include COVID-19 case counts (2 articles), mortality (8 articles), hospitalizations (7 articles), food insecurity (1 article), self-reported mental health (1 article), and social connectedness (2 articles). Dual eligibles had disparate COVID-19-related outcomes from Medicare-only enrollees in 12 of 15 studies. Studies show higher mortality for dual eligibles overall, but this was not true for dual eligibles in nursing homes and assisted living communities. Dual eligibles were more likely to experience food insecurity. More favorably, dual eligibles reported greater social connectedness. CONCLUSIONS AND IMPLICATIONS Dual eligibles had different outcomes from Medicare-only recipients in multiple health outcomes and health-related social needs during COVID-19, but studies are limited, particularly in terms of health-related social needs. Future work focusing on outcomes only among dual-eligible beneficiaries, integrated care programs, and fiscal alignment between Medicare and Medicaid plans may help stakeholders address health needs specific to dual eligibles.
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Affiliation(s)
- Sarah J Marks
- Department of Health Behavior and Policy and MSTP Program, Virginia Commonwealth University, Richmond, VA, USA.
| | - Natalie M Davoodi
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | | | | | - Elizabeth M Goldberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA
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Mao Z, Beuer F, Wu D, Zhu Q, Yassine J, Schwitalla A, Schmidt F. Microleakage along the implant-abutment interface: a systematic review and meta-analysis of in vitro studies. Int J Implant Dent 2023; 9:34. [PMID: 37733145 PMCID: PMC10514016 DOI: 10.1186/s40729-023-00494-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE This systematic review aimed to evaluate the incidence of microleakage events (IME) and to identify the potential factors influencing the sealing ability of the implant-abutment interface (IAI) under in vitro investigation. MATERIAL AND METHODS An electronic search of MEDLINE (PubMed), EMBASE, and Web of Science databases, combined with a manual literature search was conducted up to September 2022. In vitro studies that reported the degree of microleakage at IAI under dynamic loading conditions were included. A meta-analysis was performed to calculate the mean values of the incidence of microleakage events. Subgroup analysis and meta-regression were conducted to further investigate the effect of different variables. RESULTS 675 studies were identified following the search process and 17 in vitro studies were selected according to the eligibility criteria. The weighted mean incidence of microleakage events was 47% (95% confidence interval: [0.33, 0.60]), indicating that contamination was observed in nearly half of the samples. Concerning possible factors that may influence microleakage (e.g., loading condition, assessment method, implant-abutment connection design, types of abutment material, the use of sealing agents), loading condition (p = 0.016) was the only variable that significantly influenced IME in the meta-regression analysis. CONCLUSIONS The results demonstrated that dynamic loading significantly increases the potential of bacterial penetration at the implant-abutment junction. The results should be interpreted carefully due to the data heterogeneity and further well-conducted in vitro studies with homogeneous samples are needed to standardize the methodologies.
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Affiliation(s)
- Zhen Mao
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universitaet zu Berlin, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Florian Beuer
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universitaet zu Berlin, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Daomin Wu
- Department of Oral Implantology, The Affiliated Stomatology Hospital of Kunming Medical University, Block C, No. 1088, Haiyuan Middle Road, High-Tech Zone, Kunming, Yunnan, China
| | - Qiuyan Zhu
- Department of Oral Implantology, The Affiliated Stomatology Hospital of Kunming Medical University, Block C, No. 1088, Haiyuan Middle Road, High-Tech Zone, Kunming, Yunnan, China
| | - Jamila Yassine
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universitaet zu Berlin, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Andreas Schwitalla
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universitaet zu Berlin, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Franziska Schmidt
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universitaet zu Berlin, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
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Matsuda O, Ohara Y. Last-percent improvement in eligibility rates of crop seeds based on quality evaluation using near-infrared imaging spectrometry. PLoS One 2023; 18:e0291105. [PMID: 37729130 PMCID: PMC10511137 DOI: 10.1371/journal.pone.0291105] [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] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
As the world population continues to grow, the need for high-quality crop seeds that promise stable food production is increasing. Conversely, excessive demand for high quality is causing "seed loss and waste" due to slight shortfalls in eligibility rates. In this study, we applied near-infrared imaging spectrometry combined with machine learning techniques to evaluate germinability and paternal haplotype in crop seeds from 6 species and 8 cultivars. Candidate discriminants for quality evaluation were derived by linear sparse modeling using the seed reflectance spectra as explanatory variables. To systematically proceed with model selection, we defined the sorting condition where the recovery rate of seeds matches the initial eligibility rate (iP) as "standard condition". How much the eligibility rate after sorting (P) increases from iP under this condition offers a reasonable criterion for ranking candidate models. Moreover, the model performance under conditions with adjusted discrimination strength was verified using a metric "relative precision" (rP) defined as (P-iP)/(1-iP). Because rP, compared to precision (= P), is less dependent on iP in relation to recall (R), i.e., recovery rate of eligible seeds, the rP-R curve and area under the curve also offer useful criteria for spotting better discriminant models. We confirmed that the batches of seeds given higher discriminant scores by the models selected with reference to these criteria were more enriched with eligible seeds. The method presented can be readily implemented in developing a sorting device that enables "last-percent improvement" in eligibility rates of crop seeds.
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Affiliation(s)
- Osamu Matsuda
- Department of Biology, Faculty of Science, Kyushu University, Fukuoka, Japan
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50
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Sá MP, Tasoudis P, Jacquemyn X, Van den Eynde J, Caranasos TG, Ikonomidis JS, Chu D, Serna‐Gallegos D, Sultan I. Long-Term Outcomes of Patients Undergoing Aortic Root Replacement With Mechanical Versus Bioprosthetic Valves: Meta-Analysis of Reconstructed Time-to-Event Data. J Am Heart Assoc 2023; 12:e030629. [PMID: 37681555 PMCID: PMC10547304 DOI: 10.1161/jaha.123.030629] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023]
Abstract
Background An aspect not so clear in the scenario of aortic surgery is how patients fare after composite aortic valve graft replacement (CAVGR) depending on the type of valve (bioprosthetic versus mechanical). We performed a study to evaluate the long-term outcomes of both strategies comparatively. Methods and Results Pooled meta-analysis of Kaplan-Meier-derived time-to-event data from studies with follow-up for overall survival (all-cause death), event-free survival (composite end point of cardiac death, valve-related complications, stroke, bleeding, embolic events, and/or endocarditis), and freedom from reintervention. Twenty-three studies met our eligibility criteria, including 11 428 patients (3786 patients with mechanical valves and 7642 patients with bioprosthetic valve). The overall population was mostly composed of men (mean age, 45.5-75.6 years). In comparison with patients who underwent CAVGR with bioprosthetic valves, patients undergoing CAVGR with mechanical valves presented no statistically significant difference in the risk of all-cause death in the first 30 days after the procedure (hazard ratio [HR], 1.24 [95% CI, 0.95-1.60]; P=0.109), but they had a significantly lower risk of all-cause mortality after the 30-day time point (HR, 0.89 [95% CI, 0.81-0.99]; P=0.039) and lower risk of reintervention (HR, 0.33 [95% CI, 0.24-0.45]; P<0.001). Despite its increased risk for the composite end point in the first 6 years of follow-up (HR, 1.41 [95% CI, 1.09-1.82]; P=0.009), CAVGR with mechanical valves is associated with a lower risk for the composite end point after the 6-year time point (HR, 0.46 [95% CI, 0.31-0.67]; P<0.001). Conclusions CAVGR with mechanical valves is associated with better long-term outcomes in comparison with CAVGR with bioprosthetic valves.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburgh, PA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburghPA
| | - Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, Department of SurgeryUniversity of North CarolinaChapel HillNC
| | | | | | - Thomas G. Caranasos
- Division of Cardiothoracic Surgery, Department of SurgeryUniversity of North CarolinaChapel HillNC
| | - John S. Ikonomidis
- Division of Cardiothoracic Surgery, Department of SurgeryUniversity of North CarolinaChapel HillNC
| | - Danny Chu
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburgh, PA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburghPA
| | - Derek Serna‐Gallegos
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburgh, PA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburghPA
| | - Ibrahim Sultan
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburgh, PA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburghPA
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