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Chatard M, Bey E, Baus A. [Current role of the latissimus dorsi flap in traumatology: Analysis of the activity of a plastic surgery department in a military hospital]. ANN CHIR PLAST ESTH 2024; 69:249-257. [PMID: 37673772 DOI: 10.1016/j.anplas.2023.08.005] [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: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
Reconstructive surgery's workhorse, the latissimus dorsi flap is increasingly abandoned in favour of fasciocutaneous flaps. The purpose of this study was to analyse the methods used to perform this flap and the evolution of its indications in order to define its current place in traumatology. Forty-four cases were recorded retrospectively from January 2000 to December 2020 at HIA Percy, including 37 cases of free flaps, mainly performed for reconstruction of extensive loss of substance with bone and/or joint exposure. It was also performed in 10.8% of cases for salvage after failure of an alternative reconstruction solution. This analysis confirms the value of the latissimus dorsi flap in cases of significant substance loss in the lower limb, but also in burn patients for functional rehabilitation or to allow early rehabilitation.
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Affiliation(s)
- M Chatard
- Service de chirurgie plastique, reconstructrice et esthétique, département de chirurgie plastique, maxillo-faciale et reconstructrice, CHRU Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, Nancy, France; Faculté de médecine de Nancy, 9, avenue de la Forêt de Haye, Vandœuvre-lès-Nancy, France.
| | - E Bey
- Service de chirurgie plastique, reconstructrice et esthétique, département de chirurgie reconstructrice, HIA Percy, Clamart, France; Service de santé des armées, école du Val-de-Grâce, Paris, France
| | - A Baus
- Service de chirurgie plastique, reconstructrice et esthétique, département de chirurgie reconstructrice, HIA Percy, Clamart, France; Service de santé des armées, école du Val-de-Grâce, Paris, France
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Baus A, Boatman DD, Calkins A, Pollard C, Conn ME, Subramanian S, Kennedy-Rea S. A Health Information Technology Protocol to Enhance Colorectal Cancer Screening. JMIR Form Res 2024; 8:e55202. [PMID: 38640474 PMCID: PMC11069090 DOI: 10.2196/55202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/12/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
This study addresses barriers to electronic health records-based colorectal cancer screening and follow-up in primary care through the development and implementation of a health information technology protocol.
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Affiliation(s)
- Adam Baus
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Dannell D Boatman
- Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, WV, United States
| | - Andrea Calkins
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Cecil Pollard
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Mary Ellen Conn
- Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, WV, United States
| | | | - Stephenie Kennedy-Rea
- Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, WV, United States
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Boyd J, Carter M, Baus A. Access to MAT: Participants' Experiences With Transportation, Non-Emergency Transportation, and Telehealth. J Prim Care Community Health 2024; 15:21501319241233198. [PMID: 38420885 PMCID: PMC10906046 DOI: 10.1177/21501319241233198] [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: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV). METHODS We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021. RESULTS We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth. CONCLUSIONS This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery.
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Affiliation(s)
- Jennifer Boyd
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
| | - Martha Carter
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
| | - Adam Baus
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
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Carter M, Boyd J, Bennett T, Baus A. Medication Assisted Treatment Program Policies: Opinions of People in Treatment. J Prim Care Community Health 2023; 14:21501319231195606. [PMID: 37635696 PMCID: PMC10467182 DOI: 10.1177/21501319231195606] [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: 06/23/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Medication assisted treatment (MAT) for opioid use disorder (OUD) saves lives and enhances quality of life for people in recovery. However, only a small percentage of people eligible for MAT in the United States receive treatment, and among those who do seek treatment, retention is a challenge. This study aims to understand factors that help individuals enter and stay in MAT from the perspective of those in recovery. The patient perspective is vital in efforts to improve care delivery and best support individuals in treatment. METHODS Survey development was driven by a review of current peer-reviewed literature plus information gained through 3 semi-structured interviews and follow-up discussions with 5 individuals who have lived experience in MAT, termed Participant Advisors. Survey questions focused in part on MAT participants' opinions relating to program policies such as drug testing, relapse protocols, duration of treatment, participant use of anti-anxiety medications and marijuana, and requirements for attendance in peer recovery groups such as Narcotics Anonymous and Alcoholics Anonymous. Responses were collected from West Virginia-based MAT programs from February through August 2021, with 1700 surveys distributed to 21 MAT programs. RESULTS At the close of data collection, 225 survey responses, including over 500 free-text comments, were received (13.2% response rate). Most (n = 207, 95%) were currently in a MAT program and most (n = 187, 88.6%) reported using buprenorphine/naloxone for MAT, though participants reported having used other medications for treatment of OUD as well. Questions about how long a person should have MAT prescribed, how long they should be able to stay in treatment, whether they can use marijuana or anti-anxiety drugs while in treatment, and whether they should use a 12-step program generated mixed opinions. Findings strongly support consideration of individual situations and shared decision-making with providers.
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Affiliation(s)
- Martha Carter
- West Virginia Alliance for Creative Health Solutions, Inc, Culloden, WV, USA
| | - Jennifer Boyd
- West Virginia Alliance for Creative Health Solutions, Inc, Culloden, WV, USA
| | - Trey Bennett
- West Virginia Alliance for Creative Health Solutions, Inc, Culloden, WV, USA
| | - Adam Baus
- West Virginia Alliance for Creative Health Solutions, Inc, Culloden, WV, USA
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Duhamel P, Baus A, Bich C, Duhoux A, Brachet M, Ponsin P, Leclerc T, Verdaguer C, Rogez D, Annette S, Colas M, Lantiéri L, Bey E. Enjeux et perspectives des allotransplantations de tissus composites en chirurgie reconstructrice pour les très grands brûlés. Bulletin de l'Académie Nationale de Médecine 2022. [DOI: 10.1016/j.banm.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Slimani M, Baus A, Bich CS, de Rousiers A, Duhoux A, Brachet M, Duhamel P, Bey E. Methylmetacrylate (PMMA) cranioplasty technique: Technical interest of intraoperative modeling and review of the literature. ANN CHIR PLAST ESTH 2022; 68:99-105. [PMID: 36229276 DOI: 10.1016/j.anplas.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/01/2022]
Abstract
Reconstruction of bone loss in the cranial vault may be necessary for functional or aesthetic reasons following trauma, decompression craniectomy, or craniofacial malformations. Many techniques have been described in the literature, using various materials, each with its own advantages and drawbacks. Reconstruction with polymethylmetacrylate cement has the advantage of a durable result and relative ease of use. In this article we present our cement cranioplasty technique through 4 clinical cases of cranial vault reconstruction, by direct intraoperative modeling on the bone defect. This accessible, effective method, applicable to all sizes of defect, remains an attractive option in the arsenal of techniques available today.
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Baus A, Calkins A, Feinberg J, McManaway K, Moser S, Pollard C, Sutphin R. Using Health Information Technology to Create Pathways for Hepatitis C Treatment and Cure in West Virginia. Perspect Health Inf Manag 2022; 19:1j. [PMID: 35440923 PMCID: PMC9013224] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This case study describes use of health information technology for enhanced team-based care and care coordination between primary care providers and infectious disease specialists for curing and eventually eliminating hepatitis C in West Virginia. This program, the West Virginia Hepatitis Academic Mentoring Partnership, aims to improve outcomes of West Virginians with chronic hepatitis C infection by training and supporting primary care providers to screen, diagnose, evaluate, treat, cure, and follow patients in the community rather than referring them to distant specialists with long wait times. This initiative supports health equity by increasing access to quality care in severely under-resourced rural areas. Primary care providers engage with hepatitis C experts in a web-based training and mentoring process, combined with informatics training in use of a customized Research Electronic Data Capture (REDCAP) platform for secure data tracking and bidirectional communication. This use of an informatics platform available to all partners supports shared decision-making between primary care providers and specialists, fostering a primary care learning network for improved hepatitis C care in West Virginia.
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Keilani C, De Faria A, Baus A, Delbarre M, Schaal J, Froussart-Maille F, Bey E, Duhamel P. Eyelid Chemical Burns: A Multidisciplinary And Challenging Approach. Ann Burns Fire Disasters 2021; 34:312-318. [PMID: 35035323 PMCID: PMC8717906] [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] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/14/2021] [Indexed: 06/14/2023]
Abstract
During second- and third-degree eyelid sulfuric acid burns, many surgeons prefer to wait until primary wound separation occurs before grafting. However, this approach may miss the chance to recover the eyelids and can cause ectropion, resulting in delayed eyeball healing with exposure keratitis. We propose that early eyelid release and grafting makes a significant difference in long-term outcomes and improves eyeball healing. Here, we present the case of a woman who presented second- and third-degree burns of the eyelids secondary to physical domestic assault with acid, who had an early surgical management with a full-thickness skin graft. Ten days after surgery, we found that the graft had survived totally, and the donor site of the right arm had already healed. Eyelids were successfully grafted and the functions of both eyelids were well recovered, allowing complete cover of the eyeball. Two months after surgery, functional and cosmetic results were satisfying, with no postoperative lagophthalmos or difficulties with exposure-related problems. Case reports of eyelid chemical burns are very few. No specific and codified management of eyelid chemical burns was found in the literature search. This case report demonstrated that a multidisciplinary approach led by both ophthalmologists and plastic surgeons must be decided early (<6h) in order to achieve synergistic and coordinated management between the eye and the eyelid. There is a significant improvement in ocular healing with early excision and grafting of eyelids after sulfuric acid burn.
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Affiliation(s)
- C. Keilani
- Department of Plastic Surgery and Burn Treatment, Percy Military Hospital, Clamart, France
- Department of Ophthalmology, Percy Military Hospital, Clamart, France
- acial and Oculoplastic Surgery Unit, Quinze-Vingts National Center, Paris, France
- Faculty of Medicine Pierre et Marie Curie, Sorbonne University Paris VI, France
- Assistance Publique des Hôpitaux de Paris, France
| | - A. De Faria
- Department of Ophthalmology, Percy Military Hospital, Clamart, France
| | - A. Baus
- Department of Plastic Surgery and Burn Treatment, Percy Military Hospital, Clamart, France
| | - M. Delbarre
- Department of Ophthalmology, Percy Military Hospital, Clamart, France
| | - J.V. Schaal
- Burn Center, Percy Military Hospital, Clamart, France
| | | | - E. Bey
- Department of Plastic Surgery and Burn Treatment, Percy Military Hospital, Clamart, France
| | - P. Duhamel
- Department of Plastic Surgery and Burn Treatment, Percy Military Hospital, Clamart, France
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mccann KS, Baus A. Physician burnout among West Virginia primary care providers. Marshall Journal of Medicine 2021. [DOI: 10.33470/2379-9536.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Wright LE, Baus A, Calkins A, Hartman-Adams H, Conn ME, Eason S, Kennedy-Rea S. Case Study of a Comprehensive Team-Based Approach to Increase Colorectal Cancer Screening. J Appalach Health 2021; 3:86-96. [PMID: 35770036 PMCID: PMC9192119 DOI: 10.13023/jah.0303.07] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction Colorectal cancer is the second leading cause of cancer deaths among men and women in West Virginia. In addition, 51% of all colorectal cancers diagnosed in West Virginia from 2012 to 2016 were detected at either regional (31%) or distant (20%) stages indicating a need for improved early detection. Methods West Virginia University Cheat Lake Physicians participated in the West Virginia Program to Increase Colorectal Cancer Screening, a program of Cancer Prevention and Control at the WVU Cancer Institute. As a result, Cheat Lake Physicians assembled a team of health care professionals to implement evidence-based interventions and system changes including provider assessment and feedback, patient reminders, accurate data capture, and tracking of CRC screening tests. Results These efforts resulted in a 15.8% increase in colorectal cancer screening rates within one year of implementation. Additionally, the clinic achieved a 66% return rate for Fecal Immunochemical Test kits, an inexpensive, stool-based colorectal cancer screening test. Implications The utilization of a team-based approach to patient care yields positive results that can be carried over to other cancer and disease prevention efforts in primary care clinics.
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Affiliation(s)
| | - Adam Baus
- West Virginia University School of Public Health
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Baus A, Shawley-Brzoska S, Wright J, Carey S, Berry ED, Burrell S, Ross M, Pollard C, Semel A, Calkins A, Gadde D, Jarrett T. Informatics-Supported Diabetes Prevention Programming in West Virginia. Perspect Health Inf Manag 2021; 18:1l. [PMID: 34035793 PMCID: PMC8120671] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Addressing diabetes, prediabetes, and related health conditions such as high blood pressure, high cholesterol, obesity, and physical inactivity are critical public health priorities for the United States, particularly West Virginia. Preventing chronic conditions through early identification of risk and intervention to reduce risk is essential. Primary care and community-based programs need a more connected informatics system by which they work in tandem to identify, refer, treat, and track target populations. This case study in quality improvement examines the effectiveness of national diabetes prevention programming in West Virginia via the West Virginia Health Connection initiative, which was designed to provide such an informatics structure. Cohort analysis reveals an average weight loss of 13.6 pounds-or 6.3 percent total body weight loss-per person. These changes represent decreased risk of diabetes incidence and increased healthcare savings. Lessons learned are applicable to other areas aiming to build and sustain a data-informed health analytics network.
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Cochran J, Jarrett T, Baus A. Characteristics of Neonatal Abstinence Syndrome (NAS) in a rural clinic population: Tracking with Electronic Medical Health Records (EHR). OJRNHC 2020. [DOI: 10.14574/ojrnhc.v20i2.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Baus A, Bich CS, Grosset A, de Rousiers A, Duhoux A, Brachet M, Duhamel P, Thomas M, Rogez D, Mathieu L, Bey E. Medical and surgical management of lower extremity war-related injuries. Experience of the French Military Health Service (FMHS). ANN CHIR PLAST ESTH 2020; 65:447-478. [DOI: 10.1016/j.anplas.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
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Conn ME, Kennedy-Rea S, Subramanian S, Baus A, Hoover S, Cunningham C, Tangka FKL. Cost and Effectiveness of Reminders to Promote Colorectal Cancer Screening Uptake in Rural Federally Qualified Health Centers in West Virginia. Health Promot Pract 2020; 21:891-897. [PMID: 32990048 DOI: 10.1177/1524839920954164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this study is to evaluate the effectiveness of the West Virginia Program to Increase Colorectal Cancer Screening in implementing patient reminders to increase fecal immunochemical test (FIT) kit return rates in nine federally qualified health centers (FQHCs). Using process measures and cost data collected, the authors examined the differences in the intensity of the phone calls across FQHCs and compared them with the return rates achieved. They also reported the cost per kit successfully returned as a result of the intervention. Across all FQHCs, 5,041 FIT kits were ordered, and the initial return rate (without a reminder) was 41.1%. A total of 2,201 patients received reminder phone calls; on average, patients received 1.61 reminder calls each. The reminder interventions increased the average FIT kit return rate to 60.7%. The average total cost per FIT kit returned across all FQHCs was $60.18, and the average cost of only the reminders was $11.20 per FIT kit returned. FQHCs achieved an average increase of 19.6 percentage points in FIT kit return rates, and costs across clinics varied. Clinics with high-quality health information systems that enabled tracking of patients with minimal effort were able to implement lower cost reminder interventions.
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Affiliation(s)
| | | | | | - Adam Baus
- West Virginia University, Morgantown, WV, USA
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Baus A, Wright LE, Kennedy-Rea S, Conn ME, Eason S, Boatman D, Pollard C, Calkins A, Gadde D. Leveraging Electronic Health Records Data for Enhanced Colorectal Cancer Screening Efforts. J Appalach Health 2020; 2:53-63. [PMID: 35769645 PMCID: PMC9150493 DOI: 10.13023/jah.0204.07] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Colorectal cancer is the third most common type of cancer in the United States for men and women combined. While the current threat of disease nationally is significant, the majority of colorectal cancer cases and deaths could be prevented through established screening tests and guidelines. Within the Appalachian region and West Virginia in particular, colorectal cancer is a significant public health problem. A more systematic, comprehensive approach to preventing and controlling cancer is essential. Methods Through the West Virginia Program to Increase Colorectal Cancer Screening, primary care systems across the state received data-informed practice facilitation designed to increase screening rates. Results Year-1 cohort health systems had an overall baseline screening rate of 28.4% during calendar year 2014. This rate increased and remained steady during the three follow-up measurement time periods, with a rate of 49.5% during calendar year 2018. This increase is notably greater than comparable health systems not part of the initiative. Implications Lessons learned in increasing colorectal cancer screening rates are applicable to other priority health needs as well.
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Affiliation(s)
- Adam Baus
- West Virginia University School of Public Health
| | | | | | | | | | | | | | | | - Divya Gadde
- West Virginia University School of Public Health
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16
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Bich CS, Brachet M, Baus A, Duhoux A, Duhamel P, Bey É. [The "racket-like" flap: Method to increase the reliability of the sural neuro-cutaneous flap]. ANN CHIR PLAST ESTH 2020; 65:300-305. [PMID: 32593440 DOI: 10.1016/j.anplas.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
We realized a retrospective study from 2003 to 2018 comparing two surgical techniques of neuro-fascio-cutaneous sural flap harvesting to improve their reliability: the "vascular pedicle tunneling" method and the "racket-like" flap method. There are 35 flaps in this series from lower distal limb reconstruction: 21 "racket-like" flaps and 14 "tunneling-pedicle" flaps. There were no partial or total necrosis case in the "racket-like" flaps group. Our technique reduces covering failure due to partial or total necrosis risk with a statistically significant impact. We propose to extend the "racket-like" technique to every fascio-cutaneous flap available.
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Affiliation(s)
- C-S Bich
- Service de chirurgie plastique, hôpital d'Instruction des Armées Percy, Clamart, France.
| | - M Brachet
- Service de chirurgie plastique, hôpital d'Instruction des Armées Percy, Clamart, France
| | - A Baus
- Service de chirurgie plastique, hôpital d'Instruction des Armées Percy, Clamart, France
| | - A Duhoux
- Service de chirurgie plastique, hôpital d'Instruction des Armées Percy, Clamart, France
| | - P Duhamel
- Service de chirurgie plastique, hôpital d'Instruction des Armées Percy, Clamart, France
| | - É Bey
- Service de chirurgie plastique, hôpital d'Instruction des Armées Percy, Clamart, France
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Keilani C, Baus A, Tick S, Sahel JA, Boumendil J. Effectiveness and safety comparison of three eye and orbital reconstruction techniques in facial plastic surgery. ANN CHIR PLAST ESTH 2019; 64:351-361. [DOI: 10.1016/j.anplas.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
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Davis SM, Kristjansson AL, Davidov D, Zullig K, Baus A, Fisher M. Barriers to using new needles encountered by rural Appalachian people who inject drugs: implications for needle exchange. Harm Reduct J 2019; 16:23. [PMID: 30940136 PMCID: PMC6444507 DOI: 10.1186/s12954-019-0295-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/20/2019] [Indexed: 01/28/2023] Open
Abstract
Background Using a new needle for every injection can reduce the spread of infectious disease among people who inject drugs (PWID). No previous study has examined new needle use barriers among PWIDs residing in the rural Appalachian part of the United States, an area currently in the midst of a heroin epidemic. Objective Therefore, our primary aim was to explore self-reported barriers to using a new needle by PWID attending a needle exchange program (NEP). Methods We conducted a cross-sectional survey of PWID attending two NEPs in rural West Virginia located in the heart of Central Appalachia. A convenience sample of PWID (n = 100) completed the Barriers to Using New Needles Questionnaire. Results The median number of barriers reported was 5 (range 0–19). Fear of arrest by police (72% of PWID “agreed” or “strongly agreed”) and difficulty with purchasing needles from a pharmacy (64% “agreed” or “strongly agreed”) were the most frequently cited barriers. Conclusions/Importance Congruent with previous findings from urban locations, in rural West Virginia, the ability of PWID to use a new needle obtained from a needle exchange for every injection may be compromised by fear of arrest. In addition, pharmacy sales of new needles to PWID may be blunted by an absence of explicit laws mandating nonprescription sales. Future studies should explore interventions that align the public health goals of NEPs with the occupational safety of law enforcement and health outreach goals of pharmacists. Electronic supplementary material The online version of this article (10.1186/s12954-019-0295-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen M Davis
- Department of Health Policy, Management, and Leadership, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA. .,Department of Emergency Medicine, West Virginia University, PO Box 9149, Morgantown, WV, 26506, USA.
| | - Alfgeir L Kristjansson
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Danielle Davidov
- Department of Emergency Medicine, West Virginia University, PO Box 9149, Morgantown, WV, 26506, USA.,Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Keith Zullig
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Adam Baus
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Melanie Fisher
- Department of Medicine, Section of Infectious Diseases, West Virginia University, PO Box 9163, Morgantown, WV, 26506, USA
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Haggerty T, Lewis W, Plaugher C, Xiang J, Radcliffe E, Whanger S, Baus A. Residents' Views on Research and Quality Improvement Training Can Guide Practice-Based Research Network Collaboration. ACTA ACUST UNITED AC 2018; 2018. [PMID: 32483393 DOI: 10.21885/wvmj.2018.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background and Objectives This study was conducted by the West Virginia Practice-Based Research Network Learning Collaborative to assess research activity, confidence, and attitudes toward residency programs' research and quality improvement requirements and inform the integration of the state-wide practice-based research network (PBRN) as mentors to support practice transformation implementation initiatives across various resident training sites in West Virginia. Methods This pilot study assessed residents' attitudes regarding (1) research activity, (2) confidence and (3) requirements of their program in research and quality improvement training by using an anonymous survey, administered during regular residency meetings. Results Of the 68 residents,representing four DO and MD Family Medicine residency programs in West Virginia, 40 (58.8%) responded to the survey. About 64 percent of residents had worked on a quality improvement project, and more than half of residents (52.5%) submitted a research project for a competitive presentation within the most recent year. Sixty-five percent felt satisfied with the residency program's research and quality improvement curriculum. However, only 55 percent felt confident to perform a project and 52 percent submitted a project to a competitive forum. Conclusion Only half of the residents demonstrate activity and confidence in research and quality improvement. This shows an opportunity to assess current curriculums and provide new strategies to enhance their ability to conduct practice transformation initiatives.
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Affiliation(s)
- Treah Haggerty
- West Virginia University School of Medicine, Department of Family Medicine & West Virginia Clinical and Translational Science Institute
| | - William Lewis
- West Virginia University Eastern Division; Harpers Ferry Family Medicine & West Virginia Clinical and Translational Science Institute
| | - Christine Plaugher
- West Virginia School of Osteopathic Medicine & West Virginia Clinical and Translational Science Institute
| | - Jun Xiang
- West Virginia University School of Medicine, Department of Family Medicine
| | | | - Stacey Whanger
- West Virginia Clinical and Translational Science Institute
| | - Adam Baus
- West Virginia University Office of Health Services Research
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Davis SM, Davidov D, Kristjansson AL, Zullig K, Baus A, Fisher M. Qualitative case study of needle exchange programs in the Central Appalachian region of the United States. PLoS One 2018; 13:e0205466. [PMID: 30312333 PMCID: PMC6185728 DOI: 10.1371/journal.pone.0205466] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/25/2018] [Indexed: 02/04/2023] Open
Abstract
Background The Central Appalachian region of the United States is in the midst of a hepatitis C virus epidemic driven by injection of opioids, particularly heroin, with contaminated syringes. In response to this epidemic, several needle exchange programs (NEP) have opened to provide clean needles and other supplies and services to people who inject drugs (PWID). However, no studies have investigated the barriers and facilitators to implementing, operating, and expanding NEPs in less populous areas of the United States. Methods This qualitative case study consisted of interviews with program directors, police chiefs, law enforcement members, and PWID affiliated with two NEPs in the rural state of West Virginia. Interview transcripts were coded inductively and analyzed using qualitative data analysis software. Final common themes related to barriers and facilitators of past program openings, current program operations, and future program plans, were derived through a consensus of two data coders. Results Both NEPs struggled to find existing model programs, but benefited from broad community support that facilitated implementation. The largest operational barrier was the legal conundrum created by paraphernalia laws that criminalize syringe possession. However, both PWID and law enforcement appreciated the comprehensive services provided by these programs. Program location and transportation difficulties were additional noted barriers. Future program operations are threatened by funding shortages and bans, but necessitated by unexpected program demand. Conclusion Despite broad community support, program operations are threatened by growing participant volumes, funding shortages, and the federal government’s prohibition on the use of funds to purchase needles. Paraphernalia laws create a legal conundrum in the form of criminal sanctions for the possession of needles, which may inadvertently promote needle sharing and disease transmission. Future studies should examine additional barriers to using clean needles provided by rural NEPs that may blunt the effectiveness of NEPs in preventing disease transmission.
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Affiliation(s)
- Stephen M. Davis
- Department of Health Policy, Management, and Leadership, West Virginia University, Morgantown, United States of America
- Department of Emergency Medicine, West Virginia University, Morgantown, United States of America
- * E-mail:
| | - Danielle Davidov
- Department of Emergency Medicine, West Virginia University, Morgantown, United States of America
- Department of Social and Behavioral Sciences, West Virginia University, Morgantown, United States of America
| | - Alfgeir L. Kristjansson
- Department of Social and Behavioral Sciences, West Virginia University, Morgantown, United States of America
| | - Keith Zullig
- Department of Social and Behavioral Sciences, West Virginia University, Morgantown, United States of America
| | - Adam Baus
- Department of Social and Behavioral Sciences, West Virginia University, Morgantown, United States of America
| | - Melanie Fisher
- Department of Medicine, Section of Infectious Diseases, West Virginia University, Morgantown, United States of America
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Baus A, Culie D, Duong LT, Ben Lakhdar A, Schaff JB, Janot F, Kolb F. Primary clear cell sarcoma of the tongue and surgical reconstruction: About a rare case report. ANN CHIR PLAST ESTH 2018; 64:98-105. [PMID: 30262251 DOI: 10.1016/j.anplas.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/03/2018] [Indexed: 01/03/2023]
Abstract
Clear cell sarcomas (SCC), also called "soft-tissue melanoma", are rare and aggressive tumors that preferentially affect the lower limbs (tendons and fasciae) and which have also been described in head and neck localizations. Their clinical and immunohistochemical mimicry with melanoma makes it difficult to diagnose sarcomas. SCC treatment is mainly focused on large-scale resection surgery with adjuvant radiotherapy because of their low chemo-sensitivity and extreme lymphophilia. In case of head and neck localization, these treatments may lead to function and aesthetic sequelae thus requiring the use of modern techniques of reconstructive surgery. The authors describe the diagnosis, treatment and follow-up of large lingual SCC case using a DIEP free flap reconstruction according to an original technique developed in the department. Given the characteristics of patients with SCC (a high proportion of women between 20 and 40 years old) and its inherent qualities (low morbidity of the donor site, volume delivered and excellent plasticity), the fascio-cutaneous free flap type "DIEP" "taken according to the design of the" Cathedral triptych seems to be a viable choice among the range of reconstruction solutions.
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Affiliation(s)
- A Baus
- Institut Gustave-Roussy, department of plastic surgery, Gustave-Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France.
| | - D Culie
- Institut Gustave-Roussy, department of head and neck oncology, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - L T Duong
- Institut Gustave-Roussy, department of head and neck oncology, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Ben Lakhdar
- Institut Gustave-Roussy, department of biopathology, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - J-B Schaff
- Institut Gustave-Roussy, department of plastic surgery, Gustave-Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France
| | - F Janot
- Institut Gustave-Roussy, department of head and neck oncology, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - F Kolb
- Institut Gustave-Roussy, department of plastic surgery, Gustave-Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France
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Baus A, Keilani C, Bich CS, Entine F, Brachet M, Duhamel P, Amabile JC, Malfuson J, Bey E. Complex upper arm reconstruction using an antero-lateral thigh free flap after an extravasation of Yttrium-90-ibritumomab Tiuxetan: A case report and literature review. ANN CHIR PLAST ESTH 2018; 63:175-181. [DOI: 10.1016/j.anplas.2017.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
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Baus A, Rem K, Revol M, Cristofari S. [Prosthetic genioplasty versus osseous genioplasty in aesthetic chin augmentation: Literature review and knowledge update]. ANN CHIR PLAST ESTH 2017; 63:255-261. [PMID: 29217082 DOI: 10.1016/j.anplas.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
Chin augmentation is commonly practiced, whether in microgenia treatment, in cases of orthognathic or cosmetic surgery. Located at the crossroads of many specialties, the technique choice still differs according to the surgeon specialiy. A large number of publications on the subject are available. A comparaison between different surgical methods is therefore possible concerning their indications and their complication. The purpose of this study was to carry out a literature review, with updating knowledge, as well as a synthesis indication regarding aesthetic osseous and alloplastic genioplasty. Despite the generalization of "modern" implants in France, prosthetic genioplasty remains more frequently the source of serious complications (infections, extrusions, bone erosions). Similarly, this technique has much more limited indications than osseous genioplasty, which has the advantage of a better longevity. In order to increase the aesthetic appearance of the chin, osseous genioplasty should be performed more easily and more frequently by surgeons on all sides.
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Affiliation(s)
- A Baus
- Université Paris-Diderot, Sorbonne-Paris-Cité, 5, rue Thomas-Mann, 75013 Paris, France; Hôpital Saint-Louis, AP-HP, 75010 Paris, France.
| | - K Rem
- Université Paris-Diderot, Sorbonne-Paris-Cité, 5, rue Thomas-Mann, 75013 Paris, France; Hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - M Revol
- Université Paris-Diderot, Sorbonne-Paris-Cité, 5, rue Thomas-Mann, 75013 Paris, France; Hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - S Cristofari
- Université Paris-Diderot, Sorbonne-Paris-Cité, 5, rue Thomas-Mann, 75013 Paris, France; Hôpital Saint-Louis, AP-HP, 75010 Paris, France
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Baus A, Coben J, Zullig K, Pollard C, Mullett C, Taylor H, Cochran J, Jarrett T, Long D. An Electronic Health Record Data-driven Model for Identifying Older Adults at Risk of Unintentional Falls. Perspect Health Inf Manag 2017; 14:1b. [PMID: 29118679 PMCID: PMC5653950] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Screening for risk of unintentional falls remains low in the primary care setting because of the time constraints of brief office visits. National studies suggest that physicians caring for older adults provide recommended fall risk screening only 30 to 37 percent of the time. Given prior success in developing methods for repurposing electronic health record data for the identification of fall risk, this study involves building a model in which electronic health record data could be applied for use in clinical decision support to bolster screening by proactively identifying patients for whom screening would be beneficial and targeting efforts specifically to those patients. The final model, consisting of priority and extended measures, demonstrates moderate discriminatory power, indicating that it could prove useful in a clinical setting for identifying patients at risk of falls. Focus group discussions reveal important contextual issues involving the use of fall-related data and provide direction for the development of health systems-level innovations for the use of electronic health record data for fall risk identification.
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Affiliation(s)
- Adam Baus
- West Virginia University School of Public Health in Morgantown, WV
| | - Jeffrey Coben
- West Virginia University School of Public Health in Morgantown, WV
| | - Keith Zullig
- Virginia University School of Public Health in Morgantown, WV
| | - Cecil Pollard
- Virginia University School of Public Health in Morgantown, WV
| | - Charles Mullett
- West Virginia University School of Medicine in Morgantown, WV
| | - Henry Taylor
- Johns Hopkins Bloomberg School of Public Health in Baltimore, MD
| | - Jill Cochran
- West Virginia School of Osteopathic Medicine in Lewisburg, WV
| | - Traci Jarrett
- West Virginia University School of Public Health in Morgantown, WV
| | - Dustin Long
- Department of Biostatistics at the University of Alabama in Birmingham, AL
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Davis SM, Daily S, Kristjansson AL, Kelley GA, Zullig K, Baus A, Davidov D, Fisher M. Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis. Harm Reduct J 2017; 14:25. [PMID: 28514954 PMCID: PMC5436422 DOI: 10.1186/s12954-017-0156-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/08/2017] [Indexed: 12/16/2022] Open
Abstract
Background Previous research on the effectiveness of needle exchange programs (NEP) in preventing hepatitis C virus (HCV) in people who inject drugs (PWID) has shown mixed findings. The purpose of this study was to use the meta-analytic approach to examine the association between NEP use and HCV prevention in PWIDs. Methods Study inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case–control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I2 with alpha values for Q ≤ 0.10 considered statistically significant. Results Of the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05–5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39–3.03). Substantial heterogeneity (p ≤ 0.10) and moderate to large inconsistency (I2 ≥ 66%) were observed for both models. Conclusions The impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue. Trial registration PROSPERO CRD42016035315 Electronic supplementary material The online version of this article (doi:10.1186/s12954-017-0156-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen M Davis
- School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9149, Morgantown, WV, 26506-9149, USA.
| | - Shay Daily
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Alfgeir L Kristjansson
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - George A Kelley
- Department of Biostatistics, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Keith Zullig
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Adam Baus
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Danielle Davidov
- School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9149, Morgantown, WV, 26506-9149, USA.,Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Melanie Fisher
- Department of Medicine, Section of Infectious Diseases, West Virginia University, PO Box 9163, Morgantown, WV, 26506, USA
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Baus A, Zullig K, Long D, Mullett C, Pollard C, Taylor H, Coben J. Developing Methods of Repurposing Electronic Health Record Data for Identification of Older Adults at Risk of Unintentional Falls. Perspect Health Inf Manag 2016; 13:1b. [PMID: 27134607 PMCID: PMC4832126] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nationally, nearly 40 percent of community-dwelling adults age 65 and older fall at least once a year, making unintentional falls the leading cause of both fatal and nonfatal injuries among this age group. Addressing this public health problem in primary care offers promise. However, challenges in incorporating fall risk screening into primary care result in a problem of missed opportunities for screening, counseling, intervention, and ultimately prevention. Given these barriers, this study examines the potential for the innovative use of routinely collected electronic health record data to provide enhanced clinical decision support in busy, often resource-thin primary care environments. Using de-identified data from a sample of West Virginia primary care centers, we find that it is both feasible and worthwhile to repurpose routinely collected data for the purpose of identification of older adults at risk of falls. Searching of both free-text and semistructured data was particularly valuable.
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Affiliation(s)
- Adam Baus
- Office of Health Services Research at West Virginia University School of Public Health in Morgantown, WV
| | - Keith Zullig
- Department of Social and Behavioral Health Sciences at West Virginia University School of Public Health in Morgantown, WV
| | - Dustin Long
- Department of Biostatistics at West Virginia University School of Public Health in Morgantown, WV
| | - Charles Mullett
- Pediatric Critical Care in the Department of Pediatrics at West Virginia University School of Medicine in Morgantown, WV
| | - Cecil Pollard
- Office of Health Services Research at West Virginia University School of Public Health in Morgantown, WV
| | - Henry Taylor
- Johns Hopkins Bloomberg School of Public Health in Baltimore, MD
| | - Jeffrey Coben
- West Virginia University School of Public Health in Morgantown, WV
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Bridges KG, Jarrett T, Thorpe A, Baus A, Cochran J. Use of the triglyceride to HDL cholesterol ratio for assessing insulin sensitivity in overweight and obese children in rural Appalachia. J Pediatr Endocrinol Metab 2016; 29:153-6. [PMID: 26352085 PMCID: PMC4744136 DOI: 10.1515/jpem-2015-0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/14/2015] [Accepted: 07/06/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies have suggested that triglyceride to HDL-cholesterol ratio (TRG/HDL) is a surrogate marker of insulin resistance (IR), but information regarding its use in pediatric patients is limited. This study investigated the ability of TRG/HDL ratio to assess IR in obese and overweight children. METHODS The sample consisted of de-identified electronic medical records of patients aged 10-17 years (n=223). Logistic regression was performed using TRG/HDL ratio as a predictor of hyperinsulinemia or IR defined using homeostasis model assessment score. RESULTS TRG/HDL ratio had limited ability to predict hyperinsulinemia (AUROC 0.71) or IR (AUROC 0.72). Although females had higher insulin levels, male patients were significantly more likely to have hypertriglyceridemia and impaired fasting glucose. CONCLUSIONS TRG/HDL ratio was not adequate for predicting IR in this population. Gender differences in the development of obesity-related metabolic abnormalities may impact the choice of screening studies in pediatric patients.
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Affiliation(s)
- Kristie Grove Bridges
- Corresponding author: Kristie Grove Bridges, Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA, Phone: 304-647-6223,
| | - Traci Jarrett
- Prevention Research Center, School of Public Health, West Virginia University; West Virginia Clinical and Translational Science Institute, Morgantown WV, USA; and Visiting Scholar, University of Kentucky, Lexington, KY, USA
| | - Anthony Thorpe
- Department of Clinical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg WV, USA
| | - Adam Baus
- Office of Health Services Research, School of Public Health, West Virginia University; West Virginia Clinical and Translational Science Institute, Morgantown, WV, USA
| | - Jill Cochran
- Department of Clinical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg WV, USA
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Cochran J, Baus A. Developing Interventions for Overweight and Obese Children using Electronic Health Records Data. Online J Nurs Inform 2015; 19:http://www.himss.org/ResourceLibrary/GenResourceDetail.aspx?ItemNumber=39758. [PMID: 26843807 PMCID: PMC4734759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Childhood obesity and the resulting co-morbid conditions have become a massive burden for primary caregivers in West Virginia and across the United States. Building culturally sensitive clinical interventions to meet population health needs presents a multi-factorial challenge. Historically it has been is difficult to accurately assess the demographic characteristics of clinic populations. Fortunately, the use of electronic health records (EHR) has created a major shift in clinical documentation and ability to routinely collect essential demographic and clinical data. While data for Meaningful Use under the Centers for Medicare and Medicaid Services is increasingly used to evaluate clinical care and outcomes, use of EHR data outside of the Meaningful Use umbrella has not received sufficient attention. This study explores use of EHR data beyond Meaningful Use to obtain demographic characteristics of an obese and overweight pediatric population in a rural primary care center for the purpose of informing appropriate, locally relevant intervention strategies. We find that the breadth and depth of information recorded on each patient can collectively provide valuable information to describe and evaluate the clinic population, identify priority areas to address, and measure change over time. Application of EHR data to understand the demographic characteristics of this particular patient population highlights the ability to identify target patient populations, uncover critical patient-level and population-level outcomes, inform intervention development and implementation, and add value to efforts in quality improvement systems transformation. Use of EHR data outside of the Meaningful Use umbrella needs increased attention in primary care.
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Affiliation(s)
- Jill Cochran
- Department of Clinical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901
| | - Adam Baus
- School of Public Health, West Virginia University, Morgantown, WV 26506
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Baus A, Wood G, Pollard C, Summerfield B, White E. Registry-based diabetes risk detection schema for the systematic identification of patients at risk for diabetes in West Virginia primary care centers. Perspect Health Inf Manag 2013; 10:1f. [PMID: 24159274 PMCID: PMC3797553] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Approximately 466,000 West Virginians, or about 25 percent of the state population, have prediabetes and are at high risk for developing type 2 diabetes. Appropriate lifestyle intervention can prevent or delay the onset of type 2 diabetes if individuals at risk are identified and treated early. The West Virginia Diabetes Prevention and Control Program and the West Virginia University Office of Health Services Research are developing a systematic approach to diabetes prevention within primary care. This study aims to demonstrate the viability of patient registry software for the analysis of disparate electronic health record (EHR) data sets and standardized identification of at-risk patients for early detection and intervention. Preliminary analysis revealed that of 94,283 patients without a documented diagnosis of diabetes or prediabetes, 10,673 (11.3 percent) meet one or more of the risk criteria. This study indicates that EHR data can be repurposed into an actionable registry for prevention. This model supports meaningful use of EHRs, the Patient-Centered Medical Home program, and improved care through enhanced data management.
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Affiliation(s)
- Adam Baus
- Adam Baus, MA, MPH, is the assistant director of the Office of Health Services Research at the West Virginia University School of Public Health in Morgantown, WV
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Baus A, Hendryx M, Pollard C. Identifying patients with hypertension: a case for auditing electronic health record data. Perspect Health Inf Manag 2012; 9:1e. [PMID: 22737097 PMCID: PMC3329209] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Problems in the structure, consistency, and completeness of electronic health record data are barriers to outcomes research, quality improvement, and practice redesign. This nonexperimental retrospective study examines the utility of importing de-identified electronic health record data into an external system to identify patients with and at risk for essential hypertension. We find a statistically significant increase in cases based on combined use of diagnostic and free-text coding (mean = 1,256.1, 95% CI 1,232.3-1,279.7) compared to diagnostic coding alone (mean = 1,174.5, 95% CI 1,150.5-1,198.3). While it is not surprising that significantly more patients are identified when broadening search criteria, the implications are critical for quality of care, the movement toward the National Committee for Quality Assurance's Patient-Centered Medical Home program, and meaningful use of electronic health records. Further, we find a statistically significant increase in potential cases based on the last two or more blood pressure readings greater than or equal to 140/90 mm Hg (mean = 1,353.9, 95% CI 1,329.9-1,377.9).
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Affiliation(s)
- Adam Baus
- Office of Health Services Research, West Virginia University, Department of Community Medicine, Morgantown, WV, USA
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Pollard C, Bailey KA, Petitte T, Baus A, Swim M, Hendryx M. Electronic patient registries improve diabetes care and clinical outcomes in rural community health centers. J Rural Health 2009; 25:77-84. [PMID: 19166565 DOI: 10.1111/j.1748-0361.2009.00202.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CONTEXT Diabetes care is challenging in rural areas. Research has shown that the utilization of electronic patient registries improves care; however, improvements generally have been described in combination with other ongoing interventions. The level of basic registry utilization sufficient for positive change is unknown. PURPOSE The goal of the current study was to examine differential effects of basic registry utilization on diabetes care processes and clinical outcomes according to level of registry use in a rural setting. METHODS Patients with diabetes (N = 661) from 6 Federally Qualified Health Centers in rural West Virginia were entered into an electronic patient registry. Data from pre- and post-registry were compared among 3 treatment and control groups that had different levels of registry utilization: low, medium, or high (for example, variations in the use of registry-generated progress notes examined at the point-of-care and in the accuracy of registry-generated summary reports to track patients' care). Data included care processes (annual exams, screens to promote wellness, education, and self-management goal-setting) and clinical outcomes (HbA1c, LDL, HDL, cholesterol, triglycerides, blood pressure). FINDINGS The registry assisted in significantly improving 12 of 13 care processes and 3 of 6 clinical outcomes (HbA1c, LDL, cholesterol) for patients exposed to at least medium levels of registry utilization, but not for the controls. For example, the percent of patients who had received an annual eye exam at follow-up was 11%, 34%, and 38% for the low, medium, and high utilization groups, respectively; only the latter groups improved. CONCLUSIONS As an initial step to achieving control of diabetes, basic registry utilization may be sufficient to drive improvements in provider-patient care processes and in patient outcomes in rural clinics with few resources.
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Affiliation(s)
- Cecil Pollard
- Office of Health Services Research, West Virginia University, Morgantown, W VA 26506-9190, USA
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