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Ruan X, Fu S, Jia H, Mathis KL, Thiels CA, Wilson PM, Storlie CB, Liu H. Revolutionizing Postoperative Ileus Monitoring: Exploring GRU-D's Real-Time Capabilities and Cross-Hospital Transferability. medRxiv 2024:2024.04.24.24306295. [PMID: 38712199 PMCID: PMC11071561 DOI: 10.1101/2024.04.24.24306295] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Postoperative ileus (POI) after colorectal surgery leads to increased morbidity, costs, and hospital stays. Identifying POI risk for early intervention is important for improving surgical outcomes especially given the increasing trend towards early discharge after surgery. While existing studies have assessed POI risk with regression models, the role of deep learning's remains unexplored. Methods We assessed the performance and transferability (brutal force/instance/parameter transfer) of Gated Recurrent Unit with Decay (GRU-D), a longitudinal deep learning architecture, for real-time risk assessment of POI among 7,349 colorectal surgeries performed across three hospital sites operated by Mayo Clinic with two electronic health records (EHR) systems. The results were compared with atemporal models on a panel of benchmark metrics. Results GRU-D exhibits robust transferability across different EHR systems and hospital sites, showing enhanced performance by integrating new measurements, even amid the extreme sparsity of real-world longitudinal data. On average, for labs, vitals, and assisted living status, 72.2%, 26.9%, and 49.3% respectively lack measurements within 24 hours after surgery. Over the follow-up period with 4-hour intervals, 98.7%, 84%, and 95.8% of data points are missing, respectively. A maximum of 5% decrease in AUROC was observed in brutal-force transfer between different EHR systems with non-overlapping surgery date frames. Multi-source instance transfer witnessed the best performance, with a maximum of 2.6% improvement in AUROC over local learning. The significant benefit, however, lies in the reduction of variance (a maximum of 86% decrease). The GRU-D model's performance mainly depends on the prediction task's difficulty, especially the case prevalence rate. Whereas the impact of training data and transfer strategy is less crucial, underscoring the challenge of effectively leveraging transfer learning for rare outcomes. While atemporal Logit models show notably superior performance at certain pre-surgical points, their performance fluctuate significantly and generally underperform GRU-D in post-surgical hours. Conclusion GRU-D demonstrated robust transferability across EHR systems and hospital sites with highly sparse real-world EHR data. Further research on built-in explainability for meaningful intervention would be highly valuable for its integration into clinical practice.
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Affiliation(s)
- Xiaoyang Ruan
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston
- Department of Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN, United States
| | - Sunyang Fu
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston
- Department of Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN, United States
| | - Heling Jia
- Department of Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN, United States
| | - Kellie L Mathis
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Patrick M Wilson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Curtis B Storlie
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Hongfang Liu
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston
- Department of Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN, United States
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Wilson PM, Ramar P, Philpot LM, Soleimani J, Ebbert JO, Storlie CB, Morgan AA, Schaeferle GM, Asai SW, Herasevich V, Pickering BW, Tiong IC, Olson EA, Karow JC, Pinevich Y, Strand J. Effect of an Artificial Intelligence Decision Support Tool on Palliative Care Referral in Hospitalized Patients: A Randomized Clinical Trial. J Pain Symptom Manage 2023; 66:24-32. [PMID: 36842541 DOI: 10.1016/j.jpainsymman.2023.02.317] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
CONTEXT Palliative care services are commonly provided to hospitalized patients, but accurately predicting who needs them remains a challenge. OBJECTIVES To assess the effectiveness on clinical outcomes of an artificial intelligence (AI)/machine learning (ML) decision support tool for predicting patient need for palliative care services in the hospital. METHODS The study design was a pragmatic, cluster-randomized, stepped-wedge clinical trial in 12 nursing units at two hospitals over a 15-month period between August 19, 2019, and November 17, 2020. Eligible patients were randomly assigned to either a medical service consultation recommendation triggered by an AI/ML tool predicting the need for palliative care services or usual care. The primary outcome was palliative care consultation note. Secondary outcomes included: hospital readmissions, length of stay, transfer to intensive care and palliative care consultation note by unit. RESULTS A total of 3183 patient hospitalizations were enrolled. Of eligible patients, A total of 2544 patients were randomized to the decision support tool (1212; 48%) and usual care (1332; 52%). Of these, 1717 patients (67%) were retained for analyses. Patients randomized to the intervention had a statistically significant higher incidence rate of palliative care consultation compared to the control group (IRR, 1.44 [95% CI, 1.11-1.92]). Exploratory evidence suggested that the decision support tool group reduced 60-day and 90-day hospital readmissions (OR, 0.75 [95% CI, 0.57, 0.97]) and (OR, 0.72 [95% CI, 0.55-0.93]) respectively. CONCLUSION A decision support tool integrated into palliative care practice and leveraging AI/ML demonstrated an increased palliative care consultation rate among hospitalized patients and reductions in hospitalizations.
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Affiliation(s)
- Patrick M Wilson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA.
| | - Priya Ramar
- Department of Medicine (P.R., L.M.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Lindsey M Philpot
- Department of Medicine (P.R., L.M.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jalal Soleimani
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jon O Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA; Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Curtis B Storlie
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA; Department of Health Sciences Research (C.B.S.), Mayo Clinic, Rochester, Minnesota, USA
| | - Alisha A Morgan
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Gavin M Schaeferle
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA
| | - Shusaku W Asai
- Health Analytics | Global Health and Wellbeing (S.W.A.), Delta Air Lines, Atlanta, Georgia, USA
| | - Vitaly Herasevich
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Brian W Pickering
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Ing C Tiong
- Department of Information Technology (I.C.T.), Mayo Clinic, Rochester, Minnesota, USA
| | - Emily A Olson
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Jordan C Karow
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Yuliya Pinevich
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jacob Strand
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
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Heinzen EP, Wilson PM, Storlie CB, Demuth GO, Asai SW, Schaeferle GM, Bartley MM, Havyer RD. Impact of a machine learning algorithm on time to palliative care in a primary care population: protocol for a stepped-wedge pragmatic randomized trial. BMC Palliat Care 2023; 22:9. [PMID: 36737744 PMCID: PMC9896817 DOI: 10.1186/s12904-022-01113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As primary care populations age, timely identification of palliative care need is becoming increasingly relevant. Previous studies have targeted particular patient populations with life-limiting disease, but few have focused on patients in a primary care setting. Toward this end, we propose a stepped-wedge pragmatic randomized trial whereby a machine learning algorithm identifies patients empaneled to primary care units at Mayo Clinic (Rochester, Minnesota, United States) with high likelihood of palliative care need. METHODS 42 care team units in 9 clusters were randomized to 7 wedges, each lasting 42 days. For care teams in treatment wedges, palliative care specialists review identified patients, making recommendations to primary care providers when appropriate. Care teams in control wedges receive palliative care under the standard of care. DISCUSSION This pragmatic trial therefore integrates machine learning into clinical decision making, instead of simply reporting theoretical predictive performance. Such integration has the possibility to decrease time to palliative care, improving patient quality of life and symptom burden. TRIAL REGISTRATION Clinicaltrials.gov NCT04604457 , restrospectively registered 10/26/2020. PROTOCOL v0.5, dated 9/23/2020.
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Affiliation(s)
- Ethan P. Heinzen
- grid.66875.3a0000 0004 0459 167XRobert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN USA
| | - Patrick M. Wilson
- grid.66875.3a0000 0004 0459 167XRobert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN USA
| | - Curtis B. Storlie
- grid.66875.3a0000 0004 0459 167XRobert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN USA
| | - Gabriel O. Demuth
- grid.66875.3a0000 0004 0459 167XRobert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN USA
| | - Shusaku W. Asai
- grid.66875.3a0000 0004 0459 167XRobert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN USA
| | - Gavin M. Schaeferle
- grid.66875.3a0000 0004 0459 167XRobert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN USA
| | - Mairead M. Bartley
- grid.66875.3a0000 0004 0459 167XCommunity Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Rachel D. Havyer
- grid.66875.3a0000 0004 0459 167XCommunity Internal Medicine, Mayo Clinic, Rochester, MN USA
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Vassilaki M, Aakre JA, Castillo A, Chamberlain AM, Wilson PM, Kremers WK, Mielke MM, Geda YE, Machulda MM, Alhurani RE, Graff-Radford J, Vemuri P, Lowe VJ, Jack CR, Knopman DS, Petersen RC. Association of neighborhood socioeconomic disadvantage and cognitive impairment. Alzheimers Dement 2022; 19:10.1002/alz.12702. [PMID: 35666244 PMCID: PMC9722980 DOI: 10.1002/alz.12702] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/16/2022] [Accepted: 04/28/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We investigated the association of the area deprivation index (ADI) with cognitive decline, mild cognitive impairment (MCI), and dementia in older adults (≥50 years old). ADI is a neighborhood socioeconomic disadvantage measure assessed at the census block group level. METHODS The study included 4699 participants, initially without dementia, with available ADI values for 2015 and at least one study visit in 2008 through 2018. Using logistic regression and Cox proportional hazards models with age as the time scale, we assessed the odds for MCI and the risk for dementia, respectively. RESULTS In cognitively unimpaired (CU) adults at baseline, the risk for progression to dementia increased for every decile increase in the ADI state ranking (hazard ratio = 1.06, 95% confidence interval (1.01-1.11), P = .01). Higher ADI values were associated with subtly faster cognitive decline. DISCUSSION In older CU adults, higher baseline neighborhood socioeconomic deprivation levels were associated with progression to dementia and slightly faster cognitive decline. HIGHLIGHTS The study used area deprivation index, a composite freely available neighborhood deprivation measure. Higher levels of neighborhood deprivation were associated with greater mild cognitive impairment odds. Higher neighborhood deprivation levels were associated with higher dementia risk.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Jeremiah A. Aakre
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Anna Castillo
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Alanna M. Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patrick M. Wilson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Walter K. Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Yonas E. Geda
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Rabe E. Alhurani
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Internal Medicine, West Suburban Medical Center, Oak Park, Illinois
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Fu S, Wen A, Schaeferle GM, Wilson PM, Demuth G, Ruan X, Liu S, Storlie C, Liu H. Assessment of Data Quality Variability across Two EHR Systems through a Case Study of Post-Surgical Complications. AMIA Annu Symp Proc 2022; 2022:196-205. [PMID: 35854735 PMCID: PMC9285181] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Translation of predictive modeling algorithms into routine clinical care workflows faces challenges in the form of varying data quality-related issues caused by the heterogeneity of electronic health record (EHR) systems. To better understand these issues, we retrospectively assessed and compared the variability of data produced from two different EHR systems. We considered three dimensions of data quality in the context of EHR-based predictive modeling for three distinct translational stages: model development (data completeness), model deployment (data variability), and model implementation (data timeliness). The case study was conducted based on predicting post-surgical complications using both structured and unstructured data. Our study discovered a consistent level of data completeness, a high syntactic, and moderate-high semantic variability across two EHR systems, for which the quality of data is context-specific and closely related to the documentation workflow and the functionality of individual EHR systems.
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Affiliation(s)
- Sunyang Fu
- Department of AI and Informatics Research, Mayo Clinic, Rochester, MN, USA
| | - Andrew Wen
- Department of AI and Informatics Research, Mayo Clinic, Rochester, MN, USA
| | - Gavin M Schaeferle
- Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Gabriel Demuth
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Xiaoyang Ruan
- Department of AI and Informatics Research, Mayo Clinic, Rochester, MN, USA
| | - Sijia Liu
- Department of AI and Informatics Research, Mayo Clinic, Rochester, MN, USA
| | - Curtis Storlie
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Department of AI and Informatics Research, Mayo Clinic, Rochester, MN, USA
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Chamberlain AM, St Sauver JL, Finney Rutten LJ, Fan C, Jacobson DJ, Wilson PM, Boyd CM, Rocca WA. Associations of Neighborhood Socioeconomic Disadvantage With Chronic Conditions by Age, Sex, Race, and Ethnicity in a Population-Based Cohort. Mayo Clin Proc 2022; 97:57-67. [PMID: 34996566 PMCID: PMC8775356 DOI: 10.1016/j.mayocp.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine the association of socioeconomic status at the census block group level with chronic conditions and to determine whether the associations differ by age, sex, race, or ethnicity. METHODS Adults aged 20 years and older on April 1, 2015, from 7 counties in southern Minnesota were identified using the Rochester Epidemiology Project records-linkage system. We estimated the prevalence of 19 chronic conditions (7 cardiometabolic, 7 other somatic, and 5 mental health conditions) at the individual level and a composite measure of neighborhood socioeconomic disadvantage (the area deprivation index [ADI]) at the census block group level (n=249). RESULTS Among the 197,578 persons in our study, 46.7% (92,373) were male, 49.5% (97,801) were aged 50 years and older, 12.3% (24,316) were of non-White race, and 5.3% (10,546) were Hispanic. The risk of most chronic conditions increased with increasing ADI. For each cardiometabolic condition and most other somatic and mental health conditions, the pattern of increasing risk across ADI quintiles was attenuated, or there was no association across quintiles of ADI in the oldest age group (aged ≥70 years). Stronger associations between ADI and several cardiometabolic, other somatic, and mental health conditions were observed in women. CONCLUSION Higher ADI was associated with increased risk of most chronic conditions, with more pronounced associations in younger persons. For some chronic conditions, the associations were stronger in women. Our findings underscore the importance of recognizing the overall and potentially differential impact of area-level deprivation on chronic disease outcomes for diverse populations.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Jennifer L St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Lila J Finney Rutten
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Chun Fan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Debra J Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD
| | - Walter A Rocca
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN
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Wilson PM, Philpot LM, Ramar P, Storlie CB, Strand J, Morgan AA, Asai SW, Ebbert JO, Herasevich VD, Soleimani J, Pickering BW. Improving time to palliative care review with predictive modeling in an inpatient adult population: study protocol for a stepped-wedge, pragmatic randomized controlled trial. Trials 2021; 22:635. [PMID: 34530871 PMCID: PMC8444160 DOI: 10.1186/s13063-021-05546-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Palliative care is a medical specialty centered on improving the quality of life (QOL) of patients with complex or life-threatening illnesses. The need for palliative care is increasing and with that the rigorous testing of triage tools that can be used quickly and reliably to identify patients that may benefit from palliative care. Methods To that aim, we will conduct a two-armed stepped-wedge cluster randomized trial rolled out to two inpatient hospitals to evaluate whether a machine learning algorithm accurately identifies patients who may benefit from a comprehensive review by a palliative care specialist and decreases time to receiving a palliative care consult in hospital. This is a single-center study which will be conducted from August 2019 to November 2020 at Saint Mary’s Hospital & Methodist Hospital both within Mayo Clinic Rochester in Minnesota. Clusters will be nursing units which will be chosen to be a mix of complex patients from Cardiology, Critical Care, and Oncology and had previously established relationships with palliative medicine. The stepped wedge design will have 12 units allocated to a design matrix of 5 treatment wedges. Each wedge will last 75 days resulting in a study period of 12 months of recruitment unless otherwise specified. Data will be analyzed with Bayesian hierarchical models with credible intervals denoting statistical significance. Discussion This intervention offers a pragmatic approach to delivering specialty palliative care to hospital patients in need using machine learning, thereby leading to high value care and improved outcomes. It is not enough for AI to be utilized by simply publishing research showing predictive performance; clinical trials demonstrating better outcomes are critically needed. Furthermore, the deployment of an AI algorithm is a complex process that requires multiple teams with varying skill sets. To evaluate a deployed AI, a pragmatic clinical trial can accommodate the difficulties of clinical practice while retaining scientific rigor. Trial registration ClinicalTrials.gov NCT03976297. Registered on 6 June 2019, prior to trial start. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05546-5.
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Affiliation(s)
- Patrick M Wilson
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Lindsey M Philpot
- Department of Quantitative Health Sciences, Mayo Clinic, MN, 55905, Rochester, USA.,Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Priya Ramar
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Curtis B Storlie
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Quantitative Health Sciences, Mayo Clinic, MN, 55905, Rochester, USA
| | - Jacob Strand
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alisha A Morgan
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shusaku W Asai
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jon O Ebbert
- Department of Quantitative Health Sciences, Mayo Clinic, MN, 55905, Rochester, USA
| | | | - Jalal Soleimani
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Brian W Pickering
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, 55905, USA
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Storlie CB, Pollock BD, Rojas RL, Demuth GO, Johnson PW, Wilson PM, Heinzen EP, Liu H, Carter RE, Habermann EB, Kor DJ, Neville MR, Limper AH, Noe KH, Bydon M, Franco PM, Sampathkumar P, Shah ND, Dunlay SM, Dowdy SC. Quantifying the Importance of COVID-19 Vaccination to Our Future Outlook. Mayo Clin Proc 2021; 96:1890-1895. [PMID: 34218862 PMCID: PMC8075811 DOI: 10.1016/j.mayocp.2021.04.012] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022]
Abstract
Predictive models have played a critical role in local, national, and international response to the COVID-19 pandemic. In the United States, health care systems and governmental agencies have relied on several models, such as the Institute for Health Metrics and Evaluation, Youyang Gu (YYG), Massachusetts Institute of Technology, and Centers for Disease Control and Prevention ensemble, to predict short- and long-term trends in disease activity. The Mayo Clinic Bayesian SIR model, recently made publicly available, has informed Mayo Clinic practice leadership at all sites across the United States and has been shared with Minnesota governmental leadership to help inform critical decisions during the past year. One key to the accuracy of the Mayo Clinic model is its ability to adapt to the constantly changing dynamics of the pandemic and uncertainties of human behavior, such as changes in the rate of contact among the population over time and by geographic location and now new virus variants. The Mayo Clinic model can also be used to forecast COVID-19 trends in different hypothetical worlds in which no vaccine is available, vaccinations are no longer being accepted from this point forward, and 75% of the population is already vaccinated. Surveys indicate that half of American adults are hesitant to receive a COVID-19 vaccine, and lack of understanding of the benefits of vaccination is an important barrier to use. The focus of this paper is to illustrate the stark contrast between these 3 scenarios and to demonstrate, mathematically, the benefit of high vaccine uptake on the future course of the pandemic.
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Affiliation(s)
- Curtis B Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | | | - Ricardo L Rojas
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Gabriel O Demuth
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Robert D. Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ethan P Heinzen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Robert D. Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Daryl J Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, MN; Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Medicine, Mayo Clinic, Rochester, MN
| | - Shannon M Dunlay
- Department of Gynecologic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Sean C Dowdy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Murphree DH, Wilson PM, Asai SW, Quest DJ, Lin Y, Mukherjee P, Chhugani N, Strand JJ, Demuth G, Mead D, Wright B, Harrison A, Soleimani J, Herasevich V, Pickering BW, Storlie CB. Improving the delivery of palliative care through predictive modeling and healthcare informatics. J Am Med Inform Assoc 2021; 28:1065-1073. [PMID: 33611523 DOI: 10.1093/jamia/ocaa211] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/10/2020] [Revised: 07/28/2020] [Accepted: 02/16/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Access to palliative care (PC) is important for many patients with uncontrolled symptom burden from serious or complex illness. However, many patients who could benefit from PC do not receive it early enough or at all. We sought to address this problem by building a predictive model into a comprehensive clinical framework with the aims to (i) identify in-hospital patients likely to benefit from a PC consult, and (ii) intervene on such patients by contacting their care team. MATERIALS AND METHODS Electronic health record data for 68 349 inpatient encounters in 2017 at a large hospital were used to train a model to predict the need for PC consult. This model was published as a web service, connected to institutional data pipelines, and consumed by a downstream display application monitored by the PC team. For those patients that the PC team deems appropriate, a team member then contacts the patient's corresponding care team. RESULTS Training performance AUC based on a 20% holdout validation set was 0.90. The most influential variables were previous palliative care, hospital unit, Albumin, Troponin, and metastatic cancer. The model has been successfully integrated into the clinical workflow making real-time predictions on hundreds of patients per day. The model had an "in-production" AUC of 0.91. A clinical trial is currently underway to assess the effect on clinical outcomes. CONCLUSIONS A machine learning model can effectively predict the need for an inpatient PC consult and has been successfully integrated into practice to refer new patients to PC.
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Affiliation(s)
- Dennis H Murphree
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Shusaku W Asai
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Quest
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yaxiong Lin
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nirmal Chhugani
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob J Strand
- Division of Palliative Care, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabriel Demuth
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - David Mead
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Wright
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Harrison
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jalal Soleimani
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vitaly Herasevich
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian W Pickering
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Curtis B Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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10
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Chen D, Jiang J, Fu S, Demuth G, Liu S, Schaeferle GM, Wilson PM, Habermann E, Larson DW, Storlie C, Liu H. Early Detection of Post-Surgical Complications using Time-series Electronic Health Records. AMIA Jt Summits Transl Sci Proc 2021; 2021:152-160. [PMID: 34457129 PMCID: PMC8378618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Models predicting health complications are increasingly attempting to reflect the temporally changing nature of patient status. However, both the practice of medicine and electronic health records (EHR) have yet to provide a true longitudinal representation of a patient's medical history as relevant data is often asynchronous and highly missing. To match the stringent requirements of many static time models, time-series data has to be truncated, and missing values in samples have to be filled heuristically. However, these data preprocessing procedures may unconsciously misinterpret real-world data, and eventually lead into failure in practice. In this work, we proposed an augmented gated recurrent unit (GRU), which formulate both missingness and timeline signals into GRU cells. Real patient data of post-operative bleeding (POB) after Colon and Rectal Surgery (CRS) was collected from Mayo Clinic EHR system to evaluate the effectiveness of proposed model. Conventional models were also trained with imputed dataset, in which event missingness or asynchronicity were approximated. The performance of proposed model surpassed current state-of-the-art methods in this POB detection task, indicating our model could be more eligible to handle EHR datasets.
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Affiliation(s)
| | | | | | | | | | | | | | | | - David W Larson
- Department of Colorectal Surgery, Mayo Clinic, Rochester, MN, USA
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11
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Kurian SJ, Bhatti AUR, Alvi MA, Ting HH, Storlie C, Wilson PM, Shah ND, Liu H, Bydon M. Correlations Between COVID-19 Cases and Google Trends Data in the United States: A State-by-State Analysis. Mayo Clin Proc 2020; 95:2370-2381. [PMID: 33164756 PMCID: PMC7439962 DOI: 10.1016/j.mayocp.2020.08.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/12/2020] [Accepted: 08/14/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate whether a digital surveillance model using Google Trends is feasible for obtaining accurate data on coronavirus disease 2019 and whether accurate predictions can be made regarding new cases. METHODS Data on total and daily new cases in each US state were collected from January 22, 2020, to April 6, 2020. Information regarding 10 keywords was collected from Google Trends, and correlation analyses were performed for individual states as well as for the United States overall. RESULTS Among the 10 keywords analyzed from Google Trends, face mask, Lysol, and COVID stimulus check had the strongest correlations when looking at the United States as a whole, with R values of 0.88, 0.82, and 0.79, respectively. Lag and lead Pearson correlations were assessed for every state and all 10 keywords from 16 days before the first case in each state to 16 days after the first case. Strong correlations were seen up to 16 days prior to the first reported cases in some states. CONCLUSION This study documents the feasibility of syndromic surveillance of internet search terms to monitor new infectious diseases such as coronavirus disease 2019. This information could enable better preparation and planning of health care systems.
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Affiliation(s)
- Shyam J Kurian
- Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN
| | - Atiq Ur Rehman Bhatti
- Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Mohammed Ali Alvi
- Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Henry H Ting
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Curtis Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Mohamad Bydon
- Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
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12
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Chamberlain AM, Finney Rutten LJ, Wilson PM, Fan C, Boyd CM, Jacobson DJ, Rocca WA, St Sauver JL. Correction to: Neighborhood socioeconomic disadvantage is associated with multimorbidity in a geographically-defined community. BMC Public Health 2020; 20:1412. [PMID: 32938434 PMCID: PMC7495881 DOI: 10.1186/s12889-020-09527-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chun Fan
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, 5505 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Walter A Rocca
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jennifer L St Sauver
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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13
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Espinoza Suarez NR, LaVecchia CM, Ponce OJ, Fischer KM, Wilson PM, Kamath CC, LeBlanc A, Montori VM, Brito JP. Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs. Mayo Clin Proc Innov Qual Outcomes 2020; 4:416-423. [PMID: 32793869 PMCID: PMC7411159 DOI: 10.1016/j.mayocpiqo.2020.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To determine how shared decision-making (SDM) tools used during clinical encounters that raise cost as an issue impact the incidence of cost conversations between patients and clinicians. Patients and Methods A randomly selected set of 220 video recordings of clinical encounters were analyzed. Videos were obtained from eight practice-based randomized clinical trials and one quasi-randomized clinical trial (pre- and post-) comparing care with and without SDM tools. The secondary analysis took place in 2018 from trials ran between 2007 and 2015. Results Most patient participants were white (85%), educated (38% completed college), middle-aged (mean age 56 years), and female (61%). There were 105 encounters with and 115 without the SDM tool. Encounters with SDM tools were more likely to include both general cost conversations (62% vs 36%, odds ratio [OR]: 9.6; 95% CI: 4 to 26) as well as conversations on medication costs specifically (89% vs 51%, P=.01). However, clinicians using SDM tools were less likely to address cost issues during the encounter (37% vs 51%, P=.04). Encounters with patients with less than a college degree were also associated with a higher incidence of cost conversations. Conclusion Using SDM tools that raise cost as an issue increased the occurrence of cost conversations but was less likely to address cost issues or offer potential solutions to patients’ cost concerns. This result suggests that SDM tools used during the consultation can trigger cost conversations but are insufficient to support them.
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Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN.,Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Christina M LaVecchia
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN.,School of Arts and Sciences, Neumann University, Aston, PA
| | - Oscar J Ponce
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| | - Karen M Fischer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.,School of Arts and Sciences, Neumann University, Aston, PA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.,School of Arts and Sciences, Neumann University, Aston, PA
| | - Celia C Kamath
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN.,Department of Health Sciences Research, the Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.,Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN.,Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN.,Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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14
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Finney Rutten LJ, Ruddy KJ, Chlan LL, Griffin JM, Herrin J, Leppin AL, Pachman DR, Ridgeway JL, Rahman PA, Storlie CB, Wilson PM, Cheville AL. Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2). Trials 2020; 21:480. [PMID: 32503661 PMCID: PMC7275300 DOI: 10.1186/s13063-020-04335-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/21/2020] [Indexed: 01/01/2023] Open
Abstract
Background The prevalence of inadequate symptom control among cancer patients is quite high despite the availability of definitive care guidelines and accurate and efficient assessment tools. Methods We will conduct a hybrid type 2 stepped wedge pragmatic cluster randomized clinical trial to evaluate a guideline-informed enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) care model. Teams of clinicians at five hospitals that care for patients with various cancers will be randomly assigned in steps to the E2C2 intervention. The E2C2 intervention will have two levels of care: level 1 will offer low-touch, automated self-management support for patients reporting moderate sleep disturbance, pain, anxiety, depression, and energy deficit symptoms or limitations in physical function (or both). Level 2 will offer nurse-managed collaborative care for patients reporting more intense (severe) symptoms or functional limitations (or both). By surveying and interviewing clinical staff, we will also evaluate whether the use of a multifaceted, evidence-based implementation strategy to support adoption and use of the E2C2 technologies improves patient and clinical outcomes. Finally, we will conduct a mixed methods evaluation to identify disparities in the adoption and implementation of the E2C2 intervention among elderly and rural-dwelling patients with cancer. Discussion The E2C2 intervention offers a pragmatic, scalable approach to delivering guideline-based symptom and function management for cancer patients. Since discrete EHR-imbedded algorithms drive defining aspects of the intervention, the approach can be efficiently disseminated and updated by specifying and modifying these centralized EHR algorithms. Trial registration ClinicalTrials.gov, NCT03892967. Registered on 25 March 2019.
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Affiliation(s)
- Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Linda L Chlan
- Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jeph Herrin
- Yale University School of Medicine, New Haven, CT, USA
| | - Aaron L Leppin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | | | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Parvez A Rahman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Curtis B Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Andrea L Cheville
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Community Palliative Medicine, Mayo Clinic, Rochester, MN, USA
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15
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McKie PM, Kor DJ, Cook DA, Kessler ME, Carter RE, Wilson PM, Pencille LJ, Hickey BC, Chaudhry R. Computerized Advisory Decision Support for Cardiovascular Diseases in Primary Care: A Cluster Randomized Trial. Am J Med 2020; 133:750-756.e2. [PMID: 31862329 DOI: 10.1016/j.amjmed.2019.10.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this research was to evaluate the impact of an outpatient computerized advisory clinical decision support system (CDSS) on adherence to guideline-recommended treatment for heart failure, atrial fibrillation, and hyperlipidemia. METHODS Twenty care teams (109 clinicians) in a primary care practice were cluster-randomized to either access or no access to an advisory CDSS integrated into the electronic medical record. For patients with an outpatient visit, the CDSS determined if they had heart failure with reduced ejection fraction, hyperlipidemia, or atrial fibrillation; and if so, was the patient receiving guideline-recommended treatment. In the intervention group, an alert was visible in the medical record if there was a discrepancy between current and guideline-recommended treatment. Clicking the alert displayed the treatment discrepancy and recommended treatment. Outcomes included prescribing patterns, self-reported use of decision aids, and self-reported efficiency. The trial was conducted between May 1 and November 15, 2016, and incorporated 16,310 patient visits. RESULTS The advisory CDSS increased adherence to guideline-recommended treatment for heart failure (odds ratio [OR] 7.6, 95% confidence interval [CI], 1.2, 47.5) but had no impact in atrial fibrillation (OR 0.94, 95% CI 0.15, 5.94) or hyperlipidemia (OR 1.1, 95% CI 0.6, 1.8). Clinicians with access to the CDSS self-reported greater use of risk assessment tools for heart failure (3.6 [1.1] vs 2.7 [1.0], mean [standard deviation] on a 5-point scale) but not for atrial fibrillation or hyperlipidemia. The CDSS did not impact self-assessed efficiency. The overall usage of the CDSS was low (19%). CONCLUSIONS A computerized advisory CDSS improved adherence to guideline-recommended treatment for heart failure but not for atrial fibrillation or hyperlipidemia.
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Affiliation(s)
- Paul M McKie
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
| | - Daryl J Kor
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Department of Anesthesiology, Mayo Clinic, Rochester, Minn
| | - David A Cook
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Maya E Kessler
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Rickey E Carter
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Laurie J Pencille
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minn
| | - Branden C Hickey
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minn
| | - Rajeev Chaudhry
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minn; Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
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16
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Sabiston CM, Pila E, Crocker PRE, Mack DE, Wilson PM, Brunet J, Kowalski KC. Changes in body-related self-conscious emotions over time among youth female athletes. Body Image 2020; 32:24-33. [PMID: 31734408 DOI: 10.1016/j.bodyim.2019.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 01/25/2023]
Abstract
The current study explored change in body-related self-conscious emotions (e.g., shame, guilt, authentic pride, hubristic pride) over three years, and tested body surveillance, age, weight status, years in sport, and competitive status as baseline predictors of change. Adolescent females engaged in organized sport (N = 518 at baseline, Mage = 14.02, SD = 1.38 years) completed a self-report survey once a year for three years (n = 293 and n = 215 in Years 2 and 3, respectively). Based on the unconditional latent growth model, body-related shame and guilt increased over time, and authentic and hubristic pride decreased over time. There was substantial between-person variability in the intercepts for all emotions and slopes for shame, guilt, and hubristic pride. In the conditional parallel process latent growth model, body surveillance predicted shallower change in shame and guilt over time. Female athletes high in body surveillance also reported higher body-related shame and guilt and lower authentic and hubristic pride at baseline. These findings highlight the importance of studying changes in self-conscious emotions over time in sport, and demonstrate that body surveillance may be an important factor to explore in interventions early in development.
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Affiliation(s)
- C M Sabiston
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
| | - E Pila
- School of Kinesiology, Western University, London, Ontario, Canada
| | - P R E Crocker
- School of Kinesiology, University of British Columbia, Vancouver, B.C., Canada
| | - D E Mack
- Department of Kinesiolgy, Brock University, St. Catharines, ON, Canada
| | - P M Wilson
- Department of Kinesiolgy, Brock University, St. Catharines, ON, Canada
| | - J Brunet
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - K C Kowalski
- School of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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17
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Chamberlain AM, Finney Rutten LJ, Wilson PM, Fan C, Boyd CM, Jacobson DJ, Rocca WA, St Sauver JL. Neighborhood socioeconomic disadvantage is associated with multimorbidity in a geographically-defined community. BMC Public Health 2020; 20:13. [PMID: 31906992 PMCID: PMC6945427 DOI: 10.1186/s12889-019-8123-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 09/18/2019] [Accepted: 12/23/2019] [Indexed: 12/02/2022] Open
Abstract
Background Persons with low socioeconomic status may be disproportionately at risk for multimorbidity. Methods Adults aged ≥20 years on 4/1/2015 from 7 counties in Minnesota were identified using the Rochester Epidemiology Project (population-based sample). A composite measure of neighborhood socioeconomic disadvantage, the area deprivation index (ADI), was estimated at the census block group level (n = 251). The prevalence of 21 chronic conditions was obtained to calculate the proportion of persons with multimorbidity (≥2 chronic conditions) and severe multimorbidity (≥5 chronic conditions). Hierarchical logistic regression was used to estimate the association of ADI with multimorbidity and severe multimorbidity using odds ratios (OR). Results Among 198,941 persons (46.7% male, 30.6% aged ≥60 years), the age- and sex-standardized (to the United States 2010 census) median prevalence (Q1, Q3) was 23.4% (21.3%, 25.9%) for multimorbidity and 4.8% (4.0%, 5.7%) for severe multimorbidity. Compared with persons in the lowest quintile of ADI, persons in the highest quintile had a 50% increased risk of multimorbidity (OR 1.50, 95% CI 1.39–1.62) and a 67% increased risk of severe multimorbidity (OR 1.67, 95% CI 1.51–1.86) after adjusting for age, sex, race, and ethnicity. Associations were stronger after further adjustment for individual level of education; persons in the highest quintile had a 78% increased risk of multimorbidity (OR 1.78, 95% CI 1.62–1.96) and a 92% increased risk of severe multimorbidity (OR 1.92, 95% CI 1.72–2.13). There was evidence of interactions between ADI and age, between ADI and sex, and between ADI and education. After age 70 years, no difference in the risk of multimorbidity was observed across quintiles of ADI. The pattern of increasing multimorbidity with increasing ADI was more pronounced in women. Finally, there was less variability across quintiles of ADI for the most highly educated group. Conclusions Higher ADI was associated with increased risk of multimorbidity, and the associations were strengthened after adjustment for individual level of education, suggesting that neighborhood context plays a role in health above and beyond individual measures of socioeconomic status. Furthermore, associations were more pronounced in younger persons and women, highlighting the importance of interventions to prevent chronic conditions in younger women, in particular.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chun Fan
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, 5505 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Walter A Rocca
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jennifer L St Sauver
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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18
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Havyer RD, van Ryn M, Wilson PM, Bangerter LR, Griffin JM. Concordance of Patient and Caregiver Reports on the Quality of Colorectal Cancer Care. J Oncol Pract 2019; 15:e979-e988. [PMID: 31430216 PMCID: PMC6851791 DOI: 10.1200/jop.19.00136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We aimed to better understand how similarly patients with colorectal cancer and caregivers view care quality and to assess factors that may influence concordance. MATERIALS AND METHODS We conducted a secondary analysis of paired patient and caregiver quality ratings of colorectal cancer care in three specific domains: surgery, chemotherapy overall, and chemotherapy nursing. Agreement was assessed with difference scores, concordance with Gwet second-order agreement statistics (AC2), and variation in agreement with stratified analyses. We examined whether the care experiences of patients and caregivers were associated with top-box (most-positive) ratings and examined variations in concordance on the basis of the presence of a top-box score. RESULTS Four hundred seventeen patient-caregiver dyads completed the surveys. Quality-of-care ratings were positively skewed, with most dyads indicating top-box ratings. Patient and caregiver care experiences were highly associated with top-box ratings. Overall patient-caregiver concordance was very high for all three care domains (surgery: AC2, 0.87 [95% CI, 0.83 to 0.90]; chemotherapy overall: AC2, 0.84 [95% CI, 0.79 to 0.88]; chemotherapy nursing: AC2, 0.91 [95% CI, 0.87 to 0.94]). Stratified analyses of patient and caregiver characteristics did not identify any patterns that consistently affected concordance. The concordance statistic significantly decreased for all three outcomes (P < .001), however, when the patient or caregiver assessed quality as anything other than top box. CONCLUSION Caregiver and patient reports on care quality were highly concordant for top-box care and did not vary with patient or caregiver factors. Additional exploration is needed to identify reasons for increased variability when the quality scores were less than a top-box response.
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Chamberlain AM, Rutten LJF, Jacobson DJ, Fan C, Wilson PM, Rocca WA, Roger VL, St Sauver JL. Multimorbidity, functional limitations, and outcomes: Interactions in a population-based cohort of older adults. J Comorb 2019; 9:2235042X19873486. [PMID: 31523633 PMCID: PMC6734596 DOI: 10.1177/2235042x19873486] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/20/2022]
Abstract
Objective: To understand the interaction of multimorbidity and functional limitations in
determining health-care utilization and survival in older adults. Methods: Olmsted County, Minnesota, residents aged 60–89 years in 2005 were categorized into
four cohorts based on the presence or absence of multimorbidity (≥3 chronic conditions
from a list of 18) and functional limitations (≥1 limitation in an activity of daily
living from a list of 9), and were followed through December 31, 2016. Andersen–Gill and
Cox regression estimated hazard ratios (HRs) for emergency department (ED) visits,
hospitalizations, and death using persons with neither multimorbidity nor functional
limitations as the reference (interaction analyses). Results: Among 13,145 persons, 34% had neither multimorbidity nor functional limitations, 44%
had multimorbidity only, 4% had functional limitations only, and 18% had both. Over a
median follow-up of 11 years, 5906 ED visits, 2654 hospitalizations, and 4559 deaths
occurred. Synergistic interactions on an additive scale of multimorbidity and functional
limitations were observed for all outcomes; however, the magnitude of the interactions
decreased with advancing age. The HR (95% confidence interval) for death among persons
with both multimorbidity and functional limitations was 5.34 (4.40–6.47) at age 60–69,
4.16 (3.59–4.83) at age 70–79, and 2.86 (2.45–3.35) at age 80–89 years. Conclusion: The risk of ED visits, hospitalizations, and death among persons with both
multimorbidity and functional limitations is greater than additive. The magnitude of the
interaction was strongest for the youngest age group, highlighting the importance of
interventions to prevent and effectively manage multimorbidity and functional
limitations early in life.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Chun Fan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Walter A Rocca
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L St Sauver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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20
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MacLaughlin KL, Jacobson RM, Radecki Breitkopf C, Wilson PM, Jacobson DJ, Fan C, St Sauver JL, Rutten LJF. Trends Over Time in Pap and Pap-HPV Cotesting for Cervical Cancer Screening. J Womens Health (Larchmt) 2019; 28:244-249. [PMID: 30614380 DOI: 10.1089/jwh.2018.7380] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2012, updated cervical cancer screening recommendations were released with consensus on Papanicolaou (Pap) testing every 3 years for women age 21-65 years or Pap-human papillomavirus (HPV) cotesting at 5-year intervals for women age 30-65 years. Primary study aims: Assess current use of Pap-HPV cotesting and describe local population trends over time in Pap and Pap-HPV cotesting. Secondary aim: Assess sociodemographic factors correlating with screening. METHODS We assessed Rochester Epidemiology Project data for Pap and Pap-HPV cotesting among women age 16 years and older living in Olmsted County, Minnesota, yearly from 2005 (study population n = 47,203) through 2016 (study population n = 49,510). We calculated 3-year (Pap) and 5-year (Pap-HPV) moving prevalence rates of screening as proportion of eligible population. Multivariable logistic regression was used to assess factors potentially associated with screening. RESULTS In 2016, 64.6% of 27,418 eligible 30- to 65-year-old women were up to date with cervical cancer screening; 60.8% had received Pap-HPV cotest screening. Significant declines in Pap completion rates over time were observed in all age groups, including an unexpected decline in 21- to 29-year-old women. Coincident with decreasing Pap screening rates, Pap-HPV cotesting significantly increased among women age 30-65 years, from 10.0% in 2007 to 60.8% in 2016. CONCLUSIONS This suggests increasing adoption of 2012 screening recommendations in the 30- to 65-year-old population. However, decline in Pap screening among 21- to 29-year-old women is concerning. Disparities by race, ethnicity, smoking status, and comorbidity level were observed. Results suggest need for multilevel patient and clinician interventions to increase cervical cancer screening adherence.
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Affiliation(s)
| | - Robert M Jacobson
- 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,3 Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Patrick M Wilson
- 4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Debra J Jacobson
- 4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Chun Fan
- 4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L St Sauver
- 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Lila J Finney Rutten
- 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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21
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DeJesus RS, Clark MM, Rutten LJF, Hathaway JC, Wilson PM, Link SM, Sauver JS. Wellness Coaching to Improve Lifestyle Behaviors Among Adults With Prediabetes: Patients' Experience and Perceptions to Participation. J Patient Exp 2018; 5:314-319. [PMID: 30574554 PMCID: PMC6295805 DOI: 10.1177/2374373518769118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 12/25/2022] Open
Abstract
Background: Health and Wellness Coaching has been shown to enhance treatment outcomes in the primary care setting. However, little is known about the experience and perceptions of patients who worked with a wellness coach as an integrated member of their primary health-care team. Objective: This project assessed patients’ experience and obtained their perceptions on barriers and facilitators to participation in a primary care–based wellness coaching program. Method: A survey was mailed to 99 primary care patients with prediabetes who participated in a 12-week wellness coaching program. Results: Sixty-two (63%) completed the survey; responders felt that participation in the wellness coaching program helped move them toward healthier lifestyle behavior and created a personal vision of wellness. Major themes associated with participation were supportive coaching relationship, increased self-accountability, increased goal-setting, and healthy behavior strategies. No significant barrier to participation was reported. Conclusion: Participants reported highly positive experience with the program; how to best integrate health and wellness coaching into the primary care setting needs to be explored.
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Affiliation(s)
- Ramona S DeJesus
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Lila J Finney Rutten
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Julie C Hathaway
- Office of Patient Education and Consulting Services, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sara M Link
- Dan Abrahams Healthy Living Center, Mayo Clinic, Rochester, MN, USA
| | - Jennifer St Sauver
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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22
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Buckley BJR, Thijssen DHJ, Murphy RC, Graves LEF, Whyte G, Gillison FB, Crone D, Wilson PM, Watson PM. Making a move in exercise referral: co-development of a physical activity referral scheme. J Public Health (Oxf) 2018; 40:e586-e593. [DOI: 10.1093/pubmed/fdy072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/09/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- B J R Buckley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - D H J Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen GA, Netherlands
| | - R C Murphy
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - L E F Graves
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - G Whyte
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - F B Gillison
- Department for Health, University of Bath, Bath, UK
| | - D Crone
- School of Health and Social Care, University of Gloucestershire, Gloucester, UK
| | - P M Wilson
- Behavioural Health Sciences Research Lab, Department of Kinesiology, Brock University, Ontario, Canada
| | - P M Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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23
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Meyer AF, Borkovskiy NL, Brickley JL, Chaudhry R, Franqueira A, Furst JW, Hinsch DM, McDonah MR, Myers JF, Petersen RE, Finney Rutten LJ, Wilson PM, Jacobson RM. Impact of Electronic Point-of-Care Prompts on Human Papillomavirus Vaccine Uptake in Retail Clinics. Am J Prev Med 2018; 55:822-829. [PMID: 30344033 PMCID: PMC6347479 DOI: 10.1016/j.amepre.2018.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/30/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination rates nationally are low. This study determined if an electronic point-of-care prompt in the retail clinic setting increases HPV vaccination rates among an eligible population. STUDY DESIGN An interrupted time series assessed change in weekly HPV vaccination rates with the introduction of an electronic point-of-care prompt and rate change in post-intervention period. SETTING/PARTICIPANTS The study sites were two similar retail care clinics in Rochester, Minnesota. Participants were patients who presented to the retail clinics setting between the ages of 9 and 26 years from September 12, 2016, to September 30, 2017. INTERVENTION HPV vaccine (nonavalent) was made available at both retail clinics. Staff completed a 2-hour lecture on HPV vaccine and one-on-one training for use of the prompt. Pre- and post-intervention rates of HPV vaccination after initiation of electronic point-of-care prompt were measured. A satisfaction survey was given to all patients or parents/guardians between the ages of 9 and 26 years regardless of HPV vaccine status. MAIN OUTCOME MEASURES HPV vaccination rates per week before and after the introduction of the electronic point-of-care prompt along with satisfaction with HPV vaccine availability and the point-of-care prompt in the retail clinic setting. Data analysis was completed January 2018. RESULTS The point-of-care prompt increased the median weekly HPV vaccination rate by 8.6 per 100 patient visits (95% CI=5.8, 11.5, p<0.001). Patients thought it was convenient having HPV vaccine available and helpful to be reminded of the need for HPV vaccine. CONCLUSIONS This study demonstrates a significant increase of HPV vaccine rates in the retail clinic setting with use of a point-of-care prompt.
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Affiliation(s)
- Amanda F Meyer
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota.
| | | | - Jennifer L Brickley
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajeev Chaudhry
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew Franqueira
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Joseph W Furst
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Donna M Hinsch
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Jane F Myers
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Randi E Petersen
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, Rochester, Minnesota
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, Rochester, Minnesota
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, Rochester, Minnesota
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24
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Finney Rutten LJ, Radecki Breitkopf C, St Sauver JL, Croghan IT, Jacobson DJ, Wilson PM, Herrin J, Jacobson RM. Evaluating the impact of multilevel evidence-based implementation strategies to enhance provider recommendation on human papillomavirus vaccination rates among an empaneled primary care patient population: a study protocol for a stepped-wedge cluster randomized trial. Implement Sci 2018; 13:96. [PMID: 30001723 PMCID: PMC6043954 DOI: 10.1186/s13012-018-0778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Each year, human papillomavirus (HPV) causes 30,000 cancers in the USA despite the availability of effective and safe vaccines. Uptake of HPV vaccine has been low and lags behind other adolescent vaccines. This protocol describes a multilevel intervention to improve HPV vaccination rates. Methods Using a cluster randomized trial, we will evaluate the independent and combined impact of two evidence-based implementation strategies with innovative enhancements on HPV vaccination rates for female and male patients. The clusters are six primary care sites providing care to pediatric populations. We will use a stepped-wedge cluster randomized design, including process evaluation, to test the hypothesis that compared with the current course of care and a practice-level intervention using reminder-recall interventions coupled with provider-level audit and feedback with education increases HPV vaccination rates in exposed clusters. The factorial design allows us to use a single trial to test these two interventions and to assess each individually and in combination. Our design has four 12-month steps. The first step will be a baseline period; data collected during it will provide a within-practice control group for each cluster. Second, two clusters will be randomly assigned to receive intervention 1 (reminder and recall), and two clusters will be randomly selected to receive intervention 2 (audit and feedback with education). Third, the other two clusters will be randomly allocated to intervention 1 or 2. Clusters initially with intervention 1 will be randomly allocated to 1 + 2 or 1; clusters initially with intervention 2 will be randomly allocated to 1 + 2 or 2. Fourth, all clusters will receive both interventions. To ensure balance of patient numbers across interventions, we will use block randomization at the first step, with the six clusters grouped into three pairs according to volume. Our primary outcome will be vaccination rates. Discussion Results of our clinical trial and process evaluation will provide evidence showing whether practice- and provider-level interventions improve HPV vaccination rates and will offer insight into contextual factors associated with direction and magnitude of trial outcomes. Trial registration ClinicalTrials.gov, NCT03501992, registered April 18, 2018. Electronic supplementary material The online version of this article (10.1186/s13012-018-0778-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lila J Finney Rutten
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | | | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Ivana T Croghan
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.,Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Robert M Jacobson
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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25
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Rocca WA, Grossardt BR, Brue SM, Bock-Goodner CM, Chamberlain AM, Wilson PM, Finney Rutten LJ, St Sauver JL. Data Resource Profile: Expansion of the Rochester Epidemiology Project medical records-linkage system (E-REP). Int J Epidemiol 2018; 47:368-368j. [PMID: 29346555 PMCID: PMC5913632 DOI: 10.1093/ije/dyx268] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/23/2017] [Accepted: 12/12/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Walter A Rocca
- Division of Epidemiology, Department of Health Sciences Research
- Department of Neurology
- Women’s Health Research Center
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
| | | | | | - Alanna M Chamberlain
- Division of Epidemiology, Department of Health Sciences Research
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery
| | - Lila J Finney Rutten
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Health Sciences Research
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery
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26
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DeJesus RS, Clark MM, Finney Rutten LJ, Jacobson RM, Croghan IT, Wilson PM, Jacobson DJ, Link SM, Fan C, St Sauver JL. Impact of a 12-week wellness coaching on self-care behaviors among primary care adult patients with prediabetes. Prev Med Rep 2018; 10:100-105. [PMID: 29850394 PMCID: PMC5966585 DOI: 10.1016/j.pmedr.2018.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/13/2018] [Accepted: 02/18/2018] [Indexed: 12/25/2022] Open
Abstract
This single arm prospective study assessed the impact of individualized wellness coaching intervention for primary care patients with prediabetes on self-reported changes in physical activity level and food choices. Five hundred sixty adult patients 18 years and older with prediabetes, seen in primary care clinic, were invited to participate in 12 weeks wellness coaching sessions delivered by certified coaches. Responses from questionnaires at baseline, 6 and 12 weeks were analyzed. Of 168 consented patients, 99 completed at least one coaching session; majority was elderly, female, overweight or obese. At baseline, 50% had <60 min aerobic exercise/week. At 6 and 12 weeks, average aerobic exercise time significantly increased from 117 min to 166 and 199 min respectively. Effect was sustained at 24 weeks. Success in making healthy eating choices also statistically improved from baseline. Significant effects on both activity level and eating behavior persisted even after adjusting for age, sex and baseline glucose/A1c values. Secondary outcomes of self-efficacy and quality of life likewise showed significant improvement. Results suggest that integration of wellness coaching in primary care practice among individuals at high risk for diabetes is feasible and may be useful as part of diabetes prevention management strategies in target populations. Future randomized clinical trials are needed to further explore this issue. Wellness coaching alone as an effective preventive strategy in patients with prediabetes is proposed. It can be incorporated in primary care practice. A 12 weeks session resulted in improved physical activity and healthy eating behavior. Self-efficacy and quality of life were also increased with coaching. Significant changes were seen in 6 weeks with sustained effect up to 24 weeks.
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Affiliation(s)
- Ramona S DeJesus
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Lila J Finney Rutten
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Robert M Jacobson
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Community Pediatrics and Adolescent Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ivana T Croghan
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.,Nicotine Research Program, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sara M Link
- Dan Abrahams Healthy Living Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jennifer L St Sauver
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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27
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Mack DE, Wilson PM, Santos E, Brooks K. Standards of reporting: the use of CONSORT PRO and CERT in individuals living with osteoporosis. Osteoporos Int 2018; 29:305-313. [PMID: 28971256 DOI: 10.1007/s00198-017-4249-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/14/2017] [Accepted: 09/26/2017] [Indexed: 12/29/2022]
Abstract
The Consolidated Standards of Reporting Trials for Patient-Reported Outcomes (CONSORT PRO) and the Consensus on Exercise Reporting Template (CERT) have been developed to improve the quality and transparency of reporting standards in scientific research. The purpose of this study was to provide evidence for the adoption of CONSORT PRO and CERT by researchers examining the link between exercise and quality of life in individuals living with osteoporosis. A systematic search was conducted to identify randomized control trials published in English evaluating exercise interventions on quality of life in individuals living with osteoporosis. Reporting standards were assessed using CONSORT PRO and CERT. A total of 127 studies were identified with 23 meeting inclusion criteria. "Good" evidence for eight (42.1%) CONSORT PRO and two (12.5%) CERT items was found. Adherence to CONSORT PRO was not related to the year of publication, journal impact factor, or study quality. Adherence to CONSORT PRO and CERT reporting standards is inadequate in the literature examining exercise interventions on quality of life in individuals living with osteoporosis. Sufficient reporting is paramount to knowledge translation, interpretation by interventionists, and clinician confidence in understanding if (and how) exercise is associated with quality of life outcomes in this cohort. Concerns associated with failure to include this information are highlighted.
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Affiliation(s)
- D E Mack
- Behavioural Health Sciences Research Lab, Centre for Bone and Muscle Health, Department of Kinesiology, Brock University, 287 Walker Complex, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada.
| | - P M Wilson
- Behavioural Health Sciences Research Lab, Centre for Bone and Muscle Health, Department of Kinesiology, Brock University, 287 Walker Complex, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - E Santos
- Behavioural Health Sciences Research Lab, Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - K Brooks
- Behavioural Health Sciences Research Lab, Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
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Njeru JW, Damodaran S, North F, Jacobson DJ, Wilson PM, St Sauver JL, Radecki Breitkopf C, Wieland ML. Telephone triage utilization among patients with limited English proficiency. BMC Health Serv Res 2017; 17:706. [PMID: 29121920 PMCID: PMC5679138 DOI: 10.1186/s12913-017-2651-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Communication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored. The purpose of this study was to determine the utilization characteristics of a primary care triage call center by patients with LEP. METHODS This was a retrospective cohort study of the utilization of a computer-aided, nurse-led telephone triage system by English proficiency status of patients empaneled to a large primary care practice network in the Midwest United States. Interpreter Services (IS) need was used as a proxy for LEP. RESULTS Call volumes between the 587 adult patients with LEP and an age-frequency matched cohort of English-Proficient (EP) patients were similar. Calls from patients with LEP were longer and more often made by a surrogate. Patients with LEP received recommendations for higher acuity care more frequently (49.4% versus 39.0%; P < 0.0004), and disagreed with recommendations more frequently (30.1% versus 20.9%; P = 0.0004). These associations remained after adjustment for comorbidities. Patients with LEP were also less likely to follow recommendations (60.9% versus 69.4%; P = 0.0029), even after adjusting for confounders (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI], 0.49, 0.85; P < 0.001). CONCLUSION Patients with LEP who utilized a computer-aided, nurse-led telephone triage system were more likely to receive recommendations for higher acuity care compared to EP patients. They were also less likely to agree with, or follow, recommendations given. Additional research is needed to better understand how telephone triage can better serve patients with LEP.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Swathi Damodaran
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Frederick North
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - Jennifer L St Sauver
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | | | - Mark L Wieland
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Finney Rutten LJ, St Sauver JL, Beebe TJ, Wilson PM, Jacobson DJ, Fan C, Breitkopf CR, Vadaparampil ST, MacLaughlin KL, Jacobson RM. Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children. Vaccine 2017; 35:6122-6128. [PMID: 28958810 DOI: 10.1016/j.vaccine.2017.09.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 05/25/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE We tested the hypotheses that consistency and strength of clinician recommendation of the human papillomavirus (HPV) vaccination would be associated with vaccine delivery rates. METHODS From October 2015 through January 2016, we conducted a survey of primary care clinicians (n=227) in Southeastern Minnesota to evaluate clinician behaviors regarding HPV vaccination. The survey response rate was 41.0% (51 clinical sites). We used the Rochester Epidemiology Project, a clinical data linkage infrastructure, to ascertain clinical site-level HPV vaccination rates. We examined associations of clinician self-reports of both the consistency and strength of their recommendations for HPV vaccination for patients aged 11-12years (n=14,406) with site-level vaccination rates. RESULTS The majority of clinicians reported consistently (always or usually) recommending the HPV vaccine to females (79.0%) and to males (62.2%); 71.9% of clinicians reported strongly recommending the vaccine to females while 58.6% reported strongly recommending to males. Consistency and strength of recommending the HPV vaccine was significantly higher among those practicing in pediatrics and board certified in pediatrics compared to family medicine. Higher rates of initiation (1 dose) [Incidence Rate Ratio (IRR)=1.05; 95% CI (1.01-1.09)] and completion (3 doses) [IRR=1.08; 95% CI (1.02-1.13)] were observed among clinical sites where, on average, clinicians more frequently reported always or usually recommending the vaccine for females compared to sites where, on average, clinicians reported recommending the vaccine less frequently. Similarly, higher rates of initiation [IRR=1.03; 95% CI (1.00-1.06)] and completion [IRR=1.04; CI (1.00, 1.08)] were observed among sites where clinicians reported strongly recommending the vaccine to females more frequently compared to sites where, on average, clinicians reported strongly recommending the HPV vaccine less frequently; similar associations were observed for male initiation [IRR=1.05; CI (1.02,1.08)] and completion [IRR=1.05; 95% CI (1.01, 1.09)]. CONCLUSIONS Consistency and strength of HPV vaccination recommendation was associated with higher vaccination rates.
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Affiliation(s)
- Lila J Finney Rutten
- Robert D. and Patricia E. Center for the Science of Health Care Delivery, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Robert D. and Patricia E. Center for the Science of Health Care Delivery, Departments of Health Sciences Research and Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Jennifer L St Sauver
- Robert D. and Patricia E. Center for the Science of Health Care Delivery, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Timothy J Beebe
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Mayo Building A302, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - Patrick M Wilson
- Robert D. and Patricia E. Center for the Science of Health Care Delivery, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Debra J Jacobson
- Robert D. and Patricia E. Center for the Science of Health Care Delivery, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Chun Fan
- Robert D. and Patricia E. Center for the Science of Health Care Delivery, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Carmen Radecki Breitkopf
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
| | - Kathy L MacLaughlin
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Robert M Jacobson
- Robert D. and Patricia E. Center for the Science of Health Care Delivery, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Robert D. and Patricia E. Center for the Science of Health Care Delivery, Departments of Health Sciences Research and Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
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Tan EM, Njeru JW, Jacobson DJ, Wilson PM, Fan C, Marcelin JR, Springer DJ, Wieland ML, Sia IG. Pre-travel Health Care Utilization Among Travelers Who Visit Friends and Relatives. Int J Travel Med Glob Health 2017. [DOI: 10.15171/ijtmgh.2017.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Finney Rutten LJ, Jacobson RM, Wilson PM, Jacobson DJ, Fan C, Kisiel JB, Sweetser S, Tulledge-Scheitel SM, St Sauver JL. Early Adoption of a Multitarget Stool DNA Test for Colorectal Cancer Screening. Mayo Clin Proc 2017; 92:726-733. [PMID: 28473037 PMCID: PMC5505626 DOI: 10.1016/j.mayocp.2017.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/01/2016] [Revised: 12/14/2016] [Accepted: 01/09/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To characterize early adoption of a novel multitarget stool DNA (MT-sDNA) screening test for colorectal cancer (CRC) screening and to test the hypothesis that adoption differs by demographic characteristics and prior CRC screening behavior and proceeds predictably over time. PATIENTS AND METHODS We used the Rochester Epidemiology Project research infrastructure to assess the use of the MT-sDNA screening test in adults aged 50 to 75 years living in Olmsted County, Minnesota, in 2014 and identified 27,147 individuals eligible or due for screening colonoscopy from November 1, 2014, through November 30, 2015. We used electronic Current Procedure Terminology and Health Care Common Procedure codes to evaluate early adoption of the MT-sDNA screening test in this population and to test whether early adoption varies by age, sex, race, and prior CRC screening behavior. RESULTS Overall, 2193 (8.1%) and 974 (3.6%) individuals were screened by colonoscopy and MT-sDNA, respectively. Age, sex, race, and prior CRC screening behavior were significantly and independently associated with MT-sDNA screening use compared with colonoscopy use after adjustment for all other variables (P<.05 for all). The rates of adoption of MT-sDNA screening increased over time and were highest in those aged 50 to 54 years, women, whites, and those who had a history of screening. The use of the MT-sDNA screening test varied predictably by insurance coverage. The rates of colonoscopy decreased over time, whereas overall CRC screening rates remained steady. CONCLUSION The results of the present study are generally consistent with predictions derived from prior research and the diffusion of innovation framework, pointing to increasing use of the new screening test over time and early adoption by younger patients, women, whites, and those with prior CRC screening.
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Affiliation(s)
- Lila J Finney Rutten
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | - Robert M Jacobson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Patrick M Wilson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Debra J Jacobson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Chun Fan
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John B Kisiel
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Jennifer L St Sauver
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Finney Rutten LJ, Wilson PM, Jacobson DJ, Agunwamba AA, Radecki Breitkopf C, Jacobson RM, St Sauver JL. A Population-Based Study of Sociodemographic and Geographic Variation in HPV Vaccination. Cancer Epidemiol Biomarkers Prev 2017; 26:533-540. [PMID: 28196849 PMCID: PMC5405772 DOI: 10.1158/1055-9965.epi-16-0877] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 11/03/2016] [Revised: 01/26/2017] [Accepted: 02/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Human papillomavirus (HPV) vaccination rates in the United States remain low and lag behind other recommended adolescent vaccines. Studies evaluating the association of geographic and area-level characteristics with HPV vaccination rates provide a valuable resource for public health planning.Method: We used the Rochester Epidemiology Project data linkage system to ascertain HPV vaccination rates between 2010 and 2015 in a 7-county region of southern Minnesota. Geocoded individual patient data were spatially linked to socioeconomic data from the American Community Survey at the census block group level. Bayesian hierarchical logistic regression was used to model incident vaccination rates, adjusting for individual- and area-level sociodemographic characteristics, and geolocation. Geolocation was modeled as an approximated Gaussian field using a Stochastic Partial Differential Equations approach. All models were estimated using Integrated Nested Laplace Approximations.Results: In adjusted models, increasing age and female sex were associated with increased HPV vaccination. Lower socioeconomic status was associated with decreased rates of initiation [adjusted odds ratio (AOR); 95% confidence interval = 0.90 (0.86-0.95)], completion of the second dose [AOR = 0.88 (0.83-0.93)], and completion of the third dose [AOR = 0.85 (0.80-0.92)]. Geographic spatial analysis demonstrated increased odds of vaccination for the eastern region and in the greater Rochester metropolitan area, showing significant spatial variation not explained by individual level characteristics and ACS block group-level data.Conclusions: HPV vaccination rates varied geographically and by individual and geographically indexed sociodemographic characteristics.Impact: Identifying geographic regions with low HPV vaccination rates can help target clinical and community efforts to improve vaccination rates. Cancer Epidemiol Biomarkers Prev; 26(4); 533-40. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."
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Affiliation(s)
- Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Debra J Jacobson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Robert M Jacobson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Gentile N, Cristiani V, Lynch BA, Wilson PM, Weaver AL, Rutten LJ, Jacobson DJ, Chaudhry R, Sriram S, Kumar S. The effect of an automated point of care tool on diagnosis and management of childhood obesity in primary care. J Eval Clin Pract 2016; 22:958-964. [PMID: 27282887 DOI: 10.1111/jep.12572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/29/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Childhood obesity is underdiagnosed in primary care practices. Our study aimed to compare rates of documentation of diagnosis of obesity and counselling for nutrition and physical activity at an academic primary care practice prior to and following implementation of a body mass index (BMI)-based electronic point of care clinical reminder tool. METHODS We performed a retrospective record review of children aged 2-18 years undergoing well child visits during any of three calendar years (2009, 2011 and 2013). The electronic clinical reminder tool was implemented in September 2010. Records of children with BMI > 95th percentile were electronically searched for terms of documentation of diagnosis of obesity and nutrition and physical activity counselling. Multivariable logistic regression models were used to adjust for potential patient and provider confounders. RESULTS Among those with BMI ≥ 95th percentile, there was a statistically significant increase in documentation of diagnosis of obesity (45.5% in 2009 vs. 52.4% in 2011; P < 0.001; adjusted odds ratio 1.36; 95% CI 1.13-1.65) and in counselling for physical activity and nutrition (66.8% in 2009 vs. 75.2% in 2011; P < 0.001; adjusted odds ratio 1.33; 95% CI 1.06-1.66) following implementation of the tool. Compared with 2011, there was no statistically significant increase in documentation of obesity (50.4%) or nutrition and physical activity counselling (77.9%) in 2013. CONCLUSIONS The implementation of a point of care clinical reminder tool was associated with improvement in documentation of diagnosis of obesity and counselling for nutrition and physical activity. Further studies are needed to determine the impact of these automated tools on weight outcomes in children.
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Affiliation(s)
- Natalie Gentile
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Valeria Cristiani
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian A Lynch
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lila J Rutten
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Rajeev Chaudhry
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Swetha Sriram
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
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Havyer RD, van Ryn M, Wilson PM, Griffin JM. The effect of routine training on the self-efficacy of informal caregivers of colorectal cancer patients. Support Care Cancer 2016; 25:1071-1077. [PMID: 27889827 DOI: 10.1007/s00520-016-3494-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 07/21/2016] [Accepted: 11/11/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Little is known about the degree to which caregiver training as part of routine clinical care influences caregiver self-efficacy. The objective of this study was to examine the relationship between training during routine clinical cancer care and self-efficacy among caregivers of colorectal cancer patients. METHODS Caregivers completed a self-administered questionnaire about their experiences with training for specific patient problems and about their task-specific and general caregiving self-efficacy. Associations between training and self-efficacy were examined for each problem using multivariate logistic regression adjusted for caregiver age, race, care burden, education, perception of patient's health, and patient stage of disease. RESULTS Four hundred seventeen caregivers completed the survey (70% response rate), of whom 374 (90%) were female and 284 (68%) were the patient's spouse/partner. Overall, 77 (38%) reported inadequate training for pain, 80 (38%) for bowel, 121 (48%) for fatigue, 65 (26%) for medication administration, and 101 (40%) for other symptoms. The odds of having low self-efficacy were significantly higher among those with perceptions of inadequate training across the following cancer-related problems: pain 10.10 (3.36, 30.39), bowel 5.04 (1.98, 12.82), fatigue 8.45 (3.22, 22.15), managing medications 9.00 (3.30, 24.51), and other 3.87 (1.68, 8.93). CONCLUSIONS Caregivers commonly report inadequate training in routine colorectal cancer care. Significant and consistent associations between training adequacy and self-efficacy were found. This study supports the value of training caregivers in common cancer symptoms. Further work on how and when to provide caregiver training to best impact self-efficacy is needed.
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Affiliation(s)
- Rachel D Havyer
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Michelle van Ryn
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Joan M Griffin
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Rutten LJF, St Sauver JL, Beebe TJ, Wilson PM, Jacobson DJ, Fan C, Breitkopf CR, Vadaparampil ST, Jacobson RM. Clinician knowledge, clinician barriers, and perceived parental barriers regarding human papillomavirus vaccination: Association with initiation and completion rates. Vaccine 2016; 35:164-169. [PMID: 27887795 DOI: 10.1016/j.vaccine.2016.11.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 09/14/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We tested the hypothesis that clinician knowledge, clinician barriers, and perceived parental barriers relevant to the human papillomavirus (HPV) vaccination account for the variation in vaccine delivery at the practice-site level. METHODS We conducted a survey from October 2015 through January 2016 among primary care clinicians (n=280) in a 27-county geographic region to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination. Primary care clinicians included family medicine physicians, general pediatricians, and family and pediatric nurse-practitioners. We also used the Rochester Epidemiology Project to measure HPV vaccination delivery. Specifically we used administrative data to measure receipt of at least one valid HPV vaccine dose (initiation) and receipt of three valid HPV vaccine doses (completion) among 9-18year old patients residing in the same 27-county geographic region. We assessed associations of clinician survey data with variation in vaccine delivery at the clinical site using administrative data on patients aged 9-18years (n=68,272). RESULTS Consistent with our hypothesis, we found that greater knowledge of HPV and the HPV vaccination was associated with higher rates of HPV vaccination initiation (Incidence rate ratio [IRR]=1.05) and completion of three doses (IRR=1.28). We also found support for the hypothesis that greater perceived parental barriers to the HPV vaccination were associated with lower rates of initiation (IRR=0.94) and completion (IRR=0.90). These IRRs were statistically significant even after adjustment for site-level characteristics including percent white, percent female, percent ages 9-13, and percent with government insurance or self-pay at each site. CONCLUSIONS Clinician knowledge and their report of the frequency of experiencing parental barriers are associated with HPV vaccine delivery rates-initiation and completion. Higher measures of knowledge correlated with higher rates. Fewer perceived occurrences of parental barriers correlated with lower rates. These data can guide efforts to improve HPV vaccine delivery in clinical settings.
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Affiliation(s)
- Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Timothy J Beebe
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Mayo Building A302, 420 Delaware Street SE, Minneapolis, MN 55455, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Debra J Jacobson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Chun Fan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Carmen Radecki Breitkopf
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
| | - Robert M Jacobson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
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Radecki Breitkopf C, Finney Rutten LJ, Findley V, Jacobson DJ, Wilson PM, Albertie M, Jacobson RM, Colón-Otero G. Awareness and knowledge of Human Papillomavirus (HPV), HPV-related cancers, and HPV vaccines in an uninsured adult clinic population. Cancer Med 2016; 5:3346-3352. [PMID: 27748078 PMCID: PMC5119989 DOI: 10.1002/cam4.933] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/26/2016] [Accepted: 09/09/2016] [Indexed: 12/31/2022] Open
Abstract
Human papillomavirus (HPV) vaccines offer primary prevention of cervical cancer and protection against other HPV‐associated cancers. HPV vaccine coverage in the United States (U.S.) remains low, particularly among older adolescents/young adults, and the uninsured. We assessed awareness and knowledge of HPV disease, HPV‐related cancers, and HPV vaccines among working, uninsured adults. Data from the 2014 Health Information National Trends Survey (HINTS 4, Cycle 4) were used as a benchmark. Patients were surveyed in late 2014 at the Volunteers in Medicine free clinic in Duval County, Florida. Surveys contained validated measures of HPV disease and vaccine knowledge; HPV‐related cancer knowledge was also assessed. Two‐hundred and ninety‐six surveys were analyzable with an 84% participation rate. Half (50.3%) of participants had heard of HPV, and 32.1% had heard of the HPV vaccine; in HINTS, these estimates were 63.6% and 62.7%, respectively (both P < 0.0001). In adjusted models, high HPV disease knowledge was associated with white race and increased education; high vaccine knowledge was associated with white race, increased education, and female sex. Recognition of HPV as a causative agent was 43.9% for cervical, 9.1% for anal, and 11.1% for throat cancers. For all HPV‐associated cancers, participants had lower knowledge/recognition relative to HINTS. The uninsured, socioeconomically disadvantaged adults we surveyed were unaware of a ubiquitous virus that can cause cancer and the existence of a vaccine to protect against it. These findings point to settings and populations in which initiatives to promote HPV vaccination as a cancer prevention tool remain critical.
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Affiliation(s)
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | | | - Debra J Jacobson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Patrick M Wilson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Monica Albertie
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Robert M Jacobson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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DeJesus RS, Breitkopf CR, Rutten LJ, Jacobson DJ, Wilson PM, Sauver JS. Incidence Rate of Prediabetes Progression to Diabetes: Modeling an Optimum Target Group for Intervention. Popul Health Manag 2016; 20:216-223. [PMID: 27689627 DOI: 10.1089/pop.2016.0067] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Thirty-seven percent of US adults have prediabetes. Various interventions can delay diabetes progression; however, the optimum target group for risk reduction is uncertain. This study estimated rate of progression to diabetes at 1 and 5 years among a cohort of patients from 3 primary care clinics and modeled the potential magnitude in diabetes incidence risk reduction of an intervention program among specific subgroups. Records of 106,821 empaneled patients in 2005 were reviewed. Generalized population attributable risk (PAR) statistics were calculated to estimate the impact of reducing fasting blood glucose on diabetes progression. Multiple intervention effects (varying levels of glucose reduction along with multiple adherence rates) were examined for those with baseline glucose from 110 to 119 mg/dL and ≥120 mg/dL. Ten percent of patients (n = 10,796) met criteria for prediabetes. The 1- and 5-year diabetes incidence rate was 38.6 and 40.24 per 1000 person-years, respectively. Age and obesity were independent predictors of increased progression rate. The generalized PAR for a 10-point reduction in the 110-119 mg/dL subgroup with 25% adherence was 7.6%. The generalized PAR for similar percent reduction and adherence level in patients with baseline glucose of ≥120 mg/dL was only 3.0%. Rate of progression to diabetes increased over time and with associated independent risk factors. Greater risk reduction in diabetes progression within the target population can be achieved when the intervention is successful in those with baseline glucose of 110-119 mg/dL. Modeling an optimum target group for a diabetes prevention intervention offers a novel and useful guide to planning and allocating resources in population health management.
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Affiliation(s)
- Ramona S DeJesus
- 1 Robert D and Patricia E Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,2 Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic , Rochester, Minnesota
| | - Carmen Radecki Breitkopf
- 3 Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | - Lila J Rutten
- 1 Robert D and Patricia E Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,4 Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | - Debra J Jacobson
- 5 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | - Patrick M Wilson
- 5 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | - Jennifer St Sauver
- 1 Robert D and Patricia E Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,4 Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
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Lynch BA, Agunwamba A, Wilson PM, Kumar S, Jacobson RM, Phelan S, Cristiani V, Fan C, Finney Rutten LJ. Adverse family experiences and obesity in children and adolescents in the United States. Prev Med 2016; 90:148-54. [PMID: 27377335 DOI: 10.1016/j.ypmed.2016.06.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/27/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
While exposure to adverse family experiences (AFEs), subset of adverse childhood experiences (ACEs), has been associated with childhood obesity, less is known about the impact of exposures to each type of AFE. Using 2011-2012 National Survey of Children's Health data, we evaluated associations between exposure to individual AFEs and overweight/obesity status in children 10years or older, adjusting for socio-demographic factors. Caregivers reported their child's height, weight, and exposure to nine AFEs; body mass index (BMI) was classified by Center for Disease Control and Prevention's (CDC) guidelines. At Mayo Clinic, we calculated frequencies and weighted estimates of socio-demographic factors and AFEs. Unadjusted and adjusted weighted multinomial logistic regression models were employed to assess the independent associations of each AFE and the different AFE composite scores with BMI category. Exposure to two or more AFEs was independently associated with increased odds of overweight (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.13, 1.56) and obese (OR, 1.45; 95% CI, 1.21, 1.73) status after adjustment for age, household income, parents' education-level, race and sex. Death of parent (OR, 1.59; 95% CI, 1.18, 2.15) and hardship due to family income (OR, 1.26; 95% CI, 1.06, 1.50) were independently associated with obesity status with adjustment for other AFEs and socio-demographic factors. Our results suggest that, in addition to cumulative exposure to AFEs, exposure to certain childhood experiences are more strongly associated with childhood obesity than others. Death of parent and hardship due to family income are individual AFEs, which are strongly predictive of obesity.
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Affiliation(s)
- Brian A Lynch
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Amenah Agunwamba
- Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Seema Kumar
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Sean Phelan
- Department of Health Sciences Research, Division of HealthCare Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Valeria Cristiani
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Lila J Finney Rutten
- Division of Epidemiology, Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Cutrona SL, Mazor KM, Agunwamba AA, Valluri S, Wilson PM, Sadasivam RS, Finney Rutten LJ. Health Information Brokers in the General Population: An Analysis of the Health Information National Trends Survey 2013-2014. J Med Internet Res 2016; 18:e123. [PMID: 27260952 PMCID: PMC4912679 DOI: 10.2196/jmir.5447] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 11/26/2022] Open
Abstract
Background Health information exchanged between friends or family members can influence decision making, both for routine health questions and for serious health issues. A health information broker is a person to whom friends and family turn for advice or information on health-related topics. Characteristics and online behaviors of health information brokers have not previously been studied in a national population. Objective The objective of this study was to examine sociodemographic characteristics, health information seeking behaviors, and other online behaviors among health information brokers. Methods Data from the Health Information National Trends Survey (2013-2014; n=3142) were used to compare brokers with nonbrokers. Modified Poisson regression was used to examine the relationship between broker status and sociodemographics and online information seeking. Results Over half (54.8%) of the respondents were consulted by family or friends for advice or information on health topics (ie, they acted as health information brokers). Brokers represented 54.1% of respondents earning <$20,000 yearly and 56.5% of respondents born outside the United States. Women were more likely to be brokers (PR 1.34, 95% CI 1.23-1.47) as were those with education past high school (PR 1.42, CI 1.22-1.65). People aged ≥75 were less likely to be brokers as compared to respondents aged 35-49 (PR 0.81, CI 0.67-0.99). Brokers used the Internet more frequently for a variety of online behaviors such as seeking health information, creating and sharing online content, and downloading health information onto a mobile device; and also reported greater confidence in obtaining health information online. Conclusions More than 50% of adults who responded to this national survey, including those with low income and those born abroad, were providing health information or advice to friends and family. These individuals may prove to be effective targets for initiatives supporting patient engagement and disease management, and may also be well-positioned within their respective social networks to propagate health messages.
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Affiliation(s)
- Sarah L Cutrona
- University of Massachusetts Medical School, Department of Medicine, Worcester, MA, United States.
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Agunwamba AA, Kawachi I, Williams DR, Finney Rutten LJ, Wilson PM, Viswanath K. Mental Health, Racial Discrimination, and Tobacco Use Differences Across Rural-Urban California. J Rural Health 2016; 33:180-189. [PMID: 27074968 DOI: 10.1111/jrh.12182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/07/2016] [Accepted: 03/08/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Disparities in tobacco use persist despite successful policies reducing use within the United States. In particular, the prevalence of tobacco use in rural and certain minority communities is significantly higher compared to that of their counterparts. In this work, we examine the impact of rurality, mental health, and racial discrimination on tobacco use. METHODS Data come from the 2003 California Health Interview Survey (n = 42,044). Modified Poisson regression models were adjusted for age, sex, race/ethnicity, birth origin, education, income, insurance, and marital status. RESULTS Compared to urban residents, rural residents had a significantly higher risk for smoking after adjustment (RR = 1.10, 95% CI: 1.01-1.19). Those who reported having experienced racial discrimination also had a significantly greater risk for smoking compared to those who did not (RR = 1.17, 95% CI: 1.07-1.27). Additionally, those who reported higher stress had a significantly greater risk for smoking (RR = 1.61, 95% CI: 1.07-1.67). There was evidence of interaction between rurality and race/ethnicity, and rurality and gender (P < .05). CONCLUSION Residing in rural areas was associated with an increased risk for smoking, above and beyond sociodemographics. There were no significant differences across rural-urban environments for the relationship between stress and tobacco use-an indication that the impact of stress and discrimination is not buffered or exacerbated by environmental characteristics potentially found in either location. Mechanisms that explain rural-urban tobacco use disparities need to be explored, and smoking cessation programs and policies should be tailored to target these factors within rural communities.
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Affiliation(s)
- Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Ichiro Kawachi
- Social Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David R Williams
- Social Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
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Rutten LJF, Blake KD, Agunwamba AA, Grana RA, Wilson PM, Ebbert JO, Okamoto J, Leischow SJ. Use of E-Cigarettes Among Current Smokers: Associations Among Reasons for Use, Quit Intentions, and Current Tobacco Use. Nicotine Tob Res 2015; 17:1228-34. [PMID: 25589678 DOI: 10.1093/ntr/ntv003] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/29/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Research has documented growing availability and use of e-cigarettes in the United States over the last decade. METHODS We conducted a national panel survey of current adult cigarette smokers to assess attitudes, beliefs, and behaviors relating to e-cigarette use in the United States (N = 2,254). RESULTS Among current cigarette smokers, 20.4% reported current use of e-cigarettes on some days and 3.7% reported daily use. Reported reasons for e-cigarette use included: quit smoking (58.4%), reduce smoking (57.9%), and reduce health risks (51.9%). No significant differences in sociodemographic characteristics between e-cigarette users and nonusers were observed. Prior quit attempts were reported more frequently among e-cigarette users (82.8%) than nonusers (74.0%). Intention to quit was reported more frequently among e-cigarette users (64.7%) than nonusers (46.8%). Smokers intending to quit were more likely to be e-cigarette users than those not intending to quit (odds ratio [OR] = 1.90, CI =1.36-2.65). Those who used e-cigarettes to try to quit smoking (OR = 2.25, CI = 1.25-4.05), reduce stress (OR = 3.66, CI = 1.11-12.09), or because they cost less (OR = 3.42, CI = 1.64-7.13) were more likely to report decreases in cigarette smoking than those who did not indicate these reasons. Smokers who reported using e-cigarettes to quit smoking (OR = 16.25, CI = 8.32-31.74) or reduce stress (OR = 4.30, CI = 1.32-14.09) were significantly more likely to report an intention to quit than those who did not indicate those reasons for using e-cigarettes. CONCLUSIONS Nearly a quarter of smokers in our study reported e-cigarettes use, primarily motivated by intentions to quit or reduce smoking. These findings identify a clinical and public health opportunity to re-engage smokers in cessation efforts.
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Affiliation(s)
- Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;
| | - Kelly D Blake
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Rachel A Grana
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Jon O Ebbert
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Janet Okamoto
- Health Sciences Research Mayo Clinic, Scottsdale, AZ
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Lynch BA, Rutten LJF, Jacobson RM, Kumar S, Elrashidi MY, Wilson PM, Jacobson DJ, St. Sauver JL. Health Care Utilization by Body Mass Index in a Pediatric Population. Acad Pediatr 2015; 15:644-50. [PMID: 26443036 PMCID: PMC4760684 DOI: 10.1016/j.acap.2015.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 08/20/2015] [Accepted: 08/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We tested the hypothesis that the frequency of emergency department (ED) visits, outpatient clinic visits, and hospitalizations were higher among children with higher body mass index (BMI) categories, even after controlling for demographics, socioeconomic status, and presence of other chronic medical conditions. METHODS We obtained electronic height, weight, and utilization data for all residents of Olmsted County, Minnesota, aged 2 to 18 years on January 1, 2005 (n = 34,335), and calculated baseline BMI (kg/m(2)). At least 1 BMI measurement and permission to use medical record information was available for 19,771 children (58%); 19,528 with follow-up comprised the final cohort. BMIs were categorized into underweight/healthy weight (<85th percentile), overweight (85th to <95th percentile), and obese (≥95th percentile). Negative binomial models were used to compare the rate of utilization across BMI categories. Multivariable models were used to adjust for the effects of age, race, sex, socioeconomic status, and chronic medical conditions. RESULTS Compared to children with BMI <85th percentile, overweight and obese status were associated with increased ED visits (adjusted incident rate ratio [IRR] 1.16, 95% confidence interval [CI] 1.10, 1.23; and IRR 1.27, 95% CI 1.19, 1.35, respectively; P for trend <.0001), and outpatient clinic visits (IRR 1.05, 95% CI 1.02, 1.08; and IRR 1.07, 95% CI 1.04, 1.11, respectively; P for trend <.0001). No associations were observed between baseline BMI category and hospitalizations in the adjusted analyses. CONCLUSIONS Children who are overweight or obese utilize the ED and outpatient clinics more frequently than those who are underweight/healthy weight, but are not hospitalized more frequently.
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Affiliation(s)
- Brian A Lynch
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Seema Kumar
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | | | - Patrick M Wilson
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Debra J Jacobson
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Department of Health Sciences Research, Mayo Clinic, 200 First St., Rochester, MN, 55905
| | - Jennifer L St. Sauver
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Department of Health Sciences Research, Mayo Clinic, 200 First St., Rochester, MN, 55905
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Winder T, Giamas G, Wilson PM, Zhang W, Yang D, Bohanes P, Ning Y, Gerger A, Stebbing J, Lenz HJ. Insulin-like growth factor receptor polymorphism defines clinical outcome in estrogen receptor-positive breast cancer patients treated with tamoxifen. Pharmacogenomics J 2014; 14:28-34. [PMID: 23459444 DOI: 10.1038/tpj.2013.8] [Citation(s) in RCA: 27] [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] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/10/2013] [Accepted: 02/04/2013] [Indexed: 02/07/2023]
Abstract
Compelling evidence points to a key role for insulin-like growth factor 1 (IGF1) signaling in breast cancer development and progression. In addition, IGF1 receptor (IGF1R) expression has been correlated and functionally linked with estrogen receptor (ER) signaling. Recent translational studies support a cross talk between IGF1R and ERα at different levels and data suggest enhanced IGF1R signaling as a causative mechanism of tamoxifen (TAM) resistance. We tested whether functional germline variations in the IGF pathway are associated with clinical outcome in ER-positive primary invasive breast cancer patients, who were treated with surgery and adjuvant TAM. Tissue samples of 222 patients with ER+ primary invasive breast cancer, who had undergone surgery at Charing Cross Hospital, London, UK between 1981 and 2003, were analyzed. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissue samples and six functional IGF1 pathway polymorphisms were analyzed using direct DNA sequencing and PCR-restriction fragment length polymorphism. In multivariable analysis, patients with primary invasive breast cancer carrying IGF1R_rs2016347 G allele had a significantly increased risk of early tumor progression (hazard ratio (HR) 2.01; adjusted P=0.004) and death (HR 1.84; adjusted P=0.023) compared with patients carrying G/T or T/T, independent of established clinicopathological determinants. This association remained significant after adjusting for multiple testing. In addition, we were able to demonstrate that IRS1_rs1801123 and IGFBP3_rs2854744 were significantly associated with lymph node involvement and tumor size, respectively. We provide the first evidence for IGF1R_rs2016347 as an independent prognostic marker for ER+ breast cancer patients treated with TAM and support a rational for combined treatment strategies.
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Affiliation(s)
- T Winder
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - G Giamas
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - P M Wilson
- 1] Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA [2] Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - W Zhang
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - D Yang
- Department of Preventive Medicine and Molecular Biology University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - P Bohanes
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Y Ning
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - A Gerger
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - H-J Lenz
- 1] Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA [2] Department of Preventive Medicine and Molecular Biology University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
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Wilson PM, Yang D, Azuma M, Shi MM, Danenberg KD, Lebwohl D, Sherrod A, Ladner RD, Zhang W, Danenberg PV, Trarbach T, Folprecht G, Meinhardt G, Lenz HJ. Intratumoral expression profiling of genes involved in angiogenesis in colorectal cancer patients treated with chemotherapy plus the VEGFR inhibitor PTK787/ZK 222584 (vatalanib). Pharmacogenomics J 2012; 13:410-6. [PMID: 22664478 DOI: 10.1038/tpj.2012.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/06/2012] [Accepted: 04/11/2012] [Indexed: 01/07/2023]
Abstract
The phase III CONFIRM clinical trials demonstrated that metastatic colorectal cancer patients with elevated serum lactate dehydrogenase (LDH) had improved outcome when the vascular endothelial growth factor receptor (VEGFR) inhibitor PTK/ZK (Vatalanib) was added to FOLFOX4 chemotherapy. We investigated the hypothesis that high intratumoral expression of genes regulated by hypoxia-inducible factor-1 alpha (HIF1α), namely LDHA, glucose transporter-1 (GLUT-1), VEGFA, VEGFR1, and VEGFR2, were predictive of outcome in CONFIRM-1. Tumor tissue was isolated by laser-capture microdissection from 85 CONFIRM-1 tumor specimens; FOLFOX4/placebo n=42, FOLFOX4/PTK/ZK n=43. Gene expression was analyzed using quantitative RT-PCR. In univariate analyses, elevated mRNA expression of LDHA, GLUT-1, and VEGFR1 were associated with response to FOLFOX4/PTK/ZK. In univariate and multivariate analyses, elevated LDHA and VEGFR1 mRNA levels were associated with improved progression-free survival in FOLFOX4/PTK/ZK patients. Furthermore, increased HIF1α and VEGFR2 mRNA levels were associated with decreased survival in FOLFOX/placebo patients but not in patients who received FOLFOX4/PTK/ZK. These are the first data suggesting intratumoral mRNA expression of genes involved in angiogenesis/HIF pathway may predict outcome to VEGFR-inhibitors. Biomarkers that assist in directing VEGFR-inhibitors toward patients with an increased likelihood of benefit will improve the cost-effectiveness of these promising agents.
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Affiliation(s)
- P M Wilson
- Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
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Winder T, Wilson PM, Yang D, Zhang W, Ning Y, Power DG, Bohanes P, Gerger A, Tang LH, Shah M, Lenz HJ. An individual coding polymorphism and the haplotype of the SPARC gene predict gastric cancer recurrence. Pharmacogenomics J 2012; 13:342-8. [PMID: 22491017 DOI: 10.1038/tpj.2012.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/14/2012] [Accepted: 03/05/2012] [Indexed: 02/08/2023]
Abstract
The 5-year survival rate for gastric adenocarcinoma (GA) remains only 40% and biomarkers to identify patients at high risk of tumor recurrence are urgently needed. Secreted protein acidic and rich in cysteine (SPARC) is an extracellular matrix glycoprotein that mediates cell matrix interactions, and upregulation of SPARC can promote tumor progression and metastasis. This study investigated whether single-nucleotide polymorphisms (SNPs) in SPARC impact the prognosis of GA. Blood or formalin-fixed, paraffin-embedded tissues were obtained from 137 GA patients at the University of Southern California and Memorial Sloan-Kettering Cancer Center medical facilities. DNA was isolated and five SNPs in the SPARC 3'-untranslated region (UTR) were evaluated by DNA sequencing or PCR-restriction fragment length polymorphism. Associations between SNPs and time to tumor recurrence (TTR) were analyzed using Kaplan-Meier curves, log-rank tests, and likelihood-ratio test within logistic or Cox regression model as appropriate. Patients carrying at least one G allele of the SPARC rs1059829 polymorphism (GG, AG) showed a median TTR of 3.7 years compared with 2.1 years TTR for patients with AA (hazard ratio (HR) 0.57; P=0.033). In a multivariate analysis adjusted for T and N category as covariates and stratified by race, hospital and chemotherapy, patients with at least one SPARC rs1059829 G allele (GG, AG) remained significantly associated with superior TTR than patients with AA genotype (adjusted P=0.026). In addition, patients harboring the G-A-A haplotype had the highest risk of tumor recurrence (HR 1.892; adjusted P=0.016). Our findings suggest that SPARC 3'-UTR SNPs may be useful in predicting GA patients at increased risk of recurrence.
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Affiliation(s)
- T Winder
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
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Winder T, Wilson PM, Yang D, Zhang W, Ning Y, Power DG, Bohanes P, Gerger A, Tang LH, Shah M, Lenz HJ. An individual coding polymorphism and the haplotype of the SPARC gene predict gastric cancer recurrence. Pharmacogenomics J 2012. [PMID: 22491017 DOI: 10.1038/tpj.2012.11.] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The 5-year survival rate for gastric adenocarcinoma (GA) remains only 40% and biomarkers to identify patients at high risk of tumor recurrence are urgently needed. Secreted protein acidic and rich in cysteine (SPARC) is an extracellular matrix glycoprotein that mediates cell matrix interactions, and upregulation of SPARC can promote tumor progression and metastasis. This study investigated whether single-nucleotide polymorphisms (SNPs) in SPARC impact the prognosis of GA. Blood or formalin-fixed, paraffin-embedded tissues were obtained from 137 GA patients at the University of Southern California and Memorial Sloan-Kettering Cancer Center medical facilities. DNA was isolated and five SNPs in the SPARC 3'-untranslated region (UTR) were evaluated by DNA sequencing or PCR-restriction fragment length polymorphism. Associations between SNPs and time to tumor recurrence (TTR) were analyzed using Kaplan-Meier curves, log-rank tests, and likelihood-ratio test within logistic or Cox regression model as appropriate. Patients carrying at least one G allele of the SPARC rs1059829 polymorphism (GG, AG) showed a median TTR of 3.7 years compared with 2.1 years TTR for patients with AA (hazard ratio (HR) 0.57; P=0.033). In a multivariate analysis adjusted for T and N category as covariates and stratified by race, hospital and chemotherapy, patients with at least one SPARC rs1059829 G allele (GG, AG) remained significantly associated with superior TTR than patients with AA genotype (adjusted P=0.026). In addition, patients harboring the G-A-A haplotype had the highest risk of tumor recurrence (HR 1.892; adjusted P=0.016). Our findings suggest that SPARC 3'-UTR SNPs may be useful in predicting GA patients at increased risk of recurrence.
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Affiliation(s)
- T Winder
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
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Labonte MJ, Wilson PM, Yang D, Zhang W, Ladner RD, Ning Y, Gerger A, Bohanes PO, Benhaim L, El-Khoueiry R, El-Khoueiry A, Lenz HJ. The Cyclin D1 (CCND1) A870G polymorphism predicts clinical outcome to lapatinib and capecitabine in HER2-positive metastatic breast cancer. Ann Oncol 2011; 23:1455-64. [PMID: 21989330 DOI: 10.1093/annonc/mdr445] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lapatinib plus capecitabine emerged as an efficacious therapy in metastatic breast cancer (mBC). We aimed to identify germline single-nucleotide polymorphisms (SNPs) in genes involved in capecitabine catabolism and human epidermal receptor signaling that were associated with clinical outcome to assist in selecting patients likely to benefit from this combination. PATIENTS AND METHODS DNA was extracted from 240 of 399 patients enrolled in EGF100151 clinical trial (NCT00078572; clinicaltrials.gov) and SNPs were successfully evaluated in 234 patients. The associations between SNPs and clinical outcome were analyzed using Fisher's exact test, Kaplan-Meier curves, log-rank tests, likelihood ratio test within logistic or Cox regression model, as appropriate. RESULTS There were significant interactions between CCND1 A870G and clinical outcome. Patients carrying the A-allele were more likely to benefit from lapatinib plus capecitabine versus capecitabine when compared with patients harboring G/G (P = 0.022, 0.024 and 0.04, respectively). In patients with the A-allele, the response rate (RR) was significantly higher with lapatinib plus capecitabine (35%) compared with capecitabine (11%; P = 0.001) but not between treatments in patients with G/G (RR = 24% and 32%, respectively; P = 0.85). Time to tumor progression (TTP) was longer in patients with the A-allele treated with lapatinib plus capecitabine compared with capecitabine (median TTP = 7.9 and 3.4 months; P < 0.001), but not in patients with G/G (median TTP = 6.1 and 6.6 months; P = 0.92). CONCLUSION Our findings suggest that CCND1A870G may be useful in predicting clinical outcome in HER2-positive mBC patients treated with lapatinib plus capecitabine.
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Affiliation(s)
- M J Labonte
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
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Winder T, Bohanes P, Zhang W, Yang D, Power DG, Ning Y, Gerger A, Wilson PM, Tang LH, Shah M, Lee AS, Lenz HJ. GRP78 promoter polymorphism rs391957 as potential predictor for clinical outcome in gastric and colorectal cancer patients. Ann Oncol 2011; 22:2431-2439. [PMID: 21382870 DOI: 10.1093/annonc/mdq771] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Recently, the analysis of gastric and colorectal tumor specimens determined that 78-kiloDalton glucose-regulated protein (GRP78), an endoplasmic reticulum chaperone, up-regulation serves as an efficient mechanism protecting cells against apoptosis and can confer drug resistance. We tested whether functional polymorphisms within the GRP78 gene are related to clinical outcome in gastric and colorectal cancer (CRC) patients. PATIENTS AND METHODS Blood samples of 234 stage II/III CRC patients at the University of Southern California (USC) and formalin-fixed paraffin-embedded tissues of 137 patients with localized gastric adenocarcinoma (GA) at USC and Memorial Sloan-Kettering Cancer Centers were obtained. GRP78 polymorphisms analyzed on germline DNA were correlated with clinical outcome using univariate and multivariate analyses. RESULTS GA patients with the combined GRP78 rs391957 C/T and T/T genotype were at higher risk for tumor recurrence and death [hazard ratio (HR) 2.61; P < 0.001 and HR 3.17; P < 0.001, respectively], than those with C/C. These findings were subsequently tested in a CRC cohort where patients with the homozygous T/T genotype were at highest risk for tumor recurrence (HR 2.61; P = 0.015). The results remained significant after adjusting for clinicopathologic determinants. CONCLUSION These data provide the first evidence that the GRP78 rs391957 polymorphism can predict clinical outcome in localized GA and locally advanced CRC patients.
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Affiliation(s)
- T Winder
- Department of Internal Medicine, Division of Medical Oncology
| | - P Bohanes
- Department of Internal Medicine, Division of Medical Oncology
| | - W Zhang
- Department of Internal Medicine, Division of Medical Oncology
| | - D Yang
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles
| | - D G Power
- Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, Cornell University, New York
| | - Y Ning
- Department of Internal Medicine, Division of Medical Oncology
| | - A Gerger
- Department of Internal Medicine, Division of Medical Oncology
| | - P M Wilson
- Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles
| | - L H Tang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, Cornell University, New York
| | - M Shah
- Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, Cornell University, New York
| | - A S Lee
- Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, USA
| | - H-J Lenz
- Department of Internal Medicine, Division of Medical Oncology; Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles.
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Zhang W, Winder T, Ning Y, Pohl A, Yang D, Kahn M, Lurje G, LaBonte MJ, Wilson PM, Gordon MA, Hu-Lieskovan S, Mauro DJ, Langer C, Rowinsky EK, Lenz HJ. A let-7 microRNA-binding site polymorphism in 3'-untranslated region of KRAS gene predicts response in wild-type KRAS patients with metastatic colorectal cancer treated with cetuximab monotherapy. Ann Oncol 2010. [PMID: 20603437 DOI: 10.1093/annonc/mdg315] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE recent studies have found that KRAS mutations predict resistance to monoclonal antibodies targeting the epidermal growth factor receptor in metastatic colorectal cancer (mCRC). A polymorphism in a let-7 microRNA complementary site (lcs6) in the KRAS 3' untranslated region (UTR) is associated with an increased cancer risk in non-small-cell lung cancer and reduced overall survival (OS) in oral cancers. We tested the hypothesis whether this polymorphism may be associated with clinical outcome in KRAS wild-type (KRASwt) mCRC patients treated with cetuximab monotherapy. PATIENTS AND METHODS the presence of KRAS let-7 lcs6 polymorphism was evaluated in 130 mCRC patients who were enrolled in a phase II study of cetuximab monotherapy (IMCL-0144). Genomic DNA was extracted from dissected formalin-fixed paraffin-embedded tumor tissue, KRAS mutation status and polymorphism were assessed using direct sequencing and PCR restriction fragment length polymorphism technique. RESULTS KRAS let-7 lcs6 polymorphism was found to be related to object response rate (ORR) in mCRC patients whose tumors had KRASwt. The 12 KRASwt patients harboring at least a variant G allele (TG or GG) had a 42% ORR compared with a 9% ORR in 55 KRASwt patients with let-7 lcs6 TT genotype (P = 0.02, Fisher's exact test). KRASwt patients with TG/GG genotypes had trend of longer median progression-free survival (3.9 versus 1.3 months) and OS (10.7 versus 6.4 months) compared to those with TT genotypes. CONCLUSIONS these results are the first to indicate that the KRAS 3'UTR polymorphism may predict for cetuximab responsiveness in KRASwt mCRC patients, which warrants validation in other clinical trials.
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Affiliation(s)
- W Zhang
- Division of Medical Oncology
| | | | - Y Ning
- Division of Medical Oncology
| | - A Pohl
- Division of Medical Oncology
| | - D Yang
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - M Kahn
- Division of Medical Oncology
| | - G Lurje
- Department of Visceral- and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - M J LaBonte
- Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
| | - P M Wilson
- Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
| | | | | | | | - C Langer
- Early Oncology, Bristol-Myers Squibb Pharmaceuticals Limited, New York
| | | | - H-J Lenz
- Division of Medical Oncology; Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA.
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50
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Zhang W, Winder T, Ning Y, Pohl A, Yang D, Kahn M, Lurje G, LaBonte MJ, Wilson PM, Gordon MA, Hu-Lieskovan S, Mauro DJ, Langer C, Rowinsky EK, Lenz HJ. A let-7 microRNA-binding site polymorphism in 3'-untranslated region of KRAS gene predicts response in wild-type KRAS patients with metastatic colorectal cancer treated with cetuximab monotherapy. Ann Oncol 2010; 22:104-109. [PMID: 20603437 DOI: 10.1093/annonc/mdq315] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE recent studies have found that KRAS mutations predict resistance to monoclonal antibodies targeting the epidermal growth factor receptor in metastatic colorectal cancer (mCRC). A polymorphism in a let-7 microRNA complementary site (lcs6) in the KRAS 3' untranslated region (UTR) is associated with an increased cancer risk in non-small-cell lung cancer and reduced overall survival (OS) in oral cancers. We tested the hypothesis whether this polymorphism may be associated with clinical outcome in KRAS wild-type (KRASwt) mCRC patients treated with cetuximab monotherapy. PATIENTS AND METHODS the presence of KRAS let-7 lcs6 polymorphism was evaluated in 130 mCRC patients who were enrolled in a phase II study of cetuximab monotherapy (IMCL-0144). Genomic DNA was extracted from dissected formalin-fixed paraffin-embedded tumor tissue, KRAS mutation status and polymorphism were assessed using direct sequencing and PCR restriction fragment length polymorphism technique. RESULTS KRAS let-7 lcs6 polymorphism was found to be related to object response rate (ORR) in mCRC patients whose tumors had KRASwt. The 12 KRASwt patients harboring at least a variant G allele (TG or GG) had a 42% ORR compared with a 9% ORR in 55 KRASwt patients with let-7 lcs6 TT genotype (P = 0.02, Fisher's exact test). KRASwt patients with TG/GG genotypes had trend of longer median progression-free survival (3.9 versus 1.3 months) and OS (10.7 versus 6.4 months) compared to those with TT genotypes. CONCLUSIONS these results are the first to indicate that the KRAS 3'UTR polymorphism may predict for cetuximab responsiveness in KRASwt mCRC patients, which warrants validation in other clinical trials.
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Affiliation(s)
- W Zhang
- Division of Medical Oncology
| | | | - Y Ning
- Division of Medical Oncology
| | - A Pohl
- Division of Medical Oncology
| | - D Yang
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - M Kahn
- Division of Medical Oncology
| | - G Lurje
- Department of Visceral- and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - M J LaBonte
- Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
| | - P M Wilson
- Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
| | | | | | | | - C Langer
- Early Oncology, Bristol-Myers Squibb Pharmaceuticals Limited, New York
| | | | - H-J Lenz
- Division of Medical Oncology; Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA.
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