Limitations of Noninvasive Tests-Based Population-Level Risk Stratification Strategy for Nonalcoholic Fatty Liver Disease.

Background: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are highly prevalent but underdiagnosed.

Aims: We used an electronic health record data network to test a population-level risk stratification strategy using noninvasive tests (NITs) of liver fibrosis.

Methods: Data were obtained from PCORnet sites in the East, Midwest, Southwest, and Southeast United States from patients aged [Formula: see text] 18 with or without ICD-10-CM diagnosis codes for NAFLD, NASH, and NASH-cirrhosis between 9/1/2017 and 8/31/2020.

Associations of Community and Individual Social Determinants of Health With Medication Adherence in Patients With Atrial Fibrillation: A Retrospective Cohort Study.

Background Despite guideline-recommended use of oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), OAC medication adherence among patients with AF in the United States ranges from 47% to 82%. To characterize potential causes of nonadherence, we analyzed associations between community and individual social risk factors and OAC adherence for stroke prevention in AF. Methods and Results A retrospective cohort analysis of patients with AF was conducted using the IQVIA PharMetrics Plus claims data from January 2016 to June 2020, and 3-digit ZIP code-level social risk scores were calculated using American Community Survey and commercial data.

A systematic review of primary care-focused, self-reported medication adherence tools.

Background: Clinician recognition of nonadherence is generally low. Tools that clinicians have used to assess medication adherence are self-reported adherence instruments that ask patients questions about their medication use experience. There is a need for more structured reviews that help clinicians comprehensively distinguish which tool might be most useful and valuable for their clinical setting and patient populations.

GEOlimma: differential expression analysis and feature selection using pre-existing microarray data.

Background: Differential expression and feature selection analyses are essential steps for the development of accurate diagnostic/prognostic classifiers of complicated human diseases using transcriptomics data. These steps are particularly challenging due to the curse of dimensionality and the presence of technical and biological noise. A promising strategy for overcoming these challenges is the incorporation of pre-existing transcriptomics data in the identification of differentially expressed (DE) genes.

Barriers to integrating direct oral anticoagulants into anticoagulation clinic care: A mixed-methods study.

Background: Outpatient anticoagulation clinics were initially developed to care for patients taking vitamin K antagonists such as warfarin. There has not been a systematic evaluation of the barriers and facilitators to integrating direct oral anticoagulant (DOAC) care into outpatient anticoagulation clinics.

Methods: We performed a mixed methods study consisting of an online survey of anticoagulation clinic providers and semi-structured interviews with anticoagulation clinic leaders and managers between March and May of 2017.

Towards Estimating the Uncertainty Associated with Three-Dimensional Geometry Reconstructed from Medical Image Data.

Patient-specific computational modeling is increasingly used to assist with visualization, planning, and execution of medical treatments. This trend is placing more reliance on medical imaging to provide accurate representations of anatomical structures. Digital image analysis is used to extract anatomical data for use in clinical assessment/planning.

3D printing and modeling of congenital heart defects: A technical review.

Use of 3D printing technology is expanding in healthcare. One of the common applications is the creation of anatomical models of congenital heart defects (CHD) from medical image data. These patient-specific models are being used for multiple purposes including visualization of anatomy, simulation of surgical procedures, patient education, and facilitating communication between clinical staff.

Out-of-range INR results lead to increased health-care utilization in four large anticoagulation clinics.

Background: The impact on health-care costs and utilization of a single out-of-range (OOR) INR value not associated with bleeding or thromboembolic complication among chronic warfarin-treated patients is not well described.

Methods: At four large phone-based anticoagulation clinics (total 14 948 patients), warfarin-treated patients with atrial fibrillation (AF) or venous thromboembolism were retrospectively propensity matched into an OOR INR group (n = 116) and a control group (n = 58). Types and frequency of contacts (eg, phone, voicemail, facsimile) and personnel involved were identified.

Structure and function of anticoagulation clinics in the United States: an AC forum membership survey.

Many anticoagulation clinics have adapted their services to provide care for patients taking direct oral anticoagulants (DOAC) in addition to traditional warfarin management. Anticoagulation clinic scope of service and operations in this transitional environment have not been well described in the literature. A survey was conducted of United States-based Anticoagulation Forum members to inquire about anticoagulation clinic structure, function, and services provided.

Discrete element analysis is a valid method for computing joint contact stress in the hip before and after acetabular fracture.

Evaluation of abnormalities in joint contact stress that develop after inaccurate reduction of an acetabular fracture may provide a potential means for predicting the risk of developing post-traumatic osteoarthritis. Discrete element analysis (DEA) is a computational technique for calculating intra-articular contact stress distributions in a fraction of the time required to obtain the same information using the more commonly employed finite element analysis technique. The goal of this work was to validate the accuracy of DEA-computed contact stress against physical measurements of contact stress made in cadaveric hips using Tekscan sensors.

Patient-centered medical home: developing, expanding, and sustaining a role for pharmacists.

Purpose: The development of a patient-centered medical home (PCMH) health care model and the role of pharmacists in PCMHs at the University of Michigan are described.

Summary: In 2009, Blue Cross Blue Shield of Michigan (BCBSM) provided financial incentives to physician groups to implement PCMH principles. A partnership was formed among the department of pharmacy, college of pharmacy, and faculty group practice at the University of Michigan Health System (UMHS) to integrate clinical pharmacists into the PCMH model at eight general medicine practices.

Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes.

Background: The medication management of patients following coronary artery bypass graft (CABG) surgery may include antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. However, poor adherence is common, and patient attitudes and beliefs play a role in adherence.

Objective: To evaluate the association between self-reported adherence and the beliefs patients have about cardiovascular medicines used after CABG.

Prevalence of comorbidities and their influence on blood pressure goal attainment in geriatric patients.

Hypertension in elderly patients is common and is associated with unique challenges. This study examines the prevalence of comorbidities in elderly hypertensive patients and evaluates the association between comorbidities and other covariates with blood pressure goal attainment. Data were collected through retrospective review of medical records and included patient characteristics, comorbidities, treatment-related variables, and blood pressure goal attainment.

Treatment and control of blood pressure in patients with diabetes mellitus.

Purpose: A study was conducted to characterize the prevalence of hypertension in patients with diabetes mellitus and the percentage of patients with diabetes and hypertension who achieved a targeted blood pressure goal (<135/80 mm Hg).

Methods: A retrospective, cross-sectional study was conducted in an ambulatory care clinic. Eligible patients were those individuals being managed for type 2 diabetes mellitus at least once each year for two consecutive years.

Statin initiation following coronary artery bypass grafting: outcome of a hospital discharge protocol.

Study Objectives: To evaluate the outcome of a hospital discharge statin drug therapy initiation protocol following coronary artery bypass graft (CABG) surgery. Our goal was to measure the percentage of patients receiving statin drugs at hospital discharge and at a post-hospital discharge assessment following the implementation of the statin drug therapy initiation protocol. We also evaluated low-density lipoprotein cholesterol (LDL-C) goal attainment (ie, < 100 mg/dL), safety monitoring, and tolerability of the statin drug.

Risk assessment of NSAID-induced gastrointestinal toxicity in ambulatory care patients.

Purpose: The risk of gastrointestinal (GI) toxicity associated with the use of a traditional nonsteroidal antiinflammatory drug (NSAID) versus a cyclooxygenase-2 (COX-2) inhibitor was compared among patients in a managed care organization.

Methods: Patients over 18 years old who received a prescription for ibuprofen, naproxen, celecoxib, or rofecoxib between March 2001 and June 2001 were included in this study. All subjects were followed for 12 months for GI complications, medication use, and changes in physical conditions from baseline.

Antihypertensive medication compliance in a Veterans Affairs Healthcare System.

Objective: To compare compliance rates associated with categories of antihypertensive medications in a Veteran's Affairs (VA) Healthcare System by use of readily available data and standard software.

Methods: Prescriptions from the Veteran's Health Information System Technology Architecture (VISTA) database for angiotension-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, calcium-channel blockers (CCBs), diuretics, and a miscellaneous group of antihypertensives filled or refilled during a 12-month period were included in the analysis. Claims data for each prescription were exported from the VISTA database to Microsoft Excel, and compliance rates were calculated by use of a methodology reported elsewhere.