Publications by authors named "Kirchner H"
Purpose: To assess trends in continuity of care (COC) by geographic context (i.e., rural vs urban) among a cohort of persons with prediabetes prior to and after diagnosis of prediabetes.
View Article and Find Full Text PDFBackground: Despite robust evidence supporting an association with improved outcomes in eligible patients, cardiac rehabilitation (CR) remains underused, with a minority of eligible patients participating. Virtual cardiac rehabilitation (VCR) has been proposed as an alternative to traditional center-based CR (CBCR) to improve usage rates. However, data supporting the efficacy and cost-effectiveness of VCR are limited.
View Article and Find Full Text PDFObjectives: This study aims to examine the relationship between left atrial appendage closure (LAAC) and post-operative atrial fibrillation (POAF) in cardiac surgery patients with no pre-operative atrial fibrillation (AF).
Methods: We analyzed a cohort of 2059 adult patients in our Society of Thoracic Surgery (STS) database who underwent at least one of the following procedures between 2018 and 2021: coronary artery bypass grafting (CABG), aortic valve replacement, or mitral valve replacement. All patients had no pre-operative AF, and 169 (8.
Article Synopsis
- Metabolic dysfunction-associated steatohepatitis (MASH) is linked to inflammation and fatty liver, and its progression may be influenced by reduced thyroid hormone signaling, specifically through decreased DIO1 and THRB expression.
- Research revealed that miR-34a-5p is increased in MASH patients and may play a role in suppressing thyroid hormone activity in the liver by targeting genes like THRB and DIO1.
- Additionally, DNA methylation changes in the THRB gene were found in MASH patients, potentially contributing to a state of resistance to thyroid hormones as the disease progresses.
Study Objectives: To examine the association between moderate-severe obstructive sleep apnea (msOSA) and sleep characteristics with chronic kidney disease (CKD) in a population of rural and urban adults in Pennsylvania.
Methods: A cross-sectional study of 23,643 adults who underwent polysomnography (PSG) at a rural healthcare system in Pennsylvania between 2009 and 2019. Serum creatinine was abstracted from electronic health records to calculate estimated glomerular filtration rate (eGFR).
Introduction: Few studies have evaluated the potential effects of aging-related conditions like frailty in older adults with cancer on informal caregivers. Our objective was to evaluate the association between the sum total of the aging-related conditions of older adults with non-muscle-invasive bladder cancer (NMIBC) and the strain reported by their informal caregivers.
Materials And Methods: We conducted an explanatory sequential mixed methods cross-sectional survey study that recruited 81 dyads of older adults with NMIBC (age ≥ 65 at diagnosis) and their informal caregivers.
Background: Relatives of probands diagnosed with familial hypercholesterolemia (FH) should undergo cascade testing for FH.
Objectives: The purpose of this study was to evaluate probands' choices of innovative strategies to communicate their FH result with relatives and facilitate cascade testing uptake.
Methods: Probands with an FH genetic result from the MyCode Community Health Initiative could choose to share their FH result with adult blood relatives via the Family and Healthcare Professional Packet (packet), family sharing and cascade chatbots (chatbot), and/or FH Outreach and Support Program (direct contact).
The IMPACT-FH study implemented strategies (packet, chatbot, direct contact) to promote family member cascade testing for familial hypercholesterolemia (FH). We evaluated the impact of genetic counseling (GC) on medical outcomes, strategy selection, and cascade testing. Probands (i.
View Article and Find Full Text PDFObjective: There is evidence suggesting that climate change, coupled with an increase in the frequency and severity of heatwaves, affects mental health. The aim of this study was to investigate potential associations between high temperature and the utilization of an emergency department (ED) by individuals with psychiatric disorders.
Methods: A retrospective analysis of all psychiatric emergency patients from 2015 to 2022 (N=15478) was conducted and compared with local temperature data.
Background: The development of obesity-associated comorbidities such as type 2 diabetes (T2D) and hepatic steatosis has been linked to selected microRNAs in individual studies; however, an unbiased genome-wide approach to map T2D induced changes in the miRNAs landscape in human liver samples, and a subsequent robust identification and validation of target genes are still missing.
Methods: Liver biopsies from age- and gender-matched obese individuals with (n=20) or without (n=20) T2D were used for microRNA microarray analysis. The candidate microRNA and target genes were validated in 85 human liver samples, and subsequently mechanistically characterized in hepatic cells as well as by dietary interventions and hepatic overexpression in mice.
Article Synopsis
- The study explored the phenotypic spectrum of X-linked Alport Syndrome (AS) using a diverse patient group from the Geisinger MyCode study, focusing on both males and females.
- Among 170,856 patients, specific pathogenic variants were identified, revealing high penetrance rates and significant AS features, particularly in males with certain variants.
- The findings highlighted increased risks of AS-related symptoms compared to controls and emphasized the need for better screening and recognition of AS diagnoses among affected individuals.
Background: Differentiated service delivery (DSD) for children and adolescents living with HIV can improve targeted resource use. We derived a mortality prediction score to guide clinical decision making for children and adolescents living with HIV.
Methods: Data for this retrospective observational cohort study were evaluated for all children and adolescents living with HIV and initiating antiretroviral therapy (ART); aged 0-19 years; and enrolled at Baylor clinics in Eswatini, Malawi, Lesotho, Tanzania, and Uganda between 2005 and 2020.
Due to optimised treatment strategies and the availability of new therapies during the last decades, formerly devastating chronic inflammatory diseases such as rheumatoid arthritis or systemic sclerosis (SSc) have become less menacing. However, in many patients, even state-of-the-art treatment cannot induce remission. Moreover, the risk for flares strongly increases once anti-inflammatory therapy is tapered or withdrawn, suggesting that underlying pathological processes remain active even in the absence of overt inflammation.
View Article and Find Full Text PDFBackground: Despite increasing availability of rapid molecular tests for the diagnosis of tuberculosis in high-burden settings, many people with tuberculosis are undiagnosed. Reliance on sputum as the primary specimen for tuberculosis diagnostics contributes to this diagnostic gap. We evaluated the diagnostic accuracy and additive yield of a novel stool quantitative PCR (qPCR) assay for the diagnosis of tuberculosis in three countries in Africa with high tuberculosis burdens.
View Article and Find Full Text PDFArticle Synopsis
- - The CARE-FH clinical trial aimed to enhance screening for Familial Hypercholesterolemia (FH) in primary care settings by incorporating feedback from healthcare professionals involved in patient care.
- - The trial identified that FH screening was infrequent, often occurring only post-cardiovascular events, but found that healthcare providers were generally open to implementing screening with some adjustments.
- - Barriers like limited time during patient visits and lack of knowledge were noted, but effective guidance and new treatments showed promise as facilitators for improving FH screening and care initiation.
Background: The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low.
View Article and Find Full Text PDFBackground: 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.
Background: When a person's workload of healthcare exceeds their resources, they experience treatment burden. At the intersection of cancer and aging, little is known about treatment burden. We evaluated the association between a geriatric assessment-derived Deficit Accumulation Index (DAI) and patient-reported treatment burden in older adults with early-stage, non-muscle-invasive bladder cancer (NMIBC).
View Article and Find Full Text PDFBackground: In emergency departments, patients with mental health conditions are a major concern and make up the third or fourth of the most common diagnosis seen during all consultations. Over the past two decades, there has been a noticeable rise in the number of cases, particularly due to an increase in nonurgent visits for somatic medical issues. The significance of nonurgent visits for psychiatric patients is yet to be determined.
View Article and Find Full Text PDFArticle Synopsis
- Agonists targeting thyroid hormone receptor β (TRβ) have shown potential in treating non-alcoholic fatty liver disease in earlier studies, but recent findings indicate a decrease in TRβ expression in severe cases like non-alcoholic steatohepatitis (NASH), which may hinder their effectiveness.
- A mouse study using a specific diet model confirmed a decline in TRβ during NASH development, but surprisingly, mice without TRβ had less liver damage and lower levels of NASH-related genes.
- Gene therapy that boosted TRβ in normal mice with NASH did not lead to improvements in liver condition or metabolic health, suggesting that the role of TRβ may be less significant than expected and that treatments should focus more on
Article Synopsis
- The study aimed to evaluate how polygenic scores (PGS) related to psychiatric disorders affect healthcare usage and the burden of comorbid conditions among a large group of participants with linked health records.
- Using data from approximately 118,882 individuals, researchers found that higher PGS for major depressive disorder was significantly associated with increased visits to emergency departments, inpatient services, and outpatient services, especially after a depression diagnosis.
- The results indicate that individuals with a higher genetic predisposition to depression tend to use more healthcare resources and experience greater comorbidity, although similar patterns were not observed for bipolar disorder and schizophrenia.
Background: Two million patients per year are referred to urologists for hematuria, or blood in the urine. The American Urological Association recently adopted a risk-stratified hematuria evaluation guideline to limit multi-phase computed tomography to individuals at highest risk of occult malignancy.
Objectives: To understand population-level hematuria evaluations, we developed an algorithm to accurately identify hematuria cases from electronic health records (EHRs).
Objectives: Better disease management can be achieved with earlier detection through robust, sensitive, and easily accessible biomarkers. The aim of the current study was to identify novel epigenetic biomarkers determining the risk of type 2 diabetes (T2D).
Methods: Livers of 10-week-old female New Zealand Obese (NZO) mice, slightly differing in their degree of hyperglycemia and liver fat content and thereby in their diabetes susceptibility were used for expression and methylation profiling.