The impact of cigarette smoking on cognitive processing speed and brain atrophy in multiple sclerosis.

Background: Smoking is associated with an increased risk of multiple sclerosis (MS) and disability worsening. The relationship between smoking, cognitive processing speed, and brain atrophy remains uncertain.

Objective: To quantify the impact of smoking on processing speed and brain volume in MS and to explore the longitudinal relationship between smoking and changes in processing speed.

Association of socioeconomic disadvantage and neighborhood disparities with clinical outcomes in multiple sclerosis patients.

Background: Socioeconomic disadvantage may be an important contributor to clinical outcomes in MS but is not well understood. Our objective was to examine the associations between Area Deprivation Index (ADI), a validated measure of neighborhood-level disadvantage, with clinical outcomes.

Methods: We assessed the longitudinal association between MS Performance Test (MSPT) and quality of life in Neurological Disorders (Neuro-QoL) measures with ADI quartiles (Q1: lowest deprivation - Q4 highest deprivation) in relapsing remitting MS (RRMS) and progressive MS cohorts.

Clinical features and outcomes of COVID-19 despite SARS-CoV-2 vaccination in people with multiple sclerosis.

Background: Several studies have demonstrated reduced serological response to vaccines in patients treated with anti-CD20 agents. However, limited data exist surrounding the clinical effect of disease modifying therapy (DMT) use on vaccine efficacy.

Objectives: To investigate breakthrough coronavirus disease 2019 (COVID-19) in vaccinated people with multiple sclerosis (PwMS) on DMT.

Comorbidity effect on processing speed test and MRI measures in multiple sclerosis patients.

Background: Comorbid conditions are known to affect the clinical course of multiple sclerosis (MS). Our objective was to determine the impact of comorbidities on the processing speed test (PST).

Methods: We conducted a retrospective, longitudinal analysis of all patients who completed PST testing from June 2015 - August 2019 at our center.

Multiple sclerosis management during the COVID-19 pandemic.

Background: People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services.

Objectives: To evaluate risk factors for COVID-19 susceptibility and describe the pandemic's impact on healthcare delivery.

Methods: Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d'Hebron-Centre d'Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care.

Electronic medical record-assisted design of a cluster-randomized trial to improve diabetes care and outcomes.

Background: Electronic medical records (EMRs) have the potential to facilitate the design of large cluster-randomized trials (CRTs).

Objective: To describe the design of a CRT of clinical decision support to improve diabetes care and outcomes.

Methods: In the Diabetes Improvement Group-Intervention Trial (DIG-IT), we identified and balanced preassignment characteristics of 12,675 diabetic patients cared for by 147 physicians in 24 practices of 2 systems using the same vendor's EMR.

Trends in postdischarge mortality and readmissions: has length of stay declined too far?

Background: Length of hospital stay continues to decline, but the effect on postdischarge outcomes is unclear.

Methods: We determined trends in risk-adjusted mortality rates and readmission rates for 83,445 Medicare patients discharged alive after hospitalization for myocardial infarction, heart failure, gastrointestinal hemorrhage, chronic obstructive pulmonary disease, pneumonia, or stroke. Patients were stratified into deciles of observed/expected length of stay to determine whether patients whose length of stay was much shorter than expected had higher risk-adjusted mortality and readmission rates.

Changes in the use of do-not-resuscitate orders after implementation of the Patient Self-Determination Act.

Objective: To determine changes in the use of do-not-resuscitate (DNR) orders and mortality rates following a DNR order after the Patient Self-determination Act (PSDA) was implemented in December 1991.

Design: Time-series.

Setting: Twenty-nine hospitals in Northeast Ohio.

The effect of publicly reporting hospital performance on market share and risk-adjusted mortality at high-mortality hospitals.

Background: It is unclear whether publicly reporting hospitals' risk-adjusted mortality affects market share and mortality at outlier hospitals.

Objectives: To examine hospitals' market share and risk-adjusted mortality from 1991 to 1997 at hospitals participating in Cleveland Health Quality Choice (CHQC).

Research Design: Time series.

Mortality trends during a program that publicly reported hospital performance.

Background: It is unclear whether publicly reporting hospitals' risk-adjusted mortality leads to improvements in outcomes.

Objectives: To examine mortality trends during a period (1991-1997) when the Cleveland Health Quality Choice program was operational.

Research Design: Time series.