Association of Questionnaire-Assessed Fall Risk With Uncontrolled Blood Pressure and Therapeutic Inertia Among Older Adults.

Therapeutic inertia (TI), or failure to escalate or initiate BP lowering medications when BP is uncontrolled, increases with advancing age and may in part be due to perceived fall risk. This study examined the association of a fall risk assessment, based on patient response to three questions administered by trained staff, with uncontrolled BP (≥140/90 mmHg) during a clinic visit and with TI during clinic visits with uncontrolled BP among 13 893 patients age ≥ 65 years corresponding to 41 122 primary care visits. Separate generalized linear mixed effects models were used to examine the association of fall risk (low, moderate, and high) with uncontrolled BP and with TI at a clinic visit after adjustment for demographics, comorbidities, and total number of visits.

Standardized Management of Sickle Cell Disease Patients and the Effects on Care Utilization and Costs.

An individualized management program for patients with sickle cell disease (SCD) was created to reduce health care utilization and cost. The program was implemented to standardize the management of patients with SCD. SCD encounters from January 2010 to December 2020 were reviewed for analysis.

Nephrology-Palliative Care Collaboration to Promote Outpatient Hemodialysis Goals of Care Conversations.

Background: Goals of care conversations and corresponding life-sustaining treatment (LST) progress notes were completed for only one-fourth of patients on outpatient dialysis despite hospital-wide training with nephrologists at the Edward Hines, Jr. Veterans Affairs Hospital. The purpose of this quality improvement project was to increase completion of LST progress notes and corresponding orders among patients on dialysis through an interdisciplinary nephrology-palliative care collaboration.

Age and sex disparities in blood pressure control and therapeutic inertia: Impact of a quality improvement program.

Objective: Hypertension quality improvement programs reduce uncontrolled blood pressure (BP) but impact may differ by sex and age.

Methods: This study examined uncontrolled BP, defined as a BP ≥ 140/90 mmHg, and therapeutic inertia, defined as absence of medication initiation or escalation during visits with uncontrolled BP, by sex and by age group (19-40, 41-65, 66-75, and 76+ years) during a 12 month follow-up period among 21, 861 patients with hypertension and ≥ two visits in primary care clinics enrolled in the American Medical Association (AMA) easure Accurately, ct Rapidly, and artner with Patients (MAP) BP hypertension quality improvement program.

Results: The mean age was 64.

Prevalence and feasibility of assessing the frailty phenotype among hemodialysis patients in a dialysis unit.

Background: Frailty increases risk of morbidity and mortality in hemodialysis patients. Frailty assessments could trigger risk reduction interventions if broadly adopted in clinical practice. We aimed to assess the clinical feasibility of frailty assessment among Veteran hemodialysis patients.

Age and Comorbidities Are Associated With Therapeutic Inertia Among Older Adults With Uncontrolled Blood Pressure.

Background: Lack of initiation or escalation of blood pressure (BP) lowering medication when BP is uncontrolled, termed therapeutic inertia (TI), increases with age and may be influenced by comorbidities.

Methods: We examined the association of age and comorbidities with TI in 22,665 visits with a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg among 7,415 adults age ≥65 years receiving care in clinics that implemented a hypertension quality improvement program. Generalized linear mixed models were used to determine the association of comorbidity number with TI by age group (65-74 and ≥75 years) after covariate adjustment.

Applying Customer Discovery Method to a Chronic Disease Self-Management Mobile App: Qualitative Study.

Background: A significant health challenge is evident in the United States, with 6 in 10 adults having a chronic disease and 4 in 10 adults having 2 or more. Chronic disease self-management aims to prevent or delay disease progression and disability and reduce mortality risk. The evidence to support the use of information technology tools, including mobile apps, web-based portals, and web-based educational interventions, that support disease self-management and improve clinical outcomes is growing.

Integrating Community Health Workers into Hospital Systems Through a Social Work Partnership: A Report from the Field.

While studies support the effectiveness of community health worker (CHW) services, best approaches for CHW integration in health systems are not well understood. We describe early outcomes from a partnership between a safety-net hospital systems' social work department and CHWs to address adverse social determinants of health of high-risk patients.

The Evaluation of a Clinical Decision Support Tool Using Natural Language Processing to Screen Hospitalized Adults for Unhealthy Substance Use: Protocol for a Quasi-Experimental Design.

Background: Automated and data-driven methods for screening using natural language processing (NLP) and machine learning may replace resource-intensive manual approaches in the usual care of patients hospitalized with conditions related to unhealthy substance use. The rigorous evaluation of tools that use artificial intelligence (AI) is necessary to demonstrate effectiveness before system-wide implementation. An NLP tool to use routinely collected data in the electronic health record was previously validated for diagnostic accuracy in a retrospective study for screening unhealthy substance use.

Development and multimodal validation of a substance misuse algorithm for referral to treatment using artificial intelligence (SMART-AI): a retrospective deep learning study.

Background: Substance misuse is a heterogeneous and complex set of behavioural conditions that are highly prevalent in hospital settings and frequently co-occur. Few hospital-wide solutions exist to comprehensively and reliably identify these conditions to prioritise care and guide treatment. The aim of this study was to apply natural language processing (NLP) to clinical notes collected in the electronic health record (EHR) to accurately screen for substance misuse.

A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study.

Background: Chronic kidney disease (CKD) is a common and costly condition that is usually accompanied by multiple comorbidities including type 2 diabetes, hypertension, and obesity. Proper management of CKD can delay or prevent kidney failure and help mitigate cardiovascular disease risk, which increases as kidney function declines. Smart device apps hold potential to enhance patient self-management of chronic conditions including CKD.

Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients.

Unlabelled: To examine the impact before and after adoption of a procalcitonin-based protocol to guide sepsis management has on antibiotic use, care costs, and outcomes of critically ill patients.

Design: Before-after study.

Setting: ICU of an academic tertiary care center.

Age and sex disparities in hypertension control: The multi-ethnic study of atherosclerosis (MESA).

Objective: Determine sex differences in hypertension control by age group in a diverse cohort of adults age 45-84 years at baseline followed for an average of 12 years.

Methods: The Multi-Ethnic Study of Atherosclerosis enrolled 3213 men and 3601 women from six communities in the U.S.

Association of Overactive Bladder With Hypertension and Blood Pressure Control: The Multi-Ethnic Study of Atherosclerosis (MESA).

Background: The sudden urge to urinate, also known as overactive bladder (OAB), may reflect higher sympathetic activity and associate with higher blood pressure (BP).

Methods: This cross-sectional analysis utilized data from sixth follow-up exam (2015-2016) of Multi-Ethnic Study of Atherosclerosis to examine the association of OAB with systolic (SBP) and diastolic blood pressure (DBP) levels, hypertension, and BP control. Information on urinary symptoms was obtained with the International Consultation on Incontinence Questionnaire (ICIQ).

Family-based lifestyle interventions: What makes them successful? A systematic literature review.

Nearly one in five young people in the United States has obesity, putting one-fifth of America's children at higher risk of having chronic health conditions and of having obesity into adulthood. Family-based lifestyle interventions (FBLI) have been proposed as effective mechanisms to improve the health through health education and the adoption of healthier behaviors. The aim of this review is to identify and summarize effective intervention activities and lessons learned that organizations can adopt when planning health promotion interventions for families, and to assess the effect of family-based lifestyle interventions on BMI z-score.

The Status of Nutritional Management Guidelines for Head and Neck Cancer Patients.

Introduction Head and neck cancer (HNC) is the seventh leading cause of cancer worldwide. Approximately 35%-60% patients with HNC are malnourished from the disease onset, malnutrition being associated with worsened health outcomes among these patients. This study aimed to review and synthesize existing guidelines regarding nutritional interventions in HNC patients and assess providers' knowledge, opinions, and practice of guidelines for the nutritional management of HNC patients.

Racial Differences in Urinary Incontinence Prevalence, Overactive Bladder and Associated Bother among Men: The Multi-Ethnic Study of Atherosclerosis.

Purpose: We examined the association of race/ethnicity with urinary incontinence subtypes and overactive bladder, and associated bother in older men.

Materials And Methods: This cross-sectional analysis used data from the Multi-Ethnic Study of Atherosclerosis, an observational cohort of 4 racial/ethnic groups. At the sixth followup examination (age 60 to 98 years, 2015 to 2016) urinary symptoms were ascertained with the International Consultation on Incontinence Questionnaire.

Dialysis, COVID-19, Poverty, and Race in Greater Chicago: An Ecological Analysis.

Rationale & Objective: Persons with end-stage kidney disease receiving in-center maintenance hemodialysis may be at high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and severe outcomes with coronavirus disease 2019 (COVID-19). The objective of this study was to examine the correlation of SARS-CoV-2 positivity rate per capita and COVID-19-associated deaths with number of dialysis stations and demographics of residents within zip codes in Cook County, IL.

Study Design: Ecological analysis.

Socioeconomic Status and Determinants of Pediatric Antibiotic Use.

. Evidence suggests that early-life antibiotic use can alter gut microbiome, predisposing children to obesity. The obesity epidemic has a disproportionate effect on individuals from lower socioeconomic status (SES).

Racial differences in urinary incontinence prevalence and associated bother: the Multi-Ethnic Study of Atherosclerosis.

Background: Urinary incontinence is influenced by multiple factors, and the prevalence of urinary incontinence subtypes may differ by race and ethnicity.

Objective: This study aimed to determine the prevalence of urinary incontinence subtypes and associated bother among women by race and ethnicity.

Study Design: This cross-sectional analysis used data from the Multi-Ethnic Study of Atherosclerosis, an observational cohort study of 4 racial and ethnic groups recruited from 6 communities from the United States.