Transradial access mitigates bleeding benefit offered by bivalirudin over heparin in patients undergoing percutaneous coronary intervention: Insights from meta-analysis of randomized and observational studies.

Objective: Recent randomized control trials (RCTs) showed conflicting efficacy and safety between bivalirudin and heparin during percutaneous coronary intervention (PCI). We aimed to perform an updated meta-analysis, including real-world and trial data to examine the factors affecting their risk-benefit ratio.

Methods: We searched Medline, the Cochrane library, and meeting abstracts for studies comparing bivalirudin versus heparin during PCI.

Informing Policy for Reducing Stroke Health Disparities from the Experience of African-American Male Stroke Survivors.

Background: The burden of stroke is severe among African-Americans. Despite overall declines in the rate of stroke since 2000, outcomes are largely unimproved or have worsened for African-American men. Adverse psychosocial challenges may hinder adherence to a regimen of risk factor reduction.

Ecologic Momentary Assessment: Perspectives on Applications and Opportunities in Research and Practice Regarding Nutrition Behaviors.

Retrospective self-reported data have limitations, making it important to evaluate alternative forms of measurement for nutrition behaviors. Ecological momentary assessment (EMA) attempts to overcome the challenges of recalled data with real-time data collection in a subject's natural environment, often leveraging technology. This perspective piece 1) introduces the concepts and terminology of EMA, 2) provides an overview of the methodological and analytical considerations, 3) gives examples of past research using EMA, and 4) suggests new opportunities (including combining assessment and intervention) and limitations (including the need for technology) for the application of EMA to research and practice regarding nutrition behaviors.

Epilepsy misconceptions and stigma reduction: Current status in Western countries.

Objective: This systematized literature review identified reports describing epilepsy misconceptions in the developed Western countries and research interventions focused on reducing these misconceptions.

Materials And Methods: English language publications from January 2004 to January 2015 that described original research conducted in Europe, North/Central/South America, or Australia on misconceptions about epilepsy among the general public were used for this review.

Results: Eighty-one publications were selected.

Utility of DXA scanning and risk factors for osteoporosis in ankylosing spondylitis-A prospective study.

Background: Conventional DXA imaging of spine and hip to measure bone mineral density (BMD) has limitations in patients with ankylosing spondylitis (AS). We investigated the correlation of hip and spine BMD measurements in patients with AS to determine if hip DXA will prove clinically useful while avoiding the confounding effect of spinal disease. Also, we studied risk factors for osteoporosis (OP) and osteopenia in AS.

A Preliminary Analysis of Individuals With Serious Mental Illness and Comorbid Diabetes.

Objective: To understand factors related to managing illness in older individuals with serious mental illness (SMI).

Methods: Baseline data from 200 individuals with SMI and diabetes enrolled in a study were used to compare characteristics between older (age >55) vs. younger (age ≤55) individuals.

Clinical Indicators of Late-Onset Sepsis Workup in Very Low-Birth-Weight Infants in the Neonatal Intensive Care Unit.

Background Late-onset sepsis (LOS) in very low-birth-weight (VLBW) infants is associated with significant morbidity and mortality. Objectives To determine the incidence of LOS workup, association, and predictive value of clinical indicators leading to culture-positive versus culture-negative sepsis workup. Methods All sepsis workups performed after 7 days of life, in neonates with birth weight of < 1,500 g were included.

Barriers to Self-management of Serious Mental Illness and Diabetes.

Objectives: Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices.

Methods: We conducted 20 in-depth interviews with persons who had diagnoses of both SMI and DM.

Children's Exposure to Violence: The Underlying Effect of Posttraumatic Stress Symptoms on Behavior Problems.

In this study we investigated whether witnessing violence and violence victimization were associated with children's internalizing and externalizing behavior problems and examined the mediating role of posttraumatic stress (PTS) symptoms in these relationships. Secondary data analysis was conducted using 3 waves of data from the National Survey of Child and Adolescent Well-Being. Path analyses were conducted to test direct and indirect effects of violence exposure on behavior problems, using 2,064 children (ages 8-15 years) reported to Child Protective Services for maltreatment.

Long-term reduction of health care costs and utilization after epilepsy surgery.

Objective: To assess long-term direct medical costs, health care utilization, and mortality following resective surgery in persons with uncontrolled epilepsy.

Methods: Retrospective longitudinal cohort study of Medicaid beneficiaries with epilepsy from 2000 to 2008. The study population included 7,835 persons with uncontrolled focal epilepsy ages 18-64 years, with an average follow-up time of 5 years.

Effect of invasive EEG monitoring on cognitive outcome after left temporal lobe epilepsy surgery.

Objectives: The objective of this cohort study was to compare neuropsychological outcomes following left temporal lobe resection (TLR) in patients with epilepsy who had or had not undergone prior invasive monitoring.

Methods: Data were obtained from an institutional review board-approved, neuropsychology registry for patients who underwent epilepsy surgery at Cleveland Clinic between 1997 and 2013. A total of 176 patients (45 with and 131 without invasive EEG) met inclusion criteria.

Effects of Patient Centered Interventions on Persistent Urinary Incontinence after Prostate Cancer Treatment: A Randomized, Controlled Trial.

Purpose: We examined whether an intervention combining pelvic floor muscle exercise and symptom self-management would improve urinary continence and quality of life in patients with prostate cancer.

Materials And Methods: In a randomized, controlled, longitudinal clinical trial 279 patients with prostate cancer with persistent urinary incontinence were randomized to 1 of 3 groups, including biofeedback pelvic floor muscle exercise plus a support group, the biofeedback exercise plus telephone contact and usual care without intervention. The biofeedback plus support and plus telephone groups received 1 session of biofeedback assisted exercise and 6 biweekly sessions of problem solving therapy.

Interdisciplinary Rehabilitation Referrals in a Concussion Clinic Cohort: An Exploratory Analysis.

Objective: To assess the frequency and spectrum of referrals to rehabilitation disciplines in a concussion clinic population and factors associated with need for referral.

Design: Retrospective study.

Setting: Concussion clinic within the Physical Medicine and Rehabilitation Department of an academic medical center.

MetroHealth Care Plus: Effects Of A Prepared Safety Net On Quality Of Care In A Medicaid Expansion Population.

Studies of Medicaid expansion have produced conflicting results about whether the expansion is having a positive impact on health and the cost and efficiency of care delivery. To explore the issue further, we examined MetroHealth Care Plus, a Centers for Medicare and Medicaid Services (CMS) waiver program in Ohio composed of three safety-net organizations that enrolled 28,295 uninsured poor patients in closed-panel care during 2013. All participating organizations used electronic health records and patient-centered medical homes, publicly reported performance in a regional health improvement collaborative, and accepted a budget-neutral cap approved by CMS.

Electronic medical record analysis of emergency room visits and hospitalizations in individuals with epilepsy and mental illness comorbidity.

Objective: Epilepsy is a chronic neurological condition that significantly increases risk of injury and premature death. Rates of mental illness are also disproportionately high in those with epilepsy, which can be attributed in part to the stress and stigma associated with epilepsy. Psychiatric conditions generally complicate the management of epilepsy, and understanding how psychiatric comorbidity affects use of crisis-based health resources could inform care approaches that help improve epilepsy care.

Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes.

Objective: While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden.

Methods: Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II.

Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals.

Background: Antenatal corticosteroids (ANCS) reduce complications of preterm birth; however, not all eligible women receive them. Many hospitals and providers do not have the right processes and conditions to enable ANCS administration with high reliability. The objective of this study was to understand conditions that enable delivery of ANCS with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project.

A tutorial on structural equation modeling for analysis of overlapping symptoms in co-occurring conditions using MPlus.

Structural equation modeling (SEM) is a very general approach to analyzing data in the presence of measurement error and complex causal relationships. In this tutorial, we describe SEM, with special attention to exploratory factor analysis, confirmatory factor analysis, and multiple indicator multiple cause modeling. The tutorial is motivated by a problem of symptom overlap routinely faced by clinicians and researchers, in which symptoms or test results are common to two or more co-occurring conditions.

No moment wasted: the primary-care visit for adults with diabetes and low socio-economic status.

Aim: To better understand the type and range of health issues initiated by patients and providers in 'high-quality' primary-care for adults with diabetes and low socio-economic status (SES).

Background: Although quality of care guidelines are straightforward, diabetes visits in primary care are often more complex than adhering to guidelines, especially in adults with low SES who experience many financial and environmental barriers to good care.

Methods: We conducted a qualitative study using direct observation of primary-care diabetes visits at an exemplar safety net practice in 2009-2010.

Cesarean delivery as a marker for obstetric quality.

Cesarean delivery is a frequent, easily obtainable, and meaningful event in obstetrics that has frequently been used as a quality indicator. However, its utility as a widespread marker of quality has several limitations. The cesarean delivery rate does not account for variation in levels of maternal care with varying maternal and fetal conditions.

Associations between Difficulty Paying Medical Bills and Forgone Medical and Prescription Drug Care.

Problems paying medical bills have been reported to be associated with increased stress, bankruptcy, and forgone medical care. Using the Behavioral Model for Vulnerable Populations developed by Gelberg et al as a framework, as well as data from the 2010 Ohio Family Health Survey, this study examined the relationships between difficulty paying medical bills and forgone medical and prescription drug care. Logistic regression was used to examine associations between difficulty paying medical bills and predisposing, enabling, need (health status), and health behaviors (forgoing medical care).

Cultural Competency Education for Researchers: A Pilot Study Using a Neighborhood Visit Approach.

Background: Little attention has been given to the cultural competence education needs for researchers.

Objectives: To describe the planning and implementation of a neighborhood visit approach to cultural competency education in the community.

Methods: A committee of community partners and academics planned, conducted and evaluated the visit.