Racial differences in spatial patterns for poor glycemic control in the Southeastern United States.

Purpose: Evidence consistently shows poor outcomes in racial minorities, but there is limited understanding of differences that are explained by spatial variation. The goal of this analysis was to examine contribution of spatial patterns on disparities in diabetes outcomes in the Southeastern United States.

Methods: Data on 64,022 non-Hispanic black (NHB) and non-Hispanic white (NHW) veterans with diabetes living in Georgia, Alabama, and South Carolina were analyzed for 2014.

Time spent outdoors, activity levels, and chronic disease among American adults.

Chronic diseases-including cancer, cardiovascular diseases, and metabolic conditions such as diabetes and obesity-account for over 60% of overall global mortality. Sedentary time increases the risk for chronic disease incidence and mortality, while moderate to vigorous physical activity is known to decrease risk. Most Americans spend at least half of their time sedentary, with a trend toward increasingly sedentary lifestyles, and few Americans achieve recommended levels of physical activity.

Using path analysis to examine the relationship between sexual abuse in childhood and diabetes in adulthood in a sample of US adults.

To understand mechanisms underlying the relationship between adverse childhood experiences (ACE) and diabetes the study evaluated mediators of the relationship between childhood sexual abuse and diabetes in adulthood. This study used cross-sectional data from the 2011 Behavioral Risk Factor Surveillance Survey (BRFSS). Participants totaled 48, 526 who completed the ACE module.

Fractures in a nationwide population-based cohort of users of breast cancer hormonal therapy.

Purpose: Although users of aromatase inhibitors have higher total fracture risk in some randomized trials, little is known about their risk outside of clinical trials or in older higher-risk cohorts.

Methods: In a population-based retrospective cohort study, we identified all older US Medicare D prescription drug insurance plan-enrolled women who had initial breast cancer surgery in 2006-2008 and began hormonal therapy (an aromatase inhibitor (AI) or tamoxifen) within the subsequent year. Total nonvertebral and hip fractures through 2012 were identified using a validated algorithm.

Residents' Insights and Ideas about Screen-Sharing in Primary Care Clinics.

Background Previous studies described attending physicians' perceptions of the benefits and downsides of having the electronic health record (EHR) in the room during a clinical encounter. The perspective of residents has received little attention. Objective The goal of this project was to solicit internal medicine residents' perception of EHR use in primary care clinic visits.

Geographic Variation of Adjuvant Breast Cancer Therapy Initiation in the United States: Lessons From Medicare Part D.

Drug utilization under Medicare Part D varies significantly by geographic region. This study examined the extent to which geographic variation in Part D plan characteristics contributes to the variation in choice of initial endocrine therapy agent among women with incident breast cancer. Two-stage multivariate regression analyses were applied to the 16,541 women identified from Medicare claims as having incident breast cancer in 2006-2007.

Relationship between individual categories of adverse childhood experience and diabetes in adulthood in a sample of US adults: Does it differ by gender?

Aims: ACEs are known to increase risk for diabetes in adulthood. However, little is known about the differential impact of individual ACE categories on diabetes risk, and whether this relationship is gender specific.

Methods: Data from the 2011 BRFSS was used in this study.

Prevalence and Consequences of Axillary Lymph Node Dissection in the Era of Sentinel Lymph Node Biopsy for Breast Cancer.

Background: Despite clear guidelines for its use and wide adoption, no population-based study has examined the extent to which patients with early stage breast cancer are benefiting from sentinel lymph node biopsy (SLNB) by being spared a potentially avoidable axillary lymph node dissection (ALND) and its associated morbidity.

Objective: Examine variation in type of axillary surgery performed by surgeon volume; investigate the extent and consequences of potentially avoidable ALND.

Research Design/subjects: Observational study of older women with pathologically node-negative stage I-II invasive breast cancer who underwent surgery in a SEER state in 2008-2009.

Trends in healthcare expenditure among people living with HIV/AIDS in the United States: evidence from 10 Years of nationally representative data.

Background: While previous studies have examined HIV cost expenditures within the United States, the majority of these studies focused on data collected prior to or shortly after the advent and uptake of antiretroviral therapy, focused only on a short time frame, or did not provide cost comparisons between HIV/AIDS and other chronic conditions. It is critical that researchers provide accurate and updated information regarding the costs of HIV care to assist key stakeholders with economic planning, policy development, and resource allocation.

Methods: We used data from the Medical Expenditure Panel Survey-Household Component for the years 2002-2011, which represents a nationally representative U.

Virtual Surgery for the Nasal Airway: A Preliminary Report on Decision Support and Technology Acceptance.

Importance: Nasal airway obstruction (NAO) is a common problem that affects patient quality of life. Surgical success for NAO correction is variable. Virtual surgery planning via computational fluid dynamics (CFD) has the potential to improve the success rates of NAO surgery.

Effect of psychotherapy for depression via home telehealth on glycemic control in adults with type 2 diabetes: Subgroup analysis of a randomized clinical trial.

Objective We evaluated the impact of telemedicine-delivered behaviour activation treatment (BAT) on glycemic control in a subgroup of older adults with diabetes who participated in a randomized controlled trial for depression. Research design and methods We randomized older adults with major depression to same-room or telemedicine BAT. Each group received eight weekly sessions.

Chronic Myeloid Leukemia-the Promise of Tyrosine Kinase Inhibitor Discontinuation.

Some believe that tyrosine kinase inhibitor (TKI) therapy is as close to perfect as it gets in oncologic therapy. Patients diagnosed with chronic myeloid leukemia (CML) are treated with a daily oral therapy, through which most achieve remission. TKI therapy is not associated with classic chemotherapy side effects, and most patients are able to resume their normal activities of daily living.

Electrocardiographic Strain Pattern Is Associated With Left Ventricular Concentric Remodeling, Scar, and Mortality Over 10 Years: The Multi-Ethnic Study of Atherosclerosis.

Background: Both ECG strain pattern and QRS measured left ventricular (LV) hypertrophy criteria are associated with LV hypertrophy and have been used for risk stratification. However, the independent predictive value of ECG strain in apparently healthy individuals in predicting mortality and adverse cardiovascular events is unclear.

Methods And Results: MESA (Multi-Ethnic Study of Atherosclerosis) is a multicenter, prospective cohort of 6441 participants (mean age, 62 years; 54% women).

Socioeconomic status and breast cancer treatment.

Purpose: Evidence suggests substantial disparities in breast cancer survival by socioeconomic status (SES). We examine the extent to which receipt of newer, less invasive, or more effective treatments-a plausible source of disparities in survival-varies by SES among elderly women with early-stage breast cancer.

Methods: Multivariate regression analyses applied to 11,368 women (age 66-90 years) identified from SEER-Medicare as having invasive breast cancer diagnosed in 2006-2009.

A conceptual framework for patient-centered fertility treatment.

Background: Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs.

Methods: In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist.

Centralized patient-reported outcome data collection in transplantation is feasible and clinically meaningful.

Background: Allogeneic hematopoietic cell transplantation (HCT) cures many patients, but often with the risk of late effects and impaired quality of life. The value of quantifying patient-reported outcomes (PROs) is increasingly being recognized, but the routine collection of PROs is uncommon. This study evaluated the feasibility of prospective PRO collection by an outcome registry at multiple time points from unselected HCT patients undergoing transplantation at centers contributing clinical data to the Center for International Blood and Marrow Transplant Research (CIBMTR), and then it correlated the PRO data with clinical and demographic data.

Use of social adaptability index to explain self-care and diabetes outcomes.

Background: To examine whether the social adaptability index (SAI) alone or components of the index provide a better explanatory model for self-care and diabetes outcomes.

Methods: Six hundred fifteen patients were recruited from two primary care settings. A series of multiple linear regression models were run to assess (1) associations between the SAI and diabetes self-care/outcomes, and (2) associations between individual SAI indicator variables and diabetes self-care/outcomes.

Why Parents Seek Care for Acute Illness in the Clinic or the ED: The Role of Health Literacy.

Objective: To explore the decision to seek care and decision-making regarding location of care among parents with low and adequate health literacy.

Methods: Parents of children 8 years old or younger who presented for 'sick child' visits at a clinic or a nonurgent emergency department (ED) visit (triage level 5) were interviewed. The Newest Vital Sign was used to categorize parental health literacy.

Rural-Urban Differences in Trends in the Wealth Index in Kenya: 1993-2009.

Background: The aim of this study was to construct a wealth index that could be compared over time in order to understand the trends in wealth in Kenya and determine predictors of change in wealth index.

Methods: Data were from the Demographic and Health Survey program collected in Kenya between 1993 and 2009. Variable categories were collapsed to match and factor analysis was performed on the 4-year pooled data to generate a harmonized wealth index.

Differential Relationships Between Diabetes Knowledge Scales and Diabetes Outcomes.

Background Diabetes affects more than 29 million people in the US and requires daily self-management in addition to knowledge of the disease. Three knowledge assessments used are the Michigan Brief Diabetes Knowledge Test (DKT), Starr County Diabetes Knowledge Questionnaire (DKQ), and Kaiser DISTANCE Survey (DISTANCE). Purpose The purpose of the study was to test the discriminate validity of 3 diabetes knowledge scales and determine which is best associated with diabetes self-care and glycemic control.

Trends in sex differences in the receipt of quality of care indicators among adults with diabetes: United States 2002-2011.

Background: Evidence suggests disparities in quality of care (QoC) indicators based on sex exist in adults diagnosed with diabetes; however, this research is limited. Therefore, the objective of this research study was to assess differences in QOC indicators in a nationally representative sample of men and women with diabetes.

Methods: Cross-sectional study of 17,702 men and women (≥18 years of age) with diabetes from the 2002-2011 Medical Expenditure Panel Survey Household Component.

Randomized Controlled Trial of Technology-Assisted Case Management in Low Income Adults with Type 2 Diabetes.

Objective: To assess the efficacy of technology-assisted case management (TACM) with medication titration by nurses using guideline-based algorithms, under physician supervision in improving glycemic control in low-income rural adults with poorly controlled type 2 diabetes.

Research Design And Methods: Adults (aged ≥18 years) from the southeastern United States with hemoglobin A1c [HbA1c] ≥8% were randomized to TACM or usual care. Evidence-based guidelines were used to develop medication titration algorithms in conjunction with clinic physicians.

Perceived barriers to healthcare and receipt of recommended medical care among elderly Medicare beneficiaries.

Purpose: Many Medicare beneficiaries perceive barriers to receiving healthcare, although the consequences are unknown. Facilitators can aid in the receipt of healthcare services. The objective was to assess the relationship between perceived facilitators and barriers to healthcare and actual receipt of recommended medical care among elderly beneficiaries.

Trends in healthcare expenditure in United States adults with chronic kidney disease: 2002-2011.

Background: This study examines trends in healthcare expenditure in adults with chronic kidney disease (CKD) and other kidney diseases (OKD) in the U.S. from 2002 to 2011.

Erosion of Digital Professionalism During Medical Students' Core Clinical Clerkships.

Background: The increased use of social media, cloud computing, and mobile devices has led to the emergence of guidelines and novel teaching efforts to guide students toward the appropriate use of technology. Despite this, violations of professional conduct are common.

Objective: We sought to explore professional behaviors specific to appropriate use of technology by looking at changes in third-year medical students' attitudes and behaviors at the beginning and conclusion of their clinical clerkships.