Impact of bariatric surgery on life expectancy in severely obese patients with diabetes: a decision analysis.

Objective: To create a decision analytic model to estimate the balance between treatment risks and benefits for severely obese patients with diabetes.

Background: Bariatric surgery leads to many desirable metabolic changes, but long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified.

Methods: We developed a Markov state transition model with multiple Cox proportional hazards models and logistic regression models as inputs to compare bariatric surgery versus no surgical treatment for severely obese diabetic patients.

Predictors of bariatric surgery among an interested population.

Background: Severely obese patients considering bariatric surgery face a difficult decision given the tradeoff between the benefits and risks of surgery. The objectives of this study was to study the forces driving this decision and improve our understanding of the decision-making process.

Methods: A 64-item survey was developed to assess factors in the decision-making process for bariatric surgery.

Joint modeling of self-rated health and changes in physical functioning.

Self-rated health is an important indicator of future morbidity and mortality. Past research has indicated that self-rated health is related to both levels of and changes in physical functioning. However, no previous study has jointly modeled longitudinal functional status and self-rated health trajectories.

Case study of linking dental and medical healthcare records.

Objective: To link the administrative data of a large dental carrier and an integrated health plan in Washington State to conduct an observational study of diabetes and periodontal disease.

Study Design: Evaluation of variable suitability, testing of linkage variables, and performing an n - 1 deterministic linkage strategy.

Methods: We examined a variety of administrative data variables for their consistency over time and their information richness to use as matching variables.

Bayesian Calibration of Microsimulation Models.

Microsimulation models that describe disease processes synthesize information from multiple sources and can be used to estimate the effects of screening and treatment on cancer incidence and mortality at a population level. These models are characterized by simulation of individual event histories for an idealized population of interest. Microsimulation models are complex and invariably include parameters that are not well informed by existing data.

Oral contraceptive use and bone density in adolescent and young adult women.

Background: Most of the millions of oral contraceptive (OC) users are under 30 years of age and in the critical period for bone mass accrual.

Study Design: This cross-sectional study of 606 women aged 14-30 years examined both OC duration and estrogen dose and their association with bone mineral density (BMD) at the hip, spine, and whole body (dual-energy X-ray absorptiometry).

Results: Of 389 OC users and 217 nonusers enrolled, 50% were adolescents (14-18 years).

Validity of Clinical Body Weight Measures as Substitutes for Missing Data in a Randomized Trial.

BACKGROUND: Long-term follow-up of weight loss interventions is essential, but collecting weights can be difficult, and self-reports inaccurate. We examined the relationship between weight measures obtained in the context of a weight loss trial and in routine clinical care. METHODS: Body weight data from a trial of behavioral obesity treatment among 88 obese women and 203 women age 40 to 65 years with comorbid obesity and depression were compared against weight data entered into an electronic medical record (EMR) during routine clinical care.

Predictors of long-term mortality after bariatric surgery performed in Veterans Affairs medical centers.

Hypothesis: The purpose of this study was to examine patient factors associated with mortality among veterans who undergo bariatric surgery.

Design: Prospective study that uses data from the Veterans Affairs (VA) National Surgical Quality Improvement Program.

Setting: Group Health Center for Health Studies, the VA North Texas Health Care System, the Denver VA Medical Center, and the Durham VA Medical Center.

Trends in long-term opioid therapy for chronic non-cancer pain.

Objective: To report trends and characteristics of long-term opioid use for non-cancer pain.

Methods: CONSORT (CONsortium to Study Opioid Risks and Trends) includes adult enrollees of two health plans serving over 1 per cent of the US population. Using automated data, we constructed episodes of opioid use between 1997 and 2005.

Referral, receipt, and completion of chemotherapy in patients with early-stage breast cancer older than 65 years and at high risk of breast cancer recurrence.

Purpose: Some women with early-stage breast cancer are at higher risk of recurrence and can benefit from chemotherapy. We describe patterns of referral, receipt, and completion of chemotherapy among older women at high risk of recurrence.

Patients And Methods: A total of 2,124 women age 65 years or older who were diagnosed with early-stage breast cancer between 1990 and 1994 and 1996 to 1999 were included; 1,090 of these were at high risk of recurrence.

Accuracy and complexities of using automated clinical data for capturing chemotherapy administrations: implications for future research.

Background: Chemotherapy data are important to almost any study on cancer prognosis and outcomes. However, chemotherapy data obtained from tumor registries may be incomplete, and abstracting chemotherapy directly from medical records can be expensive and time consuming.

Methods: We evaluated the accuracy of using automated clinical data to capture chemotherapy administrations in a cohort of 757 ovarian cancer patients enrolled in 7 health plans in the HMO Cancer Research Network.

Looking at research consent forms through a participant-centered lens: the PRISM readability toolkit.

Communicating in lay language is an underdeveloped skill among many researchers-a limitation that contributes to low readability among research consent forms and may hinder participant understanding of study procedures and risks. We present the Project to Review and Improve Study Materials (PRISM) and its centerpiece, the PRISM Readability Toolkit. The toolkit provides strategies for creating study materials that are readable and participant centered, focusing on consent forms but also addressing other participant materials.

Risk of medically attended local reactions following diphtheria toxoid containing vaccines in adolescents and young adults: a Vaccine Safety Datalink study.

Three vaccines currently recommended for adolescents (Tdap, Td, and MCV4 meningococcal conjugate vaccine) contain diphtheria toxoid. While the safety of individual diphtheria toxoid containing vaccines has been evaluated, less is known regarding the safety of administration of two or more of these vaccines, either concomitantly or sequentially. This study evaluated the risk of medically attended local reactions in adolescents and young adults with varying patterns of receipt of diphtheria toxoid containing vaccines.

Neuropathology-based risk scoring for dementia diagnosis in the elderly.

Current neuropathologic consensus criteria for diagnosis of dementia yield a classification of processes that likely contributed to dementia in that individual. While dementia diagnosis currently relies on clinical criteria, practicing neuropathologists and researchers might benefit from a simple, accurate risk scoring protocol for the neuropathologic diagnosis of dementia. Using 232 consecutive autopsies from the population-based Adult Changes in Thought study, we developed two logistic regression-based risk scoring systems; one solely using neuropathologic measures and a second additionally including demographic information.

Best ways to provide feedback to radiologists on mammography performance.

Objective: The Mammography Quality Standards Act of 1992 required a minimum performance audit of radiologists performing mammography. Since then, no studies have evaluated radiologists' perceptions of their audit reports, such as which performance measures are the most or least useful, or what the best formats are to present performance data.

Materials And Methods: We conducted a qualitative study with focus groups and interviews of 25 radiologists currently practicing mammography.

Assigning resources to health care use for health services research: options and consequences.

Aims: Our goals are 3-fold: (1) to review the leading options for assigning resource coefficients to health services utilization; (2) to discuss the relative advantages of each option; and (3) to provide examples where the research question had marked implications for the choice of which resource measure to employ.

Methods: Three approaches have been used to establish relative resource weights in health services research: (a) direct estimation of production costs through microcosting or step down allocation methods; (b) macrocosting/regression analysis; and (c) standardized resource assignment. We describe each of these methods and provide examples of how the study question drove the choice of resource-use measure.

Statin use and risk of community acquired pneumonia in older people: population based case-control study.

Objective: To test the hypothesis that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of community acquired pneumonia.

Design: Population based case-control study.

Setting: Group Health, a large integrated healthcare delivery system.

Impact of a brief motivational smoking cessation intervention the Get PHIT randomized controlled trial.

Background: Few studies have rigorously evaluated whether providing biologically based health-risk feedback is more effective than standard interventions in increasing smokers' motivation to quit and their long-term abstinence.

Design: An RCT was conducted from 2005 to 2008. Data were analyzed in 2008.

Short-term hormone therapy suspension and mammography recall: a randomized trial.

Background: Without population-based evidence, some clinicians recommend short-term suspension of hormone therapy to improve the performance of mammography. Hormone therapy increases breast density, and abnormal screening mammograms are more common among women with denser breasts and among women using hormone therapy.

Objective: To test whether 1 to 2 months of hormone therapy suspension before screening mammography decreases additional mammographic imaging (recall) in women age 45 to 80 years.

Phase III comparison of an investigational quadrivalent meningococcal conjugate vaccine with the licensed meningococcal ACWY conjugate vaccine in adolescents.

Background: Neisseria meningitidis is an important cause of invasive bacterial infection in the United States, and disease rates are higher for adolescents than for the general population. Quadrivalent meningococcal conjugate vaccine is recommended for routine vaccination of adolescents and high-risk groups. This study compares the safety and immunogenicity of the Novartis Vaccines investigational quadrivalent meningococcal CRM(197) conjugate vaccine, MenACWY-CRM, with the licensed meningococcal conjugate vaccine, Menactra.

Short-term (1-2 mo) hormone therapy cessation before mammography.

Objective: Some healthcare providers recommend hormone therapy (HT) cessation before mammography to improve performance. Our objective was to evaluate characteristics of women willing to consider HT cessation before screening mammography.

Methods: We performed a randomized clinical trial, the Radiological Evaluation and Breast Density study, within an integrated health plan (2004-2007).

Risk factors for community-acquired pneumonia in immunocompetent seniors.

Objectives: To identify risk factors for developing community-acquired pneumonia (CAP) in seniors.

Design: Nested case-control study.

Setting: Group Health, a health maintenance organization in Washington state.