Association of ALLHAT investigator characteristics with participant recruitment

Clinical trials are often not successful because of the inability to recruit a sufficient number of patients. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest antihypertensive trial ever conducted, provided highly generalized results and successful recruitment of over 42,000 participants. The overall purpose of this study was to examine the association of investigator characteristics with anti-hypertensive (AHT) participant recruitment in ALLHAT. This secondary data analyses collected data from the ALLHAT investigator profile survey and related investigator characteristics to recruitment success. The sample size was 502 investigators, with recruitment data from 37,947AHT participants. Recruitment was dichotomized by categorizing all sites with recruitment numbers at or above the overall median recruitment number of 46 as "Successful Recruitment". Frequency distributions and univariate and multivariate logistic regression were conducted. When adjusting for all other factors, Hispanic ethnicity, suburban setting, Department of Veterans Affairs Medical Centers (VAMC) site type, number of clinical site staff working on the trial, study coordinator hours per week, medical conference sessions attended, the investigator's primary goal and the likelihood that a physician will convince a patient to continue on randomized treatment, have significant impacts on the recruitment success of ALLHAT investigators. Most of the ALLHAT investigators described their primary commitment as being towards their patients and not to scientific knowledge alone. However, investigators that distinguished themselves as leaders in research had greater recruitment success than investigators who were leaders in clinical practice. ALLHAT was a highly successful trial that proved that community based cardiovascular trials can be implemented on a large scale. Exploring characteristics of ALLHAT investigators provides data that can be generalized to sponsors, sites, and others interested in maximizing clinical trial recruitment numbers. Future studies should further evaluate investigator and study coordinator factors that impact cardiovascular clinical trial recruitment success.^

DIMETER: a haptic master device for tremor diagnosis in neurodegenerative diseases

In this study, a device based on patient motion capture is developed for the reliable and non-invasive diagnosis of neurodegenerative diseases. The primary objective of this study is the classification of differential diagnosis between Parkinson's disease (PD) and essential tremor (ET). The DIMETER system has been used in the diagnoses of a significant number of patients at two medical centers in Spain. Research studies on classification have primarily focused on the use of well-known and reliable diagnosis criteria developed by qualified personnel. Here, we first present a literature review of the methods used to detect and evaluate tremor; then, we describe the DIMETER device in terms of the software and hardware used and the battery of tests developed to obtain the best diagnoses. All of the tests are classified and described in terms of the characteristics of the data obtained. A list of parameters obtained from the tests is provided, and the results obtained using multilayer perceptron (MLP) neural networks are presented and analyzed.

Communication Between HIV Patients and Their Providers : A Qualitative Preference Match Analysis

ACKNOWLEDGMENTS We thank the HIV nurses and physicians from the two HIV clinics involved in this study (Academic Medical Center, Amsterdam; Erasmus Medical Center, Rotterdam) for their input and collaboration. We also express our gratitude to the participating patients. Finally, we thank Nicolette Strik-Mulder for her help with transcribing the audio recordings. FUNDING This study was funded by ZonMw (the Netherlands), program “Doelmatigheidsonderzoek” (grant 171002208). This funding source had no role in study design, data collection, analysis, interpretation, or writing of the report.

Análise da dinâmica e quantificação metabólica de imagens de medicina nuclear na modalidade PET/CT.

A presença da Medicina Nuclear como modalidade de obtenção de imagens médicas é um dos principais procedimentos utilizados hoje nos centros de saúde, tendo como grande vantagem a capacidade de analisar o comportamento metabólico do paciente, traduzindo-se em diagnósticos precoces. Entretanto, sabe-se que a quantificação em Medicina Nuclear é dificultada por diversos fatores, entre os quais estão a correção de atenuação, espalhamento, algoritmos de reconstrução e modelos assumidos. Neste contexto, o principal objetivo deste projeto foi melhorar a acurácia e a precisão na análise de imagens de PET/CT via processos realísticos e bem controlados. Para esse fim, foi proposta a elaboração de uma estrutura modular, a qual está composta por um conjunto de passos consecutivamente interligados começando com a simulação de phantoms antropomórficos 3D para posteriormente gerar as projeções realísticas PET/CT usando a plataforma GATE (com simulação de Monte Carlo), em seguida é aplicada uma etapa de reconstrução de imagens 3D, na sequência as imagens são filtradas (por meio do filtro de Anscombe/Wiener para a redução de ruído Poisson caraterístico deste tipo de imagens) e, segmentadas (baseados na teoria Fuzzy Connectedness). Uma vez definida a região de interesse (ROI) foram produzidas as Curvas de Atividade de Entrada e Resultante requeridas no processo de análise da dinâmica de compartimentos com o qual foi obtida a quantificação do metabolismo do órgão ou estrutura de estudo. Finalmente, de uma maneira semelhante imagens PET/CT reais fornecidas pelo Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) foram analisadas. Portanto, concluiu-se que a etapa de filtragem tridimensional usando o filtro Anscombe/Wiener foi relevante e de alto impacto no processo de quantificação metabólica e em outras etapas importantes do projeto em geral.

Risk of Cerebral Venous Thrombosis in Obese Women.

IMPORTANCE Obesity is a risk factor for deep vein thrombosis of the leg and pulmonary embolism. To date, however, whether obesity is associated with adult cerebral venous thrombosis (CVT) has not been assessed. OBJECTIVE To assess whether obesity is a risk factor for CVT. DESIGN, SETTING, AND PARTICIPANTS A case-control study was performed in consecutive adult patients with CVT admitted from July 1, 2006 (Amsterdam), and October 1, 2009 (Berne), through December 31, 2014, to the Academic Medical Center in Amsterdam, the Netherlands, or Inselspital University Hospital in Berne, Switzerland. The control group was composed of individuals from the control population of the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis study, which was a large Dutch case-control study performed from March 1, 1999, to September 31, 2004, and in which risk factors for deep vein thrombosis and pulmonary embolism were assessed. Data analysis was performed from January 2 to July 12, 2015. MAIN OUTCOMES AND MEASURES Obesity was determined by body mass index (BMI). A BMI of 30 or greater was considered to indicate obesity, and a BMI of 25 to 29.99 was considered to indicate overweight. A multiple imputation procedure was used for missing data. We adjusted for sex, age, history of cancer, ethnicity, smoking status, and oral contraceptive use. Individuals with normal weight (BMI <25) were the reference category. RESULTS The study included 186 cases and 6134 controls. Cases were younger (median age, 40 vs 48 years), more often female (133 [71.5%] vs 3220 [52.5%]), more often used oral contraceptives (97 [72.9%] vs 758 [23.5%] of women), and more frequently had a history of cancer (17 [9.1%] vs 235 [3.8%]) compared with controls. Obesity (BMI ≥30) was associated with an increased risk of CVT (adjusted odds ratio [OR], 2.63; 95% CI, 1.53-4.54). Stratification by sex revealed a strong association between CVT and obesity in women (adjusted OR, 3.50; 95% CI, 2.00-6.14) but not in men (adjusted OR, 1.16; 95% CI, 0.25-5.30). Further stratification revealed that, in women who used oral contraceptives, overweight and obesity were associated with an increased risk of CVT in a dose-dependent manner (BMI 25.0-29.9: adjusted OR, 11.87; 95% CI, 5.94-23.74; BMI ≥30: adjusted OR, 29.26; 95% CI, 13.47-63.60). No association was found in women who did not use oral contraceptives. CONCLUSIONS AND RELEVANCE Obesity is a strong risk factor for CVT in women who use oral contraceptives.

Untersuchungen über den Übergang von Infektionserregern (Milzbrand-, Rotlauf- und Tuberkelbazillen) von der trächtigen Mutter auf den Fötus.

Inaug.-diss. - Hannover, 1912.

A program evaluation of the Department of Veterans Affairs Dietetic Service /

"August 1990."

University of Michigan Hospitals

Univeristy of Michgan Hospitals, one of the nation's leading medical centers, is located on the Campus of University of Michigan at Ann Arbor.

Evaluation of a Post Discharge Intervention on 30-Day Re-admission and Emergency Room Use in Patients with Diabetes A Pilot Program

Thesis (Master's)--University of Washington, 2016-06

Coping with a diagnosis of Alzheimer's disease: A client and caregiver perspective

The purpose of this study was to examine how individuals and their caregivers cope with a diagnosis of Alzheimer's disease. The sample size consisted of six patients with Alzheimer's disease and seven caregivers. The caregivers included spouses and adult children. The study was conducted at an academic medical center in the South Florida area. Using a phenomenological approach, data were collected by audiotaped interviews. Data were analyzed following the seven steps of Colaizzi (1978).^ The results of the study indicated that clients experienced fear, social withdrawal, decreased self-esteem and a need for love and support. Caregivers experienced psychological strain, burden, lifestyle adjustments and sacrifice. Both clients and caregivers identified numerous strategies for coping with Alzheimer's disease. The findings reflect the need for a holistic approach to promoting the quality of life for patients and caregivers. ^

A Framework to Support the Sharing and Reuse of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications.

INTRODUCTION: The ability to reproducibly identify clinically equivalent patient populations is critical to the vision of learning health care systems that implement and evaluate evidence-based treatments. The use of common or semantically equivalent phenotype definitions across research and health care use cases will support this aim. Currently, there is no single consolidated repository for computable phenotype definitions, making it difficult to find all definitions that already exist, and also hindering the sharing of definitions between user groups. METHOD: Drawing from our experience in an academic medical center that supports a number of multisite research projects and quality improvement studies, we articulate a framework that will support the sharing of phenotype definitions across research and health care use cases, and highlight gaps and areas that need attention and collaborative solutions. FRAMEWORK: An infrastructure for re-using computable phenotype definitions and sharing experience across health care delivery and clinical research applications includes: access to a collection of existing phenotype definitions, information to evaluate their appropriateness for particular applications, a knowledge base of implementation guidance, supporting tools that are user-friendly and intuitive, and a willingness to use them. NEXT STEPS: We encourage prospective researchers and health administrators to re-use existing EHR-based condition definitions where appropriate and share their results with others to support a national culture of learning health care. There are a number of federally funded resources to support these activities, and research sponsors should encourage their use.

Modeling Hospital Readmissions in Dalarna County, Sweden

Unplanned hospital readmissions increase health and medical care costs and indicate lower the lower quality of the healthcare services. Hence, predicting patients at risk to be readmitted is of interest. Using administrative data of patients being treated in the medical centers and hospitals in the Dalarna County, Sweden, during 2008 – 2016 two risk prediction models of hospital readmission are built. The first model relies on the logistic regression (LR) approach, predicts correctly 2,648 out of 3,392 observed readmission in the test dataset, reaching a c-statistics of 0.69. The second model is built using random forests (RF) algorithm; correctly predicts 2,183 readmission (out of 3,366) and 13,198 non-readmission events (out of 18,982). The discriminating ability of the best performing RF model (c-statistic 0.60) is comparable to that of the logistic model. Although the discriminating ability of both LR and RF risk prediction models is relatively modest, still these models are capable to identify patients running high risk of hospital readmission. These patients can then be targeted with specific interventions, in order to prevent the readmission, improve patients’ quality of life and reduce health and medical care costs.

Les mécanismes visant à assurer la qualité et la sécurité des soins en CMS sont-ils suffisants?

Résumé : Par l’adoption des Projets de loi 33 et 34, en 2006 et 2009 respectivement, le gouvernement du Québec a créé de nouvelles organisations privées dispensatrices de soins spécialisés, soient les centres médicaux spécialisés. Il a de ce fait encadré leur pratique, notamment dans l’objectif d’assurer un niveau de qualité et de sécurité satisfaisant des soins qui y sont dispensés. L’auteure analyse les différents mécanismes existants pour assurer la qualité et la sécurité des soins offerts en centres médicaux spécialisés, afin de constater si l’objectif recherché par le législateur est rencontré. Ainsi, elle expose les mécanismes spécifiques prévus dans la Loi sur les services de santé et services sociaux applicables aux centres médicaux spécialisés qui jouent un rôle quant au maintien de la qualité et de la sécurité des services, de même que des mécanismes indirects ayant une incidence sur ce plan, tels que la motivation économique et les recours en responsabilité. Ensuite, elle s’attarde aux processus issus de la règlementation professionnelle. Elle arrive à la conclusion que deux mécanismes sont manquants pour rencontrer l’objectif visé par le législateur et propose, à ce titre, des pistes de solution.

Septic Shock Sera Containing Circulating Histones Induce Dendritic Cell–Regulated Necrosis in Fatal Septic Shock Patients

International audience

Repercusión del envejecimiento sobre la conducción: declive y estrategias compensatorias

Introducción: La conducción de vehículos por personas mayores es una realidad creciente y una de las actividades que ayuda a mantener la sensación de autonomía personal. Sin embargo, la calidad de la conducción puede verse afectada por el envejecimiento. Por ello, el objetivo del presente estudio es comparar la percepción de un grupo de conductores sobre los cambios asociados a la edad y los ajustes utilizados en la conducción en función de la edad. Material y método: Se reclutó una muestra de 312 conductores de 20 a 80 años de edad procedentes de centros de reconocimiento médico para la renovación del carné de conducir, así como de centros de recuperación de puntos. A los participantes se les administró un cuestionario sobre características de la conducción y el cuestionario de adaptación a la conducción. Resultados: Se observaron diferencias estadísticamente significativas tanto en los declives percibidos como en los ajustes compensatorios, observándose que los conductores mayores de 65 años indicaron medias más elevadas que el resto de rangos de edad. El grupo de 70 a 80 años es el que usa estrategias compensatorias: «no conducir si llueve», «evitar adelantar», «no conducir de noche», «conducir solo por determinadas zonas» o «aparcar en línea». Conclusiones: Dado que la edad influye en la conducción de vehículos, los mayores usan estrategias de compensación para aminorar el impacto que el envejecimiento provoca sobre esta habilidad.