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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 709 Research Studies Displayed
Grauer A, Duran AT, Liyanage-Don NA
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
The purpose of this retrospective cohort study was to explore whether there is a relationship between telemedicine use in primary care and risk factor assessment and control for patients with diabetes mellitus. The study included patients with diabetes mellitus ages 18-75 with a telemedicine visit in a primary care network between February 2020 and December 2020. Researchers evaluated whether low-density lipoprotein cholesterol (LDL-C), blood pressure (BP), and hemoglobin A1c (HbA1c) and were assessed for each patient. The study identified 1,824 patients with diabetes during the study period and found that telemedicine use was associated with a lower proportion of patients with all three risk factors assessed. The researchers concluded that telemedicine use was related with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic.
AHRQ-funded; HS026121; HS024262.
Citation: Grauer A, Duran AT, Liyanage-Don NA . Association between telemedicine use and diabetes risk factor assessment and control in a primary care network. J Endocrinol Invest 2022 Sep;45(9):1749-56. doi: 10.1007/s40618-022-01814-6..
Keywords: Diabetes, Chronic Conditions, Telehealth, Health Information Technology (HIT), Primary Care, Risk
Gallo T, Heise CW, Woosley RL
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
The purpose of this study was to create an advanced torsades de pointes (TdP) clinical decision support (CDS) advisory that provides relevant, patient-specific information, including 1-click management options, and to evaluate clinician satisfaction with the CDS. The researchers implemented the advanced TdP CDS across a health system comprising 29 hospitals. A brief electronic survey was developed to collect clinician feedback on the advisory and was emailed to 442 clinicians who received the advisory. Feedback was generally positive across the 38 responding providers, with 79% of respondents reporting that the advisory assisted with their care for their patients and 87% responding that the alerts clearly specified alternative actions. The researchers concluded that providers who receive an advanced TdP risk CDS alert generally view the alert favorably.
Citation: Gallo T, Heise CW, Woosley RL . Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes. J Patient Saf 2022 Sep 1;18(6):e1010-e13. doi: 10.1097/pts.0000000000000996..
Keywords: Clinical Decision Support (CDS), Decision Making, Risk, Provider: Clinician, Heart Disease and Health, Cardiovascular Conditions
Laskow T, Zhu J, Buta B
Risk factors for nonresilient outcomes in older adults after total knee replacement.
The purpose of this study was to develop a simple measure of physical resilience and identify risk factors for nonresilient patient outcomes in total knee replacement procedures (TKR). The researchers conducted a secondary analysis of the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) cohort study, including 7,239 adults aged 60 or older who underwent TKR between 2011 and 2015. The study found that the variables of age, body mass index, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically nonresilient outcomes across the 3 patient-reported outcomes of the physical component summary (PCS), bodily pain (BP), and vitality (VT). A household income of greater than $45 000 associated with lower risk for PCS (RR = 0.81 [0.70-0.93]), BP (RR = 0.80 [0.69-0.91]), and VT (RR = 0.86 [0.78-0.93]). CONCLUSIONS: We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.
Citation: Laskow T, Zhu J, Buta B . Risk factors for nonresilient outcomes in older adults after total knee replacement. J Gerontol A Biol Sci Med Sci 2022 Sep;77(9):1915-22. doi: 10.1093/gerona/glab257..
Keywords: Orthopedics, Surgery, Elderly, Risk
Dikranian L, Barry S, Ata A
Sars-CoV-2 with concurrent respiratory viral infection as a risk factor for a higher level of care in hospitalized pediatric patients.
This study’s objective was to evaluate if the presence of concurrent respiratory viral infections in pediatric patients admitted to the hospital with SARS-CoV-2 was associated with an increased rate of ICU level of care. Data from 67 participating hospitals was provided through The Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study database. A total of 922 patients were included, with 391 requiring ICU level care and 31 having concurrent non-SARS-CoV-2 viral coinfection. After accounting for age, positive blood culture, positive sputum culture, preexisting chronic medical conditions, the presence of a viral respiratory coinfection was associated with increased need for ICU care.
Citation: Dikranian L, Barry S, Ata A . Sars-CoV-2 with concurrent respiratory viral infection as a risk factor for a higher level of care in hospitalized pediatric patients. Pediatr Emerg Care 2022 Sep;38(9):472-76. doi: 10.1097/pec.0000000000002814..
Keywords: COVID-19, Children/Adolescents, Respiratory Conditions, Risk
Wang HS, Panagides J, Cahill D
Dietary risk factors for pediatric kidney stones: a case-control study.
This study’s objective was to perform a case-control study of the association of dietary nutrients with pediatric urolithiasis. Researchers obtained dietary information from pediatric urolithiasis patients and healthy controls; survey results were converted to standard nutrient intakes. Findings showed that higher dietary intake of calcium, sodium, and beta carotene, and lower potassium intake were associated with pediatric urolithiasis.
Citation: Wang HS, Panagides J, Cahill D . Dietary risk factors for pediatric kidney stones: a case-control study. J Urol 2022 Aug;208(2):434-40. doi: 10.1097/ju.0000000000002687..
Keywords: Children/Adolescents, Nutrition, Kidney Disease and Health, Risk
Lai LY, Oerline MK, Caram MEV
Risk of metabolic and cardiovascular adverse events with abiraterone or enzalutamide among men with advanced prostate cancer.
Investigators examined the association between the use of abiraterone or enzalutamide and the risk of metabolic or cardiovascular adverse events while on treatment for advanced prostate cancer. They found that, compared with men not receiving abiraterone, men receiving abiraterone were at increased risk of both a major composite adverse event and a minor composite adverse event. Compared with men not receiving enzalutamide, men receiving enzalutamide were at an increased risk of a major composite adverse event but not a minor composite adverse event. They recommended careful monitoring and management of men on abiraterone or enzalutamide through team-based approaches.
Citation: Lai LY, Oerline MK, Caram MEV . Risk of metabolic and cardiovascular adverse events with abiraterone or enzalutamide among men with advanced prostate cancer. J Natl Cancer Inst 2022 Aug 8;114(8):1127-34. doi: 10.1093/jnci/djac081..
Keywords: Cardiovascular Conditions, Cancer: Prostate Cancer, Cancer, Risk, Adverse Events, Medication, Adverse Drug Events (ADE), Medication: Safety, Patient Safety
Patnode CD, Redmond N, Iacocca MO
Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Serv
This paper’s objective was to synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a USPSTF recommendation. Findings showed that healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors.
Citation: Patnode CD, Redmond N, Iacocca MO . Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Serv JAMA 2022 Jul 26;328(4):375-88. doi: 10.1001/jama.2022.7408..
Keywords: U.S. Preventive Services Task Force (USPSTF), Lifestyle Changes, Cardiovascular Conditions, Risk, Prevention, Nutrition
Raper JD, Thomas AM, Lupez K
Can right ventricular assessments improve triaging of low risk pulmonary embolism?
Researchers sought to determine if right ventricle (RV) assessment variables add prognostic accuracy for 5-day clinical deterioration in patients classified low risk by the Simplified Pulmonary Embolism Severity Index and to determine the prognostic importance of RV assessments compared to other variables and to each other. They found that a pulmonary embolism triaging strategy with RV imaging assessments had superior prognostic performance at classifying low risk for 5-day clinical deterioration versus one without.
Citation: Raper JD, Thomas AM, Lupez K . Can right ventricular assessments improve triaging of low risk pulmonary embolism? Acad Emerg Med 2022 Jul;29(7):835-50. doi: 10.1111/acem.14484..
Keywords: Respiratory Conditions, Blood Clots, Risk
Rothberg MB, Hamilton AC, Greene MT
Derivation and validation of a risk factor model to identify medical inpatients at risk for venous thromboembolism.
This study’s objective was to compare multiple risk assessment models for hospitalized patients at high risk for venous thromboembolism (VTE). The authors developed a derivation cohort using 6 years of data from 12 hospitals to identify risk factors associated with developing VTE within 14 days of admission. The cohort included 155,026 patients with a 14-day VTE rate of 0.68%. The final multivariable model contained 13 risk factors and good calibration, and performance was evaluated using the C-statistic. The temporal validation cohort had 53,210 patients with a VTE rate of 0.64% and the external cohort had 23,413 patients and a rate of 0.49%. The Cleveland Clinic Model (CCM) outperformed both the Padua and IMPROVE models in the temporal cohort. In the external cohort the CCM C-statistic was similar to Padua and outperformed IMPROVE.
Citation: Rothberg MB, Hamilton AC, Greene MT . Derivation and validation of a risk factor model to identify medical inpatients at risk for venous thromboembolism. Thromb Haemost 2022 Jul;122(7):1231-38. doi: 10.1055/a-1698-6506..
Keywords: Inpatient Care, Risk, Blood Clots
Kerlikowske K, Su YR, Sprague BL
Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer.
The purpose of this study was to compare digital breast tomosynthesis (DBT) with digital mammography to determine whether DBT was correlated with lower rates of internal invasive cancer and advanced breast cancer, taking into consideration breast density and breast cancer risk. From 2011 through 2018, the researchers studied a cohort of 504,427 women between the ages of 40 and 79 who underwent 375,189 screening DBT exams and 1,003,900 screening digital mammography exams, and who were then followed up for cancer diagnoses between 2011 and 2019 after being identified via linkage to state or regional cancer registries. The median age at the time of screening was 58 years (IQR 50-65 years) and the diagnostic screenings took place at 44 Breast Cancer Surveillance Consortium (BCSC) facilities in the United States. The study found that among women at low to average risk, or at high risk with almost entirely fatty, scattered fibroglandular densities, or heterogeneously dense breasts, advanced cancer rates were not significantly different for DBT vs digital mammography. There was no significant difference between DBT and digital mammography for interval cancer rates per 1000 exams. Interval invasive cancer rates were also not significantly different among the 413,061 examinations with BCSC 5-year risk of 1.67% or higher (high risk) across breast density categories, or among all the 836,250 examinations with BCSC 5-year risk less than 1.67% (low to average-risk). For the 3.6% of women with extremely dense breasts and at high risk of breast cancer (13,291 examinations in the DBT group and 31,300 in the digital mammography group) advanced cancer rates per 1000 examinations were significantly lower for DBT vs digital mammography, but not for women at low to average risk (10,611 examinations in the DBT group and 37,796 in the digital mammography group). The researchers reported that there was no significant difference in the 96.4% of women with extremely dense breasts not at high risk, heterogeneously dense breasts, or nondense breasts, and concluded that screening with DBT vs digital mammography was associated with a significantly lower risk of advanced breast cancer among the 3.6% of women with extremely dense breasts and at high risk of breast cancer, and was not associated with a significant difference in risk of interval invasive cancer.
Citation: Kerlikowske K, Su YR, Sprague BL . Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer. JAMA 2022 Jun 14;327(22):2220-30. doi: 10.1001/jama.2022.7672..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Women, Imaging, Risk
Dube WC, Kellogg JT, Adams C
Quantifying risk for SARS-CoV-2 infection among nursing home workers for the 2020-2021 winter surge of the COVID-19 pandemic in Georgia, USA.
This study’s objective was to estimate incidence of risks for COVID-19 infection among nursing home staff in the state of Georgia during the 2020-2021 Winter surge in the US. Staff at fourteen nursing homes were given a survey and serologic testing at 2 time points with 3-month interval exposure assessment. At the first time point, 203 study eligible contracted or employed staff members from these participating nursing homes were seronegative. At the second time point, 72 (35.5%) had evidence of interval infection. Among unvaccinated staff, infection rates were significantly higher among nurses and certified nursing assistants accounting for race and interval infection incidence in both the community and facility.
Citation: Dube WC, Kellogg JT, Adams C . Quantifying risk for SARS-CoV-2 infection among nursing home workers for the 2020-2021 winter surge of the COVID-19 pandemic in Georgia, USA. J Am Med Dir Assoc 2022 Jun;23(6):942-46.e1. doi: 10.1016/j.jamda.2022.02.014..
Keywords: COVID-19, Nursing Homes, Provider: Health Personnel, Risk, Public Health
Giannouchos TV, Gómez-Lumbreras A, Malone DC
Risk of tizanidine-induced adverse events after concomitant exposure to ciprofloxacin: a cohort study in the U.S.
This study’s aim was to assess the risk of hypotension with coadministration of tizanidine (a painkiller medicine) and ciprofloxacin (an antibiotic). An observational nested cohort study was conducted using patients 18 years or older on tizanidine using data from electronic health records from 2000 to 2018 in the US. The analysis included 70,110 encounters across 221 hospitals. Most encounters were female (65.7%), whites (82.4%) with an average age of 56 years and an Elixhauser comorbidity index of 1.6. Only 2487 encounters (3.6%) had a co-administration of ciprofloxacin. An increased likelihood of hypotension was associated with co-administration compared to patients who did not receive ciprofloxacin.
Citation: Giannouchos TV, Gómez-Lumbreras A, Malone DC . Risk of tizanidine-induced adverse events after concomitant exposure to ciprofloxacin: a cohort study in the U.S. Am J Emerg Med 2022 May;55:147-51. doi: 10.1016/j.ajem.2022.03.008..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Risk
Kim HN, Nance RM, Lo Re V
Development and validation of a model for prediction of end-stage liver disease in people with HIV.
The authors developed and validated a risk-prediction model for end-stage liver disease (ESLD) among people with HIV (PWH). They developed and validated a risk prediction model for ESLD among PWH who received care in 12 cohorts of the North American AIDS Cohort Collaboration on Research and Design and found that their model of readily accessible clinical parameters predicted ESLD in a large diverse population of PWH.
Citation: Kim HN, Nance RM, Lo Re V . Development and validation of a model for prediction of end-stage liver disease in people with HIV. J Acquir Immune Defic Syndr 2022 Apr;89(4):396-404. doi: 10.1097/qai.0000000000002886..
Keywords: Chronic Conditions, Human Immunodeficiency Virus (HIV), Risk
Chu DK, Abrams EM, Golden BK
Risk of second allergic reaction to SARS-CoV-2 vaccines: a systematic review and meta-analysis.
The purpose of this systematic review and meta-analysis of case studies and case reports was to assess the risk of severe immediate allergic reactions to a second dose of SARS-CoV-2 mRNA vaccine in people who experienced an immediate allergic reaction to the first dose. The researchers evaluated the World Health Organization Global Coronavirus database, Web of Science, MEDLINE, and Embase from the date of inception through October 4th, 2021. The main outcomes and measures were a risk of severe immediate allergic reaction and repeated severe immediate allergic reactions with a second vaccine dose. The study found that among 22 studies of SARS-CoV-2 mRNA vaccines, 1366 individuals had immediate allergic reactions to their first vaccination. Of these, 87.8% were women with a mean age of 46.1 years. Six patients developed severe immediate allergic reactions after their second vaccination, 232 developed mild symptoms, and 1360 tolerated the dose. Among 78 persons with severe immediate allergic reactions to their first SARS-CoV-2 mRNA vaccination, 4 people had a second severe immediate reaction, and 15 had non-severe symptoms. There were no deaths. The study concluded that in a supervised setting equipped to manage severe allergic reactions, revaccination of individuals with an immediate allergic reaction to a first SARS-CoV-2 mRNA vaccine dose can be safe.
Citation: Chu DK, Abrams EM, Golden BK . Risk of second allergic reaction to SARS-CoV-2 vaccines: a systematic review and meta-analysis. JAMA Intern Med 2022 Apr;182(4):376-85. doi: 10.1001/jamainternmed.2021.8515..
Keywords: COVID-19, Vaccination, Risk, Evidence-Based Practice, Patient-Centered Outcomes Research
Jacobsohn GC, Leaf M, Liao F
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
The authors used a collaborative and iterative approach to design and implement an automated clinical decision support system (CDS) for Emergency Department (ED) providers to identify and refer older adult ED patients at high risk of future falls. The system was developed using collaborative input from an interdisciplinary design team and integrated seamlessly into existing ED workflows. A key feature of development was the unique combination of patient experience strategies, human-centered design, and implementation science, which allowed for the CDS tool and intervention implementation strategies to be designed simultaneously. Challenges included: usability problems, data inaccessibility, time constraints, low appointment availability, high volume of patients, and others. The study concluded that using the collaborative, iterative approach was successful in achieving all project goals, and could be applied to other cases.
Citation: Jacobsohn GC, Leaf M, Liao F . Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments. Healthc 2022 Mar;10(1):100598. doi: 10.1016/j.hjdsi.2021.100598..
Keywords: Elderly, Clinical Decision Support (CDS), Decision Making, Falls, Risk, Emergency Department, Health Information Technology (HIT)
Ellis RP, Hsu HE, Siracuse JJ
Development and assessment of a new framework for disease surveillance, prediction, and risk adjustment: the diagnostic items classification system.
The purpose of this study was to develop an updated classification framework for predicting diverse health care payment, quality, and performance outcomes, based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). All ICD-10-CM diagnoses were mapped into 3 types of diagnostic items (DXIs): main effect DXIs that specify diseases; modifiers, such as timing and acuity; and scaled variables, such as body mass index, gestational age, and birth weight. The primary outcome was annual health care spending top-coded at $250 000, and the researchers predicted 14 different outcomes, including: hospital days and admissions; emergency department visits; enrollee out-of-pocket spending; spending for 6 types of services; and overall and plan-paid health care spending. The researchers created 3223 DXIs: 2435 main effects, 772 modifiers, and 16 scaled items. The study found that relative to HHS-HCCs, the use of DXIs reduced underpayment for enrollees with rare diagnoses by 83%. The researchers concluded that in this study, for all spending and utilization outcomes considered, the new DXI classification system demonstrated improved predictions over current diagnostic classification systems.
Citation: Ellis RP, Hsu HE, Siracuse JJ . Development and assessment of a new framework for disease surveillance, prediction, and risk adjustment: the diagnostic items classification system. JAMA Health Forum 2022 Mar;3(3):e220276. doi: 10.1001/jamahealthforum.2022.0276..
Keywords: Risk, Research Methodologies
Kleinman LC, Howell EA
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
The researchers report that in the context of quality improvement research, risk adjustment (RA) methods can obscure disparities in health care. In this study the researchers address the impact of considering equity when conducting risk adjustments in pediatric health, and describe the danger of veiled justice, a type of overadjustment that takes place when risk adjustments obscure real disparities because more than one covariate, such as race and socioeconomic status, are on related causal paths. Underadjustment can occur when these same structural characteristics are not addressed when calculating models of payment. The purpose of this study was to describe the literature and present a conceptual framework that identifies these two problems for validity related to the interactions between risk adjustment and health equity in pediatric health care. The researchers conclude that the science of quality improvement must address issues of health equity as an essential construct, with the development of a specific conceptual model. Statistical analysis should be interpreted using the conceptual model, and the dynamics of child development and life course should also be addressed, as well as additional contextual and process factors such as the role of caregivers and public insurance, the epidemiology of the disease, family financial status, and others. The goal of RA is to make valid conclusions such that observed differences can be attributed to the relevant causes. When higher risk is attributed to social determinants and not disease differences, RA can obscure disparities (veiled injustice) and differences at the population level and experienced by individuals are falsely hidden. Not addressing these same structural characteristics when calculating models of payment can lead to patterns of underadjustment. The authors advise that these 2 sides of a similar coin reveal the critical importance of both the underlying model and the capacity to reliably evaluate disparities and quality.
AHRQ-funded; HS020518; 233201550088A.
Citation: Kleinman LC, Howell EA . Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment. Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948G.
Keywords: Children/Adolescents, Disparities, Racial / Ethnic Minorities, Risk
Wei YJ, Chen C, Lewis MO
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study used a sample of older patients who are Medicare beneficiaries who were newly prescribed opioids to determine rates of 4 prescription opioid dose trajectories and the risk of opioid-related adverse events (ORAEs). A 5% random sample of Medicare beneficiaries from 2011 to 2018 was used to conduct a nested case-control study of patients age 65 and older who were newly diagnosed with chronic noncancer pain (CNCP). Among the cases and controls, 2,192 (70.6%) were women and mean age was 77.1 years. Four prescribed opioid trajectories before the incident ORAE diagnosis or matched date emerged: gradual dose discontinuation (from ≤3 to 0 daily morphine milligram equivalent (MME), 1,456 [23.5%]), gradual dose increase (from 0 to >3 daily MME, 1,878 [30.3%]), consistent low dose (between 3 and 5 daily MME, 1,510 [24.3%]), and consistent moderate dose (>20 daily MME, 1,362 [22.0%]). Less than 5% were prescribed a mean daily dose of ≥90 daily MME during 6 months before diagnosis or matched date. Patients with gradual dose discontinuation versus those with a consistent low or moderate dose, and increase dose were more likely to be 65 to 74 years, Midwest US residents, and receiving no low-income subsidy. Those with gradual dose increase and consistent moderate dose had a higher risk of ORAE, after adjustment for covariates.
Citation: Wei YJ, Chen C, Lewis MO . Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study. PLoS Med 2022 Mar;19(3):e1003947. doi: 10.1371/journal.pmed.1003947..
Keywords: Elderly, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Chronic Conditions, Pain, Substance Abuse, Behavioral Health, Medication: Safety, Patient Safety
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
Citation: Flannery DD, Mukhopadhyay S, Morales KH . Delivery characteristics and the risk of early-onset neonatal sepsis. Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
Carpenter K, Scavotto M, McGovern A
Early parental knowledge of late effect risks in children with cancer.
This study assessed early parental knowledge of late effect risks in children with cancer. The cohort included parents of children receiving cancer treatment at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. The parents were surveyed about their knowledge of their child’s likelihood of eight late effects. Only 11 out of 96 parents correctly identified all their child’s risk for the eight late effects. Five of eight effects were the median number of correctly identified late effect risks. Among the 21 parents whose children were at risk for ototoxicity, 95% correctly identified this risk. Conversely, parents were less knowledgeable about risks of second malignancy, cardiac toxicity, neurocognitive impairment, and infertility.
Citation: Carpenter K, Scavotto M, McGovern A . Early parental knowledge of late effect risks in children with cancer. Pediatr Blood Cancer 2022 Feb;69(2):e29473. doi: 10.1002/pbc.29473..
Keywords: Children/Adolescents, Cancer, Risk, Education: Patient and Caregiver, Health Literacy
Yunusa I, Gagne JJ, Yoshida K
Risk of opioid overdose associated with concomitant use of oxycodone and selective serotonin reuptake inhibitors.
Oxycodone is a potent prescription opioid. Some Selective Serotonin Reuptake Inhibitors (SSRIs) inhibit oxycodone metabolism in the body, but the clinical consequences of this interaction on overdose risk have not been adequately determined. The study researchers compared the rates of opioid overdoses in patients who had initiated oxycodone while taking enzyme-inhibiting SSRIs with the overdose rates of patents who had initiated oxycodone while taking non-enzyme inhibiting SSRIs. Data from 3 U.S. health insurance databases was used to analyze a cohort of adults who initiated oxycodone while receiving SSRI therapy between the years 2000 and 2020. Of the total of 2,037,490 who initiated oxycodone, 69.6% were receiving SSRIs at the time of the initiation of the oxycodone. One-thousand-thirty-five overdose events were observed during this time, and the resulting incidence rate in those initiating oxycodone while using enzyme-inhibiting SSRI’s was higher than in those using other SSRIs. The researchers concluded that in the study cohort of U.S. adults, there is a small increased risk of opioid overdose when initiating oxycodone in patients taking enzyme-inhibiting SSRIs.
Citation: Yunusa I, Gagne JJ, Yoshida K . Risk of opioid overdose associated with concomitant use of oxycodone and selective serotonin reuptake inhibitors. JAMA Netw Open 2022 Feb;5(2):e220194. doi: 10.1001/jamanetworkopen.2022.0194..
Keywords: Opioids, Medication, Risk, Depression, Adverse Drug Events (ADE), Adverse Events
Fatemi P, Zhang Y, Han SS
A, et al. External validation of a predictive model of adverse events following spine surgery.
The authors externally validated a previously developed predictive model for common 30-day adverse events after spine surgery, the Risk Assessment Tool for Adverse Events after Spine Surgery (RAT-Spine). Their results are presented as low-, moderate-, and high-risk designations.
Citation: Fatemi P, Zhang Y, Han SS . A, et al. External validation of a predictive model of adverse events following spine surgery. Spine J 2022 Jan;22(1):104-12. doi: 10.1016/j.spinee.2021.06.006..
Keywords: Surgery, Adverse Events, Orthopedics, Risk
Squires A, Ma C, Miner S
Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis.
In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. The objective of this retrospective cross-sectional study was to determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge.
Citation: Squires A, Ma C, Miner S . Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis. Int J Nurs Stud 2022 Jan;125:104093. doi: 10.1016/j.ijnurstu.2021.104093..
Keywords: Cultural Competence, Home Healthcare, Hospital Readmissions, Risk, Communication
Mallela DP, Canner JK, Zarkowsky DS
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
This study investigated the association of race on carotid endarterectomy (CEA) outcomes. Perioperative outcomes (at 30 days) were compared for Black vs. White patients adjusting for age/sex, comorbidities and disease characteristics. Out of 16,764 patients from the ACS-NSQIP targeted vascular database (2011-2019), 95.2% were White and 4.8% were Black. Black patients were slightly younger and more frequently (79.5% vs 74.0%) had high-grade carotid artery stenosis compared to White patients. Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients. Crude perioperative stroke and stroke/death were higher for Black patients, but myocardial infarction leading to death were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke and stroke/death remained significantly higher for Black patients than White patients.
Citation: Mallela DP, Canner JK, Zarkowsky DS . Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP. J Am Coll Surg 2022 Jan;234(1):65-73. doi: 10.1097/xcs.0000000000000016..
Keywords: Racial / Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Frehn JL, Brewster AL, Shortell SM
Comparing health care system and physician practice influences on social risk screening.
This study examined the association of multilevel organizational capabilities and adoption of social risk screening among system-owned physician practices. A secondary analysis of the 2018 National Survey of Healthcare Organizations and Systems data was conducted. Five social risks were used as measures for physician and system screening: food insecurity, housing instability, utility needs, interpersonal violence, and transportation needs. System-owned practices screened an average of 1.7 of the 5 social risks assessed. The differences were 16% attributable to practice variation between their health system owners, and 84% attributable to differences between individual practices. Practices owned by hospital systems screened for an additional 0.44 social risks relative to practices of systems without hospitals. Characteristics associated with more social risk screening included health information technology capacity, innovation culture, and patient engagement strategies.
AHRQ-funded; HS024075; HS022241.
Citation: Frehn JL, Brewster AL, Shortell SM . Comparing health care system and physician practice influences on social risk screening. Health Care Manage Rev 2022 Jan-Mar;47(1):E1-e10. doi: 10.1097/hmr.0000000000000309..
Keywords: Health Systems, Social Determinants of Health, Screening, Risk