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\n \n 2024\n \n \n (1)\n \n \n

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\n \n\n \n \n Ruderman, S. A.; Drumright, L. N.; Delaney, J. A. C.; Webel, A. R.; Fitzpatrick, A. L.; Whitney, B. M.; Nance, R. M.; Hahn, A. W.; Ma, J.; Mixson, L. S.; Eltonsy, S.; Willig, A. L.; Mayer, K. H.; Napravnik, S.; Greene, M.; McCaul, M.; Cachay, E.; Kritchevsky, S. B.; Austad, S. N.; Landay, A.; Saag, M. S.; Kitahata, M. M.; Lau, B.; Lesko, C.; Chander, G.; Crane, H. M.; and Odden, M. C.\n\n\n \n \n \n \n \n Evaluating the Sick Quitting Hypothesis for Frailty Status and Reducing Alcohol Use Among People With HIV in a Longitudinal Clinical Cohort Study.\n \n \n \n \n\n\n \n\n\n\n Journal of the Association of Nurses in AIDS Care, 35(1): 5. February 2024.\n \n\n\n\n
\n\n\n\n \n \n $\"Evaluating$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{ruderman_evaluating_2024,\n\ttitle = {Evaluating the {Sick} {Quitting} {Hypothesis} for {Frailty} {Status} and {Reducing} {Alcohol} {Use} {Among} {People} {With} {HIV} in a {Longitudinal} {Clinical} {Cohort} {Study}},\n\tvolume = {35},\n\tissn = {1055-3290},\n\turl = {https://journals.lww.com/janac/abstract/2024/02000/evaluating_the_sick_quitting_hypothesis_for.3.aspx},\n\tdoi = {10.1097/JNC.0000000000000441},\n\tabstract = {“Sick quitting,” a phenomenon describing reductions in alcohol consumption following poor health, may explain observations that alcohol appears protective for frailty risk. We examined associations between frailty and reductions in drinking frequency among people with HIV (PWH). At six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites between January 2012 and August 2021, we assessed whether frailty, measured through validated modified frailty phenotype, precedes reductions in drinking frequency. We associated time-updated frailty with quitting and reducing frequency of any drinking and heavy episodic drinking (HED), adjusted for demographic and clinical characteristics in Cox models. Among 5,654 PWH reporting drinking, 60\\% reported {\\textgreater}monthly drinking and 18\\% reported ≥monthly HED. Over an average of 5.4 years, frail PWH had greater probabilities of quitting (HR: 1.56, 95\\% confidence interval [95\\% CI] [1.13–2.15]) and reducing (HR: 1.35, 95\\% CI [1.13–1.62]) drinking frequency, as well as reducing HED frequency (HR: 1.58, 95\\% CI [1.20–2.09]) versus robust PWH. Sick quitting likely confounds the association between alcohol use and frailty risk, requiring investigation for control.},\n\tlanguage = {en-US},\n\tnumber = {1},\n\turldate = {2024-02-07},\n\tjournal = {Journal of the Association of Nurses in AIDS Care},\n\tauthor = {Ruderman, Stephanie A. and Drumright, Lydia N. and Delaney, Joseph A. C. and Webel, Allison R. and Fitzpatrick, Annette L. and Whitney, Bridget M. and Nance, Robin M. and Hahn, Andrew W. and Ma, Jimmy and Mixson, L. Sarah and Eltonsy, Sherif and Willig, Amanda L. and Mayer, Kenneth H. and Napravnik, Sonia and Greene, Meredith and McCaul, Mary and Cachay, Edward and Kritchevsky, Stephen B. and Austad, Steven N. and Landay, Alan and Saag, Michael S. and Kitahata, Mari M. and Lau, Bryan and Lesko, Catherine and Chander, Geetanjali and Crane, Heidi M. and Odden, Michelle C.},\n\tmonth = feb,\n\tyear = {2024},\n\tpages = {5},\n}\n\n

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\n \n 2023\n \n \n (12)\n \n \n

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\n \n\n \n \n Ruderman, S. A.; Nance, R. M.; Drumright, L. N.; Whitney, B. M.; Hahn, A. W.; Ma, J.; Haidar, L.; Eltonsy, S.; Mayer, K. H.; Eron, J. J.; Greene, M.; Mathews, W. C.; Webel, A.; Saag, M. S.; Willig, A. L.; Kamen, C.; McCaul, M.; Chander, G.; Cachay, E.; Lober, W. B.; Pandya, C.; Cartujano-Barrera, F.; Kritchevsky, S. B.; Austad, S. N.; Landay, A.; Kitahata, M. M.; Crane, H. M.; and Delaney, J. A. C.\n\n\n \n \n \n \n \n Development of Frail RISC-HIV: a Risk Score for Predicting Frailty Risk in the Short-term for Care of People with HIV.\n \n \n \n \n\n\n \n\n\n\n AIDS, 37(6): 967. May 2023.\n \n\n\n\n
\n\n\n\n \n \n $\"Development$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{ruderman_development_2023,\n\ttitle = {Development of {Frail} {RISC}-{HIV}: a {Risk} {Score} for {Predicting} {Frailty} {Risk} in the {Short}-term for {Care} of {People} with {HIV}},\n\tvolume = {37},\n\tissn = {0269-9370},\n\tshorttitle = {Development of {Frail} {RISC}-{HIV}},\n\turl = {https://journals.lww.com/aidsonline/abstract/2023/05010/development_of_frail_risc_hiv__a_risk_score_for.14.aspx},\n\tdoi = {10.1097/QAD.0000000000003501},\n\tabstract = {Objective: \n          Frailty is common among people with HIV (PWH), so we developed frail risk in the short-term for care (RISC)-HIV, a frailty prediction risk score for HIV clinical decision-making.\n          Design: \n          We followed PWH for up to 2 years to identify short-term predictors of becoming frail.\n          Methods: \n          We predicted frailty risk among PWH at seven HIV clinics across the United States. A modified self-reported Fried Phenotype captured frailty, including fatigue, weight loss, inactivity, and poor mobility. PWH without frailty were separated into training and validation sets and followed until becoming frail or 2 years. Bayesian Model Averaging (BMA) and five-fold-cross-validation Lasso regression selected predictors of frailty. Predictors were selected by BMA if they had a greater than 45\\% probability of being in the best model and by Lasso if they minimized mean squared error. We included age, sex, and variables selected by both BMA and Lasso in Frail RISC-HIV by associating incident frailty with each selected variable in Cox models. Frail RISC-HIV performance was assessed in the validation set by Harrell's C and lift plots.\n          Results: \n          Among 3170 PWH (training set), 7\\% developed frailty, whereas among 1510 PWH (validation set), 12\\% developed frailty. BMA and Lasso selected baseline frailty score, prescribed antidepressants, prescribed antiretroviral therapy, depressive symptomology, and current marijuana and illicit opioid use. Discrimination was acceptable in the validation set, with Harrell's C of 0.76 (95\\% confidence interval: 0.73–0.79) and sensitivity of 80\\% and specificity of 61\\% at a 5\\% frailty risk cutoff.\n          Conclusions: \n          Frail RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.},\n\tlanguage = {en-US},\n\tnumber = {6},\n\turldate = {2024-02-07},\n\tjournal = {AIDS},\n\tauthor = {Ruderman, Stephanie A. and Nance, Robin M. and Drumright, Lydia N. and Whitney, Bridget M. and Hahn, Andrew W. and Ma, Jimmy and Haidar, Lara and Eltonsy, Sherif and Mayer, Kenneth H. and Eron, Joseph J. and Greene, Meredith and Mathews, William C. and Webel, Allison and Saag, Michael S. and Willig, Amanda L. and Kamen, Charles and McCaul, Mary and Chander, Geetanjali and Cachay, Edward and Lober, William B. and Pandya, Chintan and Cartujano-Barrera, Francisco and Kritchevsky, Stephen B. and Austad, Steven N. and Landay, Alan and Kitahata, Mari M. and Crane, Heidi M. and Delaney, Joseph A. C.},\n\tmonth = may,\n\tyear = {2023},\n\tpages = {967},\n}\n\n

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\n \n\n \n \n Drumright, L. N.; Nance, R. M.; Ruderman, S. A.; Ma, J.; Whitney, B. M.; Hahn, A.; Fredericksen, R. J.; Luu, B.; Lober, W. B.; Moore, R. D.; Budoff, M. J.; Keruly, J. C.; Christopoulos, K.; Puryear, S.; Willig, A.; Cropsey, K.; Mathews, W. C.; Cachay, E.; Bamford, L.; Eron, J. J.; Napravnik, S.; Mayer, K. H.; O'Cleirigh, C.; Mccaul, M. E.; Chander, G.; Feinstein, M. J.; Saag, M. S.; Kitahata, M. M.; Heckbert, S. R.; Crane, H. M.; and Delaney, J. A. C.\n\n\n \n \n \n \n \n Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV.\n \n \n \n \n\n\n \n\n\n\n HIV Medicine, 24(6): 703–715. 2023.\n _eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/hiv.13466\n\n\n\n
\n\n\n\n \n \n $\"Associations$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 1 download\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{drumright_associations_2023,\n\ttitle = {Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with {HIV}},\n\tvolume = {24},\n\tcopyright = {© 2023 The Authors. HIV Medicine published by John Wiley \\& Sons Ltd on behalf of British HIV Association.},\n\tissn = {1468-1293},\n\turl = {https://onlinelibrary.wiley.com/doi/abs/10.1111/hiv.13466},\n\tdoi = {10.1111/hiv.13466},\n\tabstract = {Objectives People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand–supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. Design and Methods Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time-updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. Results Among 13 506 people living with HIV, with a median 4 years of follow-up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60\\% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4\\% increase in risk of T1MI, with a suggestive, but not significant, 2\\% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. Conclusions Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.},\n\tlanguage = {en},\n\tnumber = {6},\n\turldate = {2024-02-07},\n\tjournal = {HIV Medicine},\n\tauthor = {Drumright, Lydia N. and Nance, Robin M. and Ruderman, Stephanie A. and Ma, Jimmy and Whitney, Bridget M. and Hahn, Andrew and Fredericksen, Rob J. and Luu, Brandon and Lober, William B. and Moore, Richard D. and Budoff, Matthew J. and Keruly, Jeanne C. and Christopoulos, Katerina and Puryear, Sarah and Willig, Amanda and Cropsey, Karen and Mathews, William C. and Cachay, Edward and Bamford, Laura and Eron, Joseph J. and Napravnik, Sonia and Mayer, Kenneth H. and O'Cleirigh, Conall and Mccaul, Mary E. and Chander, Geetanjali and Feinstein, Matthew J. and Saag, Michael S. and Kitahata, Mari M. and Heckbert, Susan R. and Crane, Heidi M. and Delaney, Joseph A. C.},\n\tyear = {2023},\n\tnote = {\\_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/hiv.13466},\n\tkeywords = {HIV, alcohol use, binge drinking, people with HIV, smoking, type 1 myocardial infarction, type 2 myocardial infarction},\n\tpages = {703--715},\n}\n\n

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\n \n\n \n \n Nabukenya, J.; Drumright, L.; Alunyu, A. E.; and Semwanga, A. R.\n\n\n \n \n \n \n \n Critical risk and success factors for sustainability of an electronic health data capture, processing and dissemination platform for Uganda.\n \n \n \n \n\n\n \n\n\n\n Health Informatics Journal, 29(2): 14604582231180576. April 2023.\n Publisher: SAGE Publications Ltd\n\n\n\n
\n\n\n\n \n \n $\"Critical$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{nabukenya_critical_2023,\n\ttitle = {Critical risk and success factors for sustainability of an electronic health data capture, processing and dissemination platform for {Uganda}},\n\tvolume = {29},\n\tissn = {1460-4582},\n\turl = {https://doi.org/10.1177/14604582231180576},\n\tdoi = {10.1177/14604582231180576},\n\tabstract = {Several studies have investigated challenges that have marred success or even caused the failure of eHealth implementations in Uganda; however, none has focused on the risks and success factors of their sustainability. This study explored critical risk and success factors for the sustainability of an electronic health data capture, processing and dissemination platform for Uganda. A mixed-method research design was followed involving collecting empirical data from all four regions of Uganda. A purposive sampling strategy was used to select the study districts per region, health facilities per district, and respondents/participants per facility or district. Findings revealed several risks and success factors for sustainability, including; bad leadership, corruption, lack of sustainable maintenance programs, lack of suitable sustainability plans, lack of ICT infrastructure investment, poor management systems, funds, stakeholder buy-ins, data sharing and access rights. The success factors included reinvestments as a partial sustainability plan for ICT infrastructure. These factors can be leveraged to ensure the continued operation of eHealth implementations in Uganda. Every electronic health project aiming at success should always make due consideration/sustainability plan at the onset of project conceptualisation; as lack of such a plan has often resulted in failed projects after the initial funds have been withdrawn.},\n\tlanguage = {en},\n\tnumber = {2},\n\turldate = {2024-02-07},\n\tjournal = {Health Informatics Journal},\n\tauthor = {Nabukenya, Josephine and Drumright, Lydia and Alunyu, Andrew Egwar and Semwanga, Agnes Rwashana},\n\tmonth = apr,\n\tyear = {2023},\n\tnote = {Publisher: SAGE Publications Ltd},\n\tpages = {14604582231180576},\n}\n\n

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\n \n\n \n \n Nabukenya, J.; Egwar, A. A.; Drumright, L.; Semwanga, A. R.; and Kasasa, S.\n\n\n \n \n \n \n \n Feasibility and utility of Point-of-Care electronic clinical data capture in Uganda’s healthcare system: a qualitative study.\n \n \n \n \n\n\n \n\n\n\n Journal of the American Medical Informatics Association, 30(5): 932–942. April 2023.\n \n\n\n\n
\n\n\n\n \n \n $\"Feasibility$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{nabukenya_feasibility_2023,\n\ttitle = {Feasibility and utility of {Point}-of-{Care} electronic clinical data capture in {Uganda}’s healthcare system: a qualitative study},\n\tvolume = {30},\n\tissn = {1067-5027, 1527-974X},\n\tshorttitle = {Feasibility and utility of {Point}-of-{Care} electronic clinical data capture in {Uganda}’s healthcare system},\n\turl = {https://academic.oup.com/jamia/article/30/5/932/7072779},\n\tdoi = {10.1093/jamia/ocad034},\n\tabstract = {Objective: This study aimed to assess Uganda’s readiness for implementing a national Point-of-Care (PoC) electronic clinical data capture platform that can function in near real-time.\nMethods: A qualitative, cross-sectional design was adopted to obtain a snapshot of Uganda’s eHealth system landscape with an aim to assess the readiness for implementing PoC platform. A purposive sampling strategy was used to select the study districts per region, health facilities per district, and participants per facility or district.\nResults: Nine facilitators were identiﬁed, including health worker motivation to serve the community, afﬁrmative action on eHealth ﬁnancing, improved integrating information and communication technology (ICT) infrastructure, Internet and electricity power connectivity, improved human resource skills and knowledge, the culture of sensitizing and training of stakeholders on eHealth interventions, the perceived value of the platform, health workers’ motivation to improve health data quality, interest to improve data use, and continuous improvement in the eHealth regulatory environment. Other suggestions entailed several requirements that must be met, including infrastructure, eHealth governance, human resources, as well as functional and data requirements. Discussion: Uganda, like other low-income countries, has adopted ICT to help solve some of its health system challenges. Although several challenges face eHealth implementations in Uganda, this study revealed facilitators that can be leveraged and requirements that, if met, would facilitate the successful implementation of a near real-time data capture platform capable of improving the country’s health outcomes.\nConclusion: Other countries with eHealth implementations similar to those faced in Uganda can also leverage identiﬁed facilitators and address the stakeholders’ requirements.},\n\tlanguage = {en},\n\tnumber = {5},\n\turldate = {2024-02-07},\n\tjournal = {Journal of the American Medical Informatics Association},\n\tauthor = {Nabukenya, Josephine and Egwar, Andrew Alunyu and Drumright, Lydia and Semwanga, Agnes Rwashana and Kasasa, Simon},\n\tmonth = apr,\n\tyear = {2023},\n\tpages = {932--942},\n}\n\n

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\n \n\n \n \n Ruderman, S. A.; Webel, A. R.; Willig, A. L.; Drumright, L. N.; Fitzpatrick, A. L.; Odden, M. C.; Cleveland, J. D.; Burkholder, G.; Davey, C. H.; Fleming, J.; Buford, T. W.; Jones, R.; Nance, R. M.; Whitney, B. M.; Mixson, L. S.; Hahn, A. W.; Mayer, K. H.; Greene, M.; Saag, M. S.; Kamen, C.; Pandya, C.; Lober, W. B.; Kitahata, M. M.; Crane, P. K.; Crane, H. M.; and Delaney, J. A. C.\n\n\n \n \n \n \n \n Validity Properties of a Self-reported Modified Frailty Phenotype Among People With HIV in Clinical Care in the United States.\n \n \n \n \n\n\n \n\n\n\n The Journal of the Association of Nurses in AIDS Care : JANAC, 34(2): 158–170. 2023.\n \n\n\n\n
\n\n\n\n \n \n $\"Validity$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{ruderman_validity_2023,\n\ttitle = {Validity {Properties} of a {Self}-reported {Modified} {Frailty} {Phenotype} {Among} {People} {With} {HIV} in {Clinical} {Care} in the {United} {States}},\n\tvolume = {34},\n\tissn = {1055-3290},\n\turl = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10088432/},\n\tdoi = {10.1097/JNC.0000000000000389},\n\tabstract = {Modifications to Fried’s frailty phenotype (FFP) are common. We evaluated a self-reported modified frailty phenotype (Mod-FP) used among people with HIV (PWH). Among 522 PWH engaged in two longitudinal studies, we assessed validity of the four-item Mod-FP compared with the five-item FFP. We compared the phenotypes via receiver operator characteristic curves, agreement in classifying frailty, and criterion validity via association with having experienced falls. Mod-FP classified 8\\% of PWH as frail, whereas FFP classified 9\\%. The area under the receiver operator characteristic curve for Mod-FP classifying frailty was 0.93 (95\\% CI = 0.91–0.96). We observed kappa ranging from 0.64 (unweighted) to 0.75 (weighted) for categorizing frailty status. Both definitions found frailty associated with a greater odds of experiencing a fall; FFP estimated a slightly greater magnitude (i.e., OR) for the association than Mod-FP. The Mod-FP has good performance in measuring frailty among PWH and is reasonable to use when the gold standards of observed assessments (i.e., weakness and slowness) are not feasible.},\n\tnumber = {2},\n\turldate = {2024-02-07},\n\tjournal = {The Journal of the Association of Nurses in AIDS Care : JANAC},\n\tauthor = {Ruderman, Stephanie A. and Webel, Allison R. and Willig, Amanda L. and Drumright, Lydia N. and Fitzpatrick, Annette L. and Odden, Michelle C. and Cleveland, John D. and Burkholder, Greer and Davey, Christine H. and Fleming, Julia and Buford, Thomas W. and Jones, Raymond and Nance, Robin M. and Whitney, Bridget M. and Mixson, L. Sarah and Hahn, Andrew W. and Mayer, Kenneth H. and Greene, Meredith and Saag, Michael S. and Kamen, Charles and Pandya, Chintan and Lober, William B. and Kitahata, Mari M. and Crane, Paul K. and Crane, Heidi M. and Delaney, Joseph A. C.},\n\tyear = {2023},\n\tpmid = {36652200},\n\tpmcid = {PMC10088432},\n\tpages = {158--170},\n}\n\n

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\n \n\n \n \n Dolan, S. B.; Wittenauer, R.; Njoroge, A.; Onyango, P.; Owiso, G.; Shearer, J. C.; Lober, W. B.; Liu, S.; Puttkammer, N.; and Rabinowitz, P.\n\n\n \n \n \n \n \n Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows.\n \n \n \n \n\n\n \n\n\n\n JMIR Formative Research, 7(1): e39777. March 2023.\n Company: JMIR Formative Research Distributor: JMIR Formative Research Institution: JMIR Formative Research Label: JMIR Formative Research Publisher: JMIR Publications Inc., Toronto, Canada\n\n\n\n
\n\n\n\n \n \n $\"Time$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{dolan_time_2023,\n\ttitle = {Time {Utilization} {Among} {Immunization} {Clinics} {Using} an {Electronic} {Immunization} {Registry} ({Part} 2): {Time} and {Motion} {Study} of {Modified} {User} {Workflows}},\n\tvolume = {7},\n\tcopyright = {Unless stated otherwise, all articles are open-access distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work ("first published in the Journal of Medical Internet Research...") is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.},\n\tshorttitle = {Time {Utilization} {Among} {Immunization} {Clinics} {Using} an {Electronic} {Immunization} {Registry} ({Part} 2)},\n\turl = {https://formative.jmir.org/2023/1/e39777},\n\tdoi = {10.2196/39777},\n\tabstract = {Background: Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25\\% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries.\nObjective: We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual–data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs).\nMethods: We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient’s total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models.\nResults: Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR’s performance and ability to connect to the internet were particularly insightful about potential causes of delays.\nConclusions: We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology.},\n\tlanguage = {EN},\n\tnumber = {1},\n\turldate = {2024-02-07},\n\tjournal = {JMIR Formative Research},\n\tauthor = {Dolan, Samantha B. and Wittenauer, Rachel and Njoroge, Anne and Onyango, Penina and Owiso, George and Shearer, Jessica C. and Lober, William B. and Liu, Shan and Puttkammer, Nancy and Rabinowitz, Peter},\n\tmonth = mar,\n\tyear = {2023},\n\tnote = {Company: JMIR Formative Research\nDistributor: JMIR Formative Research\nInstitution: JMIR Formative Research\nLabel: JMIR Formative Research\nPublisher: JMIR Publications Inc., Toronto, Canada},\n\tpages = {e39777},\n}\n\n

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\n Background: Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries. Objective: We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual–data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs). Methods: We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient’s total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models. Results: Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR’s performance and ability to connect to the internet were particularly insightful about potential causes of delays. Conclusions: We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology.\n

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\n \n\n \n \n Dolan, S. B.; Wittenauer, R.; Shearer, J. C.; Njoroge, A.; Onyango, P.; Owiso, G.; Lober, W. B.; Liu, S.; Puttkammer, N.; and Rabinowitz, P.\n\n\n \n \n \n \n \n Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability.\n \n \n \n \n\n\n \n\n\n\n JMIR Formative Research, 7(1): e39775. March 2023.\n Company: JMIR Formative Research Distributor: JMIR Formative Research Institution: JMIR Formative Research Label: JMIR Formative Research Publisher: JMIR Publications Inc., Toronto, Canada\n\n\n\n
\n\n\n\n \n \n $\"Integration$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{dolan_integration_2023,\n\ttitle = {Integration of a {Digital} {Health} {Intervention} {Into} {Immunization} {Clinic} {Workflows} in {Kenya}: {Qualitative}, {Realist} {Evaluation} of {Technology} {Usability}},\n\tvolume = {7},\n\tcopyright = {Unless stated otherwise, all articles are open-access distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work ("first published in the Journal of Medical Internet Research...") is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.},\n\tshorttitle = {Integration of a {Digital} {Health} {Intervention} {Into} {Immunization} {Clinic} {Workflows} in {Kenya}},\n\turl = {https://formative.jmir.org/2023/1/e39775},\n\tdoi = {10.2196/39775},\n\tabstract = {Background: In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries.\nObjective: In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry’s usability.\nMethods: Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers.\nResults: Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1—ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2—confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3—identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4—make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality.\nConclusions: We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users’ workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users’ needs and again after scale-up to ensure that interventions are suitable for all user settings.},\n\tlanguage = {EN},\n\tnumber = {1},\n\turldate = {2024-02-07},\n\tjournal = {JMIR Formative Research},\n\tauthor = {Dolan, Samantha B. and Wittenauer, Rachel and Shearer, Jessica C. and Njoroge, Anne and Onyango, Penina and Owiso, George and Lober, William B. and Liu, Shan and Puttkammer, Nancy and Rabinowitz, Peter},\n\tmonth = mar,\n\tyear = {2023},\n\tnote = {Company: JMIR Formative Research\nDistributor: JMIR Formative Research\nInstitution: JMIR Formative Research\nLabel: JMIR Formative Research\nPublisher: JMIR Publications Inc., Toronto, Canada},\n\tpages = {e39775},\n}\n\n

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\n Background: In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. Objective: In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry’s usability. Methods: Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. Results: Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1—ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2—confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3—identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4—make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. Conclusions: We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users’ workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users’ needs and again after scale-up to ensure that interventions are suitable for all user settings.\n

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\n \n\n \n \n Hartzler, A. L; Bartlett, L. E; Hobler, M. R; Reid, N.; Pryor, J. B; Kapnadak, S. G; Berry, D. L; Lober, W. B; Goss, C. H; Ramos, K. J; and for the Take on Transplant Study Group\n\n\n \n \n \n \n \n Take on transplant: human-centered design of a patient education tool to facilitate informed discussions about lung transplant among people with cystic fibrosis.\n \n \n \n \n\n\n \n\n\n\n Journal of the American Medical Informatics Association, 30(1): 26–37. January 2023.\n \n\n\n\n
\n\n\n\n \n \n $\"Take$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{hartzler_take_2023,\n\ttitle = {Take on transplant: human-centered design of a patient education tool to facilitate informed discussions about lung transplant among people with cystic fibrosis},\n\tvolume = {30},\n\tissn = {1527-974X},\n\tshorttitle = {Take on transplant},\n\turl = {https://doi.org/10.1093/jamia/ocac176},\n\tdoi = {10.1093/jamia/ocac176},\n\tabstract = {Lung transplant (LTx) saves lives in cystic fibrosis (CF). However, many potential candidates express uncertainty about LTx and die before receiving this treatment. CF guidelines recommend LTx education and clinical discussions well before the need for LTx arises, but limited patient resources exist.We engaged people with CF and CF physicians in human-centered design of “Take On Transplant” (TOT), a web-based education tool to prepare patients for LTx discussions. Across 3 phases, needs assessment, design groups, and iterative user testing of TOT, we refined TOT from wireframe prototypes, to an interactive website, to a fully functional intervention ready for clinical trials.Fifty-five people with CF and 105 physicians identified information needs to prepare for LTx discussions. Design groups (n = 14 participants) then established core requirements: didactic education (“Resource Library”), patient narratives (“CF Stories”), frequently asked questions (“FAQ”), and self-assessment to tailor content (“My CF Stage”). Iterative usability testing (n = 39) optimized the design of CF Stories and prototype layout. We then developed the TOT website and demonstrated feasibility and preliminary efficacy of use through 2-week field testing (n = 9).Our human-centered design process provided guidance for educational tools to serve the evolving needs of potential LTx candidates. Our findings support the process of patient deliberation as a foundation for shared decision-making in CF, and inform educational tools that could potentially translate beyond LTx.TOT fills a critical gap in preparing people with CF for shared decision-making about LTx and may serve as a model for educational tools for other preference-sensitive decisions.},\n\tnumber = {1},\n\turldate = {2023-03-15},\n\tjournal = {Journal of the American Medical Informatics Association},\n\tauthor = {Hartzler, Andrea L and Bartlett, Lauren E and Hobler, Mara R and Reid, Nick and Pryor, Joseph B and Kapnadak, Siddhartha G and Berry, Donna L and Lober, William B and Goss, Christopher H and Ramos, Kathleen J and {for the Take on Transplant Study Group}},\n\tmonth = jan,\n\tyear = {2023},\n\tpages = {26--37},\n}\n\n

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\n \n\n \n \n Drumright, L. N.; Nance, R. M.; Ruderman, S. A.; Ma, J.; Whitney, B. M.; Hahn, A.; Fredericksen, R. J.; Luu, B.; Lober, W. B.; Moore, R. D.; Budoff, M. J.; Keruly, J. C.; Christopoulos, K.; Puryear, S.; Willig, A.; Cropsey, K.; Mathews, W. C.; Cachay, E.; Bamford, L.; Eron, J. J.; Napravnik, S.; Mayer, K. H.; O'Cleirigh, C.; Mccaul, M. E.; Chander, G.; Feinstein, M. J.; Saag, M. S.; Kitahata, M. M.; Heckbert, S. R.; Crane, H. M.; and Delaney, J. A. C.\n\n\n \n \n \n \n \n Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV.\n \n \n \n \n\n\n \n\n\n\n HIV Medicine, n/a(n/a). February 2023.\n _eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/hiv.13466\n\n\n\n
\n\n\n\n \n \n $\"Associations$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 1 download\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{drumright_associations_2023-1,\n\ttitle = {Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with {HIV}},\n\tvolume = {n/a},\n\tissn = {1468-1293},\n\turl = {https://onlinelibrary.wiley.com/doi/abs/10.1111/hiv.13466},\n\tdoi = {10.1111/hiv.13466},\n\tabstract = {Objectives People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand–supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. Design and Methods Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time-updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. Results Among 13 506 people living with HIV, with a median 4 years of follow-up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60\\% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4\\% increase in risk of T1MI, with a suggestive, but not significant, 2\\% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. Conclusions Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.},\n\tlanguage = {en},\n\tnumber = {n/a},\n\turldate = {2023-03-15},\n\tjournal = {HIV Medicine},\n\tauthor = {Drumright, Lydia N. and Nance, Robin M. and Ruderman, Stephanie A. and Ma, Jimmy and Whitney, Bridget M. and Hahn, Andrew and Fredericksen, Rob J. and Luu, Brandon and Lober, William B. and Moore, Richard D. and Budoff, Matthew J. and Keruly, Jeanne C. and Christopoulos, Katerina and Puryear, Sarah and Willig, Amanda and Cropsey, Karen and Mathews, William C. and Cachay, Edward and Bamford, Laura and Eron, Joseph J. and Napravnik, Sonia and Mayer, Kenneth H. and O'Cleirigh, Conall and Mccaul, Mary E. and Chander, Geetanjali and Feinstein, Matthew J. and Saag, Michael S. and Kitahata, Mari M. and Heckbert, Susan R. and Crane, Heidi M. and Delaney, Joseph A. C.},\n\tmonth = feb,\n\tyear = {2023},\n\tnote = {\\_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/hiv.13466},\n\tkeywords = {HIV, alcohol use, binge drinking, people with HIV, smoking, type 1 myocardial infarction, type 2 myocardial infarction},\n}\n\n

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\n \n\n \n \n Ruderman, S. A.; Nance, R. M.; Drumright, L. N.; Whitney, B. M.; Hahn, A. W.; Ma, J.; Haidar, L.; Eltonsy, S.; Mayer, K. H.; Eron, J. J.; Greene, M.; Mathews, W. C.; Webel, A.; Saag, M. S.; Willig, A. L.; Kamen, C.; Mccaul, M.; Chander, G.; Cachay, E.; Lober, W. B.; Pandya, C.; Cartujano-barrera, F.; Kritchevsky, S. B.; Austad, S. N.; Landay, A.; Kitahata, M. M.; Crane, H. M.; and Delaney, J. A. C.\n\n\n \n \n \n \n \n Development of frail RISC-HIV: a risk score for predicting frailty risk in the short-term for care of people with HIV.\n \n \n \n \n\n\n \n\n\n\n AIDS,10.1097/QAD.0000000000003501. February 2023.\n \n\n\n\n
\n\n\n\n \n \n $\"Development$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{ruderman_development_2023-1,\n\ttitle = {Development of frail {RISC}-{HIV}: a risk score for predicting frailty risk in the short-term for care of people with {HIV}},\n\tissn = {0269-9370},\n\tshorttitle = {Development of frail {RISC}-{HIV}},\n\turl = {https://journals.lww.com/aidsonline/Abstract/9900/Development_of_frail_RISC_HIV__a_risk_score_for.200.aspx},\n\tdoi = {10.1097/QAD.0000000000003501},\n\tabstract = {Objective: \n        Frailty is common among people with HIV (PWH), so we developed Frail RISC-HIV, a frailty prediction risk score for HIV clinical decision-making.\n        Design: \n        We followed PWH for up to 2 years to identify short-term predictors of becoming frail.\n        Methods: \n        We predicted frailty risk among PWH at 7 HIV clinics across the US. A modified self-reported Fried Phenotype captured frailty, including fatigue, weight loss, inactivity, and poor mobility. PWH without frailty were separated into training and validation sets and followed until becoming frail or 2 years. Bayesian Model Averaging (BMA) and 5-fold-cross-validation Lasso regression selected predictors of frailty. Predictors were selected by BMA if they had {\\textgreater}45\\% probability of being in the best model and by Lasso if they minimized mean squared error. We included age, sex, and variables selected by both BMA and Lasso in Frail RISC-HIV by associating incident frailty with each selected variable in Cox models. Frail RISC-HIV performance was assessed in the validation set by Harrell's C and lift plots.\n        Results: \n        Among 3,170 PWH (training set), 7\\% developed frailty, while among 1,510 PWH (validation set), 12\\% developed frailty. BMA and Lasso selected baseline frailty score, prescribed antidepressants, prescribed ART, depressive symptomology, and current marijuana and illicit opioid use. Discrimination was acceptable in the validation set, with Harrell's C of 0.76 (95\\%CI: 0.73–0.79) and sensitivity of 80\\% and specificity of 61\\% at a 5\\% frailty risk cutoff.\n        Conclusions: \n        Frail RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.},\n\tlanguage = {en-US},\n\turldate = {2023-03-15},\n\tjournal = {AIDS},\n\tauthor = {Ruderman, Stephanie A. and Nance, Robin M. and Drumright, Lydia N. and Whitney, Bridget M. and Hahn, Andrew W. and Ma, Jimmy and Haidar, Lara and Eltonsy, Sherif and Mayer, Kenneth H. and Eron, Joseph J. and Greene, Meredith and Mathews, William C. and Webel, Allison and Saag, Michael S. and Willig, Amanda L. and Kamen, Charles and Mccaul, Mary and Chander, Geetanjali and Cachay, Edward and Lober, William B. and Pandya, Chintan and Cartujano-barrera, Francisco and Kritchevsky, Stephen B. and Austad, Steven N. and Landay, Alan and Kitahata, Mari M. and Crane, Heidi M. and Delaney, Joseph A. C.},\n\tmonth = feb,\n\tyear = {2023},\n\tpages = {10.1097/QAD.0000000000003501},\n}\n\n

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\n \n\n \n \n Uyeda, A. M.; Lee, R. Y.; Pollack, L. R.; Paul, S. R.; Downey, L.; Brumback, L. C.; Engelberg, R. A.; Sibley, J.; Lober, W. B.; Cohen, T.; Torrence, J.; Kross, E. K.; and Curtis, J. R.\n\n\n \n \n \n \n \n Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness.\n \n \n \n \n\n\n \n\n\n\n Journal of Pain and Symptom Management, 65(3): 233–241. March 2023.\n \n\n\n\n
\n\n\n\n \n \n $\"Predictors$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{uyeda_predictors_2023,\n\ttitle = {Predictors of {Documented} {Goals}-of-{Care} {Discussion} for {Hospitalized} {Patients} {With} {Chronic} {Illness}},\n\tvolume = {65},\n\tissn = {0885-3924},\n\turl = {https://www.sciencedirect.com/science/article/pii/S0885392422009733},\n\tdoi = {10.1016/j.jpainsymman.2022.11.012},\n\tabstract = {Context\nGoals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions.\nObjectives\nTo examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients.\nMethods\nThis retrospective cohort study used natural language processing (NLP) to examine EHR-documented goals-of-care discussions for adults with chronic life-limiting illness or age ≥80 hospitalized 2015-2019. The primary outcome was NLP-identified documentation of a goals-of-care discussion during the index hospitalization. We used multivariable logistic regression to evaluate associations with baseline characteristics.\nResults\nOf 16,262 consecutive, eligible patients without missing data, 5,918 (36.4\\%) had a documented goals-of-care discussion during hospitalization; approximately 57\\% of these discussions occurred within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common for women (OR=1.26, 95\\%CI 1.18-1.36), older patients (OR=1.04 per year, 95\\%CI 1.03-1.04), and patients with more comorbidities (OR=1.11 per Deyo-Charlson point, 95\\%CI 1.10-1.13), cancer (OR=1.88, 95\\%CI 1.72-2.06), dementia (OR=2.60, 95\\%CI 2.29-2.94), higher acute illness severity (OR=1.12 per National Early Warning Score point, 95\\%CI 1.11-1.14), or prior advance care planning documents (OR=1.18, 95\\%CI 1.08-1.30). Documentation of these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95\\%CI 0.75-0.90).\nConclusion\nAmong hospitalized patients with serious illness, documented goals-of-care discussions identified by NLP were more common among patients with older age and increased burden of acute or chronic illness, and less common among racially or ethnically minoritized patients. This suggests important disparities in goals-of-care discussions.},\n\tlanguage = {en},\n\tnumber = {3},\n\turldate = {2023-03-15},\n\tjournal = {Journal of Pain and Symptom Management},\n\tauthor = {Uyeda, Alison M. and Lee, Robert Y. and Pollack, Lauren R. and Paul, Sudiptho R. and Downey, Lois and Brumback, Lyndia C. and Engelberg, Ruth A. and Sibley, James and Lober, William B. and Cohen, Trevor and Torrence, Janaki and Kross, Erin K. and Curtis, J. Randall},\n\tmonth = mar,\n\tyear = {2023},\n\tkeywords = {Ethnicity, Goals-of-care discussions, Palliative care, Race, Serious illness},\n\tpages = {233--241},\n}\n\n

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\n Context Goals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions. Objectives To examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients. Methods This retrospective cohort study used natural language processing (NLP) to examine EHR-documented goals-of-care discussions for adults with chronic life-limiting illness or age ≥80 hospitalized 2015-2019. The primary outcome was NLP-identified documentation of a goals-of-care discussion during the index hospitalization. We used multivariable logistic regression to evaluate associations with baseline characteristics. Results Of 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization; approximately 57% of these discussions occurred within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common for women (OR=1.26, 95%CI 1.18-1.36), older patients (OR=1.04 per year, 95%CI 1.03-1.04), and patients with more comorbidities (OR=1.11 per Deyo-Charlson point, 95%CI 1.10-1.13), cancer (OR=1.88, 95%CI 1.72-2.06), dementia (OR=2.60, 95%CI 2.29-2.94), higher acute illness severity (OR=1.12 per National Early Warning Score point, 95%CI 1.11-1.14), or prior advance care planning documents (OR=1.18, 95%CI 1.08-1.30). Documentation of these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95%CI 0.75-0.90). Conclusion Among hospitalized patients with serious illness, documented goals-of-care discussions identified by NLP were more common among patients with older age and increased burden of acute or chronic illness, and less common among racially or ethnically minoritized patients. This suggests important disparities in goals-of-care discussions.\n

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\n \n\n \n \n Lee, R. Y.; Kross, E. K.; Torrence, J.; Li, K. S.; Sibley, J.; Cohen, T.; Lober, W. B.; Engelberg, R. A.; and Curtis, J. R.\n\n\n \n \n \n \n \n Assessment of Natural Language Processing of Electronic Health Records to Measure Goals-of-Care Discussions as a Clinical Trial Outcome.\n \n \n \n \n\n\n \n\n\n\n JAMA Network Open, 6(3): e231204. March 2023.\n \n\n\n\n
\n\n\n\n \n \n $\"Assessment$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{lee_assessment_2023,\n\ttitle = {Assessment of {Natural} {Language} {Processing} of {Electronic} {Health} {Records} to {Measure} {Goals}-of-{Care} {Discussions} as a {Clinical} {Trial} {Outcome}},\n\tvolume = {6},\n\tissn = {2574-3805},\n\turl = {https://doi.org/10.1001/jamanetworkopen.2023.1204},\n\tdoi = {10.1001/jamanetworkopen.2023.1204},\n\tabstract = {Many clinical trial outcomes are documented in free-text electronic health records (EHRs), making manual data collection costly and infeasible at scale. Natural language processing (NLP) is a promising approach for measuring such outcomes efficiently, but ignoring NLP-related misclassification may lead to underpowered studies.To evaluate the performance, feasibility, and power implications of using NLP to measure the primary outcome of EHR-documented goals-of-care discussions in a pragmatic randomized clinical trial of a communication intervention.This diagnostic study compared the performance, feasibility, and power implications of measuring EHR-documented goals-of-care discussions using 3 approaches: (1) deep-learning NLP, (2) NLP-screened human abstraction (manual verification of NLP-positive records), and (3) conventional manual abstraction. The study included hospitalized patients aged 55 years or older with serious illness enrolled between April 23, 2020, and March 26, 2021, in a pragmatic randomized clinical trial of a communication intervention in a multihospital US academic health system.Main outcomes were natural language processing performance characteristics, human abstractor-hours, and misclassification-adjusted statistical power of methods of measuring clinician-documented goals-of-care discussions. Performance of NLP was evaluated with receiver operating characteristic (ROC) curves and precision-recall (PR) analyses and examined the effects of misclassification on power using mathematical substitution and Monte Carlo simulation.A total of 2512 trial participants (mean [SD] age, 71.7 [10.8] years; 1456 [58\\%] female) amassed 44 324 clinical notes during 30-day follow-up. In a validation sample of 159 participants, deep-learning NLP trained on a separate training data set from identified patients with documented goals-of-care discussions with moderate accuracy (maximal F1 score, 0.82; area under the ROC curve, 0.924; area under the PR curve, 0.879). Manual abstraction of the outcome from the trial data set would require an estimated 2000 abstractor-hours and would power the trial to detect a risk difference of 5.4\\% (assuming 33.5\\% control-arm prevalence, 80\\% power, and 2-sided α = .05). Measuring the outcome by NLP alone would power the trial to detect a risk difference of 7.6\\%. Measuring the outcome by NLP-screened human abstraction would require 34.3 abstractor-hours to achieve estimated sensitivity of 92.6\\% and would power the trial to detect a risk difference of 5.7\\%. Monte Carlo simulations corroborated misclassification-adjusted power calculations.In this diagnostic study, deep-learning NLP and NLP-screened human abstraction had favorable characteristics for measuring an EHR outcome at scale. Adjusted power calculations accurately quantified power loss from NLP-related misclassification, suggesting that incorporation of this approach into the design of studies using NLP would be beneficial.},\n\tnumber = {3},\n\turldate = {2023-03-15},\n\tjournal = {JAMA Network Open},\n\tauthor = {Lee, Robert Y. and Kross, Erin K. and Torrence, Janaki and Li, Kevin S. and Sibley, James and Cohen, Trevor and Lober, William B. and Engelberg, Ruth A. and Curtis, J. Randall},\n\tmonth = mar,\n\tyear = {2023},\n\tpages = {e231204},\n}\n\n

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\n Many clinical trial outcomes are documented in free-text electronic health records (EHRs), making manual data collection costly and infeasible at scale. Natural language processing (NLP) is a promising approach for measuring such outcomes efficiently, but ignoring NLP-related misclassification may lead to underpowered studies.To evaluate the performance, feasibility, and power implications of using NLP to measure the primary outcome of EHR-documented goals-of-care discussions in a pragmatic randomized clinical trial of a communication intervention.This diagnostic study compared the performance, feasibility, and power implications of measuring EHR-documented goals-of-care discussions using 3 approaches: (1) deep-learning NLP, (2) NLP-screened human abstraction (manual verification of NLP-positive records), and (3) conventional manual abstraction. The study included hospitalized patients aged 55 years or older with serious illness enrolled between April 23, 2020, and March 26, 2021, in a pragmatic randomized clinical trial of a communication intervention in a multihospital US academic health system.Main outcomes were natural language processing performance characteristics, human abstractor-hours, and misclassification-adjusted statistical power of methods of measuring clinician-documented goals-of-care discussions. Performance of NLP was evaluated with receiver operating characteristic (ROC) curves and precision-recall (PR) analyses and examined the effects of misclassification on power using mathematical substitution and Monte Carlo simulation.A total of 2512 trial participants (mean [SD] age, 71.7 [10.8] years; 1456 [58%] female) amassed 44 324 clinical notes during 30-day follow-up. In a validation sample of 159 participants, deep-learning NLP trained on a separate training data set from identified patients with documented goals-of-care discussions with moderate accuracy (maximal F1 score, 0.82; area under the ROC curve, 0.924; area under the PR curve, 0.879). Manual abstraction of the outcome from the trial data set would require an estimated 2000 abstractor-hours and would power the trial to detect a risk difference of 5.4% (assuming 33.5% control-arm prevalence, 80% power, and 2-sided α = .05). Measuring the outcome by NLP alone would power the trial to detect a risk difference of 7.6%. Measuring the outcome by NLP-screened human abstraction would require 34.3 abstractor-hours to achieve estimated sensitivity of 92.6% and would power the trial to detect a risk difference of 5.7%. Monte Carlo simulations corroborated misclassification-adjusted power calculations.In this diagnostic study, deep-learning NLP and NLP-screened human abstraction had favorable characteristics for measuring an EHR outcome at scale. Adjusted power calculations accurately quantified power loss from NLP-related misclassification, suggesting that incorporation of this approach into the design of studies using NLP would be beneficial.\n

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\n \n 2022\n \n \n (10)\n \n \n

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\n \n\n \n \n Short, D.; Wang, X.; Suri, S.; Hsu, T. K; Jones, B.; Fredericksen, R. J; Crane, H. M; Musten, A.; Bacon, J.; Wang, Y.; Gough, K. A; Ramgopal, M.; Berry, J.; and Lober, W. B\n\n\n \n \n \n \n \n Risk Factors for Suboptimal Adherence Identified by Patient-Reported Outcomes Assessments in Routine HIV Care at 2 North American Clinics.\n \n \n \n \n\n\n \n\n\n\n Patient Preference and Adherence, 16: 2461–2472. December 2022.\n Publisher: Dove Medical Press _eprint: https://www.tandfonline.com/doi/pdf/10.2147/PPA.S378335\n\n\n\n
\n\n\n\n \n \n $\"Risk$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{short_risk_2022,\n\ttitle = {Risk {Factors} for {Suboptimal} {Adherence} {Identified} by {Patient}-{Reported} {Outcomes} {Assessments} in {Routine} {HIV} {Care} at 2 {North} {American} {Clinics}},\n\tvolume = {16},\n\tissn = {null},\n\turl = {https://www.tandfonline.com/doi/abs/10.2147/PPA.S378335},\n\tdoi = {10.2147/PPA.S378335},\n\tabstract = {Purpose Use of patient-reported outcomes assessments (PROs) can improve patient–provider communication and focus provider attention on current health issues. This analysis examines the association between suboptimal antiretroviral therapy (ART) adherence and factors obtained through PROs among people with HIV (PWH) at 2 North American outpatient clinics.Patients and Methods Immediately before a clinic visit, PWH completed self-administered PROs. Unadjusted and adjusted odds ratios (ORs) and 95\\% confidence intervals (CIs) were estimated from logistic regression models to identify sociodemographic and health-related factors (satisfaction with ART, difficulty meeting housing costs, depression, intimate partner violence, risk of malnutrition, smoking status, alcohol use, and substance use) associated with suboptimal adherence (defined as self-reporting {\\textless}95\\% or {\\textless}80\\% adherence). Multiple imputation was performed to account for missing data in the multivariate analyses.Results Of 1632 PWH, 1239 (76\\%) responded to the adherence assessment; of these, 268 (22\\%) and 106 (9\\%) reported {\\textless}95\\% and {\\textless}80\\% adherence, respectively. Of 1580 PWH who responded, 354 (22\\%) were dissatisfied with their HIV medication. Of responding PWH, 19\\% reported moderate-to-severe depression, 23\\% indicated they were at risk of malnutrition, 34\\% were current smokers, and 62\\% reported substance use in the past 3 months. Dissatisfaction with ART was significantly associated with {\\textless}95\\% and {\\textless}80\\% adherence in the unadjusted analysis (unadjusted OR [95\\% CI], 3.38 [2.51–4.56] and 4.26 [2.82–6.42], respectively) and adjusted analysis (adjusted OR [95\\% CI], 2.76 [1.91–4.00] and 3.28 [1.95–5.52], respectively); significance remained after multiple imputation. In adjusted analyses, no risk of malnutrition was significantly associated with reduced odds of {\\textless}95\\% adherence after multiple imputation (adjusted OR [95\\% CI], 0.714 [0.511–0.997]); no other factors were associated with {\\textless}95\\% or {\\textless}80\\% adherence.Conclusion These results suggest that implementation of PROs evaluating treatment satisfaction may provide value to adherence management in routine HIV care.},\n\turldate = {2023-03-15},\n\tjournal = {Patient Preference and Adherence},\n\tauthor = {Short, Duncan and Wang, Xueqi and Suri, Shivali and Hsu, Thomas K and Jones, Bryn and Fredericksen, Rob J and Crane, Heidi M and Musten, Alexandra and Bacon, Jean and Wang, Yongwei and Gough, Kevin A and Ramgopal, Moti and Berry, Jeff and Lober, William B},\n\tmonth = dec,\n\tyear = {2022},\n\tnote = {Publisher: Dove Medical Press\n\\_eprint: https://www.tandfonline.com/doi/pdf/10.2147/PPA.S378335},\n\tkeywords = {antiretroviral therapy, highly active, implementation science, patient satisfaction, quality of life, treatment adherence},\n\tpages = {2461--2472},\n}\n\n

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\n Purpose Use of patient-reported outcomes assessments (PROs) can improve patient–provider communication and focus provider attention on current health issues. This analysis examines the association between suboptimal antiretroviral therapy (ART) adherence and factors obtained through PROs among people with HIV (PWH) at 2 North American outpatient clinics.Patients and Methods Immediately before a clinic visit, PWH completed self-administered PROs. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models to identify sociodemographic and health-related factors (satisfaction with ART, difficulty meeting housing costs, depression, intimate partner violence, risk of malnutrition, smoking status, alcohol use, and substance use) associated with suboptimal adherence (defined as self-reporting \\textless95% or \\textless80% adherence). Multiple imputation was performed to account for missing data in the multivariate analyses.Results Of 1632 PWH, 1239 (76%) responded to the adherence assessment; of these, 268 (22%) and 106 (9%) reported \\textless95% and \\textless80% adherence, respectively. Of 1580 PWH who responded, 354 (22%) were dissatisfied with their HIV medication. Of responding PWH, 19% reported moderate-to-severe depression, 23% indicated they were at risk of malnutrition, 34% were current smokers, and 62% reported substance use in the past 3 months. Dissatisfaction with ART was significantly associated with \\textless95% and \\textless80% adherence in the unadjusted analysis (unadjusted OR [95% CI], 3.38 [2.51–4.56] and 4.26 [2.82–6.42], respectively) and adjusted analysis (adjusted OR [95% CI], 2.76 [1.91–4.00] and 3.28 [1.95–5.52], respectively); significance remained after multiple imputation. In adjusted analyses, no risk of malnutrition was significantly associated with reduced odds of \\textless95% adherence after multiple imputation (adjusted OR [95% CI], 0.714 [0.511–0.997]); no other factors were associated with \\textless95% or \\textless80% adherence.Conclusion These results suggest that implementation of PROs evaluating treatment satisfaction may provide value to adherence management in routine HIV care.\n

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\n \n\n \n \n Young, J.; Lo Re III, V.; Kim, H. N.; Sterling, T. R.; Althoff, K. N.; Gebo, K. A.; Gill, M. J.; Horberg, M. A.; Mayor, A. M.; Moore, R. D.; Silverberg, M. J.; Klein, M. B.; the North American AIDS Cohort Collaboration on Research; and of IeDEA, D. (.\n\n\n \n \n \n \n \n Do contemporary antiretrovirals increase the risk of end-stage liver disease? Signals from patients starting therapy in the North American AIDS Cohort Collaboration on Research and Design.\n \n \n \n \n\n\n \n\n\n\n Pharmacoepidemiology and Drug Safety, 31(2): 214–224. 2022.\n _eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1002/pds.5379\n\n\n\n
\n\n\n\n \n \n $\"Do$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 1 download\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{young_contemporary_2022,\n\ttitle = {Do contemporary antiretrovirals increase the risk of end-stage liver disease? {Signals} from patients starting therapy in the {North} {American} {AIDS} {Cohort} {Collaboration} on {Research} and {Design}},\n\tvolume = {31},\n\tissn = {1099-1557},\n\tshorttitle = {Do contemporary antiretrovirals increase the risk of end-stage liver disease?},\n\turl = {https://onlinelibrary.wiley.com/doi/abs/10.1002/pds.5379},\n\tdoi = {10.1002/pds.5379},\n\tabstract = {Purpose Despite effective antiretroviral therapy, rates of end-stage liver disease (ESLD) remain high. It is not clear whether contemporary antiretrovirals contribute to the risk of ESLD. Methods We included patients from cohorts with validated ESLD data in the North American AIDS Cohort Collaboration on Research and Design. Patients had to initiate antiretroviral therapy after 1 January 2004 with a nucleos(t)ide backbone of either abacavir/lamivudine or tenofovir/emtricitabine and a contemporary third (anchor) drug. Patients were followed until a first ESLD event, death, end of a cohort's ESLD validation period, loss to follow-up or 31 December 2015. We estimated associations between cumulative exposure to each drug and ESLD using a hierarchical Bayesian survival model with weakly informative prior distributions. Results Among 10 564 patients included from 12 cohorts, 62 had an ESLD event. Of the nine anchor drugs, boosted protease inhibitors atazanavir and darunavir had the strongest signals for ESLD, with increasing hazard ratios (HR) and narrowing credible intervals (CrI), from a prior HR of 1.5 (95\\% CrI 0.32–7.1) per 5 year's exposure to posterior HRs respectively of 1.8 (95\\% CrI 0.82–3.9) and 2.0 (95\\% CrI 0.86–4.7). Both backbones and efavirenz showed no signal. Hepatitis C coinfection was the most important covariate risk factor (HR 4.4, 95\\% CrI 2.6–7.0). Conclusions While contemporary antiretrovirals pose less risk for ESLD than hepatitis coinfection, atazanavir and darunavir had a toxicity signal. We show how hierarchical Bayesian modelling can be used to detect toxicity signals in cohort event monitoring data even with complex treatments and few events.},\n\tlanguage = {en},\n\tnumber = {2},\n\turldate = {2023-03-15},\n\tjournal = {Pharmacoepidemiology and Drug Safety},\n\tauthor = {Young, Jim and Lo Re III, Vincent and Kim, H. Nina and Sterling, Timothy R. and Althoff, Keri N. and Gebo, Kelly A. and Gill, M. John and Horberg, Michael A. and Mayor, Angel M. and Moore, Richard D. and Silverberg, Michael J. and Klein, Marina B. and {the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA}},\n\tyear = {2022},\n\tnote = {\\_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1002/pds.5379},\n\tkeywords = {Bayesian statistical methods, HIV, adverse events, end-stage liver disease, hepatocellular carcinoma, pharmacovigilance},\n\tpages = {214--224},\n}\n\n

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\n \n\n \n \n Short, D.; Fredericksen, R. J.; Crane, H. M.; Fitzsimmons, E.; Suri, S.; Bacon, J.; Musten, A.; Gough, K.; Ramgopal, M.; Berry, J.; McReynolds, J.; Kroch, A.; Jacobs, B.; Hodge, V.; Korlipara, D.; and Lober, W.\n\n\n \n \n \n \n \n Utility and Impact of the Implementation of Same-Day, Self-administered Electronic Patient-Reported Outcomes Assessments in Routine HIV Care in two North American Clinics.\n \n \n \n \n\n\n \n\n\n\n AIDS and Behavior, 26(7): 2409–2424. July 2022.\n \n\n\n\n
\n\n\n\n \n \n $\"Utility$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{short_utility_2022,\n\ttitle = {Utility and {Impact} of the {Implementation} of {Same}-{Day}, {Self}-administered {Electronic} {Patient}-{Reported} {Outcomes} {Assessments} in {Routine} {HIV} {Care} in two {North} {American} {Clinics}},\n\tvolume = {26},\n\tissn = {1573-3254},\n\turl = {https://doi.org/10.1007/s10461-022-03585-w},\n\tdoi = {10.1007/s10461-022-03585-w},\n\tabstract = {The PROgress study assessed the value and feasibility of implementing web-based patient-reported outcomes assessments (PROs) within routine HIV care at two North American outpatient clinics. People with HIV (PWH) completed PROs on a tablet computer in clinic before their routine care visit. Data collection included PROs from 1632 unique PWH, 596 chart reviews, 200 patient questionnaires, and 16 provider/staff questionnaires. During an initial setup phase involving 200 patients, PRO results were not delivered to providers; for all subsequent patients, providers received PRO results before the consultation. Chart review demonstrated that delivery of PRO results to providers improved patient-provider communication and increased the number of complex health and behavioral issues identified, recorded, and acted on, including suicidal ideation (88\\% with vs 38\\% without PRO feedback) and anxiety (54\\% with vs 24\\% without PRO feedback). In post-visit questionnaires, PWH (82\\%) and providers (82\\%) indicated that the PRO added value to the visit.},\n\tlanguage = {en},\n\tnumber = {7},\n\turldate = {2023-03-15},\n\tjournal = {AIDS and Behavior},\n\tauthor = {Short, Duncan and Fredericksen, Rob J. and Crane, Heidi M. and Fitzsimmons, Emma and Suri, Shivali and Bacon, Jean and Musten, Alexandra and Gough, Kevin and Ramgopal, Moti and Berry, Jeff and McReynolds, Justin and Kroch, Abigail and Jacobs, Brenda and Hodge, Vince and Korlipara, Divya and Lober, William},\n\tmonth = jul,\n\tyear = {2022},\n\tkeywords = {HIV care, Implementation science, Patient-reported outcomes, Quality of life, Suicidal ideation},\n\tpages = {2409--2424},\n}\n\n

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\n \n\n \n \n McGinnis, K. A; Justice, A. C; Moore, R. D; Silverberg, M. J; Althoff, K. N; Karris, M.; Lima, V. D; Crane, H. M; Horberg, M. A; Klein, M. B; Gange, S. J; Gebo, K. A; Mayor, A.; Tate, J. P; North American AIDS Cohort Collaboration on Research; of the International Epidemiologic Databases to Evaluate AIDS (IeDEA), D. (.; and (VACS), V. A. C. S.\n\n\n \n \n \n \n \n Discrimination and Calibration of the Veterans Aging Cohort Study Index 2.0 for Predicting Mortality Among People With Human Immunodeficiency Virus in North America.\n \n \n \n \n\n\n \n\n\n\n Clinical Infectious Diseases, 75(2): 297–304. July 2022.\n \n\n\n\n
\n\n\n\n \n \n $\"Discrimination$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{mcginnis_discrimination_2022,\n\ttitle = {Discrimination and {Calibration} of the {Veterans} {Aging} {Cohort} {Study} {Index} 2.0 for {Predicting} {Mortality} {Among} {People} {With} {Human} {Immunodeficiency} {Virus} in {North} {America}},\n\tvolume = {75},\n\tissn = {1058-4838},\n\turl = {https://doi.org/10.1093/cid/ciab883},\n\tdoi = {10.1093/cid/ciab883},\n\tabstract = {The updated Veterans Aging Cohort Study (VACS) Index 2.0 combines general and human immunodeficiency virus (HIV)–specific biomarkers to generate a continuous score that accurately discriminates risk of mortality in diverse cohorts of persons with HIV (PWH), but a score alone is difficult to interpret. Using data from the North American AIDS Cohort Collaboration (NA-ACCORD), we translate VACS Index 2.0 scores into validated probability estimates of mortality.Because complete mortality ascertainment is essential for accurate calibration, we restricted analyses to cohorts with mortality from the National Death Index or equivalent sources. VACS Index 2.0 components were ascertained from October 1999 to April 2018. Mortality was observed up to March 2019. Calibration curves compared predicted (estimated by fitting a gamma model to the score) to observed mortality overall and within subgroups: cohort (VACS/NA-ACCORD subset), sex, age \\&lt;50 or ≥50 years, race/ethnicity, HIV-1 RNA ≤500 or \\&gt;500 copies/mL, CD4 count \\&lt;350 or ≥350 cells/µL, and years 1999–2009 or 2010–2018. Because mortality rates have decreased over time, the final model was limited to 2010–2018.Among 37230 PWH in VACS and 8061 PWH in the NA-ACCORD subset, median age was 53 and 44 years; 3\\% and 19\\% were women; and 48\\% and 39\\% were black. Discrimination in NA-ACCORD (C-statistic = 0.842 [95\\% confidence interval \\{CI\\}, .830–.854]) was better than in VACS (C-statistic = 0.813 [95\\% CI, .809–.817]). Predicted and observed mortality largely overlapped in VACS and the NA-ACCORD subset, overall and within subgroups.Based on this validation, VACS Index 2.0 can reliably estimate probability of all-cause mortality, at various follow-up times, among PWH in North America.},\n\tnumber = {2},\n\turldate = {2023-03-15},\n\tjournal = {Clinical Infectious Diseases},\n\tauthor = {McGinnis, Kathleen A and Justice, Amy C and Moore, Richard D and Silverberg, Michael J and Althoff, Keri N and Karris, Maile and Lima, Viviane D and Crane, Heidi M and Horberg, Michael A and Klein, Marina B and Gange, Stephen J and Gebo, Kelly A and Mayor, Angel and Tate, Janet P and {North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)a of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) and Veterans Aging Cohort Study (VACS)}},\n\tmonth = jul,\n\tyear = {2022},\n\tpages = {297--304},\n}\n\n

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\n \n\n \n \n Dolan, S. B.; Burstein, R.; Shearer, J. C.; Bulula, N.; Lyons, H.; Carnahan, E.; Beylerian, E.; Thompson, J.; Puttkammer, N.; Lober, W. B.; Liu, S.; Gilbert, S. S.; Werner, L.; and Ryman, T. K.\n\n\n \n \n \n \n \n Changes in on-time vaccination following the introduction of an electronic immunization registry, Tanzania 2016-2018: interrupted time-series analysis.\n \n \n \n \n\n\n \n\n\n\n BMC Health Services Research, 22(1): 1175. September 2022.\n \n\n\n\n
\n\n\n\n \n \n $\"Changes$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{dolan_changes_2022,\n\ttitle = {Changes in on-time vaccination following the introduction of an electronic immunization registry, {Tanzania} 2016-2018: interrupted time-series analysis},\n\tvolume = {22},\n\tissn = {1472-6963},\n\tshorttitle = {Changes in on-time vaccination following the introduction of an electronic immunization registry, {Tanzania} 2016-2018},\n\turl = {https://doi.org/10.1186/s12913-022-08504-2},\n\tdoi = {10.1186/s12913-022-08504-2},\n\tabstract = {Digital health interventions (DHI) have the potential to improve the management and utilization of health information to optimize health care worker performance and provision of care. Despite the proliferation of DHI projects in low-and middle-income countries, few have been evaluated in an effort to understand their impact on health systems and health-related outcomes. Although more evidence is needed on their impact and effectiveness, the use of DHIs among immunization programs has become more widespread and shows promise for improving vaccination uptake and adherence to immunization schedules.},\n\tnumber = {1},\n\turldate = {2023-03-15},\n\tjournal = {BMC Health Services Research},\n\tauthor = {Dolan, Samantha B. and Burstein, Roy and Shearer, Jessica C. and Bulula, Ngwegwe and Lyons, Hil and Carnahan, Emily and Beylerian, Emily and Thompson, Jenny and Puttkammer, Nancy and Lober, William B. and Liu, Shan and Gilbert, Skye S. and Werner, Laurie and Ryman, Tove K.},\n\tmonth = sep,\n\tyear = {2022},\n\tkeywords = {Digital health intervention, Electronic immunisation registry, Interrupted time-series analysis, Routine health information system, Vaccination timeliness},\n\tpages = {1175},\n}\n\n

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\n \n\n \n \n Segal, C. D; Lober, W. B; Revere, D.; Lorigan, D.; Karras, B. T; and Baseman, J. G\n\n\n \n \n \n \n \n Trading-off privacy and utility: the Washington State experience assessing the performance of a public health digital exposure notification system for coronavirus disease 2019.\n \n \n \n \n\n\n \n\n\n\n Journal of the American Medical Informatics Association, 29(12): 2050–2056. December 2022.\n \n\n\n\n
\n\n\n\n \n \n $\"Trading-off$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{segal_trading-off_2022,\n\ttitle = {Trading-off privacy and utility: the {Washington} {State} experience assessing the performance of a public health digital exposure notification system for coronavirus disease 2019},\n\tvolume = {29},\n\tissn = {1527-974X},\n\tshorttitle = {Trading-off privacy and utility},\n\turl = {https://doi.org/10.1093/jamia/ocac178},\n\tdoi = {10.1093/jamia/ocac178},\n\tabstract = {Digital exposure notifications (DEN) systems were an emergency response to the coronavirus disease 2019 (COVID-19) pandemic, harnessing smartphone-based technology to enhance conventional pandemic response strategies such as contact tracing. We identify and describe performance measurement constructs relevant to the implementation of DEN tools: (1) reach (number of users enrolled in the intervention); (2) engagement (utilization of the intervention); and (3) effectiveness in preventing transmissions of COVID-19 (impact of the intervention). We also describe WA State’s experience utilizing these constructs to design data-driven evaluation approaches.We conducted an environmental scan of DEN documentation and relevant publications. Participation in multidisciplinary collaborative environments facilitated shared learning. Compilation of available data sources and their relevance to implementation and operation workflows were synthesized to develop implementation evaluation constructs.We identified 8 useful performance indicators within reach, engagement, and effectiveness constructs.We use implementation science to frame the evaluation of DEN tools by linking the theoretical constructs with the metrics available in the underlying disparate, deidentified, and aggregate data infrastructure. Our challenges in developing meaningful metrics include limited data science competencies in public health, validation of analytic methodologies in the complex and evolving pandemic environment, and the lack of integration with the public health infrastructure.Continued collaboration and multidisciplinary consensus activities can improve the utility of DEN tools for future public health emergencies.},\n\tnumber = {12},\n\turldate = {2023-03-15},\n\tjournal = {Journal of the American Medical Informatics Association},\n\tauthor = {Segal, Courtney D and Lober, William B and Revere, Debra and Lorigan, Daniel and Karras, Bryant T and Baseman, Janet G},\n\tmonth = dec,\n\tyear = {2022},\n\tpages = {2050--2056},\n}\n\n

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\n \n\n \n \n Fredericksen, R.; Short, D.; Fitzsimmons, E.; Korlipara, D.; Suri, S.; Jacobs, B.; Bacon, J.; Kroch, A.; Musten, A.; and Hodge, V.\n\n\n \n \n \n \n Patients perceptions of the usability, utility and impact of a same-day self-administered routine electronic patient-reported outcomes (PRO) assessment in HIV care in two North American clinics.\n \n \n \n\n\n \n\n\n\n Journal of AIDS and HIV Research, 14(1): 10–21. 2022.\n Publisher: Academic Journals\n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{fredericksen_patients_2022,\n\ttitle = {Patients perceptions of the usability, utility and impact of a same-day self-administered routine electronic patient-reported outcomes ({PRO}) assessment in {HIV} care in two {North} {American} clinics},\n\tvolume = {14},\n\tnumber = {1},\n\tjournal = {Journal of AIDS and HIV Research},\n\tauthor = {Fredericksen, Rob and Short, Duncan and Fitzsimmons, Emma and Korlipara, Divya and Suri, Shivali and Jacobs, Brenda and Bacon, Jean and Kroch, Abigail and Musten, Alexandra and Hodge, Vince},\n\tyear = {2022},\n\tnote = {Publisher: Academic Journals},\n\tpages = {10--21},\n}\n\n

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\n \n\n \n \n Fredericksen, R.; Short, D.; Fitzsimmons, E.; Korlipara, D.; Suri, S.; Jacobs, B.; Bacon, J.; Kroch, A.; Musten, A.; Hodge, V.; Ramgopal, M.; Tan, D.; Berry, J.; Yoong, D.; Naccarato, M.; Gough, K.; Mcreynolds, J.; Lober, W.; and Crane, H.\n\n\n \n \n \n \n \n Youre almost glancing behind a curtain: HIV care provider perceptions regarding integration and value of pre-visit electronic tablet-based patient-reported outcomes data collection in two North American clinics.\n \n \n \n \n\n\n \n\n\n\n Journal of AIDS and HIV Research, 14(1): 22–31. June 2022.\n Publisher: Academic Journals\n\n\n\n
\n\n\n\n \n \n $\"Youre$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{fredericksen_youre_2022,\n\ttitle = {Youre almost glancing behind a curtain: {HIV} care provider perceptions regarding integration and value of pre-visit electronic tablet-based patient-reported outcomes data collection in two {North} {American} clinics},\n\tvolume = {14},\n\tissn = {2141-2359},\n\tshorttitle = {Youre almost glancing behind a curtain},\n\turl = {https://academicjournals.org/journal/JAHR/article-abstract/AF221EA69224},\n\tdoi = {10.5897/JAHR2022.0548},\n\tabstract = {This study was conducted to assess provider perceptions regarding value of tablet-based patient-reported outcome (PRO) assessments in routine care. Patients self-administered a brief PRO assessment of several clinical domains on-site prior to HIV clinic visits. Providers were given succinct summary results. 1:1 interviews were conducted with providers regarding PROs utility and their integration into care, and coded interview transcripts into thematic areas. Providers described how PROs helped prioritize topics for discussion during the visit, and facilitated their identification and ability to address sensitive issues, particularly depression/suicidality, sexual behavior, and intimate partner violence. PROs further facilitated comprehensive identification of other issues and concerns which led to an additional but manageable workflow impact, regarded as a valuable tradeoff. Integration of PROs into workflows met with initial challenges that were easily resolved. Providers found PROs with results delivery prior to patient appointments valuable for routine HIV care and feasible for integration into clinic workflow.\n\n\tKey words: Patient-reported outcomes, physician-patient relations.},\n\tlanguage = {english},\n\tnumber = {1},\n\turldate = {2023-03-15},\n\tjournal = {Journal of AIDS and HIV Research},\n\tauthor = {Fredericksen, Rob and Short, Duncan and Fitzsimmons, Emma and Korlipara, Divya and Suri, Shivali and Jacobs, Brenda and Bacon, Jean and Kroch, Abigail and Musten, Alexandra and Hodge, Vincent and Ramgopal, Moti and Tan, Darrell and Berry, Jeff and Yoong, Deborah and Naccarato, Mark and Gough, Kevin and Mcreynolds, Justin and Lober, William and Crane, Heidi},\n\tmonth = jun,\n\tyear = {2022},\n\tnote = {Publisher: Academic Journals},\n\tpages = {22--31},\n}\n\n

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\n \n\n \n \n Uyeda, A. M.; Curtis, J. R.; Engelberg, R. A.; Brumback, L. C.; Guo, Y.; Sibley, J.; Lober, W. B.; Cohen, T.; Torrence, J.; Heywood, J.; Paul, S. R.; Kross, E. K.; and Lee, R. Y.\n\n\n \n \n \n \n Mixed-methods evaluation of three natural language processing modeling approaches for measuring documented goals-of-care discussions in the electronic health record.\n \n \n \n\n\n \n\n\n\n Journal of pain and symptom management,S0885–3924(22)00094–X. February 2022.\n Place: United States\n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{uyeda_mixed-methods_2022,\n\ttitle = {Mixed-methods evaluation of three natural language processing modeling approaches for measuring documented goals-of-care discussions in the electronic health record.},\n\tcopyright = {Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.},\n\tissn = {1873-6513 0885-3924},\n\tdoi = {10.1016/j.jpainsymman.2022.02.006},\n\tabstract = {CONTEXT: Documented goals-of-care discussions are an important quality metric for patients with serious illness. Natural language processing (NLP) is a promising  approach for identifying goals-of-care discussions in the electronic health record  (EHR). OBJECTIVES: To compare three NLP modeling approaches for identifying EHR  documentation of goals-of-care discussions and generate hypotheses about differences  in performance. METHODS: We conducted a mixed-methods study to evaluate performance  and misclassification for three NLP featurization approaches modeled with  regularized logistic regression: bag-of-words (BOW), rule-based, and a hybrid  approach. From a prospective cohort of 150 patients hospitalized with serious  illness over 2018 to 2020, we collected 4391 inpatient EHR notes; 99 (2.3\\%)  contained documented goals-of-care discussions. We used leave-one-out  cross-validation to estimate performance by comparing pooled NLP predictions to  human abstractors with receiver-operating-characteristic (ROC) and precision-recall  (PR) analyses. We qualitatively examined a purposive sample of 70 NLP-misclassified  notes using content analysis to identify linguistic features that allowed us to  generate hypotheses underpinning misclassification. RESULTS: All three modeling  approaches discriminated between notes with and without goals-of-care discussions  (AUC(ROC): BOW, 0.907; rule-based, 0.948; hybrid, 0.965). Precision and recall were  only moderate (precision at 70\\% recall: BOW, 16.2\\%; rule-based, 50.4\\%; hybrid,  49.3\\%; AUC(PR): BOW, 0.505; rule-based, 0.579; hybrid, 0.599). Qualitative analysis  revealed patterns underlying performance differences between BOW and rule-based  approaches. CONCLUSION: NLP holds promise for identifying EHR-documented  goals-of-care discussions. However, the rarity of goals-of-care content in EHR data  limits performance. Our findings highlight opportunities to optimize NLP modeling  approaches, and support further exploration of different NLP approaches to identify  goals-of-care discussions.},\n\tlanguage = {eng},\n\tjournal = {Journal of pain and symptom management},\n\tauthor = {Uyeda, Alison M. and Curtis, J. Randall and Engelberg, Ruth A. and Brumback, Lyndia C. and Guo, Yue and Sibley, James and Lober, William B. and Cohen, Trevor and Torrence, Janaki and Heywood, Joanna and Paul, Sudiptho R. and Kross, Erin K. and Lee, Robert Y.},\n\tmonth = feb,\n\tyear = {2022},\n\tpmid = {35182715},\n\tnote = {Place: United States},\n\tkeywords = {Natural language processing, electronic health record, goals of care, machine learning, medical informatics},\n\tpages = {S0885--3924(22)00094--X},\n}\n\n

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\n CONTEXT: Documented goals-of-care discussions are an important quality metric for patients with serious illness. Natural language processing (NLP) is a promising approach for identifying goals-of-care discussions in the electronic health record (EHR). OBJECTIVES: To compare three NLP modeling approaches for identifying EHR documentation of goals-of-care discussions and generate hypotheses about differences in performance. METHODS: We conducted a mixed-methods study to evaluate performance and misclassification for three NLP featurization approaches modeled with regularized logistic regression: bag-of-words (BOW), rule-based, and a hybrid approach. From a prospective cohort of 150 patients hospitalized with serious illness over 2018 to 2020, we collected 4391 inpatient EHR notes; 99 (2.3%) contained documented goals-of-care discussions. We used leave-one-out cross-validation to estimate performance by comparing pooled NLP predictions to human abstractors with receiver-operating-characteristic (ROC) and precision-recall (PR) analyses. We qualitatively examined a purposive sample of 70 NLP-misclassified notes using content analysis to identify linguistic features that allowed us to generate hypotheses underpinning misclassification. RESULTS: All three modeling approaches discriminated between notes with and without goals-of-care discussions (AUC(ROC): BOW, 0.907; rule-based, 0.948; hybrid, 0.965). Precision and recall were only moderate (precision at 70% recall: BOW, 16.2%; rule-based, 50.4%; hybrid, 49.3%; AUC(PR): BOW, 0.505; rule-based, 0.579; hybrid, 0.599). Qualitative analysis revealed patterns underlying performance differences between BOW and rule-based approaches. CONCLUSION: NLP holds promise for identifying EHR-documented goals-of-care discussions. However, the rarity of goals-of-care content in EHR data limits performance. Our findings highlight opportunities to optimize NLP modeling approaches, and support further exploration of different NLP approaches to identify goals-of-care discussions.\n

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\n \n\n \n \n Luu, B.; Ruderman, S.; Nance, R.; Delaney, J. A. C.; Ma, J.; Hahn, A.; Heckbert, S. R.; Budoff, M. J.; Crothers, K.; Mathews, W. C.; Christopolous, K.; Hunt, P. W.; Eron, J.; Moore, R.; Keruly, J.; Lober, W. B.; Burkholder, G. A.; Willig, A.; Chander, G.; McCaul, M. E.; Cropsey, K.; O'Cleirigh, C.; Peter, I.; Feinstein, M.; Tsui, J. I.; Lindstroem, S.; Saag, M.; Kitahata, M. M.; Crane, H. M.; Drumright, L. N.; and Whitney, B. M.\n\n\n \n \n \n \n Tobacco smoking and binge alcohol use are associated with incident venous thromboembolism in an HIV cohort.\n \n \n \n\n\n \n\n\n\n HIV medicine. March 2022.\n Place: England\n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{luu_tobacco_2022,\n\ttitle = {Tobacco smoking and binge alcohol use are associated with incident venous thromboembolism in an {HIV} cohort.},\n\tcopyright = {© 2022 British HIV Association.},\n\tissn = {1468-1293 1464-2662},\n\tdoi = {10.1111/hiv.13309},\n\tabstract = {BACKGROUND: People with HIV (PWH) are at increased risk of cardiovascular comorbidities and substance use is a potential predisposing factor. We evaluated  associations of tobacco smoking and alcohol use with venous thromboembolism (VTE) in  PWH. METHODS: We assessed incident, centrally adjudicated VTE among 12 957 PWH  within the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS)  cohort between January 2009 and December 2018. Using separate Cox proportional  hazards models, we evaluated associations of time-updated alcohol and cigarette use  with VTE, adjusting for demographic and clinical characteristics. Smoking was  evaluated as pack-years and never, former, or current use with current cigarettes  per day. Alcohol use was parameterized using categorical and continuous alcohol use  score, frequency of use, and binge frequency. RESULTS: During a median of 3.6 years  of follow-up, 213 PWH developed a VTE. One-third of PWH reported binge drinking and  40\\% reported currently smoking. In adjusted analyses, risk of VTE was increased  among both current (HR: 1.44, 95\\% CI: 1.02-2.03) and former (HR: 1.44, 95\\% CI:  0.99-2.07) smokers compared to PWH who never smoked. Additionally, total pack-years  among ever-smokers (HR: 1.10 per 5 pack-years; 95\\% CI: 1.03-1.18) was associated  with incident VTE in a dose-dependent manner. Frequency of binge drinking was  associated with incident VTE (HR: 1.30 per 7 days/month, 95\\% CI: 1.11-1.52);  however, alcohol use frequency was not. Severity of alcohol use was not  significantly associated with VTE. CONCLUSIONS: Current smoking and pack-year  smoking history were dose-dependently associated with incident VTE among PWH in  CNICS. Binge drinking was also associated with VTE. Interventions for smoking and  binge drinking may decrease VTE risk among PWH.},\n\tlanguage = {eng},\n\tjournal = {HIV medicine},\n\tauthor = {Luu, Brandon and Ruderman, Stephanie and Nance, Robin and Delaney, Joseph A. C. and Ma, Jimmy and Hahn, Andrew and Heckbert, Susan R. and Budoff, Matthew J. and Crothers, Kristina and Mathews, William C. and Christopolous, Katerina and Hunt, Peter W. and Eron, Joseph and Moore, Richard and Keruly, Jeanne and Lober, William B. and Burkholder, Greer A. and Willig, Amanda and Chander, Geetanjali and McCaul, Mary E. and Cropsey, Karen and O'Cleirigh, Conall and Peter, Inga and Feinstein, Matthew and Tsui, Judith I. and Lindstroem, Sara and Saag, Michael and Kitahata, Mari M. and Crane, Heidi M. and Drumright, Lydia N. and Whitney, Bridget M.},\n\tmonth = mar,\n\tyear = {2022},\n\tpmid = {35343038},\n\tnote = {Place: England},\n\tkeywords = {HIV, binge drinking, smoking, substance use, venous thromboembolism},\n}\n\n

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\n \n 2021\n \n \n (14)\n \n \n

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\n \n\n \n \n Trefzer, A.; Kadam, P.; Wang, S.; Pennavaria, S.; Lober, B.; Akçabozan, B.; Kranich, J.; Brocker, T.; Nakano, N.; Irmler, M.; Beckers, J.; Straub, T.; and Obst, R.\n\n\n \n \n \n \n Dynamic adoption of anergy by antigen-exhausted CD4(+) T cells.\n \n \n \n\n\n \n\n\n\n Cell reports, 34(6): 108748. February 2021.\n Place: United States\n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{trefzer_dynamic_2021,\n\ttitle = {Dynamic adoption of anergy by antigen-exhausted {CD4}(+) {T} cells.},\n\tvolume = {34},\n\tcopyright = {Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.},\n\tissn = {2211-1247},\n\tdoi = {10.1016/j.celrep.2021.108748},\n\tabstract = {Exhausted immune responses to chronic diseases represent a major challenge to global health. We study CD4(+) T cells in a mouse model with regulatable antigen  presentation. When the cells are driven through the effector phase and are then  exposed to different levels of persistent antigen, they lose their T helper 1 (Th1)  functions, upregulate exhaustion markers, resemble naturally anergic cells, and  modulate their MAPK, mTORC1, and Ca(2+)/calcineurin signaling pathways with  increasing dose and time. They also become unable to help B cells and, at the  highest dose, undergo apoptosis. Transcriptomic analyses show the dynamic adjustment  of gene expression and the accumulation of T cell receptor (TCR) signals over a  period of weeks. Upon antigen removal, the cells recover their functionality while  losing exhaustion and anergy markers. Our data suggest an adjustable response of  CD4(+) T cells to different levels of persisting antigen and contribute to a better  understanding of chronic disease.},\n\tlanguage = {eng},\n\tnumber = {6},\n\tjournal = {Cell reports},\n\tauthor = {Trefzer, Anne and Kadam, Pallavi and Wang, Shu-Hung and Pennavaria, Stefanie and Lober, Benedikt and Akçabozan, Batuhan and Kranich, Jan and Brocker, Thomas and Nakano, Naoko and Irmler, Martin and Beckers, Johannes and Straub, Tobias and Obst, Reinhard},\n\tmonth = feb,\n\tyear = {2021},\n\tpmid = {33567282},\n\tnote = {Place: United States},\n\tkeywords = {*CD4(+) T cells, *Clonal Anergy, *T cell receptor, *anergy, *exhaustion, *gene expression, *microarray, *tolerance, *transcriptomics, *tuning, Animals, Antigens/genetics/*immunology, B-Lymphocytes/immunology, Calcium Signaling/genetics/*immunology, Female, Gene Expression Profiling, Gene Expression Regulation/*immunology, MAP Kinase Signaling System/genetics/*immunology, Mechanistic Target of Rapamycin Complex 1/genetics/immunology, Mice, Mice, Transgenic, Receptors, Antigen, T-Cell/genetics/immunology, Th1 Cells/*immunology},\n\tpages = {108748},\n}\n\n

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\n \n\n \n \n Lee, J. S.; Humes, E. A.; Hogan, B. C.; Buchacz, K.; Eron, J. J.; Gill, M. J.; Sterling, T. R.; Rebeiro, P. F.; Lima, V. D.; Mayor, A.; Silverberg, M. J.; Horberg, M. A.; Moore, R. D.; and Althoff, K. N.\n\n\n \n \n \n \n CD4 Count at Entry into Care and at Antiretroviral Therapy Prescription among Adults with Human Immunodeficiency Virus in the United States, 2005-2018.\n \n \n \n\n\n \n\n\n\n Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 73(7): e2334–e2337. October 2021.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lee_cd4_2021,\n\ttitle = {{CD4} {Count} at {Entry} into {Care} and at {Antiretroviral} {Therapy} {Prescription} among {Adults} with {Human} {Immunodeficiency} {Virus} in the {United} {States}, 2005-2018.},\n\tvolume = {73},\n\tcopyright = {© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:  journals.permissions@oup.com.},\n\tissn = {1537-6591 1058-4838},\n\tdoi = {10.1093/cid/ciaa1904},\n\tabstract = {From 2005 to 2018, among 32013 adults with human immunodeficiency virus entering care, median time to antiretroviral therapy (ART) prescription declined from 69 to 6  days, CD4 count at entry into care increased from 300 to 362 cells/μL, and CD4 count  at ART prescription increased from 160 to 364 cells/μL.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},\n\tauthor = {Lee, Jennifer S. and Humes, Elizabeth A. and Hogan, Brenna C. and Buchacz, Kate and Eron, Joseph J. and Gill, M. John and Sterling, Timothy R. and Rebeiro, Peter F. and Lima, Viviane Dias and Mayor, Angel and Silverberg, Michael J. and Horberg, Michael A. and Moore, Richard D. and Althoff, Keri N.},\n\tmonth = oct,\n\tyear = {2021},\n\tpmid = {33383586},\n\tpmcid = {PMC8492212},\n\tkeywords = {*Anti-HIV Agents/therapeutic use, *CD4 count, *HIV, *HIV Infections/drug therapy/epidemiology, *antiretroviral therapy, *treat all, *universal treatment, Adult, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, HIV, Humans, Prescriptions, United States/epidemiology},\n\tpages = {e2334--e2337},\n}\n\n

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\n \n\n \n \n Michaels, M.; Syed, S.; and Lober, W. B\n\n\n \n \n \n \n \n Blueprint for aligned data exchange for research and public health.\n \n \n \n \n\n\n \n\n\n\n Journal of the American Medical Informatics Association : JAMIA, 28(12): 2702–2706. October 2021.\n \n\n\n\n
\n\n\n\n \n \n $\"Blueprint$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 1 download\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{michaels_blueprint_2021,\n\ttitle = {Blueprint for aligned data exchange for research and public health},\n\tvolume = {28},\n\tissn = {1067-5027},\n\turl = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8633601/},\n\tdoi = {10.1093/jamia/ocab210},\n\tabstract = {Making EHR Data More Available for Research and Public Health (MedMorph) is a Centers for Disease Control and Prevention-led initiative developing and demonstrating a reference architecture (RA) and implementation, including Health Level Seven International Fast Healthcare Interoperability Resources (HL7 FHIR) implementation guides (IGs), describing how to leverage FHIR for aligned research and public health access to clinical data for automated data exchange. MedMorph engaged a technical expert panel of more than 100 members to model representative use cases, develop IGs (architectural and content), align with existing efforts in the FHIR community, and demonstrate the RA in research and public health uses. The RA IG documents common workflows needed to automatically send research data to Research Patient Data Repositories for multiple use cases. Sharing a common RA and canonical data model will improve data sharing for research and public health needs and generate evidence. MedMorph delivers a robust, reusable method to utilize data from electronic health records addressing multiple research and public health needs.},\n\tnumber = {12},\n\turldate = {2022-01-24},\n\tjournal = {Journal of the American Medical Informatics Association : JAMIA},\n\tauthor = {Michaels, Maria and Syed, Sameemuddin and Lober, William B},\n\tmonth = oct,\n\tyear = {2021},\n\tpmid = {34613371},\n\tpmcid = {PMC8633601},\n\tpages = {2702--2706},\n}\n\n

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\n \n\n \n \n McGinnis, K. A; Justice, A. C; Moore, R. D; Silverberg, M. J; Althoff, K. N; Karris, M.; Lima, V. D; Crane, H. M; Horberg, M. A; Klein, M. B; Gange, S. J; Gebo, K. A; Mayor, A.; Tate, J. P; North American AIDS Cohort Collaboration on Research; of the International Epidemiologic Databases to Evaluate AIDS (IeDEA), D. (.; and (VACS), V. A. C. S.\n\n\n \n \n \n \n \n Discrimination and Calibration of the Veterans Aging Cohort Study Index 2.0 for Predicting Mortality Among People With Human Immunodeficiency Virus in North America.\n \n \n \n \n\n\n \n\n\n\n Clinical Infectious Diseases,ciab883. October 2021.\n \n\n\n\n
\n\n\n\n \n \n $\"Discrimination$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{mcginnis_discrimination_2021,\n\ttitle = {Discrimination and {Calibration} of the {Veterans} {Aging} {Cohort} {Study} {Index} 2.0 for {Predicting} {Mortality} {Among} {People} {With} {Human} {Immunodeficiency} {Virus} in {North} {America}},\n\tissn = {1058-4838},\n\turl = {https://doi.org/10.1093/cid/ciab883},\n\tdoi = {10.1093/cid/ciab883},\n\tabstract = {The updated Veterans Aging Cohort Study (VACS) Index 2.0 combines general and human immunodeficiency virus (HIV)–specific biomarkers to generate a continuous score that accurately discriminates risk of mortality in diverse cohorts of persons with HIV (PWH), but a score alone is difficult to interpret. Using data from the North American AIDS Cohort Collaboration (NA-ACCORD), we translate VACS Index 2.0 scores into validated probability estimates of mortality.Because complete mortality ascertainment is essential for accurate calibration, we restricted analyses to cohorts with mortality from the National Death Index or equivalent sources. VACS Index 2.0 components were ascertained from October 1999 to April 2018. Mortality was observed up to March 2019. Calibration curves compared predicted (estimated by fitting a gamma model to the score) to observed mortality overall and within subgroups: cohort (VACS/NA-ACCORD subset), sex, age \\&lt;50 or ≥50 years, race/ethnicity, HIV-1 RNA ≤500 or \\&gt;500 copies/mL, CD4 count \\&lt;350 or ≥350 cells/µL, and years 1999–2009 or 2010–2018. Because mortality rates have decreased over time, the final model was limited to 2010–2018.Among 37230 PWH in VACS and 8061 PWH in the NA-ACCORD subset, median age was 53 and 44 years; 3\\% and 19\\% were women; and 48\\% and 39\\% were black. Discrimination in NA-ACCORD (C-statistic = 0.842 [95\\% confidence interval \\{CI\\}, .830–.854]) was better than in VACS (C-statistic = 0.813 [95\\% CI, .809–.817]). Predicted and observed mortality largely overlapped in VACS and the NA-ACCORD subset, overall and within subgroups.Based on this validation, VACS Index 2.0 can reliably estimate probability of all-cause mortality, at various follow-up times, among PWH in North America.},\n\turldate = {2022-01-24},\n\tjournal = {Clinical Infectious Diseases},\n\tauthor = {McGinnis, Kathleen A and Justice, Amy C and Moore, Richard D and Silverberg, Michael J and Althoff, Keri N and Karris, Maile and Lima, Viviane D and Crane, Heidi M and Horberg, Michael A and Klein, Marina B and Gange, Stephen J and Gebo, Kelly A and Mayor, Angel and Tate, Janet P and {North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)a of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) and Veterans Aging Cohort Study (VACS)}},\n\tmonth = oct,\n\tyear = {2021},\n\tpages = {ciab883},\n}\n\n

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\n \n\n \n \n Davy-Mendez, T.; Napravnik, S.; Hogan, B. C; Althoff, K. N; Gebo, K. A; Moore, R. D; Horberg, M. A; Silverberg, M. J; Gill, M J.; Crane, H. M; Marconi, V. C; Bosch, R. J; Colasanti, J. A; Sterling, T. R; Mathews, W C.; Mayor, A. M; Nanditha, N. G. A.; Buchacz, K.; Li, J.; Rebeiro, P. F; Thorne, J. E; Nijhawan, A.; van Duin, D.; Wohl, D. A; Eron, J. J; Berry, S. A; North American AIDS Cohort Collaboration on Research; and of IeDEA, D.\n\n\n \n \n \n \n \n Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005–2015.\n \n \n \n \n\n\n \n\n\n\n The Journal of Infectious Diseases, 223(12): 2113–2123. June 2021.\n \n\n\n\n
\n\n\n\n \n \n $\"Hospitalization$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{davy-mendez_hospitalization_2021,\n\ttitle = {Hospitalization {Rates} and {Causes} {Among} {Persons} {With} {HIV} in the {United} {States} and {Canada}, 2005–2015},\n\tvolume = {223},\n\tissn = {0022-1899},\n\turl = {https://doi.org/10.1093/infdis/jiaa661},\n\tdoi = {10.1093/infdis/jiaa661},\n\tabstract = {To assess the possible impact of antiretroviral therapy improvements, aging, and comorbidities, we examined trends in all-cause and cause-specific hospitalization rates among persons with HIV (PWH) from 2005 to 2015.In 6 clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV load [VL] every 12 months) and categorized ICD codes of primary discharge diagnoses using modified Clinical Classifications Software. Poisson regression estimated hospitalization rate ratios for calendar time trends, adjusted for demographics, HIV risk factor, and annually updated age, CD4, and VL.Among 28 057 patients (125 724 person-years), from 2005 to 2015, the median CD4 increased from 389 to 580 cells/µL and virologic suppression from 55\\% to 85\\% of patients. Unadjusted all-cause hospitalization rates decreased from 22.3 per 100 person-years in 2005 (95\\% confidence interval [CI], 20.6–24.1) to 13.0 in 2015 (95\\% CI, 12.2–14.0). Unadjusted rates decreased for almost all diagnostic categories. Adjusted rates decreased for all-cause, cardiovascular, and AIDS-defining conditions, increased for non-AIDS–defining infection, and were stable for most other categories.Among PWH with increasing CD4 counts and viral suppression, unadjusted hospitalization rates decreased for all-cause and most cause-specific hospitalizations, despite the potential effects of aging, comorbidities, and cumulative exposure to HIV and antiretrovirals.},\n\tnumber = {12},\n\turldate = {2022-01-24},\n\tjournal = {The Journal of Infectious Diseases},\n\tauthor = {Davy-Mendez, Thibaut and Napravnik, Sonia and Hogan, Brenna C and Althoff, Keri N and Gebo, Kelly A and Moore, Richard D and Horberg, Michael A and Silverberg, Michael J and Gill, M John and Crane, Heidi M and Marconi, Vincent C and Bosch, Ronald J and Colasanti, Jonathan A and Sterling, Timothy R and Mathews, W Christopher and Mayor, Angel M and Nanditha, Ni Gusti Ayu and Buchacz, Kate and Li, Jun and Rebeiro, Peter F and Thorne, Jennifer E and Nijhawan, Ank and van Duin, David and Wohl, David A and Eron, Joseph J and Berry, Stephen A and {North American AIDS Cohort Collaboration on Research and Design of IeDEA}},\n\tmonth = jun,\n\tyear = {2021},\n\tpages = {2113--2123},\n}\n\n

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\n \n\n \n \n Austin, E. J.; LeRouge, C.; Lee, J. R.; Segal, C.; Sangameswaran, S.; Heim, J.; Lober, W. B.; Hartzler, A. L.; and Lavallee, D. C.\n\n\n \n \n \n \n \n A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization.\n \n \n \n \n\n\n \n\n\n\n Learning Health Systems, n/a(n/a): e10263. March 2021.\n _eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1002/lrh2.10263\n\n\n\n
\n\n\n\n \n \n $\"A$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{austin_learning_2021,\n\ttitle = {A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization},\n\tvolume = {n/a},\n\tissn = {2379-6146},\n\turl = {https://onlinelibrary.wiley.com/doi/abs/10.1002/lrh2.10263},\n\tdoi = {10.1002/lrh2.10263},\n\tabstract = {Introduction Foundational to a learning health system (LHS) is the presence of a data infrastructure that can support continuous learning and improve patient outcomes. To advance their capacity to drive patient-centered care, health systems are increasingly looking to expand the electronic capture of patient data, such as electronic patient-reported outcome (ePRO) measures. Yet ePROs bring unique considerations around workflow, measurement, and technology that health systems may not be poised to navigate. We report on our effort to develop generalizable learnings that can support the integration of ePROs into clinical practice within an LHS framework. Methods Guided by action research methodology, we engaged in iterative cycles of planning, acting, observing, and reflecting around ePRO use with two primary goals: (1) mobilize an ePRO community of practice to facilitate knowledge sharing, and (2) establish guidelines for ePRO use in the context of LHS practice. Multiple, emergent data collection activities generated generalizable guidelines that document the tangible best practices for ePRO use in clinical care. We organized guidelines around thematic areas that reflect LHS structures and stakeholders. Results Three core thematic areas (and 24 guidelines) emerged. The theme of governance reflects the importance of leadership, knowledge management, and facilitating organizational learning around best practice models for ePRO use. The theme of integration considers the intersection of workflow, technology, and human factors for ePROs across areas of care delivery. Lastly, the theme of reporting reflects critical considerations for curating data and information, designing system functions and interactions, and presentation of ePRO data to support the translation of knowledge to action. Conclusions The guidelines produced from this work highlight the complex, multidisciplinary nature of implementing change within LHS contexts, and the value of action research approaches to enable rapid, iterative learning that leverages the knowledge and experience of communities of practice.},\n\tlanguage = {en},\n\tnumber = {n/a},\n\turldate = {2021-08-13},\n\tjournal = {Learning Health Systems},\n\tauthor = {Austin, Elizabeth J. and LeRouge, Cynthia and Lee, Jenney R. and Segal, Courtney and Sangameswaran, Savitha and Heim, Joseph and Lober, William B. and Hartzler, Andrea L. and Lavallee, Danielle C.},\n\tmonth = mar,\n\tyear = {2021},\n\tnote = {\\_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1002/lrh2.10263},\n\tkeywords = {learning health system, patient-facing technologies, patient-reported outcomes, stakeholder engagement},\n\tpages = {e10263},\n}\n\n

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\n Introduction Foundational to a learning health system (LHS) is the presence of a data infrastructure that can support continuous learning and improve patient outcomes. To advance their capacity to drive patient-centered care, health systems are increasingly looking to expand the electronic capture of patient data, such as electronic patient-reported outcome (ePRO) measures. Yet ePROs bring unique considerations around workflow, measurement, and technology that health systems may not be poised to navigate. We report on our effort to develop generalizable learnings that can support the integration of ePROs into clinical practice within an LHS framework. Methods Guided by action research methodology, we engaged in iterative cycles of planning, acting, observing, and reflecting around ePRO use with two primary goals: (1) mobilize an ePRO community of practice to facilitate knowledge sharing, and (2) establish guidelines for ePRO use in the context of LHS practice. Multiple, emergent data collection activities generated generalizable guidelines that document the tangible best practices for ePRO use in clinical care. We organized guidelines around thematic areas that reflect LHS structures and stakeholders. Results Three core thematic areas (and 24 guidelines) emerged. The theme of governance reflects the importance of leadership, knowledge management, and facilitating organizational learning around best practice models for ePRO use. The theme of integration considers the intersection of workflow, technology, and human factors for ePROs across areas of care delivery. Lastly, the theme of reporting reflects critical considerations for curating data and information, designing system functions and interactions, and presentation of ePRO data to support the translation of knowledge to action. Conclusions The guidelines produced from this work highlight the complex, multidisciplinary nature of implementing change within LHS contexts, and the value of action research approaches to enable rapid, iterative learning that leverages the knowledge and experience of communities of practice.\n

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\n \n\n \n \n McDermott, C. L.; Engelberg, R. A.; Khandelwal, N.; Steiner, J. M.; Feemster, L. C.; Sibley, J.; Lober, W. B.; and Curtis, J. R.\n\n\n \n \n \n \n \n The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity.\n \n \n \n \n\n\n \n\n\n\n American Journal of Hospice and Palliative Medicine®, 38(8): 954–962. August 2021.\n Publisher: SAGE Publications Inc\n\n\n\n
\n\n\n\n \n \n $\"The$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{mcdermott_association_2021,\n\ttitle = {The {Association} of {Advance} {Care} {Planning} {Documentation} and {End}-of-{Life} {Healthcare} {Use} {Among} {Patients} {With} {Multimorbidity}},\n\tvolume = {38},\n\tissn = {1049-9091},\n\turl = {https://doi.org/10.1177/1049909120968527},\n\tdoi = {10.1177/1049909120968527},\n\tabstract = {Purpose:Multimorbidity is associated with increased intensity of end-of-life healthcare. This association has been examined by number but not type of conditions. Our purpose was to understand how intensity of care is influenced by multimorbidity within specific chronic conditions to provide guidance for interventions to improve end-of-life care for these patients.Methods:We identified adults cared for in a multihospital healthcare system who died between 2010?2017. We categorized patients by 4 primary chronic conditions: heart failure, pulmonary disease, renal disease, or dementia. Within each condition, we examined the effect of multimorbidity (presence of 4 or more chronic conditions) on hospital and ICU admission in the last 30 days of life, in-hospital death, and advance care planning (ACP) documentation {\\textgreater}30 days before death. We performed logistic regression to estimate associations between multimorbidity and end-of-life care utilization, stratified by the presence or absence of ACP documentation.Results:ACP documentation {\\textgreater}30 days before death was associated with lower odds of in-hospital death for all 4 conditions both in patients with and without multimorbidity. With the exception of patients with renal disease without multimorbidity, we observed lower odds of hospitalization and ICU admission for all patients with ACP {\\textgreater}30 days before death.Conclusions:Patients with dementia and multimorbidity had the highest odds of high-intensity end-of-life care. For patients with dementia, heart failure, or pulmonary disease, ACP documentation {\\textgreater}30 days before death was associated with lower likelihood of in-hospital death, hospitalization, and ICU use at end-of-life, regardless of multimorbidity.},\n\tlanguage = {en},\n\tnumber = {8},\n\turldate = {2021-08-13},\n\tjournal = {American Journal of Hospice and Palliative Medicine®},\n\tauthor = {McDermott, Cara L. and Engelberg, Ruth A. and Khandelwal, Nita and Steiner, Jill M. and Feemster, Laura C. and Sibley, James and Lober, William B. and Curtis, J. Randall},\n\tmonth = aug,\n\tyear = {2021},\n\tnote = {Publisher: SAGE Publications Inc},\n\tkeywords = {advance care planning, dementia, end-of-life, heart failure, hospitalization, multimorbidity},\n\tpages = {954--962},\n}\n\n

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\n \n\n \n \n Howell, K.; Barnes, M.; Randall Curtis, J.; Engelberg, R. A.; Lee, R. Y.; Lober, W. B.; Sibley, J.; and Cohen, T.\n\n\n \n \n \n \n \n Controlling for Confounding Variables: Accounting for Dataset Bias in Classifying Patient-Provider Interactions.\n \n \n \n \n\n\n \n\n\n\n In Shaban-Nejad, A.; Michalowski, M.; and Buckeridge, D. L., editor(s), Explainable AI in Healthcare and Medicine: Building a Culture of Transparency and Accountability, of Studies in Computational Intelligence, pages 271–282. Springer International Publishing, Cham, 2021.\n \n\n\n\n
\n\n\n\n \n \n $\"Controlling$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@incollection{howell_controlling_2021,\n\taddress = {Cham},\n\tseries = {Studies in {Computational} {Intelligence}},\n\ttitle = {Controlling for {Confounding} {Variables}: {Accounting} for {Dataset} {Bias} in {Classifying} {Patient}-{Provider} {Interactions}},\n\tisbn = {978-3-030-53352-6},\n\tshorttitle = {Controlling for {Confounding} {Variables}},\n\turl = {https://doi.org/10.1007/978-3-030-53352-6_25},\n\tabstract = {Natural Language Processing (NLP) is a key enabling technology for re-use of information in free-text clinical notes. However, a barrier to deployment is the availability of labeled corpora for supervised machine learning, which are expensive to acquire as they must be annotated by experienced clinicians. Where corpora are available, they may be opportunistically collected and thus vulnerable to bias. Here we evaluate an approach for accounting for dataset bias in the context of identifying specific patient-provider interactions. In this context, bias is the result of a phenomenon being over or under-represented in a particular type of clinical note as a result of the way a dataset was curated. Using a clinical dataset which represents a great deal of variation in terms of author and setting, we control for confounding variables using a backdoor adjustment approach [1, 2], which to our knowledge has not been previously applied the clinical domain. This approach improves precision by up to 5\\% and the adjusted models’ scores for false positives are generally lower, resulting in a more generalizable model with the potential to enhance the downstream utility of models trained using opportunistically collected clinical corpora.},\n\tlanguage = {en},\n\turldate = {2021-08-13},\n\tbooktitle = {Explainable {AI} in {Healthcare} and {Medicine}: {Building} a {Culture} of {Transparency} and {Accountability}},\n\tpublisher = {Springer International Publishing},\n\tauthor = {Howell, Kristen and Barnes, Megan and Randall Curtis, J. and Engelberg, Ruth A. and Lee, Robert Y. and Lober, William B. and Sibley, James and Cohen, Trevor},\n\teditor = {Shaban-Nejad, Arash and Michalowski, Martin and Buckeridge, David L.},\n\tyear = {2021},\n\tdoi = {10.1007/978-3-030-53352-6_25},\n\tpages = {271--282},\n}\n\n

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\n \n\n \n \n Suri, S.; Yoong, D.; Short, D.; Tan, D. H.; Naccarato, M.; Crane, H. M; Musten, A.; Fredericksen, R. J; Lober, W. B; and Gough, K.\n\n\n \n \n \n \n \n Feasibility of implementing a same-day electronic screening tool for clinical assessment to measure patient-reported outcomes for eliciting actionable information on adherence to HIV medication and related factors in a busy Canadian urban HIV clinic.\n \n \n \n \n\n\n \n\n\n\n International Journal of STD & AIDS,09564624211032796. July 2021.\n Publisher: SAGE Publications\n\n\n\n
\n\n\n\n \n \n $\"Feasibility$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{suri_feasibility_2021,\n\ttitle = {Feasibility of implementing a same-day electronic screening tool for clinical assessment to measure patient-reported outcomes for eliciting actionable information on adherence to {HIV} medication and related factors in a busy {Canadian} urban {HIV} clinic},\n\tissn = {0956-4624},\n\turl = {https://doi.org/10.1177/09564624211032796},\n\tdoi = {10.1177/09564624211032796},\n\tabstract = {Background: An optimal adherence to antiretroviral therapy (ART) is fundamental for suppression of HIV viral load and favourable treatment outcomes. Patient-reported outcomes (PROs) are effective tools for improving patient–provider communication and focusing providers’ awareness on current health problems. The objectives of this analysis were (1) to determine the feasibility of implementing an electronic screening tool to measure PROs in a Canadian HIV clinic to obtain information on ART adherence and related factors and (2) to determine the factors related to sub-optimal adherence. Methods: This implementation research with a convenience sample of 600 people living with HIV (PLWH) was conducted in a busy, academic, urban HIV clinic in Toronto, Canada. PLWH were approached to participate in PRO assessments just prior to their in-clinic appointments, including health-related domains such as mental health, housing, nutrition, financial stress and medication adherence, and responses were summarized on a single sheet available for providers to review. Feasibility of implementing PROs was assessed by quantifying response rate, completion rate, time taken and participation rate. Medication adherence was elicited by self-report of the percentage of prescribed HIV medications taken in the last month. Unadjusted and adjusted odds ratios were estimated from logistic regression models to identify factors associated with adherence of {\\textless}95\\%. Results: Of the 748 PLWH invited to participate, 692 (participation rate: 92.5\\%) completed the PRO assessments as standard of care in clinic. Of these, 600 consented to the use of their PRO results for research and were included in this analysis. The average response rate to the ART-related questions was 96.8\\% and mean completion rate was 95.5\\%. The median time taken to complete the assessment was 12.0 (IQR = 8.4–17.3) min, adjusted 8.7 (IQR = 7.2–10.8) min. 445 (74.9\\%) of participants were male, and 153 (26.2\\%) reported dissatisfaction with ART. 105 (19.7\\%) of the PLWH reported ART adherence of {\\textless}95\\%. Multivariable logistic regression identified the following risk factors for sub-optimal adherence: dissatisfaction with ART (OR = 2.30, 95\\% CI 1.38–3.83), not having a family doctor or not visiting a family doctor in last year (OR = 1.69, 95\\% CI 1.02–2.79). Conclusion: Collecting self-reported health information from PLWH through PROs in a busy urban clinic was feasible and can provide relevant information to healthcare providers on issues related to adherence. This has a potential to help in individualizing ambulatory care.},\n\tlanguage = {en},\n\turldate = {2021-08-13},\n\tjournal = {International Journal of STD \\& AIDS},\n\tauthor = {Suri, Shivali and Yoong, Deborah and Short, Duncan and Tan, Darrell HS and Naccarato, Mark and Crane, Heidi M and Musten, Alexandra and Fredericksen, Rob J and Lober, William B and Gough, Kevin},\n\tmonth = jul,\n\tyear = {2021},\n\tnote = {Publisher: SAGE Publications},\n\tkeywords = {HIV, adherence, antiretroviral therapy, feasibility, patient-reported outcomes},\n\tpages = {09564624211032796},\n}\n\n

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\n Background: An optimal adherence to antiretroviral therapy (ART) is fundamental for suppression of HIV viral load and favourable treatment outcomes. Patient-reported outcomes (PROs) are effective tools for improving patient–provider communication and focusing providers’ awareness on current health problems. The objectives of this analysis were (1) to determine the feasibility of implementing an electronic screening tool to measure PROs in a Canadian HIV clinic to obtain information on ART adherence and related factors and (2) to determine the factors related to sub-optimal adherence. Methods: This implementation research with a convenience sample of 600 people living with HIV (PLWH) was conducted in a busy, academic, urban HIV clinic in Toronto, Canada. PLWH were approached to participate in PRO assessments just prior to their in-clinic appointments, including health-related domains such as mental health, housing, nutrition, financial stress and medication adherence, and responses were summarized on a single sheet available for providers to review. Feasibility of implementing PROs was assessed by quantifying response rate, completion rate, time taken and participation rate. Medication adherence was elicited by self-report of the percentage of prescribed HIV medications taken in the last month. Unadjusted and adjusted odds ratios were estimated from logistic regression models to identify factors associated with adherence of \\textless95%. Results: Of the 748 PLWH invited to participate, 692 (participation rate: 92.5%) completed the PRO assessments as standard of care in clinic. Of these, 600 consented to the use of their PRO results for research and were included in this analysis. The average response rate to the ART-related questions was 96.8% and mean completion rate was 95.5%. The median time taken to complete the assessment was 12.0 (IQR = 8.4–17.3) min, adjusted 8.7 (IQR = 7.2–10.8) min. 445 (74.9%) of participants were male, and 153 (26.2%) reported dissatisfaction with ART. 105 (19.7%) of the PLWH reported ART adherence of \\textless95%. Multivariable logistic regression identified the following risk factors for sub-optimal adherence: dissatisfaction with ART (OR = 2.30, 95% CI 1.38–3.83), not having a family doctor or not visiting a family doctor in last year (OR = 1.69, 95% CI 1.02–2.79). Conclusion: Collecting self-reported health information from PLWH through PROs in a busy urban clinic was feasible and can provide relevant information to healthcare providers on issues related to adherence. This has a potential to help in individualizing ambulatory care.\n

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\n \n\n \n \n Crane, H. M.; Nance, R. M.; Avoundjian, T.; Harding, B. N.; Whitney, B. M.; Chow, F. C.; Becker, K. J.; Marra, C. M.; Zunt, J. R.; Ho, E. L.; Kalani, R.; Huffer, A.; Burkholder, G. A.; Willig, A. L.; Moore, R. D.; Mathews, W. C.; Eron, J. J.; Napravnik, S.; Lober, W. B.; Barnes, G. S.; McReynolds, J.; Feinstein, M. J.; Heckbert, S. R.; Saag, M. S.; Kitahata, M. M.; Delaney, J. A. C.; and Tirschwell, D. L.\n\n\n \n \n \n \n \n Types of Stroke Among People Living With HIV in the United States.\n \n \n \n \n\n\n \n\n\n\n JAIDS Journal of Acquired Immune Deficiency Syndromes, 86(5): 568–578. April 2021.\n \n\n\n\n
\n\n\n\n \n \n $\"Types$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{crane_types_2021,\n\ttitle = {Types of {Stroke} {Among} {People} {Living} {With} {HIV} in the {United} {States}},\n\tvolume = {86},\n\tissn = {1525-4135},\n\turl = {https://journals.lww.com/jaids/Fulltext/2021/04150/Types_of_Stroke_Among_People_Living_With_HIV_in.11.aspx?casa_token=jOkwzWWCmawAAAAA:V7XvfOz0ec2AW0TWwk6ynoz__9-qoJTX6cJRGe6vE3zhlJvz50TzeHYv43pV8OHz3JsnUEVZtQz8lJVSEQd3zH9i},\n\tdoi = {10.1097/QAI.0000000000002598},\n\tabstract = {Background: \n        Most studies of stroke in people living with HIV (PLWH) do not use verified stroke diagnoses, are small, and/or do not differentiate stroke types and subtypes.\n        Setting: \n        CNICS, a U.S. multisite clinical cohort of PLWH in care.\n        Methods: \n        We implemented a centralized adjudication stroke protocol to identify stroke type, subtype, and precipitating conditions identified as direct causes including infection and illicit drug use in a large diverse HIV cohort.\n        Results: \n        Among 26,514 PLWH, there were 401 strokes, 75\\% of which were ischemic. Precipitating factors such as sepsis or same-day cocaine use were identified in 40\\% of ischemic strokes. Those with precipitating factors were younger, had more severe HIV disease, and fewer traditional stroke risk factors such as diabetes and hypertension. Ischemic stroke subtypes included cardioembolic (20\\%), large vessel atherosclerosis (13\\%), and small vessel (24\\%) ischemic strokes. Individuals with small vessel strokes were older, were more likely to have a higher current CD4 cell count than those with cardioembolic strokes and had the highest mean blood pressure of the ischemic stroke subtypes.\n        Conclusion: \n        Ischemic stroke, particularly small vessel and cardioembolic subtypes, were the most common strokes among PLWH. Traditional and HIV-related risk factors differed by stroke type/subtype. Precipitating factors including infections and drug use were common. These results suggest that there may be different biological phenomena occurring among PLWH and that understanding HIV-related and traditional risk factors and in particular precipitating factors for each type/subtype may be key to understanding, and therefore preventing, strokes among PLWH.},\n\tlanguage = {en-US},\n\tnumber = {5},\n\turldate = {2021-08-13},\n\tjournal = {JAIDS Journal of Acquired Immune Deficiency Syndromes},\n\tauthor = {Crane, Heidi M. and Nance, Robin M. and Avoundjian, Tigran and Harding, Barbara N. and Whitney, Bridget M. and Chow, Felicia C. and Becker, Kyra J. and Marra, Christina M. and Zunt, Joseph R. and Ho, Emily L. and Kalani, Rizwan and Huffer, Andrew and Burkholder, Greer A. and Willig, Amanda L. and Moore, Richard D. and Mathews, William C. and Eron, Joseph J. and Napravnik, Sonia and Lober, William B. and Barnes, Greg S. and McReynolds, Justin and Feinstein, Matthew J. and Heckbert, Susan R. and Saag, Michael S. and Kitahata, Mari M. and Delaney, Joseph A. C. and Tirschwell, David L.},\n\tmonth = apr,\n\tyear = {2021},\n\tpages = {568--578},\n}\n\n

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\n \n\n \n \n Lee, R. Y.; Brumback, L. C.; Lober, W. B.; Sibley, J.; Nielsen, E. L.; Treece, P. D.; Kross, E. K.; Loggers, E. T.; Fausto, J. A.; Lindvall, C.; Engelberg, R. A.; and Curtis, J. R.\n\n\n \n \n \n \n \n Identifying Goals of Care Conversations in the Electronic Health Record Using Natural Language Processing and Machine Learning.\n \n \n \n \n\n\n \n\n\n\n Journal of Pain and Symptom Management, 61(1): 136–142.e2. January 2021.\n \n\n\n\n
\n\n\n\n \n \n $\"Identifying$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lee_identifying_2021,\n\ttitle = {Identifying {Goals} of {Care} {Conversations} in the {Electronic} {Health} {Record} {Using} {Natural} {Language} {Processing} and {Machine} {Learning}},\n\tvolume = {61},\n\tissn = {0885-3924},\n\turl = {https://www.sciencedirect.com/science/article/pii/S0885392420307107},\n\tdoi = {10.1016/j.jpainsymman.2020.08.024},\n\tabstract = {Context\nGoals-of-care discussions are an important quality metric in palliative care. However, goals-of-care discussions are often documented as free text in diverse locations. It is difficult to identify these discussions in the electronic health record (EHR) efficiently.\nObjectives\nTo develop, train, and test an automated approach to identifying goals-of-care discussions in the EHR, using natural language processing (NLP) and machine learning (ML).\nMethods\nFrom the electronic health records of an academic health system, we collected a purposive sample of 3183 EHR notes (1435 inpatient notes and 1748 outpatient notes) from 1426 patients with serious illness over 2008–2016, and manually reviewed each note for documentation of goals-of-care discussions. Separately, we developed a program to identify notes containing documentation of goals-of-care discussions using NLP and supervised ML. We estimated the performance characteristics of the NLP/ML program across 100 pairs of randomly partitioned training and test sets. We repeated these methods for inpatient-only and outpatient-only subsets.\nResults\nOf 3183 notes, 689 contained documentation of goals-of-care discussions. The mean sensitivity of the NLP/ML program was 82.3\\% (SD 3.2\\%), and the mean specificity was 97.4\\% (SD 0.7\\%). NLP/ML results had a median positive likelihood ratio of 32.2 (IQR 27.5–39.2) and a median negative likelihood ratio of 0.18 (IQR 0.16–0.20). Performance was better in inpatient-only samples than outpatient-only samples.\nConclusion\nUsing NLP and ML techniques, we developed a novel approach to identifying goals-of-care discussions in the EHR. NLP and ML represent a potential approach toward measuring goals-of-care discussions as a research outcome and quality metric.},\n\tlanguage = {en},\n\tnumber = {1},\n\turldate = {2021-08-13},\n\tjournal = {Journal of Pain and Symptom Management},\n\tauthor = {Lee, Robert Y. and Brumback, Lyndia C. and Lober, William B. and Sibley, James and Nielsen, Elizabeth L. and Treece, Patsy D. and Kross, Erin K. and Loggers, Elizabeth T. and Fausto, James A. and Lindvall, Charlotta and Engelberg, Ruth A. and Curtis, J. Randall},\n\tmonth = jan,\n\tyear = {2021},\n\tkeywords = {Natural language processing, electronic health record, goals of care, machine learning, medical informatics, quality improvement},\n\tpages = {136--142.e2},\n}\n\n

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\n \n\n \n \n Chen, T.; Baseman, J.; Lober, W. B.; Hills, R.; Klemfuss, N.; and Karras, B. T.\n\n\n \n \n \n \n \n WA Notify: the planning and implementation of a Bluetooth exposure notification tool for COVID-19 pandemic response in Washington State.\n \n \n \n \n\n\n \n\n\n\n Online Journal of Public Health Informatics, 13(1): e8. June 2021.\n \n\n\n\n
\n\n\n\n \n \n $\"WA$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{chen_wa_2021,\n\ttitle = {{WA} {Notify}: the planning and implementation of a {Bluetooth} exposure notification tool for {COVID}-19 pandemic response in {Washington} {State}},\n\tvolume = {13},\n\tissn = {1947-2579},\n\tshorttitle = {{WA} {Notify}},\n\turl = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216404/},\n\tdoi = {10.5210/ojphi.v13i1.11694},\n\tabstract = {Bluetooth exposure notification tools for mobile phones have emerged as one way\nto support public health contact tracing and mitigate the spread of COVID-19.\nMany states have launched their own versions of these tools. Washington\nState's exposure notification tool, WA Notify, became available on November\n30, 2020, following a one-month Seattle campus pilot at the University of\nWashington. By the end of April 2021, 25\\% of the state's population had\nactivated WA Notify, one of the highest adoption rates in the country.\nWashington State's formation of an Exposure Notification Advisory\nCommittee, early pilot testing, and use of the EN Express system framework were\nall important factors in its adoption. Continuous monitoring and willingness to\nmake early adjustments such as switching to automated texting of verification\ncodes have also been important for improving the tool’s value. Evaluation\nwork is ongoing to determine and quantify WA Notify’s effectiveness,\ntimeliness, and accessibility.},\n\tnumber = {1},\n\turldate = {2021-08-13},\n\tjournal = {Online Journal of Public Health Informatics},\n\tauthor = {Chen, Tiffany and Baseman, Janet and Lober, William B. and Hills, Rebecca and Klemfuss, Nola and Karras, Bryant T.},\n\tmonth = jun,\n\tyear = {2021},\n\tpmid = {34178242},\n\tpmcid = {PMC8216404},\n\tpages = {e8},\n}\n\n

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\n \n\n \n \n Crane, H. M.; Nance, R. M.; Whitney, B. M.; Ruderman, S.; Tsui, J. I.; Chander, G.; McCaul, M. E.; Lau, B.; Mayer, K. H.; Batey, D. S.; Safren, S. A.; Moore, R. D.; Eron, J. J.; Napravnik, S.; Mathews, W. C.; Fredericksen, R. J.; Hahn, A. W.; Mugavero, M. J.; Lober, W. B.; Saag, M. S.; Kitahata, M. M.; and Delaney, J. A. C.\n\n\n \n \n \n \n \n Drug and alcohol use among people living with HIV in care in the United States by geographic region.\n \n \n \n \n\n\n \n\n\n\n AIDS Care, 0(0): 1–8. January 2021.\n Publisher: Taylor & Francis _eprint: https://doi.org/10.1080/09540121.2021.1874274\n\n\n\n
\n\n\n\n \n \n $\"Drug$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{crane_drug_2021,\n\ttitle = {Drug and alcohol use among people living with {HIV} in care in the {United} {States} by geographic region},\n\tvolume = {0},\n\tissn = {0954-0121},\n\turl = {https://doi.org/10.1080/09540121.2021.1874274},\n\tdoi = {10.1080/09540121.2021.1874274},\n\tabstract = {Substance use in the U.S. varies by geographic region. Opioid prescribing practices and marijuana, heroin, and methamphetamine availability are evolving differently across regions. We examined self-reported substance use among people living with HIV (PLWH) in care at seven sites from 2017–2019 to understand current regional substance use patterns. We calculated the percentage and standardized percentage of PLWH reporting current drug use and at-risk and binge alcohol use by U.S. Census Bureau geographic region and examined associations in adjusted logistic regression analyses. Among 7,686 PLWH, marijuana use was the most prevalent drug (30\\%), followed by methamphetamine/crystal (8\\%), cocaine/crack (7\\%), and illicit opioids (3\\%). One-third reported binge alcohol use (32\\%). Differences in percent of current use by region were seen for marijuana (24–41\\%) and methamphetamine/crystal (2–15\\%), with more use in the West and Northeast, and binge alcohol use (26–40\\%). In adjusted analyses, PLWH in the Midwest were significantly less likely to use methamphetamine/crystal (aOR: 0.13;0.06–0.25) or illicit opioids (aOR:0.16;0.05–0.53), and PLWH in the Northeast were more likely to use cocaine/crack (aOR:1.59;1.16–2.17), compared to PLWH in the West. Understanding differences in substance use patterns in the current era, as policies continue to evolve, will enable more targeted interventions in clinical settings among PLWH.},\n\tnumber = {0},\n\turldate = {2021-08-13},\n\tjournal = {AIDS Care},\n\tauthor = {Crane, Heidi M. and Nance, Robin M. and Whitney, Bridget M. and Ruderman, Stephanie and Tsui, Judith I. and Chander, Geetanjali and McCaul, Mary E. and Lau, Bryan and Mayer, Kenneth H. and Batey, D. Scott and Safren, Steven A. and Moore, Richard D. and Eron, Joseph J. and Napravnik, Sonia and Mathews, W. Chris and Fredericksen, Rob J. and Hahn, Andrew W. and Mugavero, Michael J. and Lober, William B. and Saag, Michael S. and Kitahata, Mari M. and Delaney, Joseph A. C.},\n\tmonth = jan,\n\tyear = {2021},\n\tpmid = {33486978},\n\tnote = {Publisher: Taylor \\& Francis\n\\_eprint: https://doi.org/10.1080/09540121.2021.1874274},\n\tkeywords = {Drug use, HIV, alcohol use, marijuana, methamphetamine},\n\tpages = {1--8},\n}\n\n

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\n \n\n \n \n Burkhardt, H. A.; Brandt, P. S.; Lee, J. R.; Karras, S. W.; Bugni, P. F.; Cvitkovic, I.; Chen, A. Y.; and Lober, W. B.\n\n\n \n \n \n \n \n StayHome: A FHIR-Native Mobile COVID-19 Symptom Tracker and Public Health Reporting Tool.\n \n \n \n \n\n\n \n\n\n\n Online Journal of Public Health Informatics, 13(1): e2. March 2021.\n \n\n\n\n
\n\n\n\n \n \n $\"StayHome:$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 6 downloads\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{burkhardt_stayhome_2021,\n\ttitle = {{StayHome}: {A} {FHIR}-{Native} {Mobile} {COVID}-19 {Symptom} {Tracker} and {Public} {Health} {Reporting} {Tool}},\n\tvolume = {13},\n\tissn = {1947-2579},\n\tshorttitle = {{StayHome}},\n\turl = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075351/},\n\tdoi = {10.5210/ojphi.v13i1.11462},\n\tabstract = {As the COVID-19 pandemic continues to unfold and states experience the impacts of\nreopened economies, it is critical to efficiently manage new outbreaks through\nwidespread testing and monitoring of both new and possible cases. Existing\nlabor-intensive public health workflows may benefit from information collection\ndirectly from individuals through patient-reported outcomes (PROs) systems. Our\nobjective was to develop a reusable, mobile-friendly application for collecting\nPROs and experiences to support COVID-19 symptom self-monitoring and data\nsharing with appropriate public health agencies, using Fast Healthcare\nInteroperability Resources (FHIR) for interoperability. We conducted a needs\nassessment and designed and developed StayHome, a mobile PRO administration\ntool. FHIR serves as the primary data model and driver of business logic.\nKeycloak, AWS, Docker, and other technologies were used for deployment. Several\nFHIR modules were used to create a novel “FHIR-native” application\ndesign. By leveraging FHIR to shape not only the interface strategy but also the\ninformation architecture of the application, StayHome enables the consistent\nstandards-based representation of data and reduces the barrier to integration\nwith public health information systems. FHIR supported rapid application\ndevelopment by providing a domain-appropriate data model and tooling. FHIR\nmodules and implementation guides were referenced in design and implementation.\nHowever, there are gaps in the FHIR specification which must be recognized and\naddressed appropriately. StayHome is live and accessible to the public at\nhttps://stayhome.app. The code and resources required to build\nand deploy the application are available from https://github.com/uwcirg/stayhome-project.},\n\tnumber = {1},\n\turldate = {2021-08-13},\n\tjournal = {Online Journal of Public Health Informatics},\n\tauthor = {Burkhardt, Hannah A. and Brandt, Pascal S. and Lee, Jenney R. and Karras, Sierramatice W. and Bugni, Paul F. and Cvitkovic, Ivan and Chen, Amy Y. and Lober, William B.},\n\tmonth = mar,\n\tyear = {2021},\n\tpmid = {33936522},\n\tpmcid = {PMC8075351},\n\tpages = {e2},\n}\n\n

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\n \n 2020\n \n \n (7)\n \n \n

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\n \n\n \n \n Fredericksen, R. J; Short, D.; Fitzsimmons, E.; McReynolds, J.; Karras, S. W.; Lober, B.; and Crane, H. M\n\n\n \n \n \n \n Integrating Patient-Reported Outcomes (PROs) Assessments Into Routine HIV Care.\n \n \n \n\n\n \n\n\n\n ,60. November 2020.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{fredericksen_integrating_2020,\n\ttitle = {Integrating {Patient}-{Reported} {Outcomes} ({PROs}) {Assessments} {Into} {Routine} {HIV} {Care}},\n\tlanguage = {en},\n\tauthor = {Fredericksen, Rob J and Short, Duncan and Fitzsimmons, Emma and McReynolds, Justin and Karras, Sierramatice W. and Lober, Bill and Crane, Heidi M},\n\tmonth = nov,\n\tyear = {2020},\n\tpages = {60},\n}\n\n

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\n \n\n \n \n Davy-Mendez, T.; Napravnik, S.; Eron, J.; Cole, S.; van Duin, D.; Wohl, D.; Hogan, B.; Althoff, K.; Gebo, K.; Moore, R.; Silverberg, M.; Horberg, M.; Gill, M.; Whalen, C.; Klein, M.; Colasanti, J.; Sterling, T.; Mayor, A.; Rebeiro, P.; and Berry, S.\n\n\n \n \n \n \n Current and Past Immunodeficiency are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to Eleven Years.\n \n \n \n\n\n \n\n\n\n The Journal of Infectious Diseases. December 2020.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{davy-mendez_current_2020,\n\ttitle = {Current and {Past} {Immunodeficiency} are {Associated} with {Higher} {Hospitalization} {Rates} among {Persons} on {Virologically} {Suppressive} {Antiretroviral} {Therapy} for up to {Eleven} {Years}},\n\tdoi = {10.1093/infdis/jiaa786},\n\tabstract = {Background\nPersons with HIV (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk.\n\nMethods\nIn six US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (Years 2–5) and long-term (Years 6–11) suppression and lowest pre-suppression CD4 count {\\textless}200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRR) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest pre-suppression CD4 count.\n\nResults\nThe 6997 included patients (19 980 person-years) were 81\\% cisgender men and 40\\% White. Among patients with lowest pre-suppression CD4 {\\textless}200 cells/μL (44\\%), patients with current CD4 200-350 versus {\\textgreater}500 cells/μL had an aIRR of 1.44 during early suppression (95\\% CI 1.01-2.06), and 1.67 (1.03-2.72) during long-term suppression. Among patients with lowest pre-suppression CD4 ≥200 (56\\%), patients with current CD4 351-500 versus {\\textgreater}500 cells/μL had an aIRR of 1.22 (0.93-1.60) during early suppression and 2.09 (1.18-3.70) during long-term suppression.\n\nConclusions\nVirologically suppressed patients with lower CD4 counts experienced higher hospitalization rates, and could potentially benefit from targeted clinical management strategies.},\n\tjournal = {The Journal of Infectious Diseases},\n\tauthor = {Davy-Mendez, Thibaut and Napravnik, Sonia and Eron, Joseph and Cole, Stephen and van Duin, David and Wohl, David and Hogan, Brenna and Althoff, Keri and Gebo, Kelly and Moore, Richard and Silverberg, Michael and Horberg, Michael and Gill, Michael and Whalen, Christopher and Klein, Marina and Colasanti, Jonathan and Sterling, Timothy and Mayor, Angel and Rebeiro, Peter and Berry, Stephen},\n\tmonth = dec,\n\tyear = {2020},\n}\n\n

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\n \n\n \n \n Lordon, R. J; Mikles, S. P; Kneale, L.; Evans, H. L; Munson, S. A; Backonja, U.; and Lober, W. B\n\n\n \n \n \n \n \n How patient-generated health data and patient-reported outcomes affect patient–clinician relationships: A systematic review.\n \n \n \n \n\n\n \n\n\n\n Health Informatics Journal, 26(4): 2689–2706. December 2020.\n Publisher: SAGE Publications Ltd\n\n\n\n
\n\n\n\n \n \n $\"How$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lordon_how_2020,\n\ttitle = {How patient-generated health data and patient-reported outcomes affect patient–clinician relationships: {A} systematic review},\n\tvolume = {26},\n\tissn = {1460-4582},\n\tshorttitle = {How patient-generated health data and patient-reported outcomes affect patient–clinician relationships},\n\turl = {https://doi.org/10.1177/1460458220928184},\n\tdoi = {10.1177/1460458220928184},\n\tabstract = {Introduction:Many patients use mobile devices to track health conditions by recording patient-generated health data. However, patients and clinicians may disagree how to use these data.Objective:To systematically review the literature to identify how patient-generated health data and patient-reported outcomes collected outside of clinical settings can affect patient?clinician relationships within surgery and primary care.Methods:Six research databases were queried for publications documenting the effect of patient-generated health data or patient-reported outcomes on patient?clinician relationships. We conducted thematic synthesis of the results of the included publications.Results:Thirteen of the 3204 identified publications were included for synthesis. Three main themes were identified: patient-generated health data supported patient?clinician communication and health awareness, patients desired for their clinicians to be involved with their patient-generated health data, which clinicians had difficulty accommodating, and patient-generated health data platform features may support or hinder patient?clinician collaboration.Conclusion:Patient-generated health data and patient-reported outcomes may improve patient health awareness and communication with clinicians but may negatively affect patient?clinician relationships.},\n\tlanguage = {en},\n\tnumber = {4},\n\turldate = {2021-08-13},\n\tjournal = {Health Informatics Journal},\n\tauthor = {Lordon, Ross J and Mikles, Sean P and Kneale, Laura and Evans, Heather L and Munson, Sean A and Backonja, Uba and Lober, William B},\n\tmonth = dec,\n\tyear = {2020},\n\tnote = {Publisher: SAGE Publications Ltd},\n\tkeywords = {patient reported outcomes, patient-generated health data, primary care, professional-patient relations [Mesh], surgery},\n\tpages = {2689--2706},\n}\n\n

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\n \n\n \n \n Amweg, L. N.; McReynolds, J.; Lansang, K.; Jones, T.; Snow, C.; Berry, D. L.; Partridge, A. H.; and Underhill-Blazey, M. L.\n\n\n \n \n \n \n \n Hodgkin Lymphoma Survivor Wellness: Development of a Web-Based Intervention.\n \n \n \n \n\n\n \n\n\n\n Clinical Journal of Oncology Nursing, 24(3): 284–289. June 2020.\n Publisher: Oncology Nursing Society\n\n\n\n
\n\n\n\n \n \n $\"Hodgkin$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{amweg_hodgkin_2020,\n\ttitle = {Hodgkin {Lymphoma} {Survivor} {Wellness}: {Development} of a {Web}-{Based} {Intervention}},\n\tvolume = {24},\n\tshorttitle = {Hodgkin {Lymphoma} {Survivor} {Wellness}},\n\turl = {https://cjon.ons.org/cjon/24/3/hodgkin-lymphoma-survivor-wellness-development-web-based-intervention},\n\tdoi = {10.1188/20.CJON.284-289},\n\tlanguage = {en},\n\tnumber = {3},\n\turldate = {2021-08-13},\n\tjournal = {Clinical Journal of Oncology Nursing},\n\tauthor = {Amweg, Laura N. and McReynolds, Justin and Lansang, Kristina and Jones, Tarsha and Snow, Craig and Berry, Donna L. and Partridge, Ann H. and Underhill-Blazey, Meghan L.},\n\tmonth = jun,\n\tyear = {2020},\n\tnote = {Publisher: Oncology Nursing Society},\n\tpages = {284--289},\n}\n\n

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\n \n\n \n \n Loo, S.; Grasso, C.; Glushkina, J.; McReynolds, J.; Lober, W.; Crane, H.; and Mayer, K. H.\n\n\n \n \n \n \n \n Capturing Relevant Patient Data in Clinical Encounters Through Integration of an Electronic Patient-Reported Outcome System Into Routine Primary Care in a Boston Community Health Center: Development and Implementation Study.\n \n \n \n \n\n\n \n\n\n\n Journal of Medical Internet Research, 22(8): e16778. August 2020.\n Company: Journal of Medical Internet Research Distributor: Journal of Medical Internet Research Institution: Journal of Medical Internet Research Label: Journal of Medical Internet Research Publisher: JMIR Publications Inc., Toronto, Canada\n\n\n\n
\n\n\n\n \n \n $\"Capturing$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{loo_capturing_2020,\n\ttitle = {Capturing {Relevant} {Patient} {Data} in {Clinical} {Encounters} {Through} {Integration} of an {Electronic} {Patient}-{Reported} {Outcome} {System} {Into} {Routine} {Primary} {Care} in a {Boston} {Community} {Health} {Center}: {Development} and {Implementation} {Study}},\n\tvolume = {22},\n\tshorttitle = {Capturing {Relevant} {Patient} {Data} in {Clinical} {Encounters} {Through} {Integration} of an {Electronic} {Patient}-{Reported} {Outcome} {System} {Into} {Routine} {Primary} {Care} in a {Boston} {Community} {Health} {Center}},\n\turl = {https://www.jmir.org/2020/8/e16778},\n\tdoi = {10.2196/16778},\n\tabstract = {Background: Electronic patient-reported outcome (ePRO) systems can improve health outcomes by detecting health issues or risk behaviors that may be missed when relying on provider elicitation.\nObjective: This study aimed to implement an ePRO system that administers key health questionnaires in an urban community health center in Boston, Massachusetts.\nMethods: An ePRO system that administers key health questionnaires was implemented in an urban community health center in Boston, Massachusetts. The system was integrated with the electronic health record so that medical providers could review and adjudicate patient responses in real-time during the course of the patient visit. This implementation project was accomplished through careful examination of clinical workflows and a graduated rollout process that was mindful of patient and clinical staff time and burden. Patients responded to questionnaires using a tablet at the beginning of their visit.\nResults: Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model in terms of applying technological innovation to streamline clinical processes and improve patient care.\nConclusions: Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model for application of technological innovation to streamline clinical processes and improve patient care.},\n\tlanguage = {EN},\n\tnumber = {8},\n\turldate = {2021-08-13},\n\tjournal = {Journal of Medical Internet Research},\n\tauthor = {Loo, Stephanie and Grasso, Chris and Glushkina, Jessica and McReynolds, Justin and Lober, William and Crane, Heidi and Mayer, Kenneth H.},\n\tmonth = aug,\n\tyear = {2020},\n\tnote = {Company: Journal of Medical Internet Research\nDistributor: Journal of Medical Internet Research\nInstitution: Journal of Medical Internet Research\nLabel: Journal of Medical Internet Research\nPublisher: JMIR Publications Inc., Toronto, Canada},\n\tpages = {e16778},\n}\n\n

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\n \n\n \n \n Fredericksen, R. J.; Harding, B. N.; Ruderman, S. A.; McReynolds, J.; Barnes, G.; Lober, W. B.; Fitzsimmons, E.; Nance, R. M.; Whitney, B. M.; Delaney, J. A. C.; Mathews, W. C.; Willig, J.; Crane, P. K.; and Crane, H. M.\n\n\n \n \n \n \n \n Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes.\n \n \n \n \n\n\n \n\n\n\n AIDS Care, 0(0): 1–11. November 2020.\n Publisher: Taylor & Francis _eprint: https://doi.org/10.1080/09540121.2020.1845288\n\n\n\n
\n\n\n\n \n \n $\"Patient$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{fredericksen_patient_2020,\n\ttitle = {Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in {HIV} care: relationship with health behaviors and outcomes},\n\tvolume = {0},\n\tissn = {0954-0121},\n\tshorttitle = {Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in {HIV} care},\n\turl = {https://doi.org/10.1080/09540121.2020.1845288},\n\tdoi = {10.1080/09540121.2020.1845288},\n\tabstract = {We assessed acceptability/usability of tablet-based patient-reported outcome (PRO) assessments among patients in HIV care, and relationships with health outcomes using a modified Acceptability E-Scale (AES) within a self-administered PRO assessment. Using multivariable linear regression, we measured associations between patient characteristics and continuous combined AES score. Among 786 patients (median age=48; 91\\% male; 49\\% white; 17\\% Spanish-speaking) overall mean score was 26/30 points (SD: 4.4). Mean scores per dimension (max 5, 1=lowest acceptability, 5=highest): ease of use 4.7, understandability 4.7, time burden 4.3, overall satisfaction 4.3, helpfulness describing symptoms/behaviors 4.2, and enjoyability 3.8. Higher overall score was associated with race/ethnicity (+1.3 points/African-American patients (95\\%CI:0.3-2.3); +1.6 points/Latino patients (95\\%CI:0.9-2.3) compared to white patients). Patients completing PROs in Spanish scored +2.4 points on average (95\\%CI:1.6-3.3). Higher acceptability was associated with better quality of life (0.3 points (95\\%CI:0.2-0.5)) and adherence (0.4 points (95\\%CI:0.2-0.6)). Lower acceptability was associated with: higher depression symptoms (-0.9 points (95\\%CI:-1.4 to -0.4)); recent illicit opioid use (-2.0 points (95\\%CI:-3.9 to -0.2)); multiple recent sex partners (-0.8 points (95\\%CI:-1.5 to -0.1)). While patients endorsing depression symptoms, recent opioid use, condomless sex, or multiple sex partners found PROs less acceptable, overall, patients found the assessments highly acceptable and easy to use.},\n\tnumber = {0},\n\turldate = {2021-08-13},\n\tjournal = {AIDS Care},\n\tauthor = {Fredericksen, R. J. and Harding, B. N. and Ruderman, S. A. and McReynolds, J. and Barnes, G. and Lober, W. B. and Fitzsimmons, E. and Nance, R. M. and Whitney, B. M. and Delaney, J. A. C. and Mathews, W. C. and Willig, J. and Crane, P. K. and Crane, H. M.},\n\tmonth = nov,\n\tyear = {2020},\n\tpmid = {33190523},\n\tnote = {Publisher: Taylor \\& Francis\n\\_eprint: https://doi.org/10.1080/09540121.2020.1845288},\n\tkeywords = {HIV care, Patient reported outcomes, acceptability, electronic PRO administration},\n\tpages = {1--11},\n}\n\n

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\n \n\n \n \n Lee, R. Y.; Brumback, L. C.; Sathitratanacheewin, S.; Lober, W. B.; Modes, M. E.; Lynch, Y. T.; Ambrose, C. I.; Sibley, J.; Vranas, K. C.; Sullivan, D. R.; Engelberg, R. A.; Curtis, J. R.; and Kross, E. K.\n\n\n \n \n \n \n \n Association of Physician Orders for Life-Sustaining Treatment With ICU Admission Among Patients Hospitalized Near the End of Life.\n \n \n \n \n\n\n \n\n\n\n JAMA. February 2020.\n \n\n\n\n
\n\n\n\n \n \n $\"Association$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{lee_association_2020,\n\ttitle = {Association of {Physician} {Orders} for {Life}-{Sustaining} {Treatment} {With} {ICU} {Admission} {Among} {Patients} {Hospitalized} {Near} the {End} of {Life}},\n\turl = {https://jamanetwork.com/journals/jama/fullarticle/2761227},\n\tdoi = {10.1001/jama.2019.22523},\n\tabstract = {Importance  Patients with chronic illness frequently use Physician Orders for Life-Sustaining Treatment (POLST) to document treatment limitations.\n\nObjectives  To evaluate the association between POLST order for medical interventions and intensive care unit (ICU) admission for patients hospitalized near the end of life.\n\nDesign, Setting, and Participants  Retrospective cohort study of patients with POLSTs and with chronic illness who died between January 1, 2010, and December 31, 2017, and were hospitalized 6 months or less before death in a 2-hospital academic health care system.\n\nExposures  POLST order for medical interventions (“comfort measures only” vs “limited additional interventions” vs “full treatment”), age, race/ethnicity, education, days from POLST completion to admission, histories of cancer or dementia, and admission for traumatic injury.\n\nMain Outcomes and Measures  The primary outcome was the association between POLST order and ICU admission during the last hospitalization of life; the secondary outcome was receipt of a composite of 4 life-sustaining treatments: mechanical ventilation, vasopressors, dialysis, and cardiopulmonary resuscitation. For evaluating factors associated with POLST-discordant care, the outcome was ICU admission contrary to POLST order for medical interventions during the last hospitalization of life.\n\nResults  Among 1818 decedents (mean age, 70.8 [SD, 14.7] years; 41\\% women), 401 (22\\%) had POLST orders for comfort measures only, 761 (42\\%) had orders for limited additional interventions, and 656 (36\\%) had orders for full treatment. ICU admissions occurred in 31\\% (95\\% CI, 26\\%-35\\%) of patients with comfort-only orders, 46\\% (95\\% CI, 42\\%-49\\%) with limited-interventions orders, and 62\\% (95\\% CI, 58\\%-66\\%) with full-treatment orders. One or more life-sustaining treatments were delivered to 14\\% (95\\% CI, 11\\%-17\\%) of patients with comfort-only orders and to 20\\% (95\\% CI, 17\\%-23\\%) of patients with limited-interventions orders. Compared with patients with full-treatment POLSTs, those with comfort-only and limited-interventions orders were significantly less likely to receive ICU admission (comfort only: 123/401 [31\\%] vs 406/656 [62\\%], aRR, 0.53 [95\\% CI, 0.45-0.62]; limited interventions: 349/761 [46\\%] vs 406/656 [62\\%], aRR, 0.79 [95\\% CI, 0.71-0.87]). Across patients with comfort-only and limited-interventions POLSTs, 38\\% (95\\% CI, 35\\%-40\\%) received POLST-discordant care. Patients with cancer were significantly less likely to receive POLST-discordant care than those without cancer (comfort only: 41/181 [23\\%] vs 80/220 [36\\%], aRR, 0.60 [95\\% CI, 0.43-0.85]; limited interventions: 100/321 [31\\%] vs 215/440 [49\\%], aRR, 0.63 [95\\% CI, 0.51-0.78]). Patients with dementia and comfort-only orders were significantly less likely to receive POLST-discordant care than those without dementia (23/111 [21\\%] vs 98/290 [34\\%], aRR, 0.44 [95\\% CI, 0.29-0.67]). Patients admitted for traumatic injury were significantly more likely to receive POLST-discordant care (comfort only: 29/64 [45\\%] vs 92/337 [27\\%], aRR, 1.52 [95\\% CI, 1.08-2.14]; limited interventions: 51/91 [56\\%] vs 264/670 [39\\%], aRR, 1.36 [95\\% CI, 1.09-1.68]). In patients with limited-interventions orders, older age was significantly associated with less POLST-discordant care (aRR, 0.93 per 10 years [95\\% CI, 0.88-1.00]).\n\nConclusions and Relevance  Among patients with POLSTs and with chronic life-limiting illness who were hospitalized within 6 months of death, treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38\\% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST.},\n\tlanguage = {en},\n\turldate = {2020-02-27},\n\tjournal = {JAMA},\n\tauthor = {Lee, Robert Y. and Brumback, Lyndia C. and Sathitratanacheewin, Seelwan and Lober, William B. and Modes, Matthew E. and Lynch, Ylinne T. and Ambrose, Corey I. and Sibley, James and Vranas, Kelly C. and Sullivan, Donald R. and Engelberg, Ruth A. and Curtis, J. Randall and Kross, Erin K.},\n\tmonth = feb,\n\tyear = {2020},\n}\n\n

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\n Importance Patients with chronic illness frequently use Physician Orders for Life-Sustaining Treatment (POLST) to document treatment limitations. Objectives To evaluate the association between POLST order for medical interventions and intensive care unit (ICU) admission for patients hospitalized near the end of life. Design, Setting, and Participants Retrospective cohort study of patients with POLSTs and with chronic illness who died between January 1, 2010, and December 31, 2017, and were hospitalized 6 months or less before death in a 2-hospital academic health care system. Exposures POLST order for medical interventions (“comfort measures only” vs “limited additional interventions” vs “full treatment”), age, race/ethnicity, education, days from POLST completion to admission, histories of cancer or dementia, and admission for traumatic injury. Main Outcomes and Measures The primary outcome was the association between POLST order and ICU admission during the last hospitalization of life; the secondary outcome was receipt of a composite of 4 life-sustaining treatments: mechanical ventilation, vasopressors, dialysis, and cardiopulmonary resuscitation. For evaluating factors associated with POLST-discordant care, the outcome was ICU admission contrary to POLST order for medical interventions during the last hospitalization of life. Results Among 1818 decedents (mean age, 70.8 [SD, 14.7] years; 41% women), 401 (22%) had POLST orders for comfort measures only, 761 (42%) had orders for limited additional interventions, and 656 (36%) had orders for full treatment. ICU admissions occurred in 31% (95% CI, 26%-35%) of patients with comfort-only orders, 46% (95% CI, 42%-49%) with limited-interventions orders, and 62% (95% CI, 58%-66%) with full-treatment orders. One or more life-sustaining treatments were delivered to 14% (95% CI, 11%-17%) of patients with comfort-only orders and to 20% (95% CI, 17%-23%) of patients with limited-interventions orders. Compared with patients with full-treatment POLSTs, those with comfort-only and limited-interventions orders were significantly less likely to receive ICU admission (comfort only: 123/401 [31%] vs 406/656 [62%], aRR, 0.53 [95% CI, 0.45-0.62]; limited interventions: 349/761 [46%] vs 406/656 [62%], aRR, 0.79 [95% CI, 0.71-0.87]). Across patients with comfort-only and limited-interventions POLSTs, 38% (95% CI, 35%-40%) received POLST-discordant care. Patients with cancer were significantly less likely to receive POLST-discordant care than those without cancer (comfort only: 41/181 [23%] vs 80/220 [36%], aRR, 0.60 [95% CI, 0.43-0.85]; limited interventions: 100/321 [31%] vs 215/440 [49%], aRR, 0.63 [95% CI, 0.51-0.78]). Patients with dementia and comfort-only orders were significantly less likely to receive POLST-discordant care than those without dementia (23/111 [21%] vs 98/290 [34%], aRR, 0.44 [95% CI, 0.29-0.67]). Patients admitted for traumatic injury were significantly more likely to receive POLST-discordant care (comfort only: 29/64 [45%] vs 92/337 [27%], aRR, 1.52 [95% CI, 1.08-2.14]; limited interventions: 51/91 [56%] vs 264/670 [39%], aRR, 1.36 [95% CI, 1.09-1.68]). In patients with limited-interventions orders, older age was significantly associated with less POLST-discordant care (aRR, 0.93 per 10 years [95% CI, 0.88-1.00]). Conclusions and Relevance Among patients with POLSTs and with chronic life-limiting illness who were hospitalized within 6 months of death, treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST.\n

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\n \n 2019\n \n \n (14)\n \n \n

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\n \n\n \n \n Lober, W. B.; and Evans, H. L.\n\n\n \n \n \n \n Patient-Generated Health Data in Surgical Site Infection: Changing Clinical Workflow and Care Delivery.\n \n \n \n\n\n \n\n\n\n Surgical Infections, 20(7): 571–576. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 3 downloads\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_patient-generated_2019,\n\ttitle = {Patient-{Generated} {Health} {Data} in {Surgical} {Site} {Infection}: {Changing} {Clinical} {Workflow} and {Care} {Delivery}},\n\tvolume = {20},\n\tissn = {1557-8674},\n\tshorttitle = {Patient-{Generated} {Health} {Data} in {Surgical} {Site} {Infection}},\n\tdoi = {10.1089/sur.2019.195},\n\tabstract = {Background:\n                     The patient's history of present illness provides an important part of the data with which clinicians diagnose and treat. Once surgical patients are discharged, the ability to incorporate direct observation requires coordinating patient and provider for a clinical visit. Mobile technologies offer the ability to gather and organize the patient's history, supplement that history with photographs and other clinical observations, and convey those data accurately and rapidly to the entire clinical team. \n                        Methods:\n                     We review our experience with patient-generated health data in surgical site infection, draw parallels with similar work in other domains, and identify principles we have found useful. \n                        Results:\n                     Health information system implementations require substantial changes in provider workflow. Shared expectations between the patient and the surgical team, an incremental approach to change in clinical processes, and an emphasis on clinical utility all support successful implementation. \n                        Conclusions:\n                     The data collection and rapid information exchange afforded by monitoring post-operative, post-discharge patients using mobile technologies can support the expectations of both patients and providers and may provide a novel data source for public health surveillance of surgical site infection. Both uses of these data require careful attention to introducing changes in clinical workflow.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Surgical Infections},\n\tauthor = {Lober, William B. and Evans, Heather L.},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {31397635},\n\tkeywords = {CIRG Selected, Disease Management, Health Information Systems, Humans, Information Dissemination, Patient Generated Health Data, Surgical Wound Infection, Workflow, mHealth, patient-centered care, smartphone, surgical site infection, wound photograph},\n\tpages = {571--576},\n}\n\n

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\n \n\n \n \n Hernández-Ramírez, R. U.; Qin, L.; Lin, H.; Leyden, W.; Neugebauer, R. S.; Althoff, K. N.; Achenbach, C. J.; Hessol, N. A.; D'Souza, G.; Gebo, K. A.; Gill, M. J.; Grover, S.; Horberg, M. A.; Li, J.; Mathews, W. C.; Mayor, A. M.; Park, L. S.; Rabkin, C. S.; Salters, K.; Justice, A. C.; Moore, R. D.; Engels, E. A.; Silverberg, M. J.; Dubrow, R.; North American AIDS Cohort Collaboration on Research; and of the International Epidemiologic Databases to Evaluate AIDS, D.\n\n\n \n \n \n \n \n Association of immunosuppression and HIV viraemia with non-Hodgkin lymphoma risk overall and by subtype in people living with HIV in Canada and the USA: a multicentre cohort study.\n \n \n \n \n\n\n \n\n\n\n The lancet. HIV, 6(4): e240–e249. April 2019.\n \n\n\n\n
\n\n\n\n \n \n $\"Association$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{hernandez-ramirez_association_2019,\n\ttitle = {Association of immunosuppression and {HIV} viraemia with non-{Hodgkin} lymphoma risk overall and by subtype in people living with {HIV} in {Canada} and the {USA}: a multicentre cohort study},\n\tvolume = {6},\n\tissn = {2352-3018},\n\tshorttitle = {Association of immunosuppression and {HIV} viraemia with non-{Hodgkin} lymphoma risk overall and by subtype in people living with {HIV} in {Canada} and the {USA}},\n\turl = {https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30360-6/fulltext},\n\tdoi = {10.1016/S2352-3018(18)30360-6},\n\tabstract = {BACKGROUND: Research is needed to better understand relations between immunosuppression and HIV viraemia and risk for non-Hodgkin lymphoma, a common cancer in people living with HIV. We aimed to identify key CD4 count and HIV RNA (viral load) predictors of risk for non-Hodgkin lymphoma, overall and by subtype.\nMETHODS: We studied people living with HIV during 1996-2014 from 21 Canadian and US cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. To determine key independent predictors of risk for non-Hodgkin lymphoma, we assessed associations with time-updated recent, past, cumulative, and nadir or peak measures of CD4 count and viral load, using demographics-adjusted, cohort-stratified Cox models, and we compared models using Akaike's information criterion.\nFINDINGS: Of 102 131 people living with HIV during the study period, 712 people developed non-Hodgkin lymphoma. The key independent predictors of risk for overall non-Hodgkin lymphoma were recent CD4 count (ie, lagged by 6 months; {\\textless}50 cells per μL vs ≥500 cells per μL, hazard ratio [HR] 3·2, 95\\% CI 2·2-4·7) and average viral load during a 3-year window lagged by 6 months (a cumulative measure; ≥100 000 copies per mL vs ≤500 copies per mL, HR 9·6, 95\\% CI 6·5-14·0). These measures were also the key predictors of risk for diffuse large B-cell lymphoma (recent CD4 count {\\textless}50 cells per μL vs ≥500 cells per μL, HR 2·4, 95\\% CI 1·4-4·2; average viral load ≥100 000 copies per mL vs ≤500 copies per mL, HR 7·5, 95\\% CI 4·5-12·7). However, recent CD4 count was the sole key predictor of risk for CNS non-Hodgkin lymphoma ({\\textless}50 cells per μL vs ≥500 cells per μL, HR 426·3, 95\\% CI 58·1-3126·4), and proportion of time viral load was greater than 500 copies per mL during the 3-year window (a cumulative measure) was the sole key predictor for Burkitt lymphoma (100\\% vs 0\\%, HR 41·1, 95\\% CI 9·1-186·6).\nINTERPRETATION: Both recent immunosuppression and prolonged HIV viraemia have important independent roles in the development of non-Hodgkin lymphoma, with likely subtype heterogeneity. Early and sustained antiretroviral therapy to decrease HIV replication, dampen B-cell activation, and restore overall immune function is crucial for preventing non-Hodgkin lymphoma.\nFUNDING: National Institutes of Health, Centers for Disease Control and Prevention, US Agency for Healthcare Research and Quality, US Health Resources and Services Administration, Canadian Institutes of Health Research, Ontario Ministry of Health and Long Term Care, and the Government of Alberta.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {The lancet. HIV},\n\tauthor = {Hernández-Ramírez, Raúl U. and Qin, Li and Lin, Haiqun and Leyden, Wendy and Neugebauer, Romain S. and Althoff, Keri N. and Achenbach, Chad J. and Hessol, Nancy A. and D'Souza, Gypsyamber and Gebo, Kelly A. and Gill, M. John and Grover, Surbhi and Horberg, Michael A. and Li, Jun and Mathews, W. Christopher and Mayor, Angel M. and Park, Lesley S. and Rabkin, Charles S. and Salters, Kate and Justice, Amy C. and Moore, Richard D. and Engels, Eric A. and Silverberg, Michael J. and Dubrow, Robert and {North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS}},\n\tmonth = apr,\n\tyear = {2019},\n\tpmid = {30826282},\n\tpmcid = {PMC6531288},\n\tpages = {e240--e249},\n}\n\n

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\n BACKGROUND: Research is needed to better understand relations between immunosuppression and HIV viraemia and risk for non-Hodgkin lymphoma, a common cancer in people living with HIV. We aimed to identify key CD4 count and HIV RNA (viral load) predictors of risk for non-Hodgkin lymphoma, overall and by subtype. METHODS: We studied people living with HIV during 1996-2014 from 21 Canadian and US cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. To determine key independent predictors of risk for non-Hodgkin lymphoma, we assessed associations with time-updated recent, past, cumulative, and nadir or peak measures of CD4 count and viral load, using demographics-adjusted, cohort-stratified Cox models, and we compared models using Akaike's information criterion. FINDINGS: Of 102 131 people living with HIV during the study period, 712 people developed non-Hodgkin lymphoma. The key independent predictors of risk for overall non-Hodgkin lymphoma were recent CD4 count (ie, lagged by 6 months; \\textless50 cells per μL vs ≥500 cells per μL, hazard ratio [HR] 3·2, 95% CI 2·2-4·7) and average viral load during a 3-year window lagged by 6 months (a cumulative measure; ≥100 000 copies per mL vs ≤500 copies per mL, HR 9·6, 95% CI 6·5-14·0). These measures were also the key predictors of risk for diffuse large B-cell lymphoma (recent CD4 count \\textless50 cells per μL vs ≥500 cells per μL, HR 2·4, 95% CI 1·4-4·2; average viral load ≥100 000 copies per mL vs ≤500 copies per mL, HR 7·5, 95% CI 4·5-12·7). However, recent CD4 count was the sole key predictor of risk for CNS non-Hodgkin lymphoma (\\textless50 cells per μL vs ≥500 cells per μL, HR 426·3, 95% CI 58·1-3126·4), and proportion of time viral load was greater than 500 copies per mL during the 3-year window (a cumulative measure) was the sole key predictor for Burkitt lymphoma (100% vs 0%, HR 41·1, 95% CI 9·1-186·6). INTERPRETATION: Both recent immunosuppression and prolonged HIV viraemia have important independent roles in the development of non-Hodgkin lymphoma, with likely subtype heterogeneity. Early and sustained antiretroviral therapy to decrease HIV replication, dampen B-cell activation, and restore overall immune function is crucial for preventing non-Hodgkin lymphoma. FUNDING: National Institutes of Health, Centers for Disease Control and Prevention, US Agency for Healthcare Research and Quality, US Health Resources and Services Administration, Canadian Institutes of Health Research, Ontario Ministry of Health and Long Term Care, and the Government of Alberta.\n

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\n \n\n \n \n Feinstein, M. J.; Nance, R. M.; Delaney, J. A. C.; Heckbert, S. R.; Budoff, M. J.; Drozd, D. R.; Burkholder, G. A.; Willig, J. H.; Mugavero, M. J.; Mathews, W. C.; Moore, R. D.; Eron, J. J.; Napravnik, S.; Hunt, P. W.; Geng, E.; Hsue, P.; Peter, I.; Lober, W. B.; Crothers, K.; Grunfeld, C.; Saag, M. S.; Kitahata, M. M.; Lloyd-Jones, D. M.; and Crane, H. M.\n\n\n \n \n \n \n \n Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of Integrated Clinical Systems (CNICS).\n \n \n \n \n\n\n \n\n\n\n BMC medicine, 17(1): 149. July 2019.\n \n\n\n\n
\n\n\n\n \n \n $\"Mortality$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{feinstein_mortality_2019,\n\ttitle = {Mortality following myocardial infarction among {HIV}-infected persons: the {Center} for {AIDS} {Research} {Network} {Of} {Integrated} {Clinical} {Systems} ({CNICS})},\n\tvolume = {17},\n\tissn = {1741-7015},\n\tshorttitle = {Mortality following myocardial infarction among {HIV}-infected persons},\n\turl = {https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-019-1385-7},\n\tdoi = {10.1186/s12916-019-1385-7},\n\tabstract = {BACKGROUND: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown.\nMETHODS: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI.\nRESULTS: Among the 596 out of 28,186 PWH who experienced MI (2.1\\%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39\\%, 52\\%, and 62\\%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15\\%, 22\\%, and 30\\%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load.\nCONCLUSIONS: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {BMC medicine},\n\tauthor = {Feinstein, Matthew J. and Nance, Robin M. and Delaney, J. A. Chris and Heckbert, Susan R. and Budoff, Matthew J. and Drozd, Daniel R. and Burkholder, Greer A. and Willig, James H. and Mugavero, Michael J. and Mathews, William C. and Moore, Richard D. and Eron, Joseph J. and Napravnik, Sonia and Hunt, Peter W. and Geng, Elvin and Hsue, Priscilla and Peter, Inga and Lober, William B. and Crothers, Kristina and Grunfeld, Carl and Saag, Michael S. and Kitahata, Mari M. and Lloyd-Jones, Donald M. and Crane, Heidi M.},\n\tmonth = jul,\n\tyear = {2019},\n\tpmid = {31362721},\n\tpmcid = {PMC6668167},\n\tkeywords = {Acquired Immunodeficiency Syndrome, Adult, Aged, Cardiovascular diseases, Cohort Studies, Community Networks, Comorbidity, Epidemiology, Female, HIV Infections, Human immunodeficiency virus, Humans, Male, Middle Aged, Mortality, Multicenter study, Myocardial Infarction, Myocardial infarction, Plaque, Atherosclerotic, United States},\n\tpages = {149},\n}\n\n

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\n \n\n \n \n Kummerow Broman, K.; Gaskill, C. E.; Faqih, A.; Feng, M.; Phillips, S. E.; Lober, W. B.; Pierce, R. A.; Holzman, M. D.; Evans, H. L.; and Poulose, B. K.\n\n\n \n \n \n \n \n Evaluation of Wound Photography for Remote Postoperative Assessment of Surgical Site Infections.\n \n \n \n \n\n\n \n\n\n\n JAMA surgery, 154(2): 117–124. February 2019.\n \n\n\n\n
\n\n\n\n \n \n $\"Evaluation$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{kummerow_broman_evaluation_2019,\n\ttitle = {Evaluation of {Wound} {Photography} for {Remote} {Postoperative} {Assessment} of {Surgical} {Site} {Infections}},\n\tvolume = {154},\n\tissn = {2168-6262},\n\turl = {https://jamanetwork.com/journals/jamasurgery/articlepdf/2709733/jamasurgery_kummerow_broman_2018_oi_180065.pdf},\n\tdoi = {10.1001/jamasurg.2018.3861},\n\tabstract = {Importance: Surgeons are increasingly interested in using mobile and online applications with wound photography to monitor patients after surgery. Early work using remote care to diagnose surgical site infections (SSIs) demonstrated improved diagnostic accuracy using wound photographs to augment patients' electronic reports of symptoms, but it is unclear whether these findings are reproducible in real-world practice.\nObjective: To determine how wound photography affects surgeons' abilities to diagnose SSIs in a pragmatic setting.\nDesign, Setting, and Participants: This prospective study compared surgeons' paired assessments of postabdominal surgery case vignettes with vs without wound photography for detection of SSIs. Data for case vignettes were collected prospectively from May 1, 2007, to January 31, 2009, at Erasmus University Medical Center, Rotterdam, the Netherlands, and from July 1, 2015, to February 29, 2016, at Vanderbilt University Medical Center, Nashville, Tennessee. The surgeons were members of the American Medical Association whose self-designated specialty is general, abdominal, colorectal, oncologic, or vascular surgery and who completed internet-based assessments from May 21 to June 10, 2016.\nIntervention: Surgeons reviewed online clinical vignettes with or without wound photography.\nMain Outcomes and Measures: Surgeons' diagnostic accuracy, sensitivity, specificity, confidence, and proposed management with respect to SSIs.\nResults: A total of 523 surgeons (113 women and 410 men; mean [SD] age, 53 [10] years) completed a mean of 2.9 clinical vignettes. For the diagnosis of SSIs, the addition of wound photography did not change accuracy (863 of 1512 [57.1\\%] without and 878 of 1512 [58.1\\%] with photographs). Photographs decreased sensitivity (from 0.58 to 0.50) but increased specificity (from 0.56 to 0.63). In 415 of 1512 cases (27.4\\%), the addition of wound photography changed the surgeons' assessment (215 of 1512 [14.2\\%] changed from incorrect to correct and 200 of 1512 [13.2\\%] changed from correct to incorrect). Surgeons reported greater confidence when vignettes included a wound photograph compared with vignettes without a wound photograph, regardless of whether they correctly identified an SSI (median, 8 [interquartile range, 6-9] vs median, 8 [interquartile range, 7-9]; P {\\textless} .001) but they were more likely to undertriage patients when vignettes included a wound photograph, regardless of whether they correctly identified an SSI.\nConclusions and Relevance: In a practical simulation, wound photography increased specificity and surgeon confidence, but worsened sensitivity for detection of SSIs. Remote evaluation of patient-generated wound photographs may not accurately reflect the clinical state of surgical incisions. Effective widespread implementation of remote postoperative assessment with photography may require additional development of tools, participant training, and mechanisms to verify image quality.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {JAMA surgery},\n\tauthor = {Kummerow Broman, Kristy and Gaskill, Cameron E. and Faqih, Adil and Feng, Michael and Phillips, Sharon E. and Lober, William B. and Pierce, Richard A. and Holzman, Michael D. and Evans, Heather L. and Poulose, Benjamin K.},\n\tmonth = feb,\n\tyear = {2019},\n\tpmid = {30422236},\n\tpmcid = {PMC6439665},\n\tkeywords = {Clinical Competence, Female, Humans, Male, Middle Aged, Netherlands, Photography, Prospective Studies, Remote Consultation, Sensitivity and Specificity, Surgeons, Surgical Wound Infection},\n\tpages = {117--124},\n}\n\n

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\n Importance: Surgeons are increasingly interested in using mobile and online applications with wound photography to monitor patients after surgery. Early work using remote care to diagnose surgical site infections (SSIs) demonstrated improved diagnostic accuracy using wound photographs to augment patients' electronic reports of symptoms, but it is unclear whether these findings are reproducible in real-world practice. Objective: To determine how wound photography affects surgeons' abilities to diagnose SSIs in a pragmatic setting. Design, Setting, and Participants: This prospective study compared surgeons' paired assessments of postabdominal surgery case vignettes with vs without wound photography for detection of SSIs. Data for case vignettes were collected prospectively from May 1, 2007, to January 31, 2009, at Erasmus University Medical Center, Rotterdam, the Netherlands, and from July 1, 2015, to February 29, 2016, at Vanderbilt University Medical Center, Nashville, Tennessee. The surgeons were members of the American Medical Association whose self-designated specialty is general, abdominal, colorectal, oncologic, or vascular surgery and who completed internet-based assessments from May 21 to June 10, 2016. Intervention: Surgeons reviewed online clinical vignettes with or without wound photography. Main Outcomes and Measures: Surgeons' diagnostic accuracy, sensitivity, specificity, confidence, and proposed management with respect to SSIs. Results: A total of 523 surgeons (113 women and 410 men; mean [SD] age, 53 [10] years) completed a mean of 2.9 clinical vignettes. For the diagnosis of SSIs, the addition of wound photography did not change accuracy (863 of 1512 [57.1%] without and 878 of 1512 [58.1%] with photographs). Photographs decreased sensitivity (from 0.58 to 0.50) but increased specificity (from 0.56 to 0.63). In 415 of 1512 cases (27.4%), the addition of wound photography changed the surgeons' assessment (215 of 1512 [14.2%] changed from incorrect to correct and 200 of 1512 [13.2%] changed from correct to incorrect). Surgeons reported greater confidence when vignettes included a wound photograph compared with vignettes without a wound photograph, regardless of whether they correctly identified an SSI (median, 8 [interquartile range, 6-9] vs median, 8 [interquartile range, 7-9]; P \\textless .001) but they were more likely to undertriage patients when vignettes included a wound photograph, regardless of whether they correctly identified an SSI. Conclusions and Relevance: In a practical simulation, wound photography increased specificity and surgeon confidence, but worsened sensitivity for detection of SSIs. Remote evaluation of patient-generated wound photographs may not accurately reflect the clinical state of surgical incisions. Effective widespread implementation of remote postoperative assessment with photography may require additional development of tools, participant training, and mechanisms to verify image quality.\n

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\n \n\n \n \n Tolins, M. L.; Hippe, D. S.; Morse, S. C.; Evans, H. L.; Lober, W. B.; and Vrablik, M. C.\n\n\n \n \n \n \n Wound Care Follow-Up From the Emergency Department Using a Mobile Application: A Pilot Study.\n \n \n \n\n\n \n\n\n\n The Journal of Emergency Medicine, 57(5): 629–636. November 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{tolins_wound_2019,\n\ttitle = {Wound {Care} {Follow}-{Up} {From} the {Emergency} {Department} {Using} a {Mobile} {Application}: {A} {Pilot} {Study}},\n\tvolume = {57},\n\tissn = {0736-4679},\n\tshorttitle = {Wound {Care} {Follow}-{Up} {From} the {Emergency} {Department} {Using} a {Mobile} {Application}},\n\tdoi = {10.1016/j.jemermed.2019.07.017},\n\tabstract = {BACKGROUND: Many patients presenting to emergency departments (EDs) do not have primary care and risk being lost to follow-up. Technology has been used successfully in surgical populations for wound care follow-up yet this is not well studied in ED populations.\nOBJECTIVE: We aimed to conduct a pilot study demonstrating "smartphone" application-based follow-up after wound care in the ED.\nMETHODS: We enrolled participants in 2 urban EDs using a smartphone application called Mobile Post-Operative Wound Evaluator (mPOWEr) and defined participation as photographic submission at any time during the study period. We collected demographic data, frequency of use of mPOWEr, number of photographs uploaded, and timing of uploads.\nRESULTS: We approached patients for study enrollment, and 67 patients (28\\%) were not enrolled because they had no access to a smartphone. Seventy-one patients (30\\%) declined to enroll, leaving 100 (42\\%) successfully enrolled. Smartphone ownership was more common among patients {\\textless}40 years of age (81\\% vs. 64\\%, p = 0.004), more common among white patients than nonwhite patients (75\\% vs. 15\\%, p = 0.046), more common among patients approached at the university medical center than the trauma center (84\\% vs. 66\\%, p = 0.003), and among patients with commercial or other insurance than those with Medicare or Medicaid (92\\% vs. 54\\%, p {\\textless} 0.001). Of those enrolled, 58\\% submitted a photograph.\nCONCLUSIONS: Patients presenting for wound care to the ED will participate in smartphone-based app communication for wound care follow-up and are satisfied with this option. Disparities in smartphone access must be considered when using this follow-up method.},\n\tlanguage = {eng},\n\tnumber = {5},\n\tjournal = {The Journal of Emergency Medicine},\n\tauthor = {Tolins, Molly L. and Hippe, Daniel S. and Morse, Sophie C. and Evans, Heather L. and Lober, William B. and Vrablik, Marie C.},\n\tmonth = nov,\n\tyear = {2019},\n\tpmid = {31594745},\n\tkeywords = {Front Page, emergency medicine, follow-up wound care, health care disparities, smartphone, telemedicine},\n\tpages = {629--636},\n}\n\n

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\n \n\n \n \n Kim, J.; Engelberg, R. A.; Downey, L.; Lee, R. Y.; Powelson, E.; Sibley, J.; Lober, W. B.; Curtis, J. R.; and Khandelwal, N.\n\n\n \n \n \n \n Predictors of Advance Care Planning Documentation in Patients With Underlying Chronic Illness Who Died of Traumatic Injury.\n \n \n \n\n\n \n\n\n\n Journal of Pain and Symptom Management, 58(5): 857–863.e1. November 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{kim_predictors_2019,\n\ttitle = {Predictors of {Advance} {Care} {Planning} {Documentation} in {Patients} {With} {Underlying} {Chronic} {Illness} {Who} {Died} of {Traumatic} {Injury}},\n\tvolume = {58},\n\tissn = {1873-6513},\n\tdoi = {10.1016/j.jpainsymman.2019.07.015},\n\tabstract = {CONTEXT: Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity.\nOBJECTIVES: Identify predictors of absent ACP documentation in the electronic health records of patients with underlying chronic illness who died of traumatic injury.\nMETHODS: We used death records and electronic health records to identify decedents with chronic life-limiting illness who died of traumatic injury between 2010 and 2015 and to evaluate factors associated with documentation of living wills, durable powers of attorney, or physician orders for life-sustaining treatment.\nRESULTS: Only 22\\% of decedents had ACP documentation at time of injury. Among those without preinjury ACP documentation, 4\\% completed ACP documentation after injury. In multipredictor analyses, patients were less likely to have ACP documentation at the time of injury if they were younger (P {\\textless} 0.001), had fewer chronic illnesses (P = 0.002), and had fewer nonsurgical hospitalizations (P = 0.042) in the year before injury. Among patients without ACP documentation before injury, those with fewer postinjury nonsurgical hospitalizations were less likely to complete ACP documentation after injury (P = 0.019).\nCONCLUSIONS: Our findings suggest that patient characteristics play an important role in the completion of ACP among patients with chronic life-limiting illness and who died from sudden severe injury. Interventions to improve ACP completion by patients with serious chronic conditions have the potential for increasing goal-concordant care in the event of traumatic injury.},\n\tlanguage = {eng},\n\tnumber = {5},\n\tjournal = {Journal of Pain and Symptom Management},\n\tauthor = {Kim, Justin and Engelberg, Ruth A. and Downey, Lois and Lee, Robert Y. and Powelson, Elisabeth and Sibley, James and Lober, William B. and Curtis, J. Randall and Khandelwal, Nita},\n\tmonth = nov,\n\tyear = {2019},\n\tpmid = {31349036},\n\tpmcid = {PMC6823122},\n\tkeywords = {Advance care planning, Front Page, chronic illness, injury, trauma},\n\tpages = {857--863.e1},\n}\n\n

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\n \n\n \n \n Wagner, E.; Patrick, D. L.; Khandelwal, N.; Brumback, L.; Starks, H.; Fausto, J.; Dunlap, B. S.; Lober, W.; Sibley, J.; Loggers, E. T.; Curtis, J. R.; and Engelberg, R. A.\n\n\n \n \n \n \n The Influence of Multimorbidity on Health Care Utilization at the End of Life for Patients with Chronic Conditions.\n \n \n \n\n\n \n\n\n\n Journal of Palliative Medicine, 22(10): 1260–1265. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 1 download\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{wagner_influence_2019,\n\ttitle = {The {Influence} of {Multimorbidity} on {Health} {Care} {Utilization} at the {End} of {Life} for {Patients} with {Chronic} {Conditions}},\n\tvolume = {22},\n\tissn = {1557-7740},\n\tdoi = {10.1089/jpm.2018.0349},\n\tabstract = {Objective:\n                     To evaluate the association between the number of chronic conditions and hospital utilization at the end of life. \n                        Background:\n                     An understanding of the association of multimorbidity with health care utilization at the end of life may inform interventions to improve quality of care for these patients. \n                        Methods:\n                     A mortality follow-back analysis using Washington State death records and electronic health records. Subject included patients in the UW Medicine system who had at least one chronic condition and died between 2010 and 2015. Utilization was measured by inpatient admissions, emergency department use, and intensive care unit (ICU) admissions in the last 30 days of life. \n                        Results:\n                     For all utilization types, patients with three or more chronic conditions (n = 5124) had significantly higher utilization (p {\\textless} 0.001) in the last 30 days of life than those with two (n = 5775) or one condition (n = 11,169). Comparing 3 versus 2 versus 1 conditions, the following percentages of patients had each type of utilization: inpatient admissions (37\\% vs. 28\\% vs. 19\\%), ED admissions (5\\% vs. 4\\% vs. 2\\%), and ICU care (28\\% vs. 20\\% vs. 12\\%). \n                        Discussion:\n                     Multimorbidity was associated with greater health care utilization at the end of life among patients representing a range of ages and covered by diverse insurers.},\n\tlanguage = {eng},\n\tnumber = {10},\n\tjournal = {Journal of Palliative Medicine},\n\tauthor = {Wagner, Elizabeth and Patrick, Donald L. and Khandelwal, Nita and Brumback, Lyndia and Starks, Helene and Fausto, James and Dunlap, Benjamin S. and Lober, William and Sibley, James and Loggers, Elizabeth T. and Curtis, J. Randall and Engelberg, Ruth A.},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {30964382},\n\tkeywords = {end-of-life care, multimorbidity, palliative care, utilization},\n\tpages = {1260--1265},\n}\n\n

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\n \n\n \n \n Evans, H. L.; and ASSIST Investigators\n\n\n \n \n \n \n Executive Summary of the Assessing Surgical Site Infection Surveillance Technologies (ASSIST) Project.\n \n \n \n\n\n \n\n\n\n Surgical Infections, 20(7): 527–529. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{evans_executive_2019,\n\ttitle = {Executive {Summary} of the {Assessing} {Surgical} {Site} {Infection} {Surveillance} {Technologies} ({ASSIST}) {Project}},\n\tvolume = {20},\n\tissn = {1557-8674},\n\tdoi = {10.1089/sur.2019.171},\n\tabstract = {Background:\n                     The expert panel that conducted the Assessing Surgical Site Infection Surveillance Technologies (ASSIST) project elaborates on the key findings of the health technologies assessment (HTA) report in a series of articles addressing topics from workflow challenges to implementation strategies to new big data analytics tailored to incorporate serial patient-generated health data (PGHD). \n                        Conclusion:\n                     By reporting on the methodology, with an emphasis on stakeholder engagement, the ASSIST investigators provide the basis for a future deep dive into the next phase of PGHD integration into surgical site infection (SSI) surveillance.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Surgical Infections},\n\tauthor = {Evans, Heather L. and {ASSIST Investigators}},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {31335255},\n\tpmcid = {PMC6823880},\n\tkeywords = {Electronic Data Processing, Epidemiological Monitoring, Health Services Research, Humans, Patient Generated Health Data, Postoperative Period, Surgical Wound Infection, mobile health, patient generated health data, postoperative care, smartphone, surgical wound infection, technology assessment},\n\tpages = {527--529},\n}\n\n

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\n \n\n \n \n Lee, J. R.; Evans, H. L.; Lober, W. B.; Lavallee, D. C.; and ASSIST Investigators\n\n\n \n \n \n \n A Stakeholder-Driven Framework for Evaluating Surgical Site Infection Surveillance Technologies.\n \n \n \n\n\n \n\n\n\n Surgical Infections, 20(7): 588–591. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lee_stakeholder-driven_2019,\n\ttitle = {A {Stakeholder}-{Driven} {Framework} for {Evaluating} {Surgical} {Site} {Infection} {Surveillance} {Technologies}},\n\tvolume = {20},\n\tissn = {1557-8674},\n\tdoi = {10.1089/sur.2019.146},\n\tabstract = {Background:\n                     Patients increasingly use mobile devices to send text messages and photographic data to surgeons. There is potential to harness this patient-generated health data (PGHD) for clinical and public health surveillance of surgical site infection (SSI). Leveraging PGHD collected via remote monitoring in the post-operative period has the potential to produce important benefits for patients, surgeons, care teams, and infection surveillance and prevention. \n                        Methods:\n                     We conducted a health technology assessment (HTA), drawing heavily on stakeholder engagement to better understand current and potential uses of PGHD in post-operative care. Stakeholder engagement activities included assembling an advisory board composed of stakeholder experts, interviewing key informants, and seeking out stakeholder guidance to synthesize evidence from interviews, literature review, and technical app review in order to develop recommendations on the use of PGHD in SSI surveillance. \n                        Results:\n                     We conducted a review of the published literature, a technical/market scan of available apps for capturing post-operative PGHD, and two rounds of key informant interviews with stakeholders. In addition, we held a day-long workshop to solicit stakeholder feedback on initial findings of the project and to guide additional work. These activities culminated in an HTA report that provides guidance and recommendations on the use of PGHD in SSI surveillance, including practice, research, and public health surveillance, and identifies open issues on post-operative use of PGHD for which additional evidence and experience are needed to optimize application of those data for clinical and public health purposes. \n                        Conclusion:\n                     Stakeholders, individuals with direct experience, or interest in a given topic are critical to the HTA process. They provide insight to guide the work conducted, ensure that the topics addressed are relevant and important, and that products of the work are accessible and meaningful to the individuals who will be most impacted.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Surgical Infections},\n\tauthor = {Lee, Jenney R. and Evans, Heather L. and Lober, William B. and Lavallee, Danielle C. and {ASSIST Investigators}},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {31347988},\n\tkeywords = {Electronic Data Processing, Epidemiological Monitoring, Health Services Research, Humans, Patient Generated Health Data, Patient Participation, Postoperative Period, Stakeholder Participation, Surgical Wound Infection, health technology assessment, mHealth, patient-generated health data, stakeholder engagement, surgical site infection},\n\tpages = {588--591},\n}\n\n

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\n Background: Patients increasingly use mobile devices to send text messages and photographic data to surgeons. There is potential to harness this patient-generated health data (PGHD) for clinical and public health surveillance of surgical site infection (SSI). Leveraging PGHD collected via remote monitoring in the post-operative period has the potential to produce important benefits for patients, surgeons, care teams, and infection surveillance and prevention. Methods: We conducted a health technology assessment (HTA), drawing heavily on stakeholder engagement to better understand current and potential uses of PGHD in post-operative care. Stakeholder engagement activities included assembling an advisory board composed of stakeholder experts, interviewing key informants, and seeking out stakeholder guidance to synthesize evidence from interviews, literature review, and technical app review in order to develop recommendations on the use of PGHD in SSI surveillance. Results: We conducted a review of the published literature, a technical/market scan of available apps for capturing post-operative PGHD, and two rounds of key informant interviews with stakeholders. In addition, we held a day-long workshop to solicit stakeholder feedback on initial findings of the project and to guide additional work. These activities culminated in an HTA report that provides guidance and recommendations on the use of PGHD in SSI surveillance, including practice, research, and public health surveillance, and identifies open issues on post-operative use of PGHD for which additional evidence and experience are needed to optimize application of those data for clinical and public health purposes. Conclusion: Stakeholders, individuals with direct experience, or interest in a given topic are critical to the HTA process. They provide insight to guide the work conducted, ensure that the topics addressed are relevant and important, and that products of the work are accessible and meaningful to the individuals who will be most impacted.\n

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\n \n\n \n \n Semple, J. L.; Evans, H. L.; Lober, W. B.; and Lavallee, D. C.\n\n\n \n \n \n \n Implementing Mobile Health Interventions to Capture Post-Operative Patient-Generated Health Data.\n \n \n \n\n\n \n\n\n\n Surgical Infections, 20(7): 566–570. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{semple_implementing_2019,\n\ttitle = {Implementing {Mobile} {Health} {Interventions} to {Capture} {Post}-{Operative} {Patient}-{Generated} {Health} {Data}},\n\tvolume = {20},\n\tissn = {1557-8674},\n\tdoi = {10.1089/sur.2019.151},\n\tabstract = {Background:\n                     The implementation of health information technology interventions is at the forefront of most hospital institutional policy agendas. Despite the availability of numerous apps and mobile platforms focusing on specific areas in healthcare the widespread integration into clinical practice can be a complex process. Here we present guidelines and methodology that we have learned in the implementation process of new technology and an overview of some of the current barriers and enablers specific to implementation of post-surgical site surveillance technology. \n                        Methods:\n                     Analysis of the experience of successful information technology (IT) implementation in different healthcare systems reveals that, despite differences among patient groups, care providers, and hospitals, there are common barriers and enablers to implementation of health IT. \n                        Results:\n                     The process of implementation in organizations and among individuals can be most successful by identifying barriers and enablers within three key stakeholder groups: (1) patients; (2) care providers/clinicians; and (3) manager/administration within healthcare systems. This can be achieved by specific engagement and co-design processes establishing clear benefits, sufficient incentives, and adequate support for clinicians as well as payer-provider relationships, marketplace competition and privacy legislation. \n                        Conclusions:\n                     The successful implementation of such programs requires appropriate strategic planning to address the needs of three specific components: patients, care provider, and policymakers/healthcare management understanding and acceptance.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Surgical Infections},\n\tauthor = {Semple, John L. and Evans, Heather L. and Lober, William B. and Lavallee, Danielle C.},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {31429637},\n\tkeywords = {Electronic Data Processing, Guidelines as Topic, Humans, Medical Informatics, Patient Generated Health Data, Telemedicine, implementation, mobile mHealth, new health technology, wound surveillance},\n\tpages = {566--570},\n}\n\n

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\n \n\n \n \n Chernetsky Tejedor, S.; Sharma, J.; Lavallee, D. C.; Lober, W. B.; and Evans, H. L.\n\n\n \n \n \n \n Identification of Important Features in Mobile Health Applications for Surgical Site Infection Surveillance.\n \n \n \n\n\n \n\n\n\n Surgical Infections, 20(7): 530–534. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{chernetsky_tejedor_identification_2019,\n\ttitle = {Identification of {Important} {Features} in {Mobile} {Health} {Applications} for {Surgical} {Site} {Infection} {Surveillance}},\n\tvolume = {20},\n\tissn = {1557-8674},\n\tdoi = {10.1089/sur.2019.155},\n\tabstract = {Background:\n                     A landscape analysis of mobile health (mHealth) applications and published literature related to their use in surgical site infection (SSI) detection and surveillance was conducted by the Assessing Surgical Site Infection Surveillance Technologies (ASSIST) investigators. \n                        Methods:\n                     The literature review focused on post-discharge SSI detection or tracking by caregivers or patients using mHealth technology. This report is unique in its review across both commercial and research-based mHealth apps. Apps designed for long-term wound tracking and those focused on care coordination and scheduling were excluded. A structured evaluation framework was used to assess the operational, technical, and policy features of the apps. \n                        Results:\n                     Of the 10 apps evaluated, only two were in full clinical use. A variety of data were captured by the apps including wound photographs (eight apps), wound measurements (three apps), dressing assessments (two apps), physical activity metrics (three apps), medication adherence (three apps) as well as structured surveys, signs, and symptoms. Free-text responses were permitted by at least two apps. The extent of integration with the native electronic health record system was variable. \n                        Conclusion:\n                     The examination of rapidly evolving technologies is challenged by lack of standard evaluative methods, such as those more commonly used in clinical research. This review is unique in its application of a structured evaluation framework across both commercial and research-based mHealth apps.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Surgical Infections},\n\tauthor = {Chernetsky Tejedor, Sheri and Sharma, Joe and Lavallee, Danielle C. and Lober, William B. and Evans, Heather L.},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {31464572},\n\tkeywords = {Diagnostic Tests, Routine, Epidemiological Monitoring, Humans, Image Processing, Computer-Assisted, Patient Generated Health Data, Postoperative Period, Surgical Wound Infection, Telemedicine, health information technology, mobile health (mHealth), patient generated health data (PGHD), post-operative infection, surgical site infection, surveillance},\n\tpages = {530--534},\n}\n\n

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\n \n\n \n \n Jiang, Z.; Ardywibowo, R.; Samereh, A.; Evans, H. L.; Lober, W. B.; Chang, X.; Qian, X.; Wang, Z.; and Huang, S.\n\n\n \n \n \n \n A Roadmap for Automatic Surgical Site Infection Detection and Evaluation Using User-Generated Incision Images.\n \n \n \n\n\n \n\n\n\n Surgical Infections, 20(7): 555–565. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{jiang_roadmap_2019,\n\ttitle = {A {Roadmap} for {Automatic} {Surgical} {Site} {Infection} {Detection} and {Evaluation} {Using} {User}-{Generated} {Incision} {Images}},\n\tvolume = {20},\n\tissn = {1557-8674},\n\tdoi = {10.1089/sur.2019.154},\n\tabstract = {Background:\n                     Emerging technologies such as smartphones and wearable sensors have enabled the paradigm shift to new patient-centered healthcare, together with recent mobile health (mHealth) app development. One such promising healthcare app is incision monitoring based on patient-taken incision images. In this review, challenges and potential solution strategies are investigated for surgical site infection (SSI) detection and evaluation using surgical site images taken at home. \n                        Methods:\n                     Potential image quality issues, feature extraction, and surgical site image analysis challenges are discussed. Recent image analysis and machine learning solutions are reviewed to extract meaningful representations as image markers for incision monitoring. Discussions on opportunities and challenges of applying these methods to derive accurate SSI prediction are provided. \n                        Conclusions:\n                     Interactive image acquisition as well as customized image analysis and machine learning methods for SSI monitoring will play critical roles in developing sustainable mHealth apps to achieve the expected outcomes of patient-taken incision images for effective out-of-clinic patient-centered healthcare with substantially reduced cost.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Surgical Infections},\n\tauthor = {Jiang, Ziyu and Ardywibowo, Randy and Samereh, Aven and Evans, Heather L. and Lober, William B. and Chang, Xiangyu and Qian, Xiaoning and Wang, Zhangyang and Huang, Shuai},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {31424335},\n\tpmcid = {PMC6823883},\n\tkeywords = {Electronic Data Processing, Humans, Image Processing, Computer-Assisted, Patient Generated Health Data, Surgical Wound Infection, Telemedicine, surgical site infection, wound healing, wound management},\n\tpages = {555--565},\n}\n\n

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\n \n\n \n \n Lavallee, D. C.; Lee, J. R.; Semple, J. L.; Lober, W. B.; and Evans, H. L.\n\n\n \n \n \n \n Engaging Patients in Co-Design of Mobile Health Tools for Surgical Site Infection Surveillance: Implications for Research and Implementation.\n \n \n \n\n\n \n\n\n\n Surgical Infections, 20(7): 535–540. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lavallee_engaging_2019,\n\ttitle = {Engaging {Patients} in {Co}-{Design} of {Mobile} {Health} {Tools} for {Surgical} {Site} {Infection} {Surveillance}: {Implications} for {Research} and {Implementation}},\n\tvolume = {20},\n\tissn = {1557-8674},\n\tshorttitle = {Engaging {Patients} in {Co}-{Design} of {Mobile} {Health} {Tools} for {Surgical} {Site} {Infection} {Surveillance}},\n\tdoi = {10.1089/sur.2019.148},\n\tabstract = {Background:\n                     As the use of patient-owned devices, including smartphones and tablets, to manage day-to-day activities grows, so does healthcare industry's interest to better leverage technology to engage patients. For surgical care, a unique opportunity exists to capture patient-generated health data (PGHD) including photographs. As part of a broader initiative to evaluate PGHD for surgical site infection (SSI) surveillance, we sought evidence regarding patient involvement and experience with PGHD for SSI monitoring and surveillance. \n                        Methods:\n                     Through a scoping review of the literature and semi-structured stakeholder interviews we gathered evidence on what is currently known about patient perspectives of and experiences with mobile health (mHealth) interventions for post-operative recovery. We presented findings to and discussed with the ASSIST PGHD Stakeholder Advisory Group (PSAG) to generate priorities for further examination. \n                        Results:\n                     Our scoping review yielded 34 studies that addressed post-discharge use of PGHD for monitoring and surveillance of SSI. Of these, 16 studies addressed at least one outcome regarding patient experience; the most commonly measured outcome was patient satisfaction. Only three studies reported on patient involvement in the development of PGHD tools and interventions. We conducted interviews (n = 24) representing a range of stakeholder perspectives. Interviewees stressed the importance of patient involvement in tool and program design, noting patient involvement ensures the "work" that patients do in their daily lives to manage their health and healthcare is recognized. Discussion of evidence with the ASSIST PSAG resulted in formal recommendations for direct involvement of patients and caregivers for future work. \n                        Conclusions:\n                     While mHealth initiatives to advance post-operative management offer the ability to improve patient engagement, work is needed to ensure the patient voice is reflected. Active engagement with patients and caregivers in the development of new technology, the design of new workflows, and the conduct of research and evaluation ensures that the patient experiences and values are incorporated.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Surgical Infections},\n\tauthor = {Lavallee, Danielle C. and Lee, Jenney R. and Semple, John L. and Lober, William B. and Evans, Heather L.},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {31429644},\n\tpmcid = {PMC6823881},\n\tkeywords = {Diagnostic Tests, Routine, Electronic Data Processing, Epidemiological Monitoring, Humans, Patient Generated Health Data, Patient Participation, Surgical Wound Infection, Telemedicine, mHealth, patient engagement, patient-centered care, patient-generated health data, surgical site infection},\n\tpages = {535--540},\n}\n\n

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\n Background: As the use of patient-owned devices, including smartphones and tablets, to manage day-to-day activities grows, so does healthcare industry's interest to better leverage technology to engage patients. For surgical care, a unique opportunity exists to capture patient-generated health data (PGHD) including photographs. As part of a broader initiative to evaluate PGHD for surgical site infection (SSI) surveillance, we sought evidence regarding patient involvement and experience with PGHD for SSI monitoring and surveillance. Methods: Through a scoping review of the literature and semi-structured stakeholder interviews we gathered evidence on what is currently known about patient perspectives of and experiences with mobile health (mHealth) interventions for post-operative recovery. We presented findings to and discussed with the ASSIST PGHD Stakeholder Advisory Group (PSAG) to generate priorities for further examination. Results: Our scoping review yielded 34 studies that addressed post-discharge use of PGHD for monitoring and surveillance of SSI. Of these, 16 studies addressed at least one outcome regarding patient experience; the most commonly measured outcome was patient satisfaction. Only three studies reported on patient involvement in the development of PGHD tools and interventions. We conducted interviews (n = 24) representing a range of stakeholder perspectives. Interviewees stressed the importance of patient involvement in tool and program design, noting patient involvement ensures the \"work\" that patients do in their daily lives to manage their health and healthcare is recognized. Discussion of evidence with the ASSIST PSAG resulted in formal recommendations for direct involvement of patients and caregivers for future work. Conclusions: While mHealth initiatives to advance post-operative management offer the ability to improve patient engagement, work is needed to ensure the patient voice is reflected. Active engagement with patients and caregivers in the development of new technology, the design of new workflows, and the conduct of research and evaluation ensures that the patient experiences and values are incorporated.\n

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\n \n\n \n \n Samareh, A.; Chang, X.; Lober, W. B.; Evans, H. L.; Wang, Z.; Qian, X.; and Huang, S.\n\n\n \n \n \n \n Artificial Intelligence Methods for Surgical Site Infection: Impacts on Detection, Monitoring, and Decision Making.\n \n \n \n\n\n \n\n\n\n Surgical Infections, 20(7): 546–554. October 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{samareh_artificial_2019,\n\ttitle = {Artificial {Intelligence} {Methods} for {Surgical} {Site} {Infection}: {Impacts} on {Detection}, {Monitoring}, and {Decision} {Making}},\n\tvolume = {20},\n\tissn = {1557-8674},\n\tshorttitle = {Artificial {Intelligence} {Methods} for {Surgical} {Site} {Infection}},\n\tdoi = {10.1089/sur.2019.150},\n\tabstract = {Background:\n                     There has been tremendous growth in the amount of new surgical site infection (SSI) data generated. Key challenges exist in understanding the data for robust clinical decision-support. Limitations of traditional methodologies to handle these data led to the emergence of artificial intelligence (AI). This article emphasizes the capabilities of AI to identify patterns of SSI data. \n                        Method:\n                     Artificial intelligence comprises various subfields that present potential solutions to identify patterns of SSI data. Discussions on opportunities, challenges, and limitations of applying these methods to derive accurate SSI prediction are provided. \n                        Results:\n                     Four main challenges in dealing with SSI data were defined: (1) complexities in using SSI data, (2) disease knowledge, (3) decision support, and (4) heterogeneity. The implications of some of the recent advances in AI methods to optimize clinical effectiveness were discussed. \n                        Conclusions:\n                     Artificial intelligence has the potential to provide insight in detecting and decision-support of SSI. As we turn SSI data into intelligence about the disease, we increase the possibility of improving surgical practice with the promise of a future optimized for the highest quality patient care.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Surgical Infections},\n\tauthor = {Samareh, Aven and Chang, Xiangyu and Lober, William B. and Evans, Heather L. and Wang, Zhangyang and Qian, Xiaoning and Huang, Shuai},\n\tmonth = oct,\n\tyear = {2019},\n\tpmid = {31453753},\n\tkeywords = {Artificial Intelligence, Decision Making, Disease Management, Epidemiological Monitoring, Humans, Image Processing, Computer-Assisted, Surgical Wound Infection, artificial intelligence, decision support, deep learning, natural language processing, surgical site infection},\n\tpages = {546--554},\n}\n\n

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\n \n 2018\n \n \n (8)\n \n \n

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\n \n\n \n \n Sullivan, M.; Langford, D. J.; Davies, P. S.; Tran, C.; Vilardaga, R.; Cheung, G.; Yoo, D.; McReynolds, J.; Lober, W. B.; Tauben, D.; and Vowles, K. E.\n\n\n \n \n \n \n A Controlled Pilot Trial of PainTracker Self-Manager, a Web-Based Platform Combined With Patient Coaching, to Support Patients' Self-Management of Chronic Pain.\n \n \n \n\n\n \n\n\n\n The Journal of Pain: Official Journal of the American Pain Society, 19(9): 996–1005. 2018.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{sullivan_controlled_2018,\n\ttitle = {A {Controlled} {Pilot} {Trial} of {PainTracker} {Self}-{Manager}, a {Web}-{Based} {Platform} {Combined} {With} {Patient} {Coaching}, to {Support} {Patients}' {Self}-{Management} of {Chronic} {Pain}},\n\tvolume = {19},\n\tissn = {1528-8447},\n\tdoi = {10.1016/j.jpain.2018.03.009},\n\tabstract = {The objective of this study was to develop and pilot test a chronic pain empowerment and self-management platform, derived from acceptance and commitment therapy, in a pain specialty setting. A controlled, sequential, nonrandomized study design was used to accommodate intervention development and to test the efficacy of the PainTracker Self-Manager (PTSM) intervention (Web-based educational modules and outcome tracking combined with tailored patient coaching sessions and provider guidance). Generalized estimating equations evaluated changes over time (baseline, 3 months, 6 months) in pain self-efficacy (primary outcome), chronic pain acceptance (activity engagement and pain willingness), perceived efficacy in patient-provider interactions, pain intensity and interference, and overall satisfaction with pain treatment (secondary outcomes) between intervention (n = 48) and usual care control groups (n = 51). The full study sample (N = 99) showed greater improvements over time (significant Group × Time interactions) in pain self-efficacy and satisfaction with pain treatment. Among study completers (n = 82), greater improvement in activity engagement as well as pain intensity and interference were also observed. These preliminary findings support the efficacy of the PTSM intervention in a pain specialty setting. Further research is needed to refine and expand the PTSM intervention and to test it in a randomized trial in primary care settings.\nPERSPECTIVE: We developed a Web-based patient empowerment platform that combined acceptance and commitment therapy-based educational modules and tailored coaching sessions with longitudinal tracking of treatments and patient-reported outcomes, named PTSM. Pilot controlled trial results provide preliminary support for its efficacy in improving pain self-efficacy, activity engagement, pain intensity and interference, and satisfaction with pain treatment.},\n\tlanguage = {eng},\n\tnumber = {9},\n\tjournal = {The Journal of Pain: Official Journal of the American Pain Society},\n\tauthor = {Sullivan, Mark and Langford, Dale J. and Davies, Pamela Stitzlein and Tran, Christine and Vilardaga, Roger and Cheung, Gifford and Yoo, Daisy and McReynolds, Justin and Lober, William B. and Tauben, David and Vowles, Kevin E.},\n\tyear = {2018},\n\tpmid = {29605691},\n\tpmcid = {PMC6119625},\n\tkeywords = {Acceptance and Commitment Therapy, Acceptance and commitment therapy, Adolescent, Adult, Aged, CIRG Selected, Chronic Pain, Female, Humans, Internet, Male, Middle Aged, Pain Management, Patient Education as Topic, Patient Reported Outcome Measures, Pilot Projects, Self-Management, Young Adult, health coaching, patient empowerment, patient-reported outcomes},\n\tpages = {996--1005},\n}\n\n

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\n \n\n \n \n Iribarren, S.; Demiris, G.; Lober, B.; and Chirico, C.\n\n\n \n \n \n \n \n What Do Patients and Experts Want in a Smartphone-Based Application to Support Tuberculosis Treatment Completion?.\n \n \n \n \n\n\n \n\n\n\n Studies in Health Technology and Informatics, 250: 32. 2018.\n \n\n\n\n
\n\n\n\n \n \n $\"What$ Paper\n \n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{iribarren_what_2018,\n\ttitle = {What {Do} {Patients} and {Experts} {Want} in a {Smartphone}-{Based} {Application} to {Support} {Tuberculosis} {Treatment} {Completion}?},\n\tvolume = {250},\n\tissn = {1879-8365},\n\turl = {http://www.ncbi.nlm.nih.gov/pubmed/29857363},\n\tabstract = {A mobile application to support individuals receiving treatment for active tuberculosis (TB) by self-administration is being developed with TB experts and patients in active TB treatment using agile development methods to meet the needs of endusers.},\n\tlanguage = {eng},\n\tjournal = {Studies in Health Technology and Informatics},\n\tauthor = {Iribarren, Sarah and Demiris, George and Lober, Bill and Chirico, Cristina},\n\tyear = {2018},\n\tpmid = {29857363},\n\tkeywords = {CIRG\\_Selected, Humans, Mobile Applications, Self Administration, Smartphone, Tuberculosis, global health, mHealth, patient-centered support},\n\tpages = {32},\n}\n\n

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\n \n\n \n \n Steiner, J. M.; Kirkpatrick, J. N.; Heckbert, S. R.; Habib, A.; Sibley, J.; Lober, W.; and Randall Curtis, J.\n\n\n \n \n \n \n Identification of adults with congenital heart disease of moderate or great complexity from administrative data.\n \n \n \n\n\n \n\n\n\n Congenital Heart Disease, 13(1): 65–71. January 2018.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{steiner_identification_2018,\n\ttitle = {Identification of adults with congenital heart disease of moderate or great complexity from administrative data},\n\tvolume = {13},\n\tissn = {1747-0803},\n\tdoi = {10.1111/chd.12524},\n\tabstract = {INTRODUCTION: There is relatively sparse literature on the use of administrative datasets for research in patients with adult congenital heart disease (ACHD). The goal of this analysis is to examine the accuracy of administrative data for identifying patients with ACHD who died.\nMETHODS: A list of the International Classification of Diseases codes representing ACHD of moderate- or great-complexity was created. A search for these codes in the electronic health record of adults who received care in 2010-2016 was performed, and used state death records to identify patients who died during this period. Manual record review was completed to evaluate performance of this search strategy. Identified patients were also compared with a list of patients with moderate- or great-complexity ACHD known to have died.\nRESULTS: About 134 patients were identified, of which 72 had moderate- or great-complexity ACHD confirmed by manual review, yielding a positive predictive value of 0.54 (95\\% CI 0.45, 0.62). Twenty six patients had a mild ACHD diagnosis. Thirty six patients had no identified ACHD on record review. Misidentifications were attributed to coding error for 19 patients (53\\%), and to acquired ventricular septal defects for 11 patients (31\\%). Diagnostic codes incorrect more than 50\\% of the time were those for congenitally corrected transposition, endocardial cushion defect, and hypoplastic left heart syndrome. Only 1 of 21 patients known to have died was not identified by the search, yielding a sensitivity of 0.95 (0.76, 0.99).\nCONCLUSION: Use of administrative data to identify patients with ACHD of moderate or great complexity who have died had good sensitivity but suboptimal positive predictive value. Strategies to improve accuracy are needed. Administrative data is not ideal for identification of patients in this group, and manual record review is necessary to confirm these diagnoses.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Congenital Heart Disease},\n\tauthor = {Steiner, Jill M. and Kirkpatrick, James N. and Heckbert, Susan R. and Habib, Asma and Sibley, James and Lober, William and Randall Curtis, J.},\n\tmonth = jan,\n\tyear = {2018},\n\tpmid = {28736836},\n\tpmcid = {PMC5783801},\n\tkeywords = {Adult, Algorithms, Death Certificates, Electronic Health Records, Female, Heart Defects, Congenital, Humans, Male, Middle Aged, Practice Guidelines as Topic, Reproducibility of Results, Retrospective Studies, Severity of Illness Index, accuracy, administrative data, congenital heart disease, electronic health record},\n\tpages = {65--71},\n}\n\n

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\n \n\n \n \n Hicks, K.; Downey, L.; Engelberg, R. A.; Fausto, J. A.; Starks, H.; Dunlap, B.; Sibley, J.; Lober, W.; Khandelwal, N.; Loggers, E. T.; and Curtis, J. R.\n\n\n \n \n \n \n Predictors of Death in the Hospital for Patients with Chronic Serious Illness.\n \n \n \n\n\n \n\n\n\n Journal of Palliative Medicine, 21(3): 307–314. 2018.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{hicks_predictors_2018,\n\ttitle = {Predictors of {Death} in the {Hospital} for {Patients} with {Chronic} {Serious} {Illness}},\n\tvolume = {21},\n\tissn = {1557-7740},\n\tdoi = {10.1089/jpm.2017.0127},\n\tabstract = {BACKGROUND: Most people prefer to die at home, yet most do not. Understanding factors associated with terminal hospitalization may inform interventions to improve care.\nOBJECTIVE: Among patients with chronic illness receiving care in a multihospital healthcare system, we identified the following: (1) predictors of death in any hospital; (2) predictors of death in a hospital outside the system; and (3) trends from 2010 to 2015.\nDESIGN: Retrospective cohort using death certificates and electronic health records. Settings/Subjects: Decedents with one of nine chronic illnesses.\nRESULTS: Among 20,486 decedents, those most likely to die in a hospital were younger (odds ratio [OR] 0.977, confidence interval [CI] 0.974-0.980), with more comorbidities (OR 1.188, CI 1.079-1.308), or more outpatient providers (OR 1.031, CI 1.015-1.047); those with cancer or dementia, or more outpatient visits were less likely to die in hospital. Among hospital deaths, patients more likely to die in an outside hospital had lower education (OR 0.952, CI 0.923-0.981), cancer (OR 1.388, CI 1.198-1.608), diabetes (OR 1.507, CI 1.262-1.799), fewer comorbidities (OR 0.745, CI 0.644-0.862), or fewer hospitalizations within the system during the prior year (OR 0.900, CI 0.864-0.938). Deaths in hospital did not change from 2010 to 2015, but the proportion of hospital deaths outside the system increased (p {\\textless} 0.022).\nCONCLUSIONS: Patients dying in the hospital who are more likely to die in an outside hospital, and therefore at greater risk for inaccessibility of advance care planning, were more likely to be less well-educated and have cancer or diabetes, fewer comorbidities, and fewer hospitalizations. These findings may help target interventions to improve end-of-life care.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Journal of Palliative Medicine},\n\tauthor = {Hicks, Katy and Downey, Lois and Engelberg, Ruth A. and Fausto, James A. and Starks, Helene and Dunlap, Ben and Sibley, James and Lober, William and Khandelwal, Nita and Loggers, Elizabeth T. and Curtis, J. Randall},\n\tyear = {2018},\n\tpmid = {28926294},\n\tkeywords = {Aged, Chronic Disease, Death Certificates, Demography, Electronic Health Records, Female, Hospital Mortality, Humans, Male, Middle Aged, Retrospective Studies, Washington, end-of-life care, health services research, hospital utilization, palliative care},\n\tpages = {307--314},\n}\n\n

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\n \n\n \n \n Curtis, J. R.; Sathitratanacheewin, S.; Starks, H.; Lee, R. Y.; Kross, E. K.; Downey, L.; Sibley, J.; Lober, W.; Loggers, E. T.; Fausto, J. A.; Lindvall, C.; and Engelberg, R. A.\n\n\n \n \n \n \n Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges.\n \n \n \n\n\n \n\n\n\n Journal of Palliative Medicine, 21(S2): S52–S60. 2018.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{curtis_using_2018,\n\ttitle = {Using {Electronic} {Health} {Records} for {Quality} {Measurement} and {Accountability} in {Care} of the {Seriously} {Ill}: {Opportunities} and {Challenges}},\n\tvolume = {21},\n\tissn = {1557-7740},\n\tshorttitle = {Using {Electronic} {Health} {Records} for {Quality} {Measurement} and {Accountability} in {Care} of the {Seriously} {Ill}},\n\tdoi = {10.1089/jpm.2017.0542},\n\tabstract = {BACKGROUND: As our population ages and the burden of chronic illness rises, there is increasing need to implement quality metrics that measure and benchmark care of the seriously ill, including the delivery of both primary care and specialty palliative care. Such metrics can be used to drive quality improvement, value-based payment, and accountability for population-based outcomes.\nMETHODS: In this article, we examine use of the electronic health record (EHR) as a tool to assess quality of serious illness care through narrative review and description of a palliative care quality metrics program in a large healthcare system.\nRESULTS: In the search for feasible, reliable, and valid palliative care quality metrics, the EHR is an attractive option for collecting quality data on large numbers of seriously ill patients. However, important challenges to using EHR data for quality improvement and accountability exist, including understanding the validity, reliability, and completeness of the data, as well as acknowledging the difference between care documented and care delivered. Challenges also include developing achievable metrics that are clearly linked to patient and family outcomes and addressing data interoperability across sites as well as EHR platforms and vendors. This article summarizes the strengths and weakness of the EHR as a data source for accountability of community- and population-based programs for serious illness, describes the implementation of EHR data in the palliative care quality metrics program at the University of Washington, and, based on that experience, discusses opportunities and challenges. Our palliative care metrics program was designed to serve as a resource for other healthcare systems.\nDISCUSSION: Although the EHR offers great promise for enhancing quality of care provided for the seriously ill, significant challenges remain to operationalizing this promise on a national scale and using EHR data for population-based quality and accountability.},\n\tlanguage = {eng},\n\tnumber = {S2},\n\tjournal = {Journal of Palliative Medicine},\n\tauthor = {Curtis, J. Randall and Sathitratanacheewin, Seelwan and Starks, Helene and Lee, Robert Y. and Kross, Erin K. and Downey, Lois and Sibley, James and Lober, William and Loggers, Elizabeth T. and Fausto, James A. and Lindvall, Charlotta and Engelberg, Ruth A.},\n\tyear = {2018},\n\tpmid = {29182487},\n\tpmcid = {PMC5756465},\n\tkeywords = {accountability in care, electronic health records, palliative care, quality metrics, seriously ill patient population},\n\tpages = {S52--S60},\n}\n\n

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\n BACKGROUND: As our population ages and the burden of chronic illness rises, there is increasing need to implement quality metrics that measure and benchmark care of the seriously ill, including the delivery of both primary care and specialty palliative care. Such metrics can be used to drive quality improvement, value-based payment, and accountability for population-based outcomes. METHODS: In this article, we examine use of the electronic health record (EHR) as a tool to assess quality of serious illness care through narrative review and description of a palliative care quality metrics program in a large healthcare system. RESULTS: In the search for feasible, reliable, and valid palliative care quality metrics, the EHR is an attractive option for collecting quality data on large numbers of seriously ill patients. However, important challenges to using EHR data for quality improvement and accountability exist, including understanding the validity, reliability, and completeness of the data, as well as acknowledging the difference between care documented and care delivered. Challenges also include developing achievable metrics that are clearly linked to patient and family outcomes and addressing data interoperability across sites as well as EHR platforms and vendors. This article summarizes the strengths and weakness of the EHR as a data source for accountability of community- and population-based programs for serious illness, describes the implementation of EHR data in the palliative care quality metrics program at the University of Washington, and, based on that experience, discusses opportunities and challenges. Our palliative care metrics program was designed to serve as a resource for other healthcare systems. DISCUSSION: Although the EHR offers great promise for enhancing quality of care provided for the seriously ill, significant challenges remain to operationalizing this promise on a national scale and using EHR data for population-based quality and accountability.\n

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\n \n\n \n \n Brown, C. E.; Engelberg, R. A.; Sharma, R.; Downey, L.; Fausto, J. A.; Sibley, J.; Lober, W.; Khandelwal, N.; Loggers, E. T.; and Curtis, J. R.\n\n\n \n \n \n \n Race/Ethnicity, Socioeconomic Status, and Healthcare Intensity at the End of Life.\n \n \n \n\n\n \n\n\n\n Journal of Palliative Medicine, 21(9): 1308–1316. 2018.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{brown_raceethnicity_2018,\n\ttitle = {Race/{Ethnicity}, {Socioeconomic} {Status}, and {Healthcare} {Intensity} at the {End} of {Life}},\n\tvolume = {21},\n\tissn = {1557-7740},\n\tdoi = {10.1089/jpm.2018.0011},\n\tabstract = {BACKGROUND: Although racial/ethnic minorities receive more intense, nonbeneficial healthcare at the end of life, the role of race/ethnicity independent of other social determinants of health is not well understood.\nOBJECTIVES: Examine the association between race/ethnicity, other key social determinants of health, and healthcare intensity in the last 30 days of life for those with chronic, life-limiting illness.\nSUBJECTS: We identified 22,068 decedents with chronic illness cared for at a single healthcare system in Washington State who died between 2010 and 2015 and linked electronic health records to death certificate data.\nDESIGN: Binomial regression models were used to test associations of healthcare intensity with race/ethnicity, insurance status, education, and median income by zip code. Path analyses tested direct and indirect effects of race/ethnicity with insurance, education, and median income by zip code used as mediators.\nMEASUREMENTS: We examined three measures of healthcare intensity: (1) intensive care unit admission, (2) use of mechanical ventilation, and (3) receipt of cardiopulmonary resuscitation.\nRESULTS: Minority race/ethnicity, lower income and educational attainment, and Medicaid and military insurance were associated with higher intensity care. Socioeconomic disadvantage accounted for some of the higher intensity in racial/ethnic minorities, but most of the effects were direct effects of race/ethnicity.\nCONCLUSIONS: The effects of minority race/ethnicity on healthcare intensity at the end of life are only partly mediated by other social determinants of health. Future interventions should address the factors driving both direct and indirect effects of race/ethnicity on healthcare intensity.},\n\tlanguage = {eng},\n\tnumber = {9},\n\tjournal = {Journal of Palliative Medicine},\n\tauthor = {Brown, Crystal E. and Engelberg, Ruth A. and Sharma, Rashmi and Downey, Lois and Fausto, James A. and Sibley, James and Lober, William and Khandelwal, Nita and Loggers, Elizabeth T. and Curtis, J. Randall},\n\tyear = {2018},\n\tpmid = {29893618},\n\tpmcid = {PMC6154447},\n\tkeywords = {end of life, healthcare disparities, race/ethnicity, social determinants, socioeconomic status},\n\tpages = {1308--1316},\n}\n\n

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\n \n\n \n \n Sathitratanacheewin, S.; Engelberg, R. A.; Downey, L.; Lee, R. Y.; Fausto, J. A.; Starks, H.; Dunlap, B.; Sibley, J.; Lober, W.; Loggers, E. T.; Khandelwal, N.; and Curtis, J. R.\n\n\n \n \n \n \n Temporal Trends Between 2010 and 2015 in Intensity of Care at End-of-Life for Patients With Chronic Illness: Influence of Age Under vs. Over 65 Years.\n \n \n \n\n\n \n\n\n\n Journal of Pain and Symptom Management, 55(1): 75–81. 2018.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{sathitratanacheewin_temporal_2018,\n\ttitle = {Temporal {Trends} {Between} 2010 and 2015 in {Intensity} of {Care} at {End}-of-{Life} for {Patients} {With} {Chronic} {Illness}: {Influence} of {Age} {Under} vs. {Over} 65 {Years}},\n\tvolume = {55},\n\tissn = {1873-6513},\n\tshorttitle = {Temporal {Trends} {Between} 2010 and 2015 in {Intensity} of {Care} at {End}-of-{Life} for {Patients} {With} {Chronic} {Illness}},\n\tdoi = {10.1016/j.jpainsymman.2017.08.032},\n\tabstract = {CONTEXT: Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age.\nOBJECTIVES: To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utilization, for age-stratified decedents with chronic, life-limiting diagnoses ({\\textless}65 vs. ≥65 years) who received care in a large healthcare system.\nMETHODS: Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression.\nRESULTS: The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b = -0.026; CI = -0.041, -0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients aged 65 years or older (overall b = -0.023; CI = -0.039, -0.007), but was not significant for younger decedents. Length of stay (LOS) did not decrease for those using the hospital or ICU.\nCONCLUSION: From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65 years. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU LOS in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or LOS for palliative care interventions.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Journal of Pain and Symptom Management},\n\tauthor = {Sathitratanacheewin, Seelwan and Engelberg, Ruth A. and Downey, Lois and Lee, Robert Y. and Fausto, James A. and Starks, Helene and Dunlap, Ben and Sibley, James and Lober, William and Loggers, Elizabeth T. and Khandelwal, Nita and Curtis, J. Randall},\n\tyear = {2018},\n\tpmid = {28887270},\n\tpmcid = {PMC5734983},\n\tkeywords = {Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Chronic Disease, Critical Care, Female, Hospitalization, Humans, Male, Medicare, Middle Aged, Palliative care, Regression Analysis, Retrospective Studies, Terminal Care, Time Factors, United States, Young Adult, chronic conditions, end-of-life care, intensity of care, temporal trends},\n\tpages = {75--81},\n}\n\n

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\n \n\n \n \n Fredericksen, R. J.; Mayer, K. H.; Gibbons, L. E.; Edwards, T. C.; Yang, F. M.; Walcott, M.; Brown, S.; Dant, L.; Loo, S.; Gutierrez, C.; Paez, E.; Fitzsimmons, E.; Wu, A. W.; Mugavero, M. J.; Mathews, W. C.; Lober, W. B.; Kitahata, M. M.; Patrick, D. L.; Crane, P. K.; and Crane, H. M.\n\n\n \n \n \n \n Development and Content Validation of a Patient-Reported Sexual Risk Measure for Use in Primary Care.\n \n \n \n\n\n \n\n\n\n Journal of General Internal Medicine, 33(10): 1661–1668. 2018.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{fredericksen_development_2018,\n\ttitle = {Development and {Content} {Validation} of a {Patient}-{Reported} {Sexual} {Risk} {Measure} for {Use} in {Primary} {Care}},\n\tvolume = {33},\n\tissn = {1525-1497},\n\tdoi = {10.1007/s11606-018-4496-5},\n\tabstract = {BACKGROUND: Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools.\nOBJECTIVE: To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure.\nDESIGN: Qualitative item development/quantitative instrument validation.\nPARTICIPANTS: We developed SRBI items based on patient interviews (n = 128) at four geographically diverse US primary care clinics. Patients were diverse in gender identity, sex, sexual orientation, age, race/ethnicity, and HIV status. We compared sexual risk behavior identified by the SRBI and the Risk Assessment Battery (RAB) among patients (n = 422).\nAPPROACH: We constructed an item pool based on validated measures of sexual risk, developed an in-depth interview guide based on pool content, and used interviews to elicit new sexual risk concepts. We coded concepts, matched them to item pool content, and developed new content where needed. A provider team evaluated item clinical relevance. We conducted cognitive interviews to assess item comprehensibility. We administered the SRBI and the RAB to patients.\nKEY RESULTS: Common, clinically relevant concepts in the SRBI included number of sex partners; partner HIV status; partner use of antiretroviral medication (ART)/pre-exposure prophylaxis (PrEP); and recent sex without barrier protection, direction of anal sex, and concern regarding HIV/STI exposure. While 90\\% reported inconsistent condom use on the RAB, same-day SRBI administration revealed that for over one third, all their partners were on ART/PrEP.\nCONCLUSION: The SRBI is a brief, skip-patterned, clinically relevant measure that ascertains sexual risk behavior across sex, sexual orientation, gender identity, partner HIV serostatus, and partner treatment status, furnishing providers with context to determine gradations of risk for HIV/STI.},\n\tlanguage = {eng},\n\tnumber = {10},\n\tjournal = {Journal of General Internal Medicine},\n\tauthor = {Fredericksen, Rob J. and Mayer, Kenneth H. and Gibbons, Laura E. and Edwards, Todd C. and Yang, Frances M. and Walcott, Melonie and Brown, Sharon and Dant, Lydia and Loo, Stephanie and Gutierrez, Cristina and Paez, Edgar and Fitzsimmons, Emma and Wu, Albert W. and Mugavero, Michael J. and Mathews, William C. and Lober, William B. and Kitahata, Mari M. and Patrick, Donald L. and Crane, Paul K. and Crane, Heidi M.},\n\tyear = {2018},\n\tpmid = {29845470},\n\tpmcid = {PMC6153230},\n\tkeywords = {Adult, Antiretroviral Therapy, Highly Active, Diagnosis, Computer-Assisted, Female, Gender Identity, HIV Infections, Humans, Interviews as Topic, Male, Middle Aged, Patient Reported Outcome Measures, Primary Health Care, Risk Assessment, Risk-Taking, Sexual Behavior, Sexual Partners, Terminology as Topic, United States, Unsafe Sex, patient-reported outcomes, sexual risk behavior measurement},\n\tpages = {1661--1668},\n}\n\n

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\n \n\n \n \n Evans, H. L.; and Lober, W. B.\n\n\n \n \n \n \n A Pilot Use of Patient-Generated Wound Data to Improve Postdischarge Surgical Site Infection Monitoring.\n \n \n \n\n\n \n\n\n\n JAMA surgery, 152(6): 595–596. 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n\n \n \n \n 2 downloads\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{evans_pilot_2017,\n\ttitle = {A {Pilot} {Use} of {Patient}-{Generated} {Wound} {Data} to {Improve} {Postdischarge} {Surgical} {Site} {Infection} {Monitoring}},\n\tvolume = {152},\n\tissn = {2168-6262},\n\tdoi = {10.1001/jamasurg.2017.0568},\n\tlanguage = {eng},\n\tnumber = {6},\n\tjournal = {JAMA surgery},\n\tauthor = {Evans, Heather L. and Lober, William B.},\n\tyear = {2017},\n\tpmid = {28423162},\n\tkeywords = {CIRG Selected, Humans, Incidence, Patient Compliance, Patient Discharge, Patient Reported Outcome Measures, Pilot Projects, Surgical Wound Infection, United States},\n\tpages = {595--596},\n}\n\n

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\n \n\n \n \n Mikles, S. P.; Wiltz, J. L.; Reed-Fourquet, L.; Painter, I. S.; and Lober, W. B.\n\n\n \n \n \n \n Utilizing Standard Data Transactions and Public-Private Partnerships to Support Healthy Weight Within the Community.\n \n \n \n\n\n \n\n\n\n EGEMS (Washington, DC), 5(1): 21. December 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n\n\n\n

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@article{mikles_utilizing_2017,\n\ttitle = {Utilizing {Standard} {Data} {Transactions} and {Public}-{Private} {Partnerships} to {Support} {Healthy} {Weight} {Within} the {Community}},\n\tvolume = {5},\n\tissn = {2327-9214},\n\tdoi = {10.5334/egems.242},\n\tabstract = {Context: Obesity is a significant health issue in the United States that both clinical and public health systems struggle to address. Electronic health record data could help support multi-sectoral interventions to address obesity. Standards have been identified and created to support the electronic exchange of weight-related data across many stakeholder groups.\nCase Description: The Centers for Disease Control and Prevention initiated a public-private partnership including government, industry, and academic technology partners to develop workflow scenarios and supporting systems to exchange weight-related data through standard transactions. This partnership tested the transmission of data using this newly-defined Healthy Weight (HW) profile at multiple health data interoperability demonstration events.\nFindings: Five transaction types were tested by 12 partners who demonstrated how the standards and related systems support end-to-end workflows around managing weight-related issues in the community. The standard transactions were successfully tested at two Integrating the Healthcare Enterprise (IHE) Connectathon events through 86 validated tests encompassing 38 multi-partner transactions.\nDiscussion: We have successfully demonstrated the transactions defined in the HW profile with a public-private partnership. These tested IT products and HW standards could be used to support a continuum of care around health related issues encompassing both health care and public health functions.\nConclusion: The use of the HW profile, including a set of transactions and identified standards to implement those transactions, in IT products is a helpful first step in leveraging health information technology to address weight-related issues in the United States. Future work is needed to expand the use of these standards and to assess their use in real world settings.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {EGEMS (Washington, DC)},\n\tauthor = {Mikles, Sean P. and Wiltz, Jennifer L. and Reed-Fourquet, Lori and Painter, Ian S. and Lober, William B.},\n\tmonth = dec,\n\tyear = {2017},\n\tpmid = {29930962},\n\tpmcid = {PMC5994932},\n\tkeywords = {CIRG\\_Selected},\n\tpages = {21},\n}\n\n

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\n \n\n \n \n Kang'a, S.; Puttkammer, N.; Wanyee, S.; Kimanga, D.; Madrano, J.; Muthee, V.; Odawo, P.; Sharma, A.; Oluoch, T.; Robinson, K.; Kwach, J.; and Lober, W. B.\n\n\n \n \n \n \n A national standards-based assessment on functionality of electronic medical records systems used in Kenyan public-Sector health facilities.\n \n \n \n\n\n \n\n\n\n International Journal of Medical Informatics, 97: 68–75. January 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{kanga_national_2017,\n\ttitle = {A national standards-based assessment on functionality of electronic medical records systems used in {Kenyan} public-{Sector} health facilities},\n\tvolume = {97},\n\tissn = {1872-8243},\n\tdoi = {10.1016/j.ijmedinf.2016.09.013},\n\tabstract = {BACKGROUND: Variations in the functionality, content and form of electronic medical record systems (EMRs) challenge national roll-out of these systems as part of a national strategy to monitor HIV response. To enforce the EMRs minimum requirements for delivery of quality HIV services, the Kenya Ministry of Health (MoH) developed EMRs standards and guidelines. The standards guided the recommendation of EMRs that met a preset threshold for national roll-out.\nMETHODS: Using a standards-based checklist, six review teams formed by the MoH EMRs Technical Working Group rated a total of 17 unique EMRs in 28 heath facilities selected by individual owners for their optimal EMR implementation. EMRs with an aggregate score of ≥60\\% against checklist criteria were identified by the MoH as suitable for upgrading and rollout to Kenyan public health facilities.\nRESULTS: In Kenya, existing EMRs scored highly in health information and reporting (mean score=71.8\\%), followed by security, system features, core clinical information, and order entry criteria (mean score=58.1\\%-55.9\\%), and lowest against clinical decision support (mean score=17.6\\%) and interoperability criteria (mean score=14.3\\%). Four EMRs met the 60.0\\% threshold: OpenMRS, IQ-Care, C-PAD and Funsoft. On the basis of the review, the MoH provided EMRs upgrade plans to owners of all the 17 systems reviewed.\nCONCLUSION: The standards-based review in Kenya represents an effort to determine level of conformance to the EMRs standards and prioritize EMRs for enhancement and rollout. The results support concentrated use of resources towards development of the four recommended EMRs. Further review should be conducted to determine the effect of the EMR-specific upgrade plans on the other 13 EMRs that participated in the review exercise.},\n\tlanguage = {eng},\n\tjournal = {International Journal of Medical Informatics},\n\tauthor = {Kang'a, Samuel and Puttkammer, Nancy and Wanyee, Steven and Kimanga, Davies and Madrano, Jason and Muthee, Veronica and Odawo, Patrick and Sharma, Anjali and Oluoch, Tom and Robinson, Katherine and Kwach, James and Lober, William B.},\n\tmonth = jan,\n\tyear = {2017},\n\tpmid = {27919397},\n\tkeywords = {CIRG\\_Selected, Checklist, EMRs, Electronic Health Records, Health Facilities, Humans, Kenya, Public Health, Review, Standards},\n\tpages = {68--75},\n}\n\n

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\n \n\n \n \n Engels, E. A.; Yanik, E. L.; Wheeler, W.; Gill, M. J.; Shiels, M. S.; Dubrow, R.; Althoff, K. N.; Silverberg, M. J.; Brooks, J. T.; Kitahata, M. M.; Goedert, J. J.; Grover, S.; Mayor, A. M.; Moore, R. D.; Park, L. S.; Rachlis, A.; Sigel, K.; Sterling, T. R.; Thorne, J. E.; Pfeiffer, R. M.; North American AIDS Cohort Collaboration on Research; of the International Epidemiologic Databases to Evaluate AIDS, D.; North American AIDS Cohort Collaboration on Research; and of the International Epidemiologic Databases to Evaluate AIDS, D.\n\n\n \n \n \n \n Cancer-Attributable Mortality Among People With Treated Human Immunodeficiency Virus Infection in North America.\n \n \n \n\n\n \n\n\n\n Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 65(4): 636–643. August 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{engels_cancer-attributable_2017,\n\ttitle = {Cancer-{Attributable} {Mortality} {Among} {People} {With} {Treated} {Human} {Immunodeficiency} {Virus} {Infection} in {North} {America}},\n\tvolume = {65},\n\tissn = {1537-6591},\n\tdoi = {10.1093/cid/cix392},\n\tabstract = {Background: Cancer remains an important cause of morbidity and mortality in people with human immunodeficiency virus (PWHIV) on effective antiretroviral therapy (ART). Estimates of cancer-attributable mortality can inform public health efforts.\nMethods: We evaluated 46956 PWHIV receiving ART in North American HIV cohorts (1995-2009). Using information on incident cancers and deaths, we calculated population-attributable fractions (PAFs), estimating the proportion of deaths due to cancer. Calculations were based on proportional hazards models adjusted for age, sex, race, HIV risk group, calendar year, cohort, CD4 count, and viral load.\nResults: There were 1997 incident cancers and 8956 deaths during 267145 person-years of follow-up, and 11.9\\% of decedents had a prior cancer. An estimated 9.8\\% of deaths were attributable to cancer (cancer-attributable mortality rate 327 per 100000 person-years). PAFs were 2.6\\% for AIDS-defining cancers (ADCs, including non-Hodgkin lymphoma, 2.0\\% of deaths) and 7.1\\% for non-AIDS-defining cancers (NADCs: lung cancer, 2.3\\%; liver cancer, 0.9\\%). PAFs for NADCs were higher in males and increased strongly with age, reaching 12.5\\% in PWHIV aged 55+ years. Mortality rates attributable to ADCs and NADCs were highest for PWHIV with CD4 counts {\\textless}100 cells/mm3. PAFs for NADCs increased during 1995-2009, reaching 10.1\\% in 2006-2009.\nConclusions: Approximately 10\\% of deaths in PWHIV prescribed ART during 1995-2009 were attributable to cancer, but this fraction increased over time. A large proportion of cancer-attributable deaths were associated with non-Hodgkin lymphoma, lung cancer, and liver cancer. Deaths due to NADCs will likely grow in importance as AIDS mortality declines and PWHIV age.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America},\n\tauthor = {Engels, Eric A. and Yanik, Elizabeth L. and Wheeler, Willian and Gill, M. John and Shiels, Meredith S. and Dubrow, Robert and Althoff, Keri N. and Silverberg, Michael J. and Brooks, John T. and Kitahata, Mari M. and Goedert, James J. and Grover, Surbhi and Mayor, Angel M. and Moore, Richard D. and Park, Lesley S. and Rachlis, Anita and Sigel, Keith and Sterling, Timothy R. and Thorne, Jennifer E. and Pfeiffer, Ruth M. and {North American AIDS Cohort Collaboration on Research and\n                    Design of the International Epidemiologic Databases to Evaluate AIDS} and {North American AIDS Cohort Collaboration on Research and Design\n                    of the International Epidemiologic Databases to Evaluate AIDS}},\n\tmonth = aug,\n\tyear = {2017},\n\tpmid = {29017269},\n\tpmcid = {PMC5849088},\n\tkeywords = {AIDS, Adolescent, Adult, CD4 Lymphocyte Count, Female, HIV, HIV Infections, Humans, Male, Middle Aged, Neoplasms, North America, Proportional Hazards Models, Retrospective Studies, Viral Load, Young Adult, aging, cancer, mortality},\n\tpages = {636--643},\n}\n\n

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\n \n\n \n \n Crane, H. M.; Paramsothy, P.; Drozd, D. R.; Nance, R. M.; Delaney, J. A. C.; Heckbert, S. R.; Budoff, M. J.; Burkholder, G. A.; Willig, J. H.; Mugavero, M. J.; Mathews, W. C.; Crane, P. K.; Moore, R. D.; Eron, J. J.; Napravnik, S.; Hunt, P. W.; Geng, E.; Hsue, P.; Rodriguez, C.; Peter, I.; Barnes, G. S.; McReynolds, J.; Lober, W. B.; Crothers, K.; Feinstein, M. J.; Grunfeld, C.; Saag, M. S.; Kitahata, M. M.; and Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) Cohort\n\n\n \n \n \n \n Types of Myocardial Infarction Among Human Immunodeficiency Virus-Infected Individuals in the United States.\n \n \n \n\n\n \n\n\n\n JAMA cardiology, 2(3): 260–267. 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{crane_types_2017,\n\ttitle = {Types of {Myocardial} {Infarction} {Among} {Human} {Immunodeficiency} {Virus}-{Infected} {Individuals} in the {United} {States}},\n\tvolume = {2},\n\tissn = {2380-6591},\n\tdoi = {10.1001/jamacardio.2016.5139},\n\tabstract = {Importance: The Second Universal Definition of Myocardial Infarction (MI) divides MIs into different types. Type 1 MIs result spontaneously from instability of atherosclerotic plaque, whereas type 2 MIs occur in the setting of a mismatch between oxygen demand and supply, as with severe hypotension. Type 2 MIs are uncommon in the general population, but their frequency in human immunodeficiency virus (HIV)-infected individuals is unknown.\nObjectives: To characterize MIs, including type; identify causes of type 2 MIs; and compare demographic and clinical characteristics among HIV-infected individuals with type 1 vs type 2 MIs.\nDesign, Setting, and Participants: This longitudinal study identified potential MIs among patients with HIV receiving clinical care at 6 US sites from January 1, 1996, to March 1, 2014, using diagnoses and cardiac biomarkers recorded in the centralized data repository. Sites assembled deidentified packets, including physician notes and electrocardiograms, procedures, and clinical laboratory tests. Two physician experts adjudicated each event, categorizing each definite or probable MI as type 1 or type 2 and identifying the causes of type 2 MI.\nMain Outcomes and Measures: The number and proportion of type 1 vs type 2 MIs, demographic and clinical characteristics among those with type 1 vs type 2 MIs, and the causes of type 2 MIs.\nResults: Among 571 patients (median age, 49 years [interquartile range, 43-55 years]; 430 men and 141 women) with definite or probable MIs, 288 MIs (50.4\\%) were type 2 and 283 (49.6\\%) were type 1. In analyses of type 1 MIs, 79 patients who underwent cardiac interventions, such as coronary artery bypass graft surgery, were also included, totaling 362 patients. Sepsis or bacteremia (100 [34.7\\%]) and recent use of cocaine or other illicit drugs (39 [13.5\\%]) were the most common causes of type 2 MIs. A higher proportion of patients with type 2 MIs were younger than 40 years (47 of 288 [16.3\\%] vs 32 of 362 [8.8\\%]) and had lower current CD4 cell counts (median, 230 vs 383 cells/µL), lipid levels (mean [SD] total cholesterol level, 167 [63] vs 190 [54] mg/dL, and mean (SD) Framingham risk scores (8\\% [7\\%] vs 10\\% [8\\%]) than those with type 1 MIs or who underwent cardiac interventions.\nConclusions and Relevance: Approximately half of all MIs among HIV-infected individuals were type 2 MIs caused by heterogeneous clinical conditions, including sepsis or bacteremia and recent use of cocaine or other illicit drugs. Demographic characteristics and cardiovascular risk factors among those with type 1 and type 2 MIs differed, suggesting the need to specifically consider type among HIV-infected individuals to further understand MI outcomes and to guide prevention and treatment.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {JAMA cardiology},\n\tauthor = {Crane, Heidi M. and Paramsothy, Pathmaja and Drozd, Daniel R. and Nance, Robin M. and Delaney, J. A. Chris and Heckbert, Susan R. and Budoff, Matthew J. and Burkholder, Greer A. and Willig, James H. and Mugavero, Michael J. and Mathews, William C. and Crane, Paul K. and Moore, Richard D. and Eron, Joseph J. and Napravnik, Sonia and Hunt, Peter W. and Geng, Elvin and Hsue, Priscilla and Rodriguez, Carla and Peter, Inga and Barnes, Greg S. and McReynolds, Justin and Lober, William B. and Crothers, Kristina and Feinstein, Matthew J. and Grunfeld, Carl and Saag, Michael S. and Kitahata, Mari M. and {Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) Cohort}},\n\tyear = {2017},\n\tpmid = {28052152},\n\tpmcid = {PMC5538773},\n\tkeywords = {Adult, Coronary Angiography, Electrocardiography, Female, Follow-Up Studies, HIV, HIV Infections, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Retrospective Studies, Risk Assessment, Risk Factors, Survival Rate, Time Factors, United States},\n\tpages = {260--267},\n}\n\n

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\n Importance: The Second Universal Definition of Myocardial Infarction (MI) divides MIs into different types. Type 1 MIs result spontaneously from instability of atherosclerotic plaque, whereas type 2 MIs occur in the setting of a mismatch between oxygen demand and supply, as with severe hypotension. Type 2 MIs are uncommon in the general population, but their frequency in human immunodeficiency virus (HIV)-infected individuals is unknown. Objectives: To characterize MIs, including type; identify causes of type 2 MIs; and compare demographic and clinical characteristics among HIV-infected individuals with type 1 vs type 2 MIs. Design, Setting, and Participants: This longitudinal study identified potential MIs among patients with HIV receiving clinical care at 6 US sites from January 1, 1996, to March 1, 2014, using diagnoses and cardiac biomarkers recorded in the centralized data repository. Sites assembled deidentified packets, including physician notes and electrocardiograms, procedures, and clinical laboratory tests. Two physician experts adjudicated each event, categorizing each definite or probable MI as type 1 or type 2 and identifying the causes of type 2 MI. Main Outcomes and Measures: The number and proportion of type 1 vs type 2 MIs, demographic and clinical characteristics among those with type 1 vs type 2 MIs, and the causes of type 2 MIs. Results: Among 571 patients (median age, 49 years [interquartile range, 43-55 years]; 430 men and 141 women) with definite or probable MIs, 288 MIs (50.4%) were type 2 and 283 (49.6%) were type 1. In analyses of type 1 MIs, 79 patients who underwent cardiac interventions, such as coronary artery bypass graft surgery, were also included, totaling 362 patients. Sepsis or bacteremia (100 [34.7%]) and recent use of cocaine or other illicit drugs (39 [13.5%]) were the most common causes of type 2 MIs. A higher proportion of patients with type 2 MIs were younger than 40 years (47 of 288 [16.3%] vs 32 of 362 [8.8%]) and had lower current CD4 cell counts (median, 230 vs 383 cells/µL), lipid levels (mean [SD] total cholesterol level, 167 [63] vs 190 [54] mg/dL, and mean (SD) Framingham risk scores (8% [7%] vs 10% [8%]) than those with type 1 MIs or who underwent cardiac interventions. Conclusions and Relevance: Approximately half of all MIs among HIV-infected individuals were type 2 MIs caused by heterogeneous clinical conditions, including sepsis or bacteremia and recent use of cocaine or other illicit drugs. Demographic characteristics and cardiovascular risk factors among those with type 1 and type 2 MIs differed, suggesting the need to specifically consider type among HIV-infected individuals to further understand MI outcomes and to guide prevention and treatment.\n

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\n \n\n \n \n Lavin, K.; Davydow, D. S.; Downey, L.; Engelberg, R. A.; Dunlap, B.; Sibley, J.; Lober, W. B.; Okimoto, K.; Khandelwal, N.; Loggers, E. T.; Teno, J. M.; and Curtis, J. R.\n\n\n \n \n \n \n Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness.\n \n \n \n\n\n \n\n\n\n Journal of Pain and Symptom Management, 54(2): 176–185.e1. 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lavin_effect_2017,\n\ttitle = {Effect of {Psychiatric} {Illness} on {Acute} {Care} {Utilization} at {End} of {Life} {From} {Serious} {Medical} {Illness}},\n\tvolume = {54},\n\tissn = {1873-6513},\n\tdoi = {10.1016/j.jpainsymman.2017.04.003},\n\tabstract = {CONTEXT: Little is known about psychiatric illness and utilization of end-of-life care.\nOBJECTIVES: We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation.\nMETHODS: We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases-9 codes. We used International Classification of Diseases-9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation.\nRESULTS: Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P {\\textless} 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations.\nCONCLUSION: Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Journal of Pain and Symptom Management},\n\tauthor = {Lavin, Kyle and Davydow, Dimitry S. and Downey, Lois and Engelberg, Ruth A. and Dunlap, Ben and Sibley, James and Lober, William B. and Okimoto, Kelson and Khandelwal, Nita and Loggers, Elizabeth T. and Teno, Joan M. and Curtis, J. Randall},\n\tyear = {2017},\n\tpmid = {28495487},\n\tkeywords = {Chronic Disease, Cohort Studies, Critical Care, Emergency Medical Services, Female, Hospitalization, Humans, Male, Mental Disorders, Middle Aged, Palliative Care, Palliative care, Regression Analysis, Risk Factors, Severity of Illness Index, Terminal Care, end-of-life care, epidemiology, multimorbidity, psychiatric illness},\n\tpages = {176--185.e1},\n}\n\n

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\n \n\n \n \n Ke, C.; Jin, Y.; Evans, H.; Lober, B.; Qian, X.; Liu, J.; and Huang, S.\n\n\n \n \n \n \n Prognostics of surgical site infections using dynamic health data.\n \n \n \n\n\n \n\n\n\n Journal of Biomedical Informatics, 65: 22–33. 2017.\n \n\n\n\n
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@article{ke_prognostics_2017,\n\ttitle = {Prognostics of surgical site infections using dynamic health data},\n\tvolume = {65},\n\tissn = {1532-0480},\n\tdoi = {10.1016/j.jbi.2016.10.021},\n\tabstract = {Surgical Site Infection (SSI) is a national priority in healthcare research. Much research attention has been attracted to develop better SSI risk prediction models. However, most of the existing SSI risk prediction models are built on static risk factors such as comorbidities and operative factors. In this paper, we investigate the use of the dynamic wound data for SSI risk prediction. There have been emerging mobile health (mHealth) tools that can closely monitor the patients and generate continuous measurements of many wound-related variables and other evolving clinical variables. Since existing prediction models of SSI have quite limited capacity to utilize the evolving clinical data, we develop the corresponding solution to equip these mHealth tools with decision-making capabilities for SSI prediction with a seamless assembly of several machine learning models to tackle the analytic challenges arising from the spatial-temporal data. The basic idea is to exploit the low-rank property of the spatial-temporal data via the bilinear formulation, and further enhance it with automatic missing data imputation by the matrix completion technique. We derive efficient optimization algorithms to implement these models and demonstrate the superior performances of our new predictive model on a real-world dataset of SSI, compared to a range of state-of-the-art methods.},\n\tlanguage = {eng},\n\tjournal = {Journal of Biomedical Informatics},\n\tauthor = {Ke, Chuyang and Jin, Yan and Evans, Heather and Lober, Bill and Qian, Xiaoning and Liu, Ji and Huang, Shuai},\n\tyear = {2017},\n\tpmid = {27825798},\n\tkeywords = {Algorithms, Forecasting, Humans, Machine learning, Prognosis, Risk Factors, Risk prediction, Surgical Site Infections (SSI), Surgical Wound Infection, Telemedicine, mHealth},\n\tpages = {22--33},\n}\n\n

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\n \n\n \n \n Huang, Y.; Meng, Q.; Evans, H.; Lober, W.; Cheng, Y.; Qian, X.; Liu, J.; and Huang, S.\n\n\n \n \n \n \n CHI: A contemporaneous health index for degenerative disease monitoring using longitudinal measurements.\n \n \n \n\n\n \n\n\n\n Journal of Biomedical Informatics, 73: 115–124. 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{huang_chi_2017,\n\ttitle = {{CHI}: {A} contemporaneous health index for degenerative disease monitoring using longitudinal measurements},\n\tvolume = {73},\n\tissn = {1532-0480},\n\tshorttitle = {{CHI}},\n\tdoi = {10.1016/j.jbi.2017.07.003},\n\tabstract = {In this paper, we develop a novel formulation for contemporaneous patient risk monitoring by exploiting the emerging data-rich environment in many healthcare applications, where an abundance of longitudinal data that reflect the degeneration of the health condition can be continuously collected. Our objective, and the developed formulation, is fundamentally different from many existing risk score models for different healthcare applications, which mostly focus on predicting the likelihood of a certain outcome at a pre-specified time. Rather, our formulation translates multivariate longitudinal measurements into a contemporaneous health index (CHI) that captures patient condition changes over the course of progression. Another significant feature of our formulation is that, CHI can be estimated with or without label information, different from other risk score models strictly based on supervised learning. To develop this formulation, we focus on the degenerative disease conditions, for which we could utilize the monotonic progression characteristic (either towards disease or recovery) to learn CHI. Such a domain knowledge leads us to a novel learning formulation, and on top of that, we further generalize this formulation with a capacity to incorporate label information if available. We further develop algorithms to mitigate the challenges associated with the nonsmooth convex optimization problem by first identifying its dual reformulation as a constrained smooth optimization problem, and then, using the block coordinate descent algorithm to iteratively solve the optimization with a derived efficient projection at each iteration. Extensive numerical studies are performed on both synthetic datasets and real-world applications on Alzheimer's disease and Surgical Site Infection, which demonstrate the utility and efficacy of the proposed method on degenerative conditions that include a wide range of applications.},\n\tlanguage = {eng},\n\tjournal = {Journal of Biomedical Informatics},\n\tauthor = {Huang, Yijun and Meng, Qiang and Evans, Heather and Lober, William and Cheng, Yu and Qian, Xiaoning and Liu, Ji and Huang, Shuai},\n\tyear = {2017},\n\tpmid = {28712748},\n\tkeywords = {Algorithms, Alzheimer Disease, Convex optimization, Degenerative disease, Humans, Longitudinal measurements, Machine learning, Risk Assessment, Risk monitoring},\n\tpages = {115--124},\n}\n\n

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\n \n\n \n \n Crane, H. M.; Nance, R. M.; Delaney, J. a. C.; Fredericksen, R. J.; Church, A.; Simoni, J. M.; Harrington, R. D.; Dhanireddy, S.; Safren, S. A.; McCaul, M. E.; Lober, W. B.; Crane, P. K.; Wilson, I. B.; Mugavero, M. J.; and Kitahata, M. M.\n\n\n \n \n \n \n A Comparison of Adherence Timeframes Using Missed Dose Items and Their Associations with Viral Load in Routine Clinical Care: Is Longer Better?.\n \n \n \n\n\n \n\n\n\n AIDS and behavior, 21(2): 470–480. February 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{crane_comparison_2017,\n\ttitle = {A {Comparison} of {Adherence} {Timeframes} {Using} {Missed} {Dose} {Items} and {Their} {Associations} with {Viral} {Load} in {Routine} {Clinical} {Care}: {Is} {Longer} {Better}?},\n\tvolume = {21},\n\tissn = {1573-3254},\n\tshorttitle = {A {Comparison} of {Adherence} {Timeframes} {Using} {Missed} {Dose} {Items} and {Their} {Associations} with {Viral} {Load} in {Routine} {Clinical} {Care}},\n\tdoi = {10.1007/s10461-016-1566-8},\n\tabstract = {Questions remain regarding optimal timeframes for asking about adherence in clinical care. We compared 4-, 7-, 14-, 30-, and 60-day timeframe missed dose items with viral load levels among 1099 patients on antiretroviral therapy in routine care. We conducted logistic and linear regression analyses examining associations between different timeframes and viral load using Bayesian model averaging (BMA). We conducted sensitivity analyses with subgroups at increased risk for suboptimal adherence (e.g. patients with depression, substance use). The 14-day timeframe had the largest mean difference in adherence levels among those with detectable and undetectable viral loads. BMA estimates suggested the 14-day timeframe was strongest overall and for most subgroups although findings differed somewhat for hazardous alcohol users and those with current depression. Adherence measured by all missed dose timeframes correlated with viral load. Adherence calculated from intermediate timeframes (e.g. 14-day) appeared best able to capture adherence behavior as measured by viral load.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {AIDS and behavior},\n\tauthor = {Crane, H. M. and Nance, R. M. and Delaney, J. a. C. and Fredericksen, R. J. and Church, A. and Simoni, J. M. and Harrington, R. D. and Dhanireddy, S. and Safren, S. A. and McCaul, M. E. and Lober, W. B. and Crane, P. K. and Wilson, I. B. and Mugavero, M. J. and Kitahata, M. M.},\n\tmonth = feb,\n\tyear = {2017},\n\tpmid = {27714525},\n\tpmcid = {PMC5290185},\n\tkeywords = {Adherence, Adult, Alcohol-Related Disorders, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Bayes Theorem, Comorbidity, Depression, Depressive Disorder, Female, HIV Infections, Hazardous alcohol use, Humans, Linear Models, Logistic Models, Male, Medication Adherence, Middle Aged, Patient Health Questionnaire, Substance use, Substance-Related Disorders, Surveys and Questionnaires, Time Factors, Viral Load, Viral load},\n\tpages = {470--480},\n}\n\n

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\n \n\n \n \n Crane, H. M.; Crane, P. K.; Tufano, J. T.; Ralston, J. D.; Wilson, I. B.; Brown, T. D.; Davis, T. E.; Smith, L. F.; Lober, W. B.; McReynolds, J.; Dhanireddy, S.; Harrington, R. D.; Rodriguez, C. V.; Nance, R. M.; Delaney, J. A. C.; Safren, S. A.; Kitahata, M. M.; and Fredericksen, R. J.\n\n\n \n \n \n \n HIV Provider Documentation and Actions Following Patient Reports of At-risk Behaviors and Conditions When Identified by a Web-Based Point-of-Care Assessment.\n \n \n \n\n\n \n\n\n\n AIDS and behavior, 21(11): 3111–3121. November 2017.\n \n\n\n\n
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@article{crane_hiv_2017,\n\ttitle = {{HIV} {Provider} {Documentation} and {Actions} {Following} {Patient} {Reports} of {At}-risk {Behaviors} and {Conditions} {When} {Identified} by a {Web}-{Based} {Point}-of-{Care} {Assessment}},\n\tvolume = {21},\n\tissn = {1573-3254},\n\tdoi = {10.1007/s10461-017-1718-5},\n\tabstract = {We compared same-day provider medical record documentation and interventions addressing depression and risk behaviors before and after delivering point-of-care patient-reported outcomes (PROs) feedback for patients who self-reported clinically relevant levels of depression or risk behaviors. During the study period (1 January 2006-15 October 2010), 2289 PRO assessments were completed by HIV-infected patients. Comparing the 8 months before versus after feedback implementation, providers were more likely to document depression (74\\% before vs. 87\\% after feedback, p = 0.02) in patients with moderate-to-severe depression (n = 317 assessments), at-risk alcohol use (41 vs. 64\\%, p = 0.04, n = 155) and substance use (60 vs. 80\\%, p = 0.004, n = 212). Providers were less likely to incorrectly document good adherence among patients with inadequate adherence after feedback (42 vs. 24\\%, p = 0.02, n = 205). While PRO feedback of depression and adherence were followed by increased provider intervention, other domains were not. Further investigation of factors associated with the gap between awareness and intervention are needed in order to bridge this divide.},\n\tlanguage = {eng},\n\tnumber = {11},\n\tjournal = {AIDS and behavior},\n\tauthor = {Crane, Heidi M. and Crane, Paul K. and Tufano, James T. and Ralston, James D. and Wilson, Ira B. and Brown, Tyler D. and Davis, Thomas E. and Smith, Laurie F. and Lober, William B. and McReynolds, Justin and Dhanireddy, Shireesha and Harrington, Robert D. and Rodriguez, Carla V. and Nance, Robin M. and Delaney, Joseph A. C. and Safren, Steven A. and Kitahata, Mari M. and Fredericksen, Rob J.},\n\tmonth = nov,\n\tyear = {2017},\n\tpmid = {28205041},\n\tpmcid = {PMC6021024},\n\tkeywords = {Adherence, Adult, Alcohol Drinking, Alcohol use, Anti-HIV Agents, Data Collection, Depression, Documentation, Female, HIV Infections, Humans, Internet, Male, Medication Adherence, Middle Aged, Patient Reported Outcome Measures, Patient reported outcomes, Point-of-Care Systems, Risk-Taking, Sexual risk behavior, Substance use, Substance-Related Disorders, Treatment Outcome},\n\tpages = {3111--3121},\n}\n\n

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\n \n\n \n \n Sanger, P. C.; Simianu, V. V.; Gaskill, C. E.; Armstrong, C. A. L.; Hartzler, A. L.; Lordon, R. J.; Lober, W. B.; and Evans, H. L.\n\n\n \n \n \n \n Diagnosing Surgical Site Infection Using Wound Photography: A Scenario-Based Study.\n \n \n \n\n\n \n\n\n\n Journal of the American College of Surgeons, 224(1): 8–15.e1. 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{sanger_diagnosing_2017,\n\ttitle = {Diagnosing {Surgical} {Site} {Infection} {Using} {Wound} {Photography}: {A} {Scenario}-{Based} {Study}},\n\tvolume = {224},\n\tissn = {1879-1190},\n\tshorttitle = {Diagnosing {Surgical} {Site} {Infection} {Using} {Wound} {Photography}},\n\tdoi = {10.1016/j.jamcollsurg.2016.10.027},\n\tabstract = {BACKGROUND: Postoperative surgical site infections (SSI) are common and costly. Most occur post discharge, and can result in potentially preventable readmission or unnecessary urgent evaluation. Mobile health approaches incorporating patient-generated wound photos are being implemented in an attempt to optimize triage and management. We assessed how adding wound photos to existing data sources modifies provider decision making.\nSTUDY DESIGN: We used a web-based simulation survey using a convenience sample of providers with expertise in surgical infections. Participants viewed a range of scenarios, including surgical history, physical exam, and description of wound appearance. All participants reported SSI diagnosis, diagnostic confidence, and management recommendations (main outcomes) first without, and then with, accompanying wound photos. At each step, participants ranked the most important features contributing to their decision.\nRESULTS: Eighty-three participants completed a median of 5 scenarios (interquartile range 4 to 7). Most participants were physicians in academic surgical specialties (n = 70 [84\\%]). The addition of photos improved overall diagnostic accuracy from 67\\% to 76\\% (p {\\textless} 0.001), and increased specificity from 77\\% to 92\\% (p {\\textless} 0.001), but did not significantly increase sensitivity (55\\% to 65\\%; p = 0.16). Photos increased mean confidence in diagnosis from 5.9 of 10 to 7.4 of 10 (p {\\textless} 0.001). Overtreatment recommendations decreased from 48\\% to 16\\% (p {\\textless} 0.001), and undertreatment did not change (28\\% to 23\\%; p = 0.20) with the addition of photos.\nCONCLUSIONS: The addition of wound photos to existing data as available via chart review and telephone consultation with patients significantly improved diagnostic accuracy and confidence, and prevented proposed overtreatment in scenarios without SSI. Post-discharge mobile health technologies have the potential to facilitate patient-centered care, decrease costs, and improve clinical outcomes.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Journal of the American College of Surgeons},\n\tauthor = {Sanger, Patrick C. and Simianu, Vlad V. and Gaskill, Cameron E. and Armstrong, Cheryl A. L. and Hartzler, Andrea L. and Lordon, Ross J. and Lober, William B. and Evans, Heather L.},\n\tyear = {2017},\n\tpmid = {27746223},\n\tpmcid = {PMC5183503},\n\tkeywords = {Adult, Clinical Decision-Making, Female, Humans, Male, Middle Aged, Patient Discharge, Photography, Postoperative Care, Sensitivity and Specificity, Surgical Wound Infection, Telemedicine},\n\tpages = {8--15.e1},\n}\n\n

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\n BACKGROUND: Postoperative surgical site infections (SSI) are common and costly. Most occur post discharge, and can result in potentially preventable readmission or unnecessary urgent evaluation. Mobile health approaches incorporating patient-generated wound photos are being implemented in an attempt to optimize triage and management. We assessed how adding wound photos to existing data sources modifies provider decision making. STUDY DESIGN: We used a web-based simulation survey using a convenience sample of providers with expertise in surgical infections. Participants viewed a range of scenarios, including surgical history, physical exam, and description of wound appearance. All participants reported SSI diagnosis, diagnostic confidence, and management recommendations (main outcomes) first without, and then with, accompanying wound photos. At each step, participants ranked the most important features contributing to their decision. RESULTS: Eighty-three participants completed a median of 5 scenarios (interquartile range 4 to 7). Most participants were physicians in academic surgical specialties (n = 70 [84%]). The addition of photos improved overall diagnostic accuracy from 67% to 76% (p \\textless 0.001), and increased specificity from 77% to 92% (p \\textless 0.001), but did not significantly increase sensitivity (55% to 65%; p = 0.16). Photos increased mean confidence in diagnosis from 5.9 of 10 to 7.4 of 10 (p \\textless 0.001). Overtreatment recommendations decreased from 48% to 16% (p \\textless 0.001), and undertreatment did not change (28% to 23%; p = 0.20) with the addition of photos. CONCLUSIONS: The addition of wound photos to existing data as available via chart review and telephone consultation with patients significantly improved diagnostic accuracy and confidence, and prevented proposed overtreatment in scenarios without SSI. Post-discharge mobile health technologies have the potential to facilitate patient-centered care, decrease costs, and improve clinical outcomes.\n

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\n \n\n \n \n Sanger, P. C.; Granich, M.; Olsen-Scribner, R.; Jain, R.; Lober, W. B.; Stapleton, A.; and Pottinger, P. S.\n\n\n \n \n \n \n Electronic Surveillance For Catheter-Associated Urinary Tract Infection Using Natural Language Processing.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium, 2017: 1507–1516. 2017.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{sanger_electronic_2017,\n\ttitle = {Electronic {Surveillance} {For} {Catheter}-{Associated} {Urinary} {Tract} {Infection} {Using} {Natural} {Language} {Processing}},\n\tvolume = {2017},\n\tissn = {1942-597X},\n\tabstract = {Catheter-associated urinary tract infection (CAUTI) is a common and costly healthcare-associated infection, yet measuring it accurately is challenging and resource-intensive. Electronic surveillance promises to make this task more objective and efficient in an era of new financial and regulatory imperatives, but previous surveillance approaches have used a simplified version of the definition. We applied a complete definition, including subjective elements identified through natural language processing of clinical notes. Through examination of documentation practices, we defined a set of rules that identified positively and negatively asserted symptoms of CAUTI. Our algorithm was developed on a training set of 1421 catheterizedpatients and prospectively validated on 1567 catheterizedpatients. Compared to gold standard chart review, our tool had a sensitivity of 97.1\\%, specificity of 94.5\\% PPV of 66.7\\% and NPV of 99.6\\% for identifying CAUTI. We discuss sources of error and suggestions for more computable future definitions.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Sanger, Patrick C. and Granich, Marion and Olsen-Scribner, Robin and Jain, Rupali and Lober, William B. and Stapleton, Ann and Pottinger, Paul S.},\n\tyear = {2017},\n\tpmid = {29854220},\n\tpmcid = {PMC5977673},\n\tkeywords = {Algorithms, Catheter-Related Infections, Cross Infection, Data Mining, Documentation, Electronic Health Records, Humans, Monitoring, Physiologic, Natural Language Processing, Patient Acuity, Prospective Studies, Urinary Tract Infections},\n\tpages = {1507--1516},\n}\n\n

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\n \n\n \n \n Althoff, K. N.; Rebeiro, P. F.; Hanna, D. B.; Padgett, D.; Horberg, M. A.; Grinsztejn, B.; Abraham, A. G.; Hogg, R.; Gill, M. J.; Wolff, M. J.; Mayor, A.; Rachlis, A.; Williams, C.; Sterling, T. R.; Kitahata, M. M.; Buchacz, K.; Thorne, J. E.; Cesar, C.; Cordero, F. M.; Rourke, S. B.; Sierra-Madero, J.; Pape, J. W.; Cahn, P.; McGowan, C.; North American Aids Cohort Collaboration on Research; (NA-ACCORD), D.; Caribbean, C.; and for Hiv Epidemiology (CCASAnet), S. A. N.\n\n\n \n \n \n \n \n A picture is worth a thousand words: maps of HIV indicators to inform research, programs, and policy from NA-ACCORD and CCASAnet clinical cohorts.\n \n \n \n \n\n\n \n\n\n\n Journal of the International AIDS Society, 19(1): 20707. April 2016.\n \n\n\n\n
\n\n\n\n \n \n $\"A$ Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{althoff_picture_2016,\n\ttitle = {A picture is worth a thousand words: maps of {HIV} indicators to inform research, programs, and policy from {NA}-{ACCORD} and {CCASAnet} clinical cohorts},\n\tvolume = {19},\n\tissn = {1758-2652},\n\tshorttitle = {A picture is worth a thousand words},\n\turl = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821890/pdf/JIAS-19-20707.pdf},\n\tdoi = {10.7448/IAS.19.1.20707},\n\tabstract = {INTRODUCTION: Maps are powerful tools for visualization of differences in health indicators by geographical region, but multi-country maps of HIV indicators do not exist, perhaps due to lack of consistent data across countries. Our objective was to create maps of four HIV indicators in North, Central, and South American countries.\nMETHODS: Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and the Caribbean, Central, and South America network for HIV epidemiology (CCASAnet), we mapped median CD4 at presentation for HIV clinical care, proportion retained in HIV primary care, proportion prescribed antiretroviral therapy (ART), and the proportion with suppressed plasma HIV viral load (VL) from 2010 to 2012 for North, Central, and South America. The 15 Canadian and US clinical cohorts and 7 clinical cohorts in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru represented approximately 2-7\\% of persons known to be living with HIV in these countries.\nRESULTS: Study populations were selected for each indicator: median CD4 at presentation for care was estimated among 14,811 adults; retention was estimated among 87,979 adults; ART use was estimated among 84,757 adults; and suppressed VL was estimated among 51,118 adults. Only three US states and the District of Columbia had a median CD4 at presentation {\\textgreater}350 cells/mm(3). Haiti, Mexico, and several states had {\\textgreater}85\\% retention in care; lower (50-74\\%) retention in care was observed in the US West, South, and Mid-Atlantic, and in Argentina, Brazil, and Peru. ART use was highest (90\\%) in Mexico. The percentages of patients with suppressed VL in the US South and Northeast were lower than in most of Central and South America.\nCONCLUSIONS: These maps provide visualization of gaps in the quality of HIV care and allow for comparison between and within countries as well as monitoring policy and programme goals within geographical boundaries.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Journal of the International AIDS Society},\n\tauthor = {Althoff, Keri N. and Rebeiro, Peter F. and Hanna, David B. and Padgett, Denis and Horberg, Michael A. and Grinsztejn, Beatriz and Abraham, Alison G. and Hogg, Robert and Gill, M. John and Wolff, Marcelo J. and Mayor, Angel and Rachlis, Anita and Williams, Carolyn and Sterling, Timothy R. and Kitahata, Mari M. and Buchacz, Kate and Thorne, Jennifer E. and Cesar, Carina and Cordero, Fernando M. and Rourke, Sean B. and Sierra-Madero, Juan and Pape, Jean W. and Cahn, Pedro and McGowan, Catherine and {North American Aids Cohort Collaboration on Research and Design (NA-ACCORD) and Caribbean, Central and South America Network for Hiv Epidemiology (CCASAnet)}},\n\tmonth = apr,\n\tyear = {2016},\n\tpmid = {27049052},\n\tpmcid = {PMC4821890},\n\tkeywords = {Adult, CD4 Lymphocyte Count, CD4 T-lymphocyte count, Central America, Cohort Studies, Cooperative Behavior, Cross-Sectional Studies, Female, HIV Infections, HIV RNA suppression, HIV indicators, Health Policy, Humans, Male, Map, Middle Aged, North America, Research Design, South America, antiretroviral therapy, implementation science, retention in care},\n\tpages = {20707},\n}\n\n

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\n \n\n \n \n Klein, M. B.; Althoff, K. N.; Jing, Y.; Lau, B.; Kitahata, M.; Lo Re, V.; Kirk, G. D.; Hull, M.; Kim, H. N.; Sebastiani, G.; Moodie, E. E. M.; Silverberg, M. J.; Sterling, T. R.; Thorne, J. E.; Cescon, A.; Napravnik, S.; Eron, J.; Gill, M. J.; Justice, A.; Peters, M. G.; Goedert, J. J.; Mayor, A.; Thio, C. L.; Cachay, E. R.; Moore, R.; North American AIDS Cohort Collaboration on Research; of IeDEA, D.; North American AIDS Cohort Collaboration on Research; and of IeDEA, D. (.\n\n\n \n \n \n \n Risk of End-Stage Liver Disease in HIV-Viral Hepatitis Coinfected Persons in North America From the Early to Modern Antiretroviral Therapy Eras.\n \n \n \n\n\n \n\n\n\n Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 63(9): 1160–1167. 2016.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{klein_risk_2016,\n\ttitle = {Risk of {End}-{Stage} {Liver} {Disease} in {HIV}-{Viral} {Hepatitis} {Coinfected} {Persons} in {North} {America} {From} the {Early} to {Modern} {Antiretroviral} {Therapy} {Eras}},\n\tvolume = {63},\n\tissn = {1537-6591},\n\tdoi = {10.1093/cid/ciw531},\n\tabstract = {BACKGROUND: Human immunodeficiency virus (HIV)-infected patients coinfected with hepatitis B (HBV) and C (HCV) viruses are at increased risk of end-stage liver disease (ESLD). Whether modern antiretroviral therapy has reduced ESLD risk is unknown.\nMETHODS: Twelve clinical cohorts in the United States and Canada participating in the North American AIDS Cohort Collaboration on Research and Design validated ESLD events from 1996 to 2010. ESLD incidence rates and rate ratios according to hepatitis status adjusted for age, sex, race, cohort, time-updated CD4 cell count and HIV RNA were estimated in calendar periods corresponding to major changes in antiretroviral therapy: early (1996-2000), middle (2001-2005), and modern (2006-2010) eras.\nRESULTS: Among 34 119 HIV-infected adults followed for 129 818 person-years, 380 incident ESLD outcomes occurred. ESLD incidence (per 1000 person-years) was highest in triply infected (11.57) followed by HBV- (8.72) and HCV- (6.10) coinfected vs 1.27 in HIV-monoinfected patients. Adjusted incidence rate ratios (95\\% confidence intervals) comparing the modern to the early antiretroviral era were 0.95 (.61-1.47) for HCV, 0.95 (.40-2.26) for HBV, and 1.52 (.46-5.02) for triply infected patients. Use of antiretrovirals dually activity against HBV increased over time. However, in the modern era, 35\\% of HBV-coinfected patients were not receiving tenofovir. There was little use of HCV therapy.\nCONCLUSIONS: Despite increasing use of antiretrovirals, no clear reduction in ESLD risk was observed over 15 years. Treatment with direct-acting antivirals for HCV and wider use of tenofovir-based regimens for HBV should be prioritized for coinfected patients.},\n\tlanguage = {eng},\n\tnumber = {9},\n\tjournal = {Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America},\n\tauthor = {Klein, Marina B. and Althoff, Keri N. and Jing, Yuezhou and Lau, Bryan and Kitahata, Mari and Lo Re, Vincent and Kirk, Gregory D. and Hull, Mark and Kim, H. Nina and Sebastiani, Giada and Moodie, Erica E. M. and Silverberg, Michael J. and Sterling, Timothy R. and Thorne, Jennifer E. and Cescon, Angela and Napravnik, Sonia and Eron, Joe and Gill, M. John and Justice, Amy and Peters, Marion G. and Goedert, James J. and Mayor, Angel and Thio, Chloe L. and Cachay, Edward R. and Moore, Richard and {North American AIDS Cohort Collaboration on Research and Design of IeDEA} and {North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA}},\n\tyear = {2016},\n\tpmid = {27506682},\n\tpmcid = {PMC5064164},\n\tkeywords = {Adult, Aged, Alcohol Drinking, Anti-HIV Agents, Canada, Cohort Studies, Coinfection, End Stage Liver Disease, Female, HIV, HIV Infections, Hepatitis B, Hepatitis C, Humans, Incidence, Male, Middle Aged, Risk Factors, United States, coinfection, end-stage liver disease, hepatitis B virus, hepatitis C virus},\n\tpages = {1160--1167},\n}\n\n

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\n \n\n \n \n Crane, H. M.; Fredericksen, R. J.; Church, A.; Harrington, A.; Ciechanowski, P.; Magnani, J.; Nasby, K.; Brown, T.; Dhanireddy, S.; Harrington, R. D.; Lober, W. B.; Simoni, J.; Safren, S. A.; Edwards, T. C.; Patrick, D. L.; Saag, M. S.; Crane, P. K.; and Kitahata, M. M.\n\n\n \n \n \n \n A Randomized Controlled Trial Protocol to Evaluate the Effectiveness of an Integrated Care Management Approach to Improve Adherence Among HIV-Infected Patients in Routine Clinical Care: Rationale and Design.\n \n \n \n\n\n \n\n\n\n JMIR research protocols, 5(4): e156. October 2016.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{crane_randomized_2016,\n\ttitle = {A {Randomized} {Controlled} {Trial} {Protocol} to {Evaluate} the {Effectiveness} of an {Integrated} {Care} {Management} {Approach} to {Improve} {Adherence} {Among} {HIV}-{Infected} {Patients} in {Routine} {Clinical} {Care}: {Rationale} and {Design}},\n\tvolume = {5},\n\tissn = {1929-0748},\n\tshorttitle = {A {Randomized} {Controlled} {Trial} {Protocol} to {Evaluate} the {Effectiveness} of an {Integrated} {Care} {Management} {Approach} to {Improve} {Adherence} {Among} {HIV}-{Infected} {Patients} in {Routine} {Clinical} {Care}},\n\tdoi = {10.2196/resprot.5492},\n\tabstract = {BACKGROUND: Adherence to antiretroviral medications is a key determinant of clinical outcomes. Many adherence intervention trials investigated the effects of time-intensive or costly interventions that are not feasible in most clinical care settings.\nOBJECTIVE: We set out to evaluate a collaborative care approach as a feasible intervention applicable to patients in clinical care including those with mental illness and/or substance use issues.\nMETHODS: We developed a randomized controlled trial (RCT) investigating an integrated, clinic-based care management approach to improve clinical outcomes that could be integrated into the clinical care setting. This is based on the routine integration and systematic follow-up of a clinical assessment of patient-reported outcomes targeting adherence, depression, and substance use, and adapts previously developed and tested care management approaches. The primary health coach or care management role is provided by clinic case managers allowing the intervention to be generalized to other human immunodeficiency virus (HIV) clinics that have case managers. We used a stepped-care approach to target interventions to those at greatest need who are most likely to benefit rather than to everyone to maintain feasibility in a busy clinical care setting.\nRESULTS: The National Institutes of Health funded this study and had no role in study design, data collection, or decisions regarding whether or not to submit manuscripts for publication. This trial is currently underway, enrollment was completed in 2015, and follow-up time still accruing. First results are expected to be ready for publication in early 2017.\nDISCUSSION: This paper describes the protocol for an ongoing clinical trial including the design and the rationale for key methodological decisions. There is a need to identify best practices for implementing evidence-based collaborative care models that are effective and feasible in clinical care. Adherence efficacy trials have not led to sufficient improvements, and there remains little guidance regarding how adherence interventions should be implemented into clinical care. By focusing on improving adherence within care settings using existing staff, routine assessment of key domains, such as depression, adherence, and substance use, and feasible interventions, we propose to evaluate this innovative way to improve clinical outcomes.\nTRIAL REGISTRATION: Clinicaltrials.gov NCT01505660; http://clinicaltrials.gov/ct2/show/NCT01505660 (Archived by WebCite at http://www.webcitation/ 6ktOq6Xj7).},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {JMIR research protocols},\n\tauthor = {Crane, Heidi M. and Fredericksen, Rob J. and Church, Anna and Harrington, Anna and Ciechanowski, Paul and Magnani, Jennifer and Nasby, Kari and Brown, Tyler and Dhanireddy, Shireesha and Harrington, Robert D. and Lober, William B. and Simoni, Jane and Safren, Stevan A. and Edwards, Todd C. and Patrick, Donald L. and Saag, Michael S. and Crane, Paul K. and Kitahata, Mari M.},\n\tmonth = oct,\n\tyear = {2016},\n\tpmid = {27707688},\n\tpmcid = {PMC5071617},\n\tkeywords = {HIV, adherence, alcohol use, care management, depression, intervention, randomized controlled trial, substance use},\n\tpages = {e156},\n}\n\n

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\n BACKGROUND: Adherence to antiretroviral medications is a key determinant of clinical outcomes. Many adherence intervention trials investigated the effects of time-intensive or costly interventions that are not feasible in most clinical care settings. OBJECTIVE: We set out to evaluate a collaborative care approach as a feasible intervention applicable to patients in clinical care including those with mental illness and/or substance use issues. METHODS: We developed a randomized controlled trial (RCT) investigating an integrated, clinic-based care management approach to improve clinical outcomes that could be integrated into the clinical care setting. This is based on the routine integration and systematic follow-up of a clinical assessment of patient-reported outcomes targeting adherence, depression, and substance use, and adapts previously developed and tested care management approaches. The primary health coach or care management role is provided by clinic case managers allowing the intervention to be generalized to other human immunodeficiency virus (HIV) clinics that have case managers. We used a stepped-care approach to target interventions to those at greatest need who are most likely to benefit rather than to everyone to maintain feasibility in a busy clinical care setting. RESULTS: The National Institutes of Health funded this study and had no role in study design, data collection, or decisions regarding whether or not to submit manuscripts for publication. This trial is currently underway, enrollment was completed in 2015, and follow-up time still accruing. First results are expected to be ready for publication in early 2017. DISCUSSION: This paper describes the protocol for an ongoing clinical trial including the design and the rationale for key methodological decisions. There is a need to identify best practices for implementing evidence-based collaborative care models that are effective and feasible in clinical care. Adherence efficacy trials have not led to sufficient improvements, and there remains little guidance regarding how adherence interventions should be implemented into clinical care. By focusing on improving adherence within care settings using existing staff, routine assessment of key domains, such as depression, adherence, and substance use, and feasible interventions, we propose to evaluate this innovative way to improve clinical outcomes. TRIAL REGISTRATION: Clinicaltrials.gov NCT01505660; http://clinicaltrials.gov/ct2/show/NCT01505660 (Archived by WebCite at http://www.webcitation/ 6ktOq6Xj7).\n

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\n \n\n \n \n Cesar, C.; Koethe, J. R.; Giganti, M. J.; Rebeiro, P.; Althoff, K. N.; Napravnik, S.; Mayor, A.; Grinsztejn, B.; Wolff, M.; Padgett, D.; Sierra-Madero, J.; Gotuzzo, E.; Sterling, T. R.; Willig, J.; Levison, J.; Kitahata, M.; Rodriguez-Barradas, M. C.; Moore, R. D.; McGowan, C.; Shepherd, B. E.; Cahn, P.; Caribbean, Central; for HIV epidemiology (CCASAnet), S. A. N.; on Research, N. A. A. C. C.; and (NA-ACCORD), D.\n\n\n \n \n \n \n Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America.\n \n \n \n\n\n \n\n\n\n Journal of the International AIDS Society, 19(1): 20684. 2016.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{cesar_health_2016,\n\ttitle = {Health outcomes among {HIV}-positive {Latinos} initiating antiretroviral therapy in {North} {America} versus {Central} and {South} {America}},\n\tvolume = {19},\n\tissn = {1758-2652},\n\tdoi = {10.7448/IAS.19.1.20684},\n\tabstract = {INTRODUCTION: Latinos living with HIV in the Americas share a common ethnic and cultural heritage. In North America, Latinos have a relatively high rate of new HIV infections but lower rates of engagement at all stages of the care continuum, whereas in Latin America antiretroviral therapy (ART) services continue to expand to meet treatment needs. In this analysis, we compare HIV treatment outcomes between Latinos receiving ART in North America versus Latin America.\nMETHODS: HIV-positive adults initiating ART at Caribbean, Central and South America Network for HIV (CCASAnet) sites were compared to Latino patients (based on country of origin or ethnic identity) starting treatment at North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) sites in the United States and Canada between 2000 and 2011. Cox proportional hazards models compared mortality, treatment interruption, antiretroviral regimen change, virologic failure and loss to follow-up between cohorts.\nRESULTS: The study included 8400 CCASAnet and 2786 NA-ACCORD patients initiating ART. CCASAnet patients were younger (median 35 vs. 37 years), more likely to be female (27\\% vs. 20\\%) and had lower nadir CD4 count (median 148 vs. 195 cells/µL, p{\\textless}0.001 for all). In multivariable analyses, CCASAnet patients had a higher risk of mortality after ART initiation (adjusted hazard ratio (AHR) 1.61; 95\\% confidence interval (CI): 1.32 to 1.96), particularly during the first year, but a lower hazard of treatment interruption (AHR: 0.46; 95\\% CI: 0.42 to 0.50), change to second-line ART (AHR: 0.56; 95\\% CI: 0.51 to 0.62) and virologic failure (AHR: 0.52; 95\\% CI: 0.48 to 0.57).\nCONCLUSIONS: HIV-positive Latinos initiating ART in Latin America have greater continuity of treatment but are at higher risk of death than Latinos in North America. Factors underlying these differences, such as HIV testing, linkage and access to care, warrant further investigation.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Journal of the International AIDS Society},\n\tauthor = {Cesar, Carina and Koethe, John R. and Giganti, Mark J. and Rebeiro, Peter and Althoff, Keri N. and Napravnik, Sonia and Mayor, Angel and Grinsztejn, Beatriz and Wolff, Marcelo and Padgett, Denis and Sierra-Madero, Juan and Gotuzzo, Eduardo and Sterling, Timothy R. and Willig, James and Levison, Julie and Kitahata, Mari and Rodriguez-Barradas, Maria C. and Moore, Richard D. and McGowan, Catherine and Shepherd, Bryan E. and Cahn, Pedro and {Caribbean, Central and South America Network for HIV epidemiology (CCASAnet) and North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)}},\n\tyear = {2016},\n\tpmid = {26996992},\n\tpmcid = {PMC4800379},\n\tkeywords = {Adult, Anti-HIV Agents, Canada, Female, HIV, HIV Infections, Hispanic Americans, Humans, Latin America, Male, North America, Proportional Hazards Models, South America, Treatment Outcome, United States, antiretroviral therapy, cohort studies, highly active, mortality},\n\tpages = {20684},\n}\n\n

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\n \n\n \n \n Gibbons, L. E.; Fredericksen, R.; Merrill, J. O.; McCaul, M. E.; Chander, G.; Hutton, H.; Lober, W. B.; Mathews, W. C.; Mayer, K.; Burkholder, G.; Willig, J. H.; Mugavero, M. J.; Saag, M. S.; Kitahata, M. M.; Edwards, T. C.; Patrick, D. L.; Crane, H. M.; and Crane, P. K.\n\n\n \n \n \n \n Suitability of the PROMIS alcohol use short form for screening in a HIV clinical care setting.\n \n \n \n\n\n \n\n\n\n Drug and Alcohol Dependence, 164: 113–119. July 2016.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{gibbons_suitability_2016,\n\ttitle = {Suitability of the {PROMIS} alcohol use short form for screening in a {HIV} clinical care setting},\n\tvolume = {164},\n\tissn = {1879-0046},\n\tdoi = {10.1016/j.drugalcdep.2016.04.038},\n\tabstract = {BACKGROUND: At-risk alcohol use is important to identify in clinical settings to facilitate interventions. The Patient-Reported Outcomes Measurement Information System (PROMIS) Alcohol Use Short Form was developed through an item response theory process, but its utility as a screening instrument in clinical care has not been reported.\nOBJECTIVE: To determine the ability of the PROMIS Alcohol Use Short Form to identify people with current or future at-risk alcohol use defined by the Alcohol Use Disorders Identification Test consumption (AUDIT-C) instrument.\nMETHODS: Observational study of people living with HIV (PLWH) in clinical care at four sites across the US. Patients completed a tablet-based clinical assessment prior to seeing their providers at clinic appointments. We used 3 definitions of clinically-relevant at-risk alcohol use and determined the proportion of PLWH with current or future at-risk drinking identified by the PROMIS instrument.\nRESULTS: Of 2497 PLWH who endorsed ≥1 drink in the prior 12 months, 1500 PLWH (60\\%) endorsed "never" for all PROMIS items. In that group, 26\\% had clinically-relevant at-risk alcohol use defined by one or more AUDIT-C definitions. At follow-up (N=1608), high baseline PROMIS scores had 55\\% sensitivity for at-risk drinking among those with at-risk drinking at baseline, and 22\\% sensitivity among those without baseline risk.\nCONCLUSIONS: The PROMIS Alcohol Use Short Form cannot be used alone to identify PLWH with clinically-relevant at-risk alcohol use. Optimal assessment of problem drinking behavior is not clear, but there does not seem to be an important role for the PROMIS instrument in this clinical setting.},\n\tlanguage = {eng},\n\tjournal = {Drug and Alcohol Dependence},\n\tauthor = {Gibbons, Laura E. and Fredericksen, Rob and Merrill, Joseph O. and McCaul, Mary E. and Chander, Geetanjali and Hutton, Heidi and Lober, William B. and Mathews, W. Chris and Mayer, Kenneth and Burkholder, Greer and Willig, James H. and Mugavero, Michael J. and Saag, Michael S. and Kitahata, Mari M. and Edwards, Todd C. and Patrick, Donald L. and Crane, Heidi M. and Crane, Paul K.},\n\tmonth = jul,\n\tyear = {2016},\n\tpmid = {27209223},\n\tpmcid = {PMC4896136},\n\tkeywords = {Adult, Alcohol Drinking, Alcoholism, Ambulatory Care Facilities, At-risk alcohol use, Clinical care, Female, HIV, HIV Infections, Humans, Male, Mass Screening, Middle Aged, Patient-reported outcomes, Psychometrics, Reproducibility of Results, Risk-Taking, Screening, Surveys and Questionnaires},\n\tpages = {113--119},\n}\n\n

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\n \n\n \n \n Fredericksen, R. J.; Tufano, J.; Ralston, J.; McReynolds, J.; Stewart, M.; Lober, W. B.; Mayer, K. H.; Mathews, W. C.; Mugavero, M. J.; Crane, P. K.; and Crane, H. M.\n\n\n \n \n \n \n Provider perceptions of the value of same-day, electronic patient-reported measures for use in clinical HIV care.\n \n \n \n\n\n \n\n\n\n AIDS care, 28(11): 1428–1433. 2016.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{fredericksen_provider_2016,\n\ttitle = {Provider perceptions of the value of same-day, electronic patient-reported measures for use in clinical {HIV} care},\n\tvolume = {28},\n\tissn = {1360-0451},\n\tdoi = {10.1080/09540121.2016.1189501},\n\tabstract = {Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions, reduce omissions in care, and improve patient-provider communication. However, provider acceptability of PROs and their use in clinical HIV care is not well known. We interviewed providers (n = 27) from four geographically diverse HIV and community care clinics in the US that have integrated PROs into routine HIV care, querying perceived value, challenges, and use of PRO data. Perceived benefits included the ability of PROs to identify less-observable behaviors and conditions, particularly suicidal ideation, depression, and substance use; usefulness in agenda setting prior to a visit; and reduction of social desirability bias in patient-provider communication. Challenges included initial flow integration issues and ease of interpretation of PRO feedback. Providers value same-day, electronic patient-reported measures for use in clinical HIV care with the condition that PROs are (1) tailored to be the most clinically relevant to their population; (2) well integrated into clinic flow; and (3) easy to interpret, highlighting chief patient concerns and changes over time.},\n\tlanguage = {eng},\n\tnumber = {11},\n\tjournal = {AIDS care},\n\tauthor = {Fredericksen, R. J. and Tufano, J. and Ralston, J. and McReynolds, J. and Stewart, M. and Lober, W. B. and Mayer, K. H. and Mathews, W. C. and Mugavero, M. J. and Crane, P. K. and Crane, H. M.},\n\tyear = {2016},\n\tpmid = {27237187},\n\tpmcid = {PMC5310959},\n\tkeywords = {Attitude of Health Personnel, Communication, Depression, HIV Infections, HIV care, Humans, Interviews as Topic, Patient Care Planning, Patient Reported Outcome Measures, Patient-reported outcomes, Perception, Physician-Patient Relations, Substance-Related Disorders, Suicidal Ideation, Time Factors},\n\tpages = {1428--1433},\n}\n\n

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\n \n\n \n \n Sanger, P. C.; Hartzler, A.; Lordon, R. J.; Armstrong, C. A.; Lober, W. B.; Evans, H. L.; and Pratt, W.\n\n\n \n \n \n \n A patient-centered system in a provider-centered world: challenges of incorporating post-discharge wound data into practice.\n \n \n \n\n\n \n\n\n\n Journal of the American Medical Informatics Association: JAMIA, 23(3): 514–525. 2016.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{sanger_patient-centered_2016,\n\ttitle = {A patient-centered system in a provider-centered world: challenges of incorporating post-discharge wound data into practice},\n\tvolume = {23},\n\tissn = {1527-974X},\n\tshorttitle = {A patient-centered system in a provider-centered world},\n\tdoi = {10.1093/jamia/ocv183},\n\tabstract = {OBJECTIVE: The proposed Meaningful Use Stage 3 recommendations require healthcare providers to accept patient-generated health data (PGHD) by 2017. Yet, we know little about the tensions that arise in supporting the needs of both patients and providers in this context. We sought to examine these tensions when designing a novel, patient-centered technology - mobile Post-Operative Wound Evaluator (mPOWEr) - that uses PGHD for post-discharge surgical wound monitoring.\nMATERIALS AND METHODS: As part of the iterative design process of mPOWEr, we conducted semistructured interviews and think-aloud sessions using mockups with surgical patients and providers. We asked participants how mPOWEr could enhance the current post-discharge process for surgical patients, then used grounded theory to develop themes related to conflicts and agreements between patients and providers.\nRESULTS: We identified four areas of agreement: providing contextual metadata, accessible and actionable data presentation, building on existing sociotechnical systems, and process transparency. We identified six areas of conflict, with patients preferring: more flexibility in data input, frequent data transfer, text-based communication, patient input in provider response prioritization, timely and reliable provider responses, and definitive diagnoses.\nDISCUSSION: We present design implications and potential solutions to the identified conflicts for each theme, illustrated using our work on mPOWEr. Our experience highlights the importance of bringing a variety of stakeholders, including patients, into the design process for PGHD applications.\nCONCLUSION: We have identified critical barriers to integrating PGHD into clinical care and describe design implications to help address these barriers. Our work informs future efforts to ensure the smooth integration of essential PGHD into clinical practice.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Journal of the American Medical Informatics Association: JAMIA},\n\tauthor = {Sanger, Patrick C. and Hartzler, Andrea and Lordon, Ross J. and Armstrong, Cheryl Al and Lober, William B. and Evans, Heather L. and Pratt, Wanda},\n\tyear = {2016},\n\tpmid = {26977103},\n\tpmcid = {PMC6375197},\n\tkeywords = {Adult, Aftercare, Aged, Attitude of Health Personnel, Female, Humans, Internet, Male, Middle Aged, Mobile Applications, Monitoring, Physiologic, Patient Preference, Patient-Centered Care, Self Report, Surgical Wound Infection, Telemedicine, Text Messaging, Young Adult, dissent and disputes, mobile health, patient engagement, patient-centered care, surgical wound infection},\n\tpages = {514--525},\n}\n\n

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\n \n\n \n \n Sanger, P. C.; van Ramshorst, G. H.; Mercan, E.; Huang, S.; Hartzler, A. L.; Armstrong, C. A. L.; Lordon, R. J.; Lober, W. B.; and Evans, H. L.\n\n\n \n \n \n \n A Prognostic Model of Surgical Site Infection Using Daily Clinical Wound Assessment.\n \n \n \n\n\n \n\n\n\n Journal of the American College of Surgeons, 223(2): 259–270.e2. 2016.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{sanger_prognostic_2016,\n\ttitle = {A {Prognostic} {Model} of {Surgical} {Site} {Infection} {Using} {Daily} {Clinical} {Wound} {Assessment}},\n\tvolume = {223},\n\tissn = {1879-1190},\n\tdoi = {10.1016/j.jamcollsurg.2016.04.046},\n\tabstract = {BACKGROUND: Surgical site infection (SSI) remains a common, costly, and morbid health care-associated infection. Early detection can improve outcomes, yet previous risk models consider only baseline risk factors (BF) not incorporating a proximate and timely data source-the wound itself. We hypothesize that incorporation of daily wound assessment improves the accuracy of SSI identification compared with traditional BF alone.\nSTUDY DESIGN: A prospective cohort of 1,000 post open abdominal surgery patients at an academic teaching hospital were examined daily for serial features (SF), for example, wound characteristics and vital signs, in addition to standard BF, for example, wound class. Using supervised machine learning, we trained 3 Naïve Bayes classifiers (BF, SF, and BF+SF) using patient data from 1 to 5 days before diagnosis to classify SSI on the following day. For comparison, we also created a simplified SF model that used logistic regression. Control patients without SSI were matched on 5 similar consecutive postoperative days to avoid confounding by length of stay. Accuracy, sensitivity/specificity, and area under the receiver operating characteristic curve were calculated on a training and hold-out testing set.\nRESULTS: Of 851 patients, 19.4\\% had inpatient SSIs. Univariate analysis showed differences in C-reactive protein, surgery duration, and contamination, but no differences in American Society of Anesthesiologists scores, diabetes, or emergency surgery. The BF, SF, and BF+SF classifiers had area under the receiver operating characteristic curves of 0.67, 0.76, and 0.76, respectively. The best-performing classifier (SF) had optimal sensitivity of 0.80, specificity of 0.64, positive predictive value of 0.35, and negative predictive value of 0.93. Features most associated with subsequent SSI diagnosis were granulation degree, exudate amount, nasogastric tube presence, and heart rate.\nCONCLUSIONS: Serial features provided moderate positive predictive value and high negative predictive value for early identification of SSI. Addition of baseline risk factors did not improve identification. Features of evolving wound infection are discernable before the day of diagnosis, based primarily on visual inspection.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Journal of the American College of Surgeons},\n\tauthor = {Sanger, Patrick C. and van Ramshorst, Gabrielle H. and Mercan, Ezgi and Huang, Shuai and Hartzler, Andrea L. and Armstrong, Cheryl A. L. and Lordon, Ross J. and Lober, William B. and Evans, Heather L.},\n\tyear = {2016},\n\tpmid = {27188832},\n\tpmcid = {PMC4961603},\n\tkeywords = {Adult, Aged, Bayes Theorem, Decision Support Techniques, Female, Follow-Up Studies, Humans, Logistic Models, Male, Middle Aged, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Risk Factors, Sensitivity and Specificity, Surgical Wound, Surgical Wound Infection},\n\tpages = {259--270.e2},\n}\n\n

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\n BACKGROUND: Surgical site infection (SSI) remains a common, costly, and morbid health care-associated infection. Early detection can improve outcomes, yet previous risk models consider only baseline risk factors (BF) not incorporating a proximate and timely data source-the wound itself. We hypothesize that incorporation of daily wound assessment improves the accuracy of SSI identification compared with traditional BF alone. STUDY DESIGN: A prospective cohort of 1,000 post open abdominal surgery patients at an academic teaching hospital were examined daily for serial features (SF), for example, wound characteristics and vital signs, in addition to standard BF, for example, wound class. Using supervised machine learning, we trained 3 Naïve Bayes classifiers (BF, SF, and BF+SF) using patient data from 1 to 5 days before diagnosis to classify SSI on the following day. For comparison, we also created a simplified SF model that used logistic regression. Control patients without SSI were matched on 5 similar consecutive postoperative days to avoid confounding by length of stay. Accuracy, sensitivity/specificity, and area under the receiver operating characteristic curve were calculated on a training and hold-out testing set. RESULTS: Of 851 patients, 19.4% had inpatient SSIs. Univariate analysis showed differences in C-reactive protein, surgery duration, and contamination, but no differences in American Society of Anesthesiologists scores, diabetes, or emergency surgery. The BF, SF, and BF+SF classifiers had area under the receiver operating characteristic curves of 0.67, 0.76, and 0.76, respectively. The best-performing classifier (SF) had optimal sensitivity of 0.80, specificity of 0.64, positive predictive value of 0.35, and negative predictive value of 0.93. Features most associated with subsequent SSI diagnosis were granulation degree, exudate amount, nasogastric tube presence, and heart rate. CONCLUSIONS: Serial features provided moderate positive predictive value and high negative predictive value for early identification of SSI. Addition of baseline risk factors did not improve identification. Features of evolving wound infection are discernable before the day of diagnosis, based primarily on visual inspection.\n

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\n \n\n \n \n Kitahata, M. M.; Drozd, D. R.; Crane, H. M.; Van Rompaey, S. E.; Althoff, K. N.; Gange, S. J.; Klein, M. B.; Lucas, G. M.; Abraham, A. G.; Lo Re, V.; McReynolds, J.; Lober, W. B.; Mendes, A.; Modur, S. P.; Jing, Y.; Morton, E. J.; Griffith, M. A.; Freeman, A. M.; and Moore, R. D.\n\n\n \n \n \n \n Ascertainment and verification of end-stage renal disease and end-stage liver disease in the north american AIDS cohort collaboration on research and design.\n \n \n \n\n\n \n\n\n\n AIDS research and treatment, 2015: 923194. January 2015.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{kitahata_ascertainment_2015,\n\ttitle = {Ascertainment and verification of end-stage renal disease and end-stage liver disease in the north american {AIDS} cohort collaboration on research and design},\n\tvolume = {2015},\n\tissn = {2090-1240},\n\tdoi = {10.1155/2015/923194},\n\tabstract = {The burden of HIV disease has shifted from traditional AIDS-defining illnesses to serious non-AIDS-defining comorbid conditions. Research aimed at improving HIV-related comorbid disease outcomes requires well-defined, verified clinical endpoints. We developed methods to ascertain and verify end-stage renal disease (ESRD) and end-stage liver disease (ESLD) and validated screening algorithms within the largest HIV cohort collaboration in North America (NA-ACCORD). Individuals who screened positive among all participants in twelve cohorts enrolled between January 1996 and December 2009 underwent medical record review to verify incident ESRD or ESLD using standardized protocols. We randomly sampled 6\\% of contributing cohorts to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ESLD and ESRD screening algorithms in a validation subcohort. Among 43,433 patients screened for ESRD, 822 screened positive of which 620 met clinical criteria for ESRD. The algorithm had 100\\% sensitivity, 99\\% specificity, 82\\% PPV, and 100\\% NPV for ESRD. Among 41,463 patients screened for ESLD, 2,024 screened positive of which 645 met diagnostic criteria for ESLD. The algorithm had 100\\% sensitivity, 95\\% specificity, 27\\% PPV, and 100\\% NPV for ESLD. Our methods proved robust for ascertainment of ESRD and ESLD in persons infected with HIV.},\n\tlanguage = {eng},\n\tjournal = {AIDS research and treatment},\n\tauthor = {Kitahata, Mari M. and Drozd, Daniel R. and Crane, Heidi M. and Van Rompaey, Stephen E. and Althoff, Keri N. and Gange, Stephen J. and Klein, Marina B. and Lucas, Gregory M. and Abraham, Alison G. and Lo Re, Vincent and McReynolds, Justin and Lober, William B. and Mendes, Adell and Modur, Sharada P. and Jing, Yuezhou and Morton, Elizabeth J. and Griffith, Margaret A. and Freeman, Aimee M. and Moore, Richard D.},\n\tmonth = jan,\n\tyear = {2015},\n\tpmid = {25789171},\n\tpmcid = {PMC4350581},\n\tpages = {923194},\n}\n\n

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\n \n\n \n \n Silverberg, M. J.; Lau, B.; Achenbach, C. J.; Jing, Y.; Althoff, K. N.; D'Souza, G.; Engels, E. A.; Hessol, N. A.; Brooks, J. T.; Burchell, A. N.; Gill, M. J.; Goedert, J. J.; Hogg, R.; Horberg, M. A.; Kirk, G. D.; Kitahata, M. M.; Korthuis, P. T.; Mathews, W. C.; Mayor, A.; Modur, S. P.; Napravnik, S.; Novak, R. M.; Patel, P.; Rachlis, A. R.; Sterling, T. R.; Willig, J. H.; Justice, A. C.; Moore, R. D.; Dubrow, R.; North American AIDS Cohort Collaboration on Research; and of the International Epidemiologic Databases to Evaluate AIDS, D.\n\n\n \n \n \n \n Cumulative Incidence of Cancer Among Persons With HIV in North America: A Cohort Study.\n \n \n \n\n\n \n\n\n\n Annals of Internal Medicine, 163(7): 507–518. October 2015.\n \n\n\n\n
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@article{silverberg_cumulative_2015,\n\ttitle = {Cumulative {Incidence} of {Cancer} {Among} {Persons} {With} {HIV} in {North} {America}: {A} {Cohort} {Study}},\n\tvolume = {163},\n\tissn = {1539-3704},\n\tshorttitle = {Cumulative {Incidence} of {Cancer} {Among} {Persons} {With} {HIV} in {North} {America}},\n\tdoi = {10.7326/M14-2768},\n\tabstract = {BACKGROUND: Cancer is increasingly common among persons with HIV.\nOBJECTIVE: To examine calendar trends in cumulative cancer incidence and hazard rate by HIV status.\nDESIGN: Cohort study.\nSETTING: North American AIDS Cohort Collaboration on Research and Design during 1996 to 2009.\nPARTICIPANTS: 86 620 persons with HIV and 196 987 uninfected adults.\nMEASUREMENTS: Cancer type-specific cumulative incidence by age 75 years and calendar trends in cumulative incidence and hazard rates, each by HIV status.\nRESULTS: Cumulative incidences of cancer by age 75 years for persons with and without HIV, respectively, were as follows: Kaposi sarcoma, 4.4\\% and 0.01\\%; non-Hodgkin lymphoma, 4.5\\% and 0.7\\%; lung cancer, 3.4\\% and 2.8\\%; anal cancer, 1.5\\% and 0.05\\%; colorectal cancer, 1.0\\% and 1.5\\%; liver cancer, 1.1\\% and 0.4\\%; Hodgkin lymphoma, 0.9\\% and 0.09\\%; melanoma, 0.5\\% and 0.6\\%; and oral cavity/pharyngeal cancer, 0.8\\% and 0.8\\%. Among persons with HIV, calendar trends in cumulative incidence and hazard rate decreased for Kaposi sarcoma and non-Hodgkin lymphoma. For anal, colorectal, and liver cancer, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (-9\\% per year), allowing greater opportunity to be diagnosed. Despite decreasing hazard rate trends for lung cancer, Hodgkin lymphoma, and melanoma, cumulative incidence trends were not seen because of the compensating effect of the declining mortality rate.\nLIMITATION: Secular trends in screening, smoking, and viral co-infections were not evaluated.\nCONCLUSION: Cumulative cancer incidence by age 75 years, approximating lifetime risk in persons with HIV, may have clinical utility in this population. The high cumulative incidences by age 75 years for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer support early and sustained antiretroviral therapy and smoking cessation.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Annals of Internal Medicine},\n\tauthor = {Silverberg, Michael J. and Lau, Bryan and Achenbach, Chad J. and Jing, Yuezhou and Althoff, Keri N. and D'Souza, Gypsyamber and Engels, Eric A. and Hessol, Nancy A. and Brooks, John T. and Burchell, Ann N. and Gill, M. John and Goedert, James J. and Hogg, Robert and Horberg, Michael A. and Kirk, Gregory D. and Kitahata, Mari M. and Korthuis, Philip T. and Mathews, William C. and Mayor, Angel and Modur, Sharada P. and Napravnik, Sonia and Novak, Richard M. and Patel, Pragna and Rachlis, Anita R. and Sterling, Timothy R. and Willig, James H. and Justice, Amy C. and Moore, Richard D. and Dubrow, Robert and {North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS}},\n\tmonth = oct,\n\tyear = {2015},\n\tpmid = {26436616},\n\tpmcid = {PMC4711936},\n\tkeywords = {Adult, Age Distribution, Aged, Anus Neoplasms, Cohort Studies, Colorectal Neoplasms, Comorbidity, Female, HIV Infections, Humans, Incidence, Liver Neoplasms, Lung Neoplasms, Lymphoma, Non-Hodgkin, Male, Middle Aged, Neoplasms, North America, Proportional Hazards Models, Sarcoma, Kaposi},\n\tpages = {507--518},\n}\n\n

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\n \n\n \n \n Wolpin, S. E.; Halpenny, B.; Whitman, G.; McReynolds, J.; Stewart, M.; Lober, W. B.; and Berry, D. L.\n\n\n \n \n \n \n Development and usability testing of a web-based cancer symptom and quality-of-life support intervention.\n \n \n \n\n\n \n\n\n\n Health Informatics Journal, 21(1): 10–23. March 2015.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{wolpin_development_2015,\n\ttitle = {Development and usability testing of a web-based cancer symptom and quality-of-life support intervention},\n\tvolume = {21},\n\tissn = {1741-2811},\n\tdoi = {10.1177/1460458213495744},\n\tabstract = {The feasibility and acceptability of computerized screening and patient-reported outcome measures have been demonstrated in the literature. However, patient-centered management of health information entails two challenges: gathering and presenting data using "patient-tailored" methods and supporting "patient-control" of health information. The design and development of many symptom and quality-of-life information systems have not included opportunities for systematically collecting and analyzing user input. As part of a larger clinical trial, the Electronic Self-Report Assessment for Cancer-II project, participatory design approaches were used to build and test new features and interfaces for patient/caregiver users. The research questions centered on patient/caregiver preferences with regard to the following: (a) content, (b) user interface needs, (c) patient-oriented summary, and (d) patient-controlled sharing of information with family, caregivers, and clinicians. Mixed methods were used with an emphasis on qualitative approaches; focus groups and individual usability tests were the primary research methods. Focus group data were content analyzed, while individual usability sessions were assessed with both qualitative and quantitative methods. We identified 12 key patient/caregiver preferences through focus groups with 6 participants. We implemented seven of these preferences during the iterative design process. We deferred development for some of the preferences due to resource constraints. During individual usability testing (n = 8), we were able to identify 65 usability issues ranging from minor user confusion to critical errors that blocked task completion. The participatory development model that we used led to features and design revisions that were patient centered. We are currently evaluating new approaches for the application interface and for future research pathways. We encourage other researchers to adopt user-centered design approaches when building patient-centered technologies.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Health Informatics Journal},\n\tauthor = {Wolpin, S. E. and Halpenny, B. and Whitman, G. and McReynolds, J. and Stewart, M. and Lober, W. B. and Berry, D. L.},\n\tmonth = mar,\n\tyear = {2015},\n\tpmid = {24406906},\n\tpmcid = {PMC4747103},\n\tkeywords = {Computers, Consumer Health Information, Focus Groups, Humans, IT design and development methodologies, Internet, Neoplasms, Patient Education as Topic, Patient Outcome Assessment, Quality of Life, Research Design, consumer health information, decision-support systems, ehealth, evidence-based practice},\n\tpages = {10--23},\n}\n\n

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\n The feasibility and acceptability of computerized screening and patient-reported outcome measures have been demonstrated in the literature. However, patient-centered management of health information entails two challenges: gathering and presenting data using \"patient-tailored\" methods and supporting \"patient-control\" of health information. The design and development of many symptom and quality-of-life information systems have not included opportunities for systematically collecting and analyzing user input. As part of a larger clinical trial, the Electronic Self-Report Assessment for Cancer-II project, participatory design approaches were used to build and test new features and interfaces for patient/caregiver users. The research questions centered on patient/caregiver preferences with regard to the following: (a) content, (b) user interface needs, (c) patient-oriented summary, and (d) patient-controlled sharing of information with family, caregivers, and clinicians. Mixed methods were used with an emphasis on qualitative approaches; focus groups and individual usability tests were the primary research methods. Focus group data were content analyzed, while individual usability sessions were assessed with both qualitative and quantitative methods. We identified 12 key patient/caregiver preferences through focus groups with 6 participants. We implemented seven of these preferences during the iterative design process. We deferred development for some of the preferences due to resource constraints. During individual usability testing (n = 8), we were able to identify 65 usability issues ranging from minor user confusion to critical errors that blocked task completion. The participatory development model that we used led to features and design revisions that were patient centered. We are currently evaluating new approaches for the application interface and for future research pathways. We encourage other researchers to adopt user-centered design approaches when building patient-centered technologies.\n

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\n \n\n \n \n Eaton, J.; Painter, I.; Olson, D.; and Lober, W. B.\n\n\n \n \n \n \n Visualizing the quality of partially accruing data for use in decision making.\n \n \n \n\n\n \n\n\n\n Online Journal of Public Health Informatics, 7(3): e226. 2015.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{eaton_visualizing_2015,\n\ttitle = {Visualizing the quality of partially accruing data for use in decision making},\n\tvolume = {7},\n\tissn = {1947-2579},\n\tdoi = {10.5210/ojphi.v7i3.6096},\n\tabstract = {Secondary use of clinical health data for near real-time public health surveillance presents challenges surrounding its utility due to data quality issues. Data used for real-time surveillance must be timely, accurate and complete if it is to be useful; if incomplete data are used for surveillance, understanding the structure of the incompleteness is necessary. Such data are commonly aggregated due to privacy concerns. The Distribute project was a near real-time influenza-like-illness (ILI) surveillance system that relied on aggregated secondary clinical health data. The goal of this work is to disseminate the data quality tools developed to gain insight into the data quality problems associated with these data. These tools apply in general to any system where aggregate data are accrued over time and were created through the end-user-as-developer paradigm. Each tool was developed during the exploratory analysis to gain insight into structural aspects of data quality. Our key finding is that data quality of partially accruing data must be studied in the context of accrual lag-the difference between the time an event occurs and the time data for that event are received, i.e. the time at which data become available to the surveillance system. Our visualization methods therefore revolve around visualizing dimensions of data quality affected by accrual lag, in particular the tradeoff between timeliness and completion, and the effects of accrual lag on accuracy. Accounting for accrual lag in partially accruing data is necessary to avoid misleading or biased conclusions about trends in indicator values and data quality.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Online Journal of Public Health Informatics},\n\tauthor = {Eaton, Julia and Painter, Ian and Olson, Don and Lober, William B.},\n\tyear = {2015},\n\tpmid = {27252794},\n\tpmcid = {PMC4874726},\n\tkeywords = {accrual lag, data quality, data visualization, incomplete data, partially accruing data, real-time surveillance, secondary-use data},\n\tpages = {e226},\n}\n\n

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\n \n 2014\n \n \n (11)\n \n \n

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\n \n\n \n \n Sanger, P.; Hartzler, A.; Lober, W. B.; Evans, H. L.; and Pratt, W.\n\n\n \n \n \n \n Design Considerations for Post-Acute Care mHealth: Patient Perspectives.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium, 2014: 1920–1929. 2014.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{sanger_design_2014,\n\ttitle = {Design {Considerations} for {Post}-{Acute} {Care} {mHealth}: {Patient} {Perspectives}},\n\tvolume = {2014},\n\tissn = {1942-597X},\n\tshorttitle = {Design {Considerations} for {Post}-{Acute} {Care} {mHealth}},\n\tabstract = {Many current mobile health applications ("apps") and most previous research have been directed at management of chronic illnesses. However, little is known about patient preferences and design considerations for apps intended to help in a post-acute setting. Our team is developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Post-discharge SSIs are a major source of morbidity and expense, and occur at a critical care transition when patients are physically and emotionally stressed. Through interviews with surgical patients who experienced SSI, we derived design considerations for such a post-acute care app. Key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. We illustrate our application of these guiding design considerations and propose a new framework for mHealth design based on illness duration and intensity.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Sanger, Patrick and Hartzler, Andrea and Lober, William B. and Evans, Heather L. and Pratt, Wanda},\n\tyear = {2014},\n\tpmid = {25954465},\n\tpmcid = {PMC4419922},\n\tkeywords = {Acute Disease, Adult, Aged, Attitude to Health, CIRG Selected, Continuity of Patient Care, Female, Humans, Male, Middle Aged, Mobile Applications, Patient Discharge, Self Care, Surgical Wound Infection, Telemedicine},\n\tpages = {1920--1929},\n}\n\n

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\n \n\n \n \n Lober, W. B.; Reeder, B.; Painter, I.; Revere, D.; Goldov, K.; Bugni, P. F.; McReynolds, J.; and Olson, D. R.\n\n\n \n \n \n \n Technical Description of the Distribute Project: A Community-based Syndromic Surveillance System Implementation.\n \n \n \n\n\n \n\n\n\n Online Journal of Public Health Informatics, 5(3): 224. 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_technical_2014,\n\ttitle = {Technical {Description} of the {Distribute} {Project}: {A} {Community}-based {Syndromic} {Surveillance} {System} {Implementation}},\n\tvolume = {5},\n\tissn = {1947-2579},\n\tshorttitle = {Technical {Description} of the {Distribute} {Project}},\n\tdoi = {10.5210/ojphi.v5i3.4938},\n\tabstract = {This paper describes the design of a syndromic surveillance system implemented for community-based monitoring of influenza-like illness. The system began as collaboration between colleagues from state and large metropolitan area health jurisdictions, academic institutions, and the non-profit, International Society for Disease Surveillance. Over the six influenza seasons from 2006 to 2012, the system was automated and enhanced, with new features and infrastructure, and the resulting, reliable, enterprise grade system supported peer comparisons between 44 state and local public health jurisdictions who voluntarily contributed summarized data on influenza-like illness and gastrointestinal syndromes. The system was unusual in that it addressed the needs of a widely distributed, voluntary, community engaged in real-time data integration to support operational public health.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Online Journal of Public Health Informatics},\n\tauthor = {Lober, William B. and Reeder, Blaine and Painter, Ian and Revere, Debra and Goldov, Kim and Bugni, Paul F. and McReynolds, Justin and Olson, Donald R.},\n\tyear = {2014},\n\tpmid = {24678377},\n\tpmcid = {PMC3959914},\n\tkeywords = {CIRG\\_Selected, Internet, public health standards, secondary use of health data, surveillance practice, syndromic surveillance},\n\tpages = {224},\n}\n\n

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\n \n\n \n \n Fredericksen, R.; Feldman, B. J.; Brown, T.; Schmidt, S.; Crane, P. K.; Harrington, R. D.; Dhanireddy, S.; McReynolds, J.; Lober, W. B.; Bangsberg, D. R.; Kitahata, M. M.; and Crane, H. M.\n\n\n \n \n \n \n Unannounced telephone-based pill counts: a valid and feasible method for monitoring adherence.\n \n \n \n\n\n \n\n\n\n AIDS and behavior, 18(12): 2265–2273. December 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{fredericksen_unannounced_2014,\n\ttitle = {Unannounced telephone-based pill counts: a valid and feasible method for monitoring adherence},\n\tvolume = {18},\n\tissn = {1573-3254},\n\tshorttitle = {Unannounced telephone-based pill counts},\n\tdoi = {10.1007/s10461-014-0916-7},\n\tabstract = {Phone-based unannounced pill counts to measure medication adherence are much more practical and less expensive than home-based unannounced pill counts, but their validity has not been widely assessed. We examined the validity of phone versus home-based pill counts using a simplified protocol streamlined for studies embedded in clinical care settings. A total of 100 paired counts were used to compare concordance between unannounced phone and home-based pill counts using interclass correlations. Discrepancy analyses using χ(2) tests compared demographic and clinical characteristics across patients who were concordant between phone and home-based pill counts and patients who were not concordant. Concordance was high for phone-based and home-based unannounced total pill counts, as well as individual medication counts and calculated adherence. This study demonstrates that a simplified phone-based pill count protocol can be implemented among patients from a routine clinical care setting and is a feasible means of monitoring medication adherence.},\n\tlanguage = {eng},\n\tnumber = {12},\n\tjournal = {AIDS and behavior},\n\tauthor = {Fredericksen, R. and Feldman, B. J. and Brown, T. and Schmidt, S. and Crane, P. K. and Harrington, R. D. and Dhanireddy, S. and McReynolds, J. and Lober, W. B. and Bangsberg, D. R. and Kitahata, M. M. and Crane, Heidi M.},\n\tmonth = dec,\n\tyear = {2014},\n\tpmid = {25331265},\n\tpmcid = {PMC4495998},\n\tkeywords = {Adult, Anti-HIV Agents, Clinical Protocols, Drug Administration Schedule, Female, HIV Infections, House Calls, Humans, Male, Medication Adherence, Middle Aged, Reproducibility of Results, Self Report, Telephone, Washington},\n\tpages = {2265--2273},\n}\n\n

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\n \n\n \n \n Edwards, J. K.; Cole, S. R.; Westreich, D.; Moore, R.; Mathews, C.; Geng, E.; Eron, J. J.; Mugavero, M. J.; and CNICS Research Network\n\n\n \n \n \n \n Loss to clinic and five-year mortality among HIV-infected antiretroviral therapy initiators.\n \n \n \n\n\n \n\n\n\n PloS One, 9(7): e102305. 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{edwards_loss_2014,\n\ttitle = {Loss to clinic and five-year mortality among {HIV}-infected antiretroviral therapy initiators},\n\tvolume = {9},\n\tissn = {1932-6203},\n\tdoi = {10.1371/journal.pone.0102305},\n\tabstract = {Missing outcome data due to loss to follow-up occurs frequently in clinical cohort studies of HIV-infected patients. Censoring patients when they become lost can produce inaccurate results if the risk of the outcome among the censored patients differs from the risk of the outcome among patients remaining under observation. We examine whether patients who are considered lost to follow up are at increased risk of mortality compared to those who remain under observation. Patients from the US Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) who newly initiated combination antiretroviral therapy between January 1, 1998 and December 31, 2009 and survived for at least one year were included in the study. Mortality information was available for all participants regardless of continued observation in the CNICS. We compare mortality between patients retained in the cohort and those lost-to-clinic, as commonly defined by a 12-month gap in care. Patients who were considered lost-to-clinic had modestly elevated mortality compared to patients who remained under observation after 5 years (risk ratio (RR): 1.2; 95\\% CI: 0.9, 1.5). Results were similar after redefining loss-to-clinic as 6 months (RR: 1.0; 95\\% CI: 0.8, 1.3) or 18 months (RR: 1.2; 95\\% CI: 0.8, 1.6) without a documented clinic visit. The small increase in mortality associated with becoming lost to clinic suggests that these patients were not lost to care, rather they likely transitioned to care at a facility outside the study. The modestly higher mortality among patients who were lost-to-clinic implies that when we necessarily censor these patients in studies of time-varying exposures, we are likely to incur at most a modest selection bias.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {PloS One},\n\tauthor = {Edwards, Jessie K. and Cole, Stephen R. and Westreich, Daniel and Moore, Richard and Mathews, Christopher and Geng, Elvin and Eron, Joseph J. and Mugavero, Michael J. and {CNICS Research Network}},\n\tyear = {2014},\n\tpmid = {25010739},\n\tpmcid = {PMC4092142},\n\tkeywords = {Adult, Antiretroviral Therapy, Highly Active, Cohort Studies, Female, HIV, HIV Infections, Humans, Male, Middle Aged, United States, Viral Load},\n\tpages = {e102305},\n}\n\n

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\n \n\n \n \n Duda, S. N.; Farr, A. M.; Lindegren, M. L.; Blevins, M.; Wester, C. W.; Wools-Kaloustian, K.; Ekouevi, D. K.; Egger, M.; Hemingway-Foday, J.; Cooper, D. A.; Moore, R. D.; McGowan, C. C.; Nash, D.; and International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration\n\n\n \n \n \n \n Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration.\n \n \n \n\n\n \n\n\n\n Journal of the International AIDS Society, 17: 19045. 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{duda_characteristics_2014,\n\ttitle = {Characteristics and comprehensiveness of adult {HIV} care and treatment programmes in {Asia}-{Pacific}, sub-{Saharan} {Africa} and the {Americas}: results of a site assessment conducted by the {International} epidemiologic {Databases} to {Evaluate} {AIDS} ({IeDEA}) {Collaboration}},\n\tvolume = {17},\n\tissn = {1758-2652},\n\tshorttitle = {Characteristics and comprehensiveness of adult {HIV} care and treatment programmes in {Asia}-{Pacific}, sub-{Saharan} {Africa} and the {Americas}},\n\tdoi = {10.7448/IAS.17.1.19045},\n\tabstract = {INTRODUCTION: HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide.\nMETHODS: Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services.\nRESULTS: Most sites reported serving urban (61\\%; region range (rr): 33-100\\%) and both adult and paediatric populations (77\\%; rr: 29-96\\%). Only 45\\% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72\\%, respectively. The remaining four essential services - nutritional support (82\\%), combination antiretroviral therapy adherence support (88\\%), prevention of mother-to-child transmission (PMTCT) (94\\%) and other prevention and clinical management services (97\\%) - were uniformly available. Approximately half (46\\%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services.\nCONCLUSIONS: This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.},\n\tlanguage = {eng},\n\tjournal = {Journal of the International AIDS Society},\n\tauthor = {Duda, Stephany N. and Farr, Amanda M. and Lindegren, Mary Lou and Blevins, Meridith and Wester, C. William and Wools-Kaloustian, Kara and Ekouevi, Didier K. and Egger, Matthias and Hemingway-Foday, Jennifer and Cooper, David A. and Moore, Richard D. and McGowan, Catherine C. and Nash, Denis and {International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration}},\n\tyear = {2014},\n\tpmid = {25516092},\n\tpmcid = {PMC4268491},\n\tkeywords = {Adult, Africa South of the Sahara, Americas, Australasia, Child, Child, Preschool, Comprehensive Health Care, Female, HIV Infections, HIV care capacity, HIV/AIDS, Health Services Research, Humans, Male, clinic characteristics, comprehensive care, resource-limited settings},\n\tpages = {19045},\n}\n\n

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\n INTRODUCTION: HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS: Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS: Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS: This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.\n

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\n \n\n \n \n Althoff, K. N.; Rebeiro, P.; Brooks, J. T.; Buchacz, K.; Gebo, K.; Martin, J.; Hogg, R.; Thorne, J. E.; Klein, M.; Gill, M. J.; Sterling, T. R.; Yehia, B.; Silverberg, M. J.; Crane, H.; Justice, A. C.; Gange, S. J.; Moore, R.; Kitahata, M. M.; Horberg, M. A.; North American AIDS Cohort Collaboration on Research; and (NA-ACCORD), D.\n\n\n \n \n \n \n Disparities in the quality of HIV care when using US Department of Health and Human Services indicators.\n \n \n \n\n\n \n\n\n\n Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 58(8): 1185–1189. April 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{althoff_disparities_2014,\n\ttitle = {Disparities in the quality of {HIV} care when using {US} {Department} of {Health} and {Human} {Services} indicators},\n\tvolume = {58},\n\tissn = {1537-6591},\n\tdoi = {10.1093/cid/ciu044},\n\tabstract = {We estimated US Department of Health and Human Services (DHHS)-approved human immunodeficiency virus (HIV) indicators. Among patients, 71\\% were retained in care, 82\\% were prescribed treatment, and 78\\% had HIV RNA ≤200 copies/mL; younger adults, women, blacks, and injection drug users had poorer outcomes. Interventions are needed to reduce retention- and treatment-related disparities.},\n\tlanguage = {eng},\n\tnumber = {8},\n\tjournal = {Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America},\n\tauthor = {Althoff, Keri N. and Rebeiro, Peter and Brooks, John T. and Buchacz, Kate and Gebo, Kelly and Martin, Jeffrey and Hogg, Robert and Thorne, Jennifer E. and Klein, Marina and Gill, M. John and Sterling, Timothy R. and Yehia, Baligh and Silverberg, Michael J. and Crane, Heidi and Justice, Amy C. and Gange, Stephen J. and Moore, Richard and Kitahata, Mari M. and Horberg, Michael A. and {North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)}},\n\tmonth = apr,\n\tyear = {2014},\n\tpmid = {24463281},\n\tpmcid = {PMC3967825},\n\tkeywords = {Adult, Aged, Aged, 80 and over, Anti-Retroviral Agents, Cohort Studies, Continuity of Patient Care, Cross-Sectional Studies, Female, HIV, HIV Infections, HIV RNA suppression, Healthcare Disparities, Humans, Male, Middle Aged, United States, United States Dept. of Health and Human Services, Viral Load, antiretroviral therapy, quality of care, retention in care},\n\tpages = {1185--1189},\n}\n\n

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\n \n\n \n \n Berry, D. L.; Hong, F.; Halpenny, B.; Partridge, A. H.; Fann, J. R.; Wolpin, S.; Lober, W. B.; Bush, N. E.; Parvathaneni, U.; Back, A. L.; Amtmann, D.; and Ford, R.\n\n\n \n \n \n \n Electronic self-report assessment for cancer and self-care support: results of a multicenter randomized trial.\n \n \n \n\n\n \n\n\n\n Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 32(3): 199–205. January 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{berry_electronic_2014,\n\ttitle = {Electronic self-report assessment for cancer and self-care support: results of a multicenter randomized trial},\n\tvolume = {32},\n\tissn = {1527-7755},\n\tshorttitle = {Electronic self-report assessment for cancer and self-care support},\n\tdoi = {10.1200/JCO.2013.48.6662},\n\tabstract = {PURPOSE: The purpose of this trial was to evaluate the effect of a Web-based, self-report assessment and educational intervention on symptom distress during cancer therapy.\nPATIENTS AND METHODS: A total of 752 ambulatory adult participants were randomly assigned to symptom/quality-of-life (SxQOL) screening at four time points (control) versus screening, targeted education, communication coaching, and the opportunity to track/graph SxQOL over time (intervention). A summary of the participant-reported data was delivered to clinicians at each time point in both groups. All participants used the assessment before a new therapeutic regimen, at 3 to 6 weeks and 6 to 8 weeks later, completing the final assessment at the end of therapy. Change in Symptom Distress Scale-15 (SDS-15) score from pretreatment to end of study was compared using analysis of covariance and regression analysis adjusting for selected variables.\nRESULTS: We detected a significant difference between study groups in mean SDS-15 score change from baseline to end of study: 1.27 (standard deviation [SD], 6.7) in the control group (higher distress) versus -0.04 (SD, 5.8) in the intervention group (lower distress). SDS-15 score was reduced by an estimated 1.21 (95\\% CI, 0.23 to 2.20; P = .02) in the intervention group. Baseline SDS-15 score (P {\\textless} .001) and clinical service (P = .01) were predictive. Multivariable analyses suggested an interaction between age and study group (P = .06); in subset analysis, the benefit of intervention was strongest in those age {\\textgreater} 50 years (P = .002).\nCONCLUSION: Web-based self-care support and communication coaching added to SxQOL screening reduced symptom distress in a multicenter sample of participants with various diagnoses during and after active cancer treatment. Participants age {\\textgreater} 50 years, in particular, may have benefited from the intervention.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology},\n\tauthor = {Berry, Donna L. and Hong, Fangxin and Halpenny, Barbara and Partridge, Ann H. and Fann, Jesse R. and Wolpin, Seth and Lober, William B. and Bush, Nigel E. and Parvathaneni, Upendra and Back, Anthony L. and Amtmann, Dagmar and Ford, Rosemary},\n\tmonth = jan,\n\tyear = {2014},\n\tpmid = {24344222},\n\tpmcid = {PMC3887477},\n\tkeywords = {Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Female, Humans, Internet, Male, Middle Aged, Neoplasms, Patient Education as Topic, Patient-Centered Care, Prospective Studies, Quality of Life, Self Care, Self Report, Surveys and Questionnaires, Treatment Outcome},\n\tpages = {199--205},\n}\n\n

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\n \n\n \n \n Berry, D. L.; Hong, F.; Halpenny, B.; Partridge, A.; Fox, E.; Fann, J. R.; Wolpin, S.; Lober, W. B.; Bush, N.; Parvathaneni, U.; Amtmann, D.; and Ford, R.\n\n\n \n \n \n \n The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial.\n \n \n \n\n\n \n\n\n\n BMC cancer, 14: 513. July 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{berry_electronic_2014-1,\n\ttitle = {The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial},\n\tvolume = {14},\n\tissn = {1471-2407},\n\tshorttitle = {The electronic self report assessment and intervention for cancer},\n\tdoi = {10.1186/1471-2407-14-513},\n\tabstract = {BACKGROUND: The electronic self report assessment - cancer (ESRA-C), has been shown to reduce symptom distress during cancer therapy The purpose of this analysis was to evaluate aspects of how the ESRA-C intervention may have resulted in lower symptom distress (SD).\nMETHODS: Patients at two cancer centers were randomized to ESRA-C assessment only (control) or the Web-based ESRA-C intervention delivered to patients' homes or to a tablet in clinic. The intervention allowed patients to self-monitor symptom and quality of life (SxQOL) between visits, receive self-care education and coaching to report SxQOL to clinicians. Summaries of assessments were delivered to clinicians in both groups. Audio-recordings of clinic visits made 6 weeks after treatment initiation were coded for discussions of 26 SxQOL issues, focusing on patients'/caregivers' coached verbal reports of SxQOL severity, pattern, alleviating/aggravating factors and requests for help. Among issues identified as problematic, two measures were defined for each patient: the percent SxQOL reported that included a coached statement, and an index of verbalized coached statements per SxQOL. The Wilcoxon rank test was used to compare measures between groups. Clinician responses to problematic SxQOL were compared. A mediation analysis was conducted, exploring the effect of verbal reports on SD outcomes.\nRESULTS: 517 (256 intervention) clinic visits were audio-recorded. General discussion of problematic SxQOL was similar in both groups. Control group patients reported a median 75\\% of problematic SxQOL using any specific coached statement compared to a median 85\\% in the intervention group (p = .0009). The median report index of coached statements was 0.25 for the control group and 0.31 for the intervention group (p = 0.008). Fatigue, pain and physical function issues were reported significantly more often in the intervention group (all p {\\textless} .05). Clinicians' verbalized responses did not differ between groups. Patients' verbal reports did not mediate final SD outcomes (p = .41).\nCONCLUSIONS: Adding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reports.\nTRIAL REGISTRATION: NCT00852852; 26 Feb 2009.},\n\tlanguage = {eng},\n\tjournal = {BMC cancer},\n\tauthor = {Berry, Donna L. and Hong, Fangxin and Halpenny, Barbara and Partridge, Anne and Fox, Erica and Fann, Jesse R. and Wolpin, Seth and Lober, William B. and Bush, Nigel and Parvathaneni, Upendra and Amtmann, Dagmar and Ford, Rosemary},\n\tmonth = jul,\n\tyear = {2014},\n\tpmid = {25014995},\n\tpmcid = {PMC4226951},\n\tkeywords = {Adult, Aged, Aged, 80 and over, Female, Humans, Internet, Male, Middle Aged, Neoplasms, Patient Education as Topic, Patient-Centered Care, Quality of Life, Self Report, Surveys and Questionnaires, Young Adult},\n\tpages = {513},\n}\n\n

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\n BACKGROUND: The electronic self report assessment - cancer (ESRA-C), has been shown to reduce symptom distress during cancer therapy The purpose of this analysis was to evaluate aspects of how the ESRA-C intervention may have resulted in lower symptom distress (SD). METHODS: Patients at two cancer centers were randomized to ESRA-C assessment only (control) or the Web-based ESRA-C intervention delivered to patients' homes or to a tablet in clinic. The intervention allowed patients to self-monitor symptom and quality of life (SxQOL) between visits, receive self-care education and coaching to report SxQOL to clinicians. Summaries of assessments were delivered to clinicians in both groups. Audio-recordings of clinic visits made 6 weeks after treatment initiation were coded for discussions of 26 SxQOL issues, focusing on patients'/caregivers' coached verbal reports of SxQOL severity, pattern, alleviating/aggravating factors and requests for help. Among issues identified as problematic, two measures were defined for each patient: the percent SxQOL reported that included a coached statement, and an index of verbalized coached statements per SxQOL. The Wilcoxon rank test was used to compare measures between groups. Clinician responses to problematic SxQOL were compared. A mediation analysis was conducted, exploring the effect of verbal reports on SD outcomes. RESULTS: 517 (256 intervention) clinic visits were audio-recorded. General discussion of problematic SxQOL was similar in both groups. Control group patients reported a median 75% of problematic SxQOL using any specific coached statement compared to a median 85% in the intervention group (p = .0009). The median report index of coached statements was 0.25 for the control group and 0.31 for the intervention group (p = 0.008). Fatigue, pain and physical function issues were reported significantly more often in the intervention group (all p \\textless .05). Clinicians' verbalized responses did not differ between groups. Patients' verbal reports did not mediate final SD outcomes (p = .41). CONCLUSIONS: Adding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reports. TRIAL REGISTRATION: NCT00852852; 26 Feb 2009.\n

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\n \n\n \n \n Crane, H. M.; Heckbert, S. R.; Drozd, D. R.; Budoff, M. J.; Delaney, J. a. C.; Rodriguez, C.; Paramsothy, P.; Lober, W. B.; Burkholder, G.; Willig, J. H.; Mugavero, M. J.; Mathews, W. C.; Crane, P. K.; Moore, R. D.; Napravnik, S.; Eron, J. J.; Hunt, P.; Geng, E.; Hsue, P.; Barnes, G. S.; McReynolds, J.; Peter, I.; Grunfeld, C.; Saag, M. S.; Kitahata, M. M.; and Centers for AIDS Research Network of Integrated Clinical Systems Cohort Investigators\n\n\n \n \n \n \n Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.\n \n \n \n\n\n \n\n\n\n American Journal of Epidemiology, 179(8): 996–1005. April 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{crane_lessons_2014,\n\ttitle = {Lessons learned from the design and implementation of myocardial infarction adjudication tailored for {HIV} clinical cohorts},\n\tvolume = {179},\n\tissn = {1476-6256},\n\tdoi = {10.1093/aje/kwu010},\n\tabstract = {We developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. Potential events were identified through the centralized Centers for AIDS Research Network of Integrated Clinical Systems data repository using MI diagnoses and/or cardiac enzyme laboratory results (1995-2012). Sites assembled de-identified packets, including physician notes and results from electrocardiograms, procedures, and laboratory tests. Information pertaining to the specific antiretroviral medications used was redacted for blinded review. Two experts reviewed each packet, and a third review was conducted if discrepancies occurred. Reviewers categorized probable/definite MIs as primary or secondary and identified secondary causes of MIs. The positive predictive value and sensitivity for each identification/ascertainment method were calculated. Of the 1,119 potential events that were adjudicated, 294 (26\\%) were definite/probable MIs. Almost as many secondary (48\\%) as primary (52\\%) MIs occurred, often as the result of sepsis or cocaine use. Of the patients with adjudicated definite/probable MIs, 78\\% had elevated troponin concentrations (positive predictive value = 57\\%, 95\\% confidence interval: 52, 62); however, only 44\\% had clinical diagnoses of MI (positive predictive value = 45\\%, 95\\% confidence interval: 39, 51). We found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half of the events ultimately determined to be MIs were not identified by clinical diagnoses. Adjudication protocols used in traditional cardiovascular disease cohorts facilitate cross-cohort comparisons but do not address issues such as identifying secondary MIs that may be common in persons with human immunodeficiency virus.},\n\tlanguage = {eng},\n\tnumber = {8},\n\tjournal = {American Journal of Epidemiology},\n\tauthor = {Crane, H. M. and Heckbert, S. R. and Drozd, D. R. and Budoff, M. J. and Delaney, J. a. C. and Rodriguez, C. and Paramsothy, P. and Lober, W. B. and Burkholder, G. and Willig, J. H. and Mugavero, M. J. and Mathews, W. C. and Crane, P. K. and Moore, R. D. and Napravnik, S. and Eron, J. J. and Hunt, P. and Geng, E. and Hsue, P. and Barnes, G. S. and McReynolds, J. and Peter, I. and Grunfeld, C. and Saag, M. S. and Kitahata, M. M. and {Centers for AIDS Research Network of Integrated Clinical Systems Cohort Investigators}},\n\tmonth = apr,\n\tyear = {2014},\n\tpmid = {24618065},\n\tpmcid = {PMC3966717},\n\tkeywords = {Adult, Aged, Aged, 80 and over, Cohort Studies, Decision Support Techniques, Epidemiologic Research Design, False Positive Reactions, Female, HIV, HIV Infections, Humans, Male, Middle Aged, Myocardial Infarction, Predictive Value of Tests, Sensitivity and Specificity, Single-Blind Method, myocardial infarction, validation},\n\tpages = {996--1005},\n}\n\n

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\n \n\n \n \n Crane, H. M.; Heckbert, S. R.; Drozd, D. R.; Budoff, M. J.; Delaney, J. a. C.; Rodriguez, C.; Paramsothy, P.; Lober, W. B.; Burkholder, G.; Willig, J. H.; Mugavero, M. J.; Mathews, W. C.; Crane, P. K.; Moore, R. D.; Napravnik, S.; Eron, J. J.; Hunt, P.; Geng, E.; Hsue, P.; Barnes, G. S.; McReynolds, J.; Peter, I.; Grunfeld, C.; Saag, M. S.; and Kitahata, M. M.\n\n\n \n \n \n \n The authors reply.\n \n \n \n\n\n \n\n\n\n American Journal of Epidemiology, 180(4): 450. August 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{crane_authors_2014,\n\ttitle = {The authors reply},\n\tvolume = {180},\n\tissn = {1476-6256},\n\tdoi = {10.1093/aje/kwu167},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {American Journal of Epidemiology},\n\tauthor = {Crane, H. M. and Heckbert, S. R. and Drozd, D. R. and Budoff, M. J. and Delaney, J. a. C. and Rodriguez, C. and Paramsothy, P. and Lober, W. B. and Burkholder, G. and Willig, J. H. and Mugavero, M. J. and Mathews, W. C. and Crane, P. K. and Moore, R. D. and Napravnik, S. and Eron, J. J. and Hunt, P. and Geng, E. and Hsue, P. and Barnes, G. S. and McReynolds, J. and Peter, I. and Grunfeld, C. and Saag, M. S. and Kitahata, M. M.},\n\tmonth = aug,\n\tyear = {2014},\n\tpmid = {24989243},\n\tpmcid = {PMC4809980},\n\tkeywords = {Decision Support Techniques, Epidemiologic Research Design, Female, HIV Infections, Humans, Male, Myocardial Infarction},\n\tpages = {450},\n}\n\n

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\n \n\n \n \n Sanger, P. C.; Hartzler, A.; Han, S. M.; Armstrong, C. A. L.; Stewart, M. R.; Lordon, R. J.; Lober, W. B.; and Evans, H. L.\n\n\n \n \n \n \n Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution.\n \n \n \n\n\n \n\n\n\n PloS One, 9(12): e114016. 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{sanger_patient_2014,\n\ttitle = {Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution},\n\tvolume = {9},\n\tissn = {1932-6203},\n\tshorttitle = {Patient perspectives on post-discharge surgical site infections},\n\tdoi = {10.1371/journal.pone.0114016},\n\tabstract = {BACKGROUND: Post-discharge surgical site infections (SSI) are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth) wound monitoring "app" as a novel solution to address this problem.\nMETHODS: Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center.\nRESULTS: From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges.\nCONCLUSIONS: Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home.},\n\tlanguage = {eng},\n\tnumber = {12},\n\tjournal = {PloS One},\n\tauthor = {Sanger, Patrick C. and Hartzler, Andrea and Han, Sarah M. and Armstrong, Cheryl A. L. and Stewart, Mark R. and Lordon, Ross J. and Lober, William B. and Evans, Heather L.},\n\tyear = {2014},\n\tpmid = {25436912},\n\tpmcid = {PMC4250175},\n\tkeywords = {Adult, Aged, Female, Humans, Male, Middle Aged, Mobile Applications, Patient Discharge, Risk Factors, Surgical Wound Infection, Surveys and Questionnaires, Telemedicine, Young Adult},\n\tpages = {e114016},\n}\n\n

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\n \n\n \n \n Smith, P. F.; Hadler, J. L.; Stanbury, M.; Rolfs, R. T.; Hopkins, R. S.; and CSTE Surveillance Strategy Group\n\n\n \n \n \n \n \"Blueprint version 2.0\": updating public health surveillance for the 21st century.\n \n \n \n\n\n \n\n\n\n Journal of public health management and practice: JPHMP, 19(3): 231–239. June 2013.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{smith_blueprint_2013,\n\ttitle = {"{Blueprint} version 2.0": updating public health surveillance for the 21st century},\n\tvolume = {19},\n\tissn = {1550-5022},\n\tshorttitle = {"{Blueprint} version 2.0"},\n\tdoi = {10.1097/PHH.0b013e318262906e},\n\tabstract = {Rapid changes to the United States public health system challenge the current strategic approach to surveillance. During 2011, the Council of State and Territorial Epidemiologists convened national experts to reassess public health surveillance in the United States and update surveillance strategies that were published in a 1996 report and endorsed by the Council of State and Territorial Epidemiologists. Although surveillance goals, historical influences, and most methods have not changed, surveillance is being transformed by 3 influences: public health information and preparedness as national security issues; new information technologies; and health care reform. Each offers opportunities for surveillance, but each also presents challenges that public health epidemiologists can best meet by rigorously applying surveillance evaluation concepts, engaging in national standardization activities driven by electronic technologies and health care reform, and ensuring an adequately trained epidemiology workforce.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Journal of public health management and practice: JPHMP},\n\tauthor = {Smith, Perry F. and Hadler, James L. and Stanbury, Martha and Rolfs, Robert T. and Hopkins, Richard S. and {CSTE Surveillance Strategy Group}},\n\tmonth = jun,\n\tyear = {2013},\n\tpmid = {22759985},\n\tkeywords = {Government, Health Care Reform, History, 21st Century, Humans, Medical Informatics, Public Health Surveillance, United States},\n\tpages = {231--239},\n}\n\n

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\n \n\n \n \n Berry, D. L.; Halpenny, B.; Hong, F.; Wolpin, S.; Lober, W. B.; Russell, K. J.; Ellis, W. J.; Govindarajulu, U.; Bosco, J.; Davison, B. J.; Bennett, G.; Terris, M. K.; Barsevick, A.; Lin, D. W.; Yang, C. C.; and Swanson, G.\n\n\n \n \n \n \n The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: a multi-center randomized trial.\n \n \n \n\n\n \n\n\n\n Urologic Oncology, 31(7): 1012–1021. October 2013.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{berry_personal_2013,\n\ttitle = {The {Personal} {Patient} {Profile}-{Prostate} decision support for men with localized prostate cancer: a multi-center randomized trial},\n\tvolume = {31},\n\tissn = {1873-2496},\n\tshorttitle = {The {Personal} {Patient} {Profile}-{Prostate} decision support for men with localized prostate cancer},\n\tdoi = {10.1016/j.urolonc.2011.10.004},\n\tabstract = {OBJECTIVE: The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice.\nMETHODS: A randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored.\nRESULTS: A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate -3.61; (confidence interval, -7.01, 0.22), and values clarity (estimate -3.57; confidence interval (-5.85,-1.30). Borderline effect was seen for the total decisional conflict score (estimate -1.75; confidence interval (-3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated.\nCONCLUSION: The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Urologic Oncology},\n\tauthor = {Berry, Donna L. and Halpenny, Barbara and Hong, Fangxin and Wolpin, Seth and Lober, William B. and Russell, Kenneth J. and Ellis, William J. and Govindarajulu, Usha and Bosco, Jaclyn and Davison, B. Joyce and Bennett, Gerald and Terris, Martha K. and Barsevick, Andrea and Lin, Daniel W. and Yang, Claire C. and Swanson, Greg},\n\tmonth = oct,\n\tyear = {2013},\n\tpmid = {22153756},\n\tpmcid = {PMC3349002},\n\tkeywords = {Adult, Aged, Aged, 80 and over, Choice Behavior, Decision Making, Decision making, Decisional conflict, Health Knowledge, Attitudes, Practice, Humans, Internet, Linear Models, Male, Middle Aged, Outcome Assessment, Health Care, Patient Education as Topic, Prospective Studies, Prostate cancer, Prostatic Neoplasms, Randomized trial},\n\tpages = {1012--1021},\n}\n\n

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\n OBJECTIVE: The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice. METHODS: A randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored. RESULTS: A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate -3.61; (confidence interval, -7.01, 0.22), and values clarity (estimate -3.57; confidence interval (-5.85,-1.30). Borderline effect was seen for the total decisional conflict score (estimate -1.75; confidence interval (-3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated. CONCLUSION: The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences.\n

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\n \n 2012\n \n \n (5)\n \n \n

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\n \n\n \n \n Reeder, B.; Revere, D.; Hills, R. A.; Baseman, J. G.; and Lober, W. B.\n\n\n \n \n \n \n Public Health Practice within a Health Information Exchange: Information Needs and Barriers to Disease Surveillance.\n \n \n \n\n\n \n\n\n\n Online Journal of Public Health Informatics, 4(3). 2012.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{reeder_public_2012,\n\ttitle = {Public {Health} {Practice} within a {Health} {Information} {Exchange}: {Information} {Needs} and {Barriers} to {Disease} {Surveillance}},\n\tvolume = {4},\n\tissn = {1947-2579},\n\tshorttitle = {Public {Health} {Practice} within a {Health} {Information} {Exchange}},\n\tdoi = {10.5210/ojphi.v4i3.4277},\n\tabstract = {INTRODUCTION: Public health professionals engage in frequent exchange of health information while pursuing the objectives of protecting and improving population health. Yet, there has been little study of the information work of public health workers with regard to information exchange. Our objective was to gain a better understanding of information work at a local health jurisdiction before and during the early stages of participation in a regional Health Information Exchange.\nMETHODS: We investigated the information work of public health workers engaged in disease surveillance activities at a medium-sized local health jurisdiction by conducting semi-structured interviews and thematically analyzing interview transcripts.\nRESULTS: ANALYSIS OF THE INFORMATION WORK OF PUBLIC HEALTH WORKERS REVEALED BARRIERS IN THE FOLLOWING AREAS: information system usability; data timeliness, accuracy and completeness; and social interaction with clients. We illustrate these barriers by focusing on the work of epidemiologists.\nCONCLUSION: Characterizing information work and barriers to information exchange for public health workers should be part of early system design efforts. A comprehensive understanding of the information practice of public health workers will inform the design of systems that better support public health work.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Online Journal of Public Health Informatics},\n\tauthor = {Reeder, Blaine and Revere, Debra and Hills, Rebecca A. and Baseman, Janet G. and Lober, William B.},\n\tyear = {2012},\n\tpmid = {23569649},\n\tpmcid = {PMC3615831},\n\tkeywords = {CIRG Selected, Communication Barriers, Disease Notification, Health Information Technology, Information Services, Public Health Informatics, Public Health Practice},\n}\n\n

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\n \n\n \n \n Matheson, A. I.; Baseman, J. G.; Wagner, S. H.; O'Malley, G. E.; Puttkammer, N. H.; Emmanuel, E.; Zamor, G.; Frédéric, R.; Coq, N. R.; and Lober, W. B.\n\n\n \n \n \n \n Implementation and expansion of an electronic medical record for HIV care and treatment in Haiti: an assessment of system use and the impact of large-scale disruptions.\n \n \n \n\n\n \n\n\n\n International Journal of Medical Informatics, 81(4): 244–256. April 2012.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{matheson_implementation_2012,\n\ttitle = {Implementation and expansion of an electronic medical record for {HIV} care and treatment in {Haiti}: an assessment of system use and the impact of large-scale disruptions},\n\tvolume = {81},\n\tissn = {1872-8243},\n\tshorttitle = {Implementation and expansion of an electronic medical record for {HIV} care and treatment in {Haiti}},\n\tdoi = {10.1016/j.ijmedinf.2012.01.011},\n\tabstract = {PURPOSE: System use is a key criterion of success in an electronic medical record (EMR) implementation, and there is little research on long-term use of systems following implementation. The aim of the paper was to describe the development, implementation and use of iSanté, Haiti's national HIV care and treatment EMR.\nMETHODS: To build a picture of the history of iSanté, we interviewed 11 staff involved with the development and implementation of the EMR, and reviewed organization records. Data entry and report use were ascertained by querying the central patient database.\nRESULTS: By the end of 2010 there were 67 sites with iSanté installed, and the scope of the system had been expanded to include primary care and obstetrics and gynecology. New functionality includes data forms specific to subpopulations, the ability to transfer patient records among clinics, and integration with an electronic laboratory system. We observed fluctuations in use over time, with substantial reductions in the number of active sites during times of large-scale disruptions in Haiti. A surge in report use following the January 2010 earthquake suggests that clinics found the EMR to be a valuable source of data during the recovery phase.\nCONCLUSION: There is real potential for EMRs in developing countries to improve clinical practice and make data available for efficient reporting, quality improvement and other population health uses. An approach of continuous system improvement, combined with regular assessments of use, is necessary for achieving an effective, national implementation of a standardized EMR. We have achieved successes in terms of rolling out new functionality and expanding to new sites, but more work remains to be done to improve perceptions of data quality and increase use of population data for accurate and timely reporting.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {International Journal of Medical Informatics},\n\tauthor = {Matheson, Alastair I. and Baseman, Janet G. and Wagner, Stephen H. and O'Malley, Gabrielle E. and Puttkammer, Nancy H. and Emmanuel, Emmlyne and Zamor, Garry and Frédéric, Rikerdy and Coq, Nancy R. and Lober, William B.},\n\tmonth = apr,\n\tyear = {2012},\n\tpmid = {22361158},\n\tkeywords = {Attitude of Health Personnel, CIRG\\_Selected, HIV, HIV Infections, Haiti, Health Plan Implementation, Hospital Information Systems, Humans, Medical Records Systems, Computerized, Quality of Health Care},\n\tpages = {244--256},\n}\n\n

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\n \n\n \n \n May, M. T.; Hogg, R. S.; Justice, A. C.; Shepherd, B. E.; Costagliola, D.; Ledergerber, B.; Thiébaut, R.; Gill, M. J.; Kirk, O.; van Sighem, A.; Saag, M. S.; Navarro, G.; Sobrino-Vegas, P.; Lampe, F.; Ingle, S.; Guest, J. L.; Crane, H. M.; D'Arminio Monforte, A.; Vehreschild, J. J.; Sterne, J. A. C.; and Antiretroviral Therapy Cohort Collaboration (ART-CC)\n\n\n \n \n \n \n Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics.\n \n \n \n\n\n \n\n\n\n International Journal of Epidemiology, 41(6): 1807–1820. December 2012.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{may_heterogeneity_2012,\n\ttitle = {Heterogeneity in outcomes of treated {HIV}-positive patients in {Europe} and {North} {America}: relation with patient and cohort characteristics},\n\tvolume = {41},\n\tissn = {1464-3685},\n\tshorttitle = {Heterogeneity in outcomes of treated {HIV}-positive patients in {Europe} and {North} {America}},\n\tdoi = {10.1093/ije/dys164},\n\tabstract = {BACKGROUND: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear.\nMETHODS: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression.\nRESULTS: During 61 520 person-years, 754/38 706 (1.9\\%) patients died and 1890 (4.9\\%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100\\%, good: 90-95\\%, average: 75-89\\%; mortality rate ratio 0.66 (95\\% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment.\nCONCLUSIONS: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.},\n\tlanguage = {eng},\n\tnumber = {6},\n\tjournal = {International Journal of Epidemiology},\n\tauthor = {May, Margaret T. and Hogg, Robert S. and Justice, Amy C. and Shepherd, Bryan E. and Costagliola, Dominique and Ledergerber, Bruno and Thiébaut, Rodolphe and Gill, M. John and Kirk, Ole and van Sighem, Ard and Saag, Michael S. and Navarro, Gemma and Sobrino-Vegas, Paz and Lampe, Fiona and Ingle, Suzanne and Guest, Jodie L. and Crane, Heidi M. and D'Arminio Monforte, Antonella and Vehreschild, Jörg J. and Sterne, Jonathan A. C. and {Antiretroviral Therapy Cohort Collaboration (ART-CC)}},\n\tmonth = dec,\n\tyear = {2012},\n\tpmid = {23148105},\n\tpmcid = {PMC3535877},\n\tkeywords = {Acquired Immunodeficiency Syndrome, Adolescent, Adult, Age Factors, Aged, Anti-Retroviral Agents, CD4 Lymphocyte Count, Europe, Female, HIV Infections, HIV Seropositivity, Humans, Male, Middle Aged, North America, Prognosis, Risk Factors, Sex Factors, Young Adult},\n\tpages = {1807--1820},\n}\n\n

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\n \n\n \n \n Hills, R. A.; Revere, D.; Altamore, R.; Abernethy, N. F.; and Lober, W. B.\n\n\n \n \n \n \n Timeliness and data element completeness of immunization data in Washington State in 2010: a comparison of data exchange methods.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium, 2012: 340–349. 2012.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{hills_timeliness_2012,\n\ttitle = {Timeliness and data element completeness of immunization data in {Washington} {State} in 2010: a comparison of data exchange methods},\n\tvolume = {2012},\n\tissn = {1942-597X},\n\tshorttitle = {Timeliness and data element completeness of immunization data in {Washington} {State} in 2010},\n\tabstract = {Health information systems receive data through various methods. These data exchange methods have the potential to influence data quality. We assessed a de-identified 2010 dataset including 757,476 demographic records and 2,634,101 vaccination records from Washington State's Immunization Information System (IIS) to describe timeliness and completeness of IIS data across several data exchange methods: manual entry, HL7, and flat file upload. Overall, manually-entered data and HL7 records were more timely than records imported as flat files. Completeness, though very high overall, was slightly higher for records arriving via flat file. Washington State IIS users, including clinicians and public health, rely on its data to inform patient care and determine population coverage of immunizations. Our results suggest that although data element completeness in systems like Washington's IIS will likely not be immediately or significantly impacted by provider's migration to HL7 connections with IISs, timeliness could be substantially improved when using HL7 connections.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Hills, Rebecca A. and Revere, Debra and Altamore, Rita and Abernethy, Neil F. and Lober, William B.},\n\tyear = {2012},\n\tpmid = {23304304},\n\tpmcid = {PMC3540489},\n\tkeywords = {Birth Certificates, Child, Demography, Health Information Systems, Humans, Immunization Programs, Infant, Quality Control, Vaccination, Washington},\n\tpages = {340--349},\n}\n\n

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\n \n\n \n \n Fredericksen, R.; Crane, P. K.; Tufano, J.; Ralston, J.; Schmidt, S.; Brown, T.; Layman, D.; Harrington, R. D.; Dhanireddy, S.; Stone, T.; Lober, W.; Kitahata, M. M.; and Crane, H. M.\n\n\n \n \n \n \n Integrating a web-based, patient-administered assessment into primary care for HIV-infected adults.\n \n \n \n\n\n \n\n\n\n Journal of AIDS and HIV research (Online), 4(2): 47–55. February 2012.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{fredericksen_integrating_2012,\n\ttitle = {Integrating a web-based, patient-administered assessment into primary care for {HIV}-infected adults},\n\tvolume = {4},\n\tissn = {2141-2359},\n\tdoi = {10.5897/jahr11.046},\n\tabstract = {Providers routinely under diagnose at risk behaviors and outcomes, including depression, suicidal ideation, substance abuse, and poor medication adherence. To address this, we developed a web-based, self-administered patient-reported assessment tool and integrated it into routine primary care for HIV-infected adults. Printed results were delivered to providers and social workers immediately prior to patient appointments. The assessment included brief, validated instruments measuring clinically relevant domains including depression, substance use, medication adherence, and HIV transmission risk behaviors. Utilizing the Institute for Healthcare Improvement's Plan-Do-Study-Act (PDSA) approach to quality improvement, we addressed issues with clinic flow, technology, scheduling, and delivery of assessment results with the support of all levels of clinic staff. We found web-based patient-reported assessments to be a feasible tool that can be integrated into a busy multi-provider HIV primary care clinic. These assessments may improve provider recognition of key patient behaviors and outcomes. Critical factors for successful integration of such assessments into clinical care include: strong top-level /ort from clinic management, provider understanding of patient-reported assessments as a valuable clinical tool, tailoring the assessment to meet provider needs, communication among clinic staff to address flow issues, timeliness of delivery, and sound technological resources.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Journal of AIDS and HIV research (Online)},\n\tauthor = {Fredericksen, R. and Crane, P. K. and Tufano, J. and Ralston, J. and Schmidt, S. and Brown, T. and Layman, D. and Harrington, R. D. and Dhanireddy, S. and Stone, T. and Lober, W. and Kitahata, M. M. and Crane, H. M.},\n\tmonth = feb,\n\tyear = {2012},\n\tpmid = {26561537},\n\tpmcid = {PMC4638326},\n\tkeywords = {HIV-infection, Patient-reported outcomes, patient-provider communication, plan-do-study-act (PDSA) cycle, quality improvement},\n\tpages = {47--55},\n}\n\n

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\n \n 2011\n \n \n (6)\n \n \n

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\n \n\n \n \n Lober, W. B.; and Flowers, J. L.\n\n\n \n \n \n \n Consumer empowerment in health care amid the internet and social media.\n \n \n \n\n\n \n\n\n\n Seminars in Oncology Nursing, 27(3): 169–182. August 2011.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_consumer_2011,\n\ttitle = {Consumer empowerment in health care amid the internet and social media},\n\tvolume = {27},\n\tissn = {1878-3449},\n\tdoi = {10.1016/j.soncn.2011.04.002},\n\tabstract = {OBJECTIVES: Consumer empowerment in health and rapid change in health information and communication technologies have their roots in broader social trends. This article reviews the activities at the intersection of consumer empowerment and technology.\nDATA SOURCES: Technical reports, white papers, books, journal articles, and Web sites.\nCONCLUSION: Social trends are visible in the integration of information and communication technologies into health care, in both searching for and sharing information on the Internet, in the use of social media to create new types of interactions with family, providers, and peers, and in the e-patient, who integrates these new roles and new technologies.\nIMPLICATIONS FOR NURSING PRACTICE: Changes in both patients and technology will impact oncology nursing practice as new, patient-centered, interactions emerge.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Seminars in Oncology Nursing},\n\tauthor = {Lober, William B. and Flowers, Janine L.},\n\tmonth = aug,\n\tyear = {2011},\n\tpmid = {21783008},\n\tkeywords = {CIRG Selected, Community Participation, Health Education, Humans, Internet, Power, Psychological, Social Support},\n\tpages = {169--182},\n}\n\n

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\n \n\n \n \n Kim, E.; Coumar, A.; Lober, W. B.; and Kim, Y.\n\n\n \n \n \n \n Addressing mental health epidemic among university students via web-based, self-screening, and referral system: a preliminary study.\n \n \n \n\n\n \n\n\n\n IEEE transactions on information technology in biomedicine: a publication of the IEEE Engineering in Medicine and Biology Society, 15(2): 301–307. March 2011.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{kim_addressing_2011,\n\ttitle = {Addressing mental health epidemic among university students via web-based, self-screening, and referral system: a preliminary study},\n\tvolume = {15},\n\tissn = {1558-0032},\n\tshorttitle = {Addressing mental health epidemic among university students via web-based, self-screening, and referral system},\n\tdoi = {10.1109/TITB.2011.2107561},\n\tabstract = {The prevalence and severity of mental health problems in college and university communities are alarming. However, the majority of students with mental disorders do not seek help from professionals. To help students assess their mental conditions and encourage them to take an active role in seeking care, we developed a web-based self-screening, referral, and secure communication system and evaluated it at the University of Washington for 17 months. The system handled more than 1000 screenings during the study period. Of the subjects who used the system, 75\\% noted that the system helped them to make a decision to receive help from professionals. The system was able to provide outreach to students with mental health concerns effectively, allow them to self-screen their conditions, and encourage them to receive professional assistance. The system provided students with 24/7 web-based access to the clinic, and more than 50\\% of the system use was made during off-hours. The system was well received by patients, referral managers, and care providers, and it was transferred to the clinic for daily clinical use. We believe that a web-based system like ours could be used as one way to tackle the growing epidemic of mental health problems among college and university students.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {IEEE transactions on information technology in biomedicine: a publication of the IEEE Engineering in Medicine and Biology Society},\n\tauthor = {Kim, Eung-Hun and Coumar, Anil and Lober, William B. and Kim, Yongmin},\n\tmonth = mar,\n\tyear = {2011},\n\tpmid = {21257386},\n\tkeywords = {Adult, Epidemics, Female, Humans, Internet, Male, Mass Screening, Mental Disorders, Middle Aged, Referral and Consultation, Self Report, Students, Surveys and Questionnaires, Universities},\n\tpages = {301--307},\n}\n\n

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\n \n\n \n \n Hills, R. A.; Baseman, J. G.; Revere, D.; Boge, C. L. K.; Oberle, M. W.; Doctor, J. N.; and Lober, W. B.\n\n\n \n \n \n \n Applying the XForms Standard to Public Health Case Reporting and Alerting.\n \n \n \n\n\n \n\n\n\n Online Journal of Public Health Informatics, 3(2). 2011.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{hills_applying_2011,\n\ttitle = {Applying the {XForms} {Standard} to {Public} {Health} {Case} {Reporting} and {Alerting}},\n\tvolume = {3},\n\tissn = {1947-2579},\n\tdoi = {10.5210/ojphi.v3i2.3656},\n\tabstract = {Notifiable condition reporting and alerting are two important public health functions. Today, a variety of methods are used to transfer these types of information. The increasing use of electronic health record systems by healthcare providers makes new types of electronic communication possible. We used the XForms standard and nationally recognized technical profiles to demonstrate the communication of both notifiable condition reports and patient-tailored public health alerts. This demonstration of bi-directional communication took placein a prototypical health information exchange environment. We successfully transferred information between provider electronic health record systems and public health systems for notifiable condition reporting. Patient-specific alerts were successfully sent from public health to provider systems. In this paper we discuss the benefits of XForms, including the use of XML, advanced form controls, form initialization and reduction in scripting. We also review implementation challenges, the maturity of the technology and its suitability for use in public health.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Online Journal of Public Health Informatics},\n\tauthor = {Hills, Rebecca A. and Baseman, Janet G. and Revere, Debra and Boge, Craig L. K. and Oberle, Mark W. and Doctor, Jason N. and Lober, William B.},\n\tyear = {2011},\n\tpmid = {23569609},\n\tpmcid = {PMC3615786},\n\tkeywords = {alerting, bi-directional communication, notifiable condition reporting, public health informatics, public health practice},\n}\n\n

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\n \n\n \n \n Olson, D. R.; Paladini, M.; Lober, W. B.; Buckeridge, D. L.; and ISDS Distribute Working Group\n\n\n \n \n \n \n Applying a New Model for Sharing Population Health Data to National Syndromic Influenza Surveillance: DiSTRIBuTE Project Proof of Concept, 2006 to 2009.\n \n \n \n\n\n \n\n\n\n PLoS currents, 3: RRN1251. August 2011.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{olson_applying_2011,\n\ttitle = {Applying a {New} {Model} for {Sharing} {Population} {Health} {Data} to {National} {Syndromic} {Influenza} {Surveillance}: {DiSTRIBuTE} {Project} {Proof} of {Concept}, 2006 to 2009},\n\tvolume = {3},\n\tissn = {2157-3999},\n\tshorttitle = {Applying a {New} {Model} for {Sharing} {Population} {Health} {Data} to {National} {Syndromic} {Influenza} {Surveillance}},\n\tdoi = {10.1371/currents.RRN1251},\n\tabstract = {The Distributed Surveillance Taskforce for Real-time Influenza Burden Tracking and Evaluation (DiSTRIBuTE) project began as a pilot effort initiated by the International Society for Disease Surveillance (ISDS) in autumn 2006 to create a collaborative electronic emergency department (ED) syndromic influenza-like illness (ILI) surveillance network based on existing state and local systems and expertise. DiSTRIBuTE brought together health departments that were interested in: 1) sharing aggregate level data; 2) maintaining jurisdictional control; 3) minimizing barriers to participation; and 4) leveraging the flexibility of local systems to create a dynamic and collaborative surveillance network. This approach was in contrast to the prevailing paradigm for surveillance where record level information was collected, stored and analyzed centrally. The DiSTRIBuTE project was created with a distributed design, where individual level data remained local and only summarized, stratified counts were reported centrally, thus minimizing privacy risks. The project was responsive to federal mandates to improve integration of federal, state, and local biosurveillance capabilities. During the proof of concept phase, 2006 to 2009, ten jurisdictions from across North America sent ISDS on a daily to weekly basis year-round, aggregated data by day, stratified by local ILI syndrome, age-group and region. During this period, data from participating U.S. state or local health departments captured over 13\\% of all ED visits nationwide. The initiative focused on state and local health department trust, expertise, and control. Morbidity trends observed in DiSTRIBuTE were highly correlated with other influenza surveillance measures. With the emergence of novel A/H1N1 influenza in the spring of 2009, the project was used to support information sharing and ad hoc querying at the state and local level. In the fall of 2009, through a broadly collaborative effort, the project was expanded to enhance electronic ED surveillance nationwide.},\n\tlanguage = {eng},\n\tjournal = {PLoS currents},\n\tauthor = {Olson, Donald R. and Paladini, Marc and Lober, William B. and Buckeridge, David L. and {ISDS Distribute Working Group}},\n\tmonth = aug,\n\tyear = {2011},\n\tpmid = {21894257},\n\tpmcid = {PMC3148528},\n\tpages = {RRN1251},\n}\n\n

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\n The Distributed Surveillance Taskforce for Real-time Influenza Burden Tracking and Evaluation (DiSTRIBuTE) project began as a pilot effort initiated by the International Society for Disease Surveillance (ISDS) in autumn 2006 to create a collaborative electronic emergency department (ED) syndromic influenza-like illness (ILI) surveillance network based on existing state and local systems and expertise. DiSTRIBuTE brought together health departments that were interested in: 1) sharing aggregate level data; 2) maintaining jurisdictional control; 3) minimizing barriers to participation; and 4) leveraging the flexibility of local systems to create a dynamic and collaborative surveillance network. This approach was in contrast to the prevailing paradigm for surveillance where record level information was collected, stored and analyzed centrally. The DiSTRIBuTE project was created with a distributed design, where individual level data remained local and only summarized, stratified counts were reported centrally, thus minimizing privacy risks. The project was responsive to federal mandates to improve integration of federal, state, and local biosurveillance capabilities. During the proof of concept phase, 2006 to 2009, ten jurisdictions from across North America sent ISDS on a daily to weekly basis year-round, aggregated data by day, stratified by local ILI syndrome, age-group and region. During this period, data from participating U.S. state or local health departments captured over 13% of all ED visits nationwide. The initiative focused on state and local health department trust, expertise, and control. Morbidity trends observed in DiSTRIBuTE were highly correlated with other influenza surveillance measures. With the emergence of novel A/H1N1 influenza in the spring of 2009, the project was used to support information sharing and ad hoc querying at the state and local level. In the fall of 2009, through a broadly collaborative effort, the project was expanded to enhance electronic ED surveillance nationwide.\n

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\n \n\n \n \n Reeder, B.; Revere, D.; Olson, D. R.; and Lober, W. B.\n\n\n \n \n \n \n Perceived usefulness of a distributed community-based syndromic surveillance system: a pilot qualitative evaluation study.\n \n \n \n\n\n \n\n\n\n BMC research notes, 4: 187. June 2011.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@article{reeder_perceived_2011,\n\ttitle = {Perceived usefulness of a distributed community-based syndromic surveillance system: a pilot qualitative evaluation study},\n\tvolume = {4},\n\tissn = {1756-0500},\n\tshorttitle = {Perceived usefulness of a distributed community-based syndromic surveillance system},\n\tdoi = {10.1186/1756-0500-4-187},\n\tabstract = {BACKGROUND: We conducted a pilot utility evaluation and information needs assessment of the Distribute Project at the 2010 Washington State Public Health Association (WSPHA) Joint Conference. Distribute is a distributed community-based syndromic surveillance system and network for detection of influenza-like illness (ILI). Using qualitative methods, we assessed the perceived usefulness of the Distribute system and explored areas for improvement. Nine state and local public health professionals participated in a focus group (n = 6) and in semi-structured interviews (n = 3). Field notes were taken, summarized and analyzed.\nFINDINGS: Several emergent themes that contribute to the perceived usefulness of system data and the Distribute system were identified: 1) Standardization: a common ILI syndrome definition; 2) Regional Comparability: views that support county-by-county comparisons of syndromic surveillance data; 3) Completeness: complete data for all expected data at a given time; 4) Coverage: data coverage of all jurisdictions in WA state; 5) CONTEXT: metadata incorporated into the views to provide context for graphed data; 6) Trusted Data: verification that information is valid and timely; and 7) Customization: the ability to customize views as necessary. As a result of the focus group, a new county level health jurisdiction expressed interest in contributing data to the Distribute system.\nCONCLUSION: The resulting themes from this study can be used to guide future information design efforts for the Distribute system and other syndromic surveillance systems. In addition, this study demonstrates the benefits of conducting a low cost, qualitative evaluation at a professional conference.},\n\tlanguage = {eng},\n\tjournal = {BMC research notes},\n\tauthor = {Reeder, Blaine and Revere, Debra and Olson, Donald R. and Lober, William B.},\n\tmonth = jun,\n\tyear = {2011},\n\tpmid = {21672242},\n\tpmcid = {PMC3146436},\n\tpages = {187},\n}\n\n

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\n \n\n \n \n Berry, D. L.; Blumenstein, B. A.; Halpenny, B.; Wolpin, S.; Fann, J. R.; Austin-Seymour, M.; Bush, N.; Karras, B. T.; Lober, W. B.; and McCorkle, R.\n\n\n \n \n \n \n Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial.\n \n \n \n\n\n \n\n\n\n Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 29(8): 1029–1035. March 2011.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{berry_enhancing_2011,\n\ttitle = {Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial},\n\tvolume = {29},\n\tissn = {1527-7755},\n\tshorttitle = {Enhancing patient-provider communication with the electronic self-report assessment for cancer},\n\tdoi = {10.1200/JCO.2010.30.3909},\n\tabstract = {PURPOSE: Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment-Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians.\nPATIENTS AND METHODS: This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians.\nRESULTS: The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful.\nCONCLUSION: The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.},\n\tlanguage = {eng},\n\tnumber = {8},\n\tjournal = {Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology},\n\tauthor = {Berry, Donna L. and Blumenstein, Brent A. and Halpenny, Barbara and Wolpin, Seth and Fann, Jesse R. and Austin-Seymour, Mary and Bush, Nigel and Karras, Bryant T. and Lober, William B. and McCorkle, Ruth},\n\tmonth = mar,\n\tyear = {2011},\n\tpmid = {21282548},\n\tpmcid = {PMC3068053},\n\tkeywords = {Adolescent, Adult, Aged, Aged, 80 and over, Ambulatory Care, Computer Graphics, Decision Support Systems, Clinical, Electronic Mail, Female, Humans, Logistic Models, Male, Middle Aged, Neoplasms, Odds Ratio, Physician-Patient Relations, Prospective Studies, Quality of Life, Self Report, United States, Young Adult},\n\tpages = {1029--1035},\n}\n\n

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\n \n 2010\n \n \n (6)\n \n \n

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\n \n\n \n \n Lober, W. B.; Revere, D.; and Hills, R.\n\n\n \n \n \n \n A Lab-EMR interoperability profile as an eHealth architecture component for resource-constrained settings.\n \n \n \n\n\n \n\n\n\n Studies in Health Technology and Informatics, 160(Pt 1): 257–261. 2010.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_lab-emr_2010,\n\ttitle = {A {Lab}-{EMR} interoperability profile as an {eHealth} architecture component for resource-constrained settings},\n\tvolume = {160},\n\tissn = {0926-9630},\n\tabstract = {Implementation of computerized systems in resource-constrained settings have been gaining traction as a means of improving the delivery of health care, the use and reuse of information, and providing a standards-based capacity for assessing the process and impact of health care. In a resource-constrained environment, systems are often implemented as stand-alone entities focused on specific care activities (for example, delivering antiretroviral therapy). As such, in many countries, taking a generalized approach to linking electronic medical record systems with laboratory information systems (EMR-LIS) is an important area in which to achieve interoperability. In this paper we describe a scenario of use and information interaction interoperability profile based on our experience implementing EMR-LIS integration in two resource-constrained settings. Of significance, the profile emphasizes queued matching in order to avoid mutual dependence while achieving interoperability between systems.},\n\tlanguage = {eng},\n\tnumber = {Pt 1},\n\tjournal = {Studies in Health Technology and Informatics},\n\tauthor = {Lober, William B. and Revere, Debra and Hills, Rebecca},\n\tyear = {2010},\n\tpmid = {20841689},\n\tkeywords = {CIRG\\_Selected, Clinical Laboratory Information Systems, Database Management Systems, Electronic Health Records, Health Care Rationing, Information Storage and Retrieval, Medical Record Linkage, Models, Organizational, Washington},\n\tpages = {257--261},\n}\n\n

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\n \n\n \n \n Chapman, W. W.; Dowling, J. N.; Baer, A.; Buckeridge, D. L.; Cochrane, D.; Conway, M. A.; Elkin, P.; Espino, J.; Gunn, J. E.; Hales, C. M.; Hutwagner, L.; Keller, M.; Larson, C.; Noe, R.; Okhmatovskaia, A.; Olson, K.; Paladini, M.; Scholer, M.; Sniegoski, C.; Thompson, D.; and Lober, B.\n\n\n \n \n \n \n Developing syndrome definitions based on consensus and current use.\n \n \n \n\n\n \n\n\n\n Journal of the American Medical Informatics Association: JAMIA, 17(5): 595–601. October 2010.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{chapman_developing_2010,\n\ttitle = {Developing syndrome definitions based on consensus and current use},\n\tvolume = {17},\n\tissn = {1527-974X},\n\tdoi = {10.1136/jamia.2010.003210},\n\tabstract = {OBJECTIVE: Standardized surveillance syndromes do not exist but would facilitate sharing data among surveillance systems and comparing the accuracy of existing systems. The objective of this study was to create reference syndrome definitions from a consensus of investigators who currently have or are building syndromic surveillance systems.\nDESIGN: Clinical condition-syndrome pairs were catalogued for 10 surveillance systems across the United States and the representatives of these systems were brought together for a workshop to discuss consensus syndrome definitions.\nRESULTS: Consensus syndrome definitions were generated for the four syndromes monitored by the majority of the 10 participating surveillance systems: Respiratory, gastrointestinal, constitutional, and influenza-like illness (ILI). An important element in coming to consensus quickly was the development of a sensitive and specific definition for respiratory and gastrointestinal syndromes. After the workshop, the definitions were refined and supplemented with keywords and regular expressions, the keywords were mapped to standard vocabularies, and a web ontology language (OWL) ontology was created.\nLIMITATIONS: The consensus definitions have not yet been validated through implementation.\nCONCLUSION: The consensus definitions provide an explicit description of the current state-of-the-art syndromes used in automated surveillance, which can subsequently be systematically evaluated against real data to improve the definitions. The method for creating consensus definitions could be applied to other domains that have diverse existing definitions.},\n\tlanguage = {eng},\n\tnumber = {5},\n\tjournal = {Journal of the American Medical Informatics Association: JAMIA},\n\tauthor = {Chapman, Wendy W. and Dowling, John N. and Baer, Atar and Buckeridge, David L. and Cochrane, Dennis and Conway, Michael A. and Elkin, Peter and Espino, Jeremy and Gunn, Julia E. and Hales, Craig M. and Hutwagner, Lori and Keller, Mikaela and Larson, Catherine and Noe, Rebecca and Okhmatovskaia, Anya and Olson, Karen and Paladini, Marc and Scholer, Matthew and Sniegoski, Carol and Thompson, David and Lober, Bill},\n\tmonth = oct,\n\tyear = {2010},\n\tpmid = {20819870},\n\tpmcid = {PMC2995670},\n\tkeywords = {Communicable Diseases, Group Processes, Humans, Population Surveillance, Syndrome, United States},\n\tpages = {595--601},\n}\n\n

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\n \n\n \n \n Wolpin, S.; Berry, D. L.; Kurth, A.; and Lober, W. B.\n\n\n \n \n \n \n Improving health literacy: a Web application for evaluating text-to-speech engines.\n \n \n \n\n\n \n\n\n\n Computers, informatics, nursing: CIN, 28(4): 198–204. August 2010.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{wolpin_improving_2010,\n\ttitle = {Improving health literacy: a {Web} application for evaluating text-to-speech engines},\n\tvolume = {28},\n\tissn = {1538-9774},\n\tshorttitle = {Improving health literacy},\n\tdoi = {10.1097/NCN.0b013e3181e1ddca},\n\tabstract = {The Internet is increasingly used as a medium for gathering and exchanging health information exchange. Healthcare professionals and organizations need to consider barriers that may exist within their patient-oriented Web applications. One approach to making the Web more accessible for those with lower health literacy may be to supplement textual content with audio annotation using text-to-speech engines, allowing for the creation of a virtual surrogate reader. One challenge is that with numerous text-to-speech engines on the market, objective measures of quality are difficult to obtain. To facilitate comparisons of text-to-speech engines, we developed an open-source Web application that measures user reaction times, subjective quality ratings, and accuracy in completing tasks across different audio files created by text-to-speech engines. Our research endeavor was successful in building and piloting this Web application; significant differences were found for subjective ratings of quality across three text-to-speech engines priced at different levels. However, no significant differences were found with reaction times or accuracy between these text-to-speech engines. Future avenues of research include exploring more complex tasks, usability issues related to implementing text-to-speech features, and applied health promotion and education opportunities among vulnerable populations.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {Computers, informatics, nursing: CIN},\n\tauthor = {Wolpin, Seth and Berry, Donna L. and Kurth, Ann and Lober, William B.},\n\tmonth = aug,\n\tyear = {2010},\n\tpmid = {20571370},\n\tkeywords = {Adult, Analysis of Variance, Attitude to Computers, Computer-Assisted Instruction, Female, Health Education, Health Literacy, Health Promotion, Humans, Internet, Male, Middle Aged, Pilot Projects, Speech Recognition Software, User-Computer Interface, Vulnerable Populations},\n\tpages = {198--204},\n}\n\n

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\n \n\n \n \n Berry, D. L.; Halpenny, B.; Wolpin, S.; Davison, B. J.; Ellis, W. J.; Lober, W. B.; McReynolds, J.; and Wulff, J.\n\n\n \n \n \n \n Development and evaluation of the personal patient profile-prostate (P3P), a Web-based decision support system for men newly diagnosed with localized prostate cancer.\n \n \n \n\n\n \n\n\n\n Journal of Medical Internet Research, 12(4): e67. December 2010.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{berry_development_2010,\n\ttitle = {Development and evaluation of the personal patient profile-prostate ({P3P}), a {Web}-based decision support system for men newly diagnosed with localized prostate cancer},\n\tvolume = {12},\n\tissn = {1438-8871},\n\tdoi = {10.2196/jmir.1576},\n\tabstract = {BACKGROUND: Given that no other disease with the high incidence of localized prostate cancer (LPC) has so many treatments with so few certainties related to outcomes, many men are faced with assuming some responsibility for the treatment decision along with guidance from clinicians. Men strongly consider their own personal characteristics and other personal factors as important and influential to the decision. Clinical researchers have not developed or comprehensively investigated interventions to facilitate the insight and prioritizing of personal factors along with medical factors that are required of a man in preparation for the treatment decision.\nOBJECTIVES: The purpose of this pilot study was to develop and evaluate the feasibility and usability of a Web-based decision support technology, the Personal Patient Profile-Prostate (P3P), in men newly diagnosed with LPC.\nMETHODS: Use cases were developed followed by infrastructure and content application. The program was provided on a personal desktop computer with a touch screen monitor. Participant responses to the query component of P3P determined the content of the multimedia educational and coaching intervention. The intervention was tailored to race, age, and personal factors reported as influencing the decision. Prepilot usability testing was conducted using a "think aloud" interview to identify navigation and content challenges. These issues were addressed prior to deployment in the clinic. A clinical pilot was conducted in an academic medical center where men sought consultation and treatment for LPC. Completion time, missing data, and acceptability were measured.\nRESULTS: Prepilot testing included 4 men with a past diagnosis of LPC who had completed therapy. Technical navigation issues were documented along with confusing content language. A total of 30 additional men with a recent diagnosis of LPC completed the P3P program in clinic prior to consulting with a urologist regarding treatment options. In a mean time of 46 minutes (SD 13 minutes), participants completed the P3P query and intervention components. Of a possible 4560 items for 30 participants, 22 (0.5\\%) were missing. Acceptability was reported as high overall. The sections of the intervention reported as most useful were the statistics graphs, priority information topics, and annotated external website links.\nCONCLUSIONS: The P3P intervention is a feasible and usable program to facilitate treatment decision making by men with newly diagnosed LPC. Testing in a multisite randomized trial with a diverse sample is warranted.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {Journal of Medical Internet Research},\n\tauthor = {Berry, Donna L. and Halpenny, Barbara and Wolpin, Seth and Davison, B. Joyce and Ellis, William J. and Lober, William B. and McReynolds, Justin and Wulff, Jennifer},\n\tmonth = dec,\n\tyear = {2010},\n\tpmid = {21169159},\n\tpmcid = {PMC3056527},\n\tkeywords = {Aged, Counseling, Decision Making, Decision Support Systems, Clinical, Decision Support Techniques, Feasibility Studies, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Patient Education as Topic, Pilot Projects, Program Evaluation, Prostatic Neoplasms, Software, User-Computer Interface},\n\tpages = {e67},\n}\n\n

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\n BACKGROUND: Given that no other disease with the high incidence of localized prostate cancer (LPC) has so many treatments with so few certainties related to outcomes, many men are faced with assuming some responsibility for the treatment decision along with guidance from clinicians. Men strongly consider their own personal characteristics and other personal factors as important and influential to the decision. Clinical researchers have not developed or comprehensively investigated interventions to facilitate the insight and prioritizing of personal factors along with medical factors that are required of a man in preparation for the treatment decision. OBJECTIVES: The purpose of this pilot study was to develop and evaluate the feasibility and usability of a Web-based decision support technology, the Personal Patient Profile-Prostate (P3P), in men newly diagnosed with LPC. METHODS: Use cases were developed followed by infrastructure and content application. The program was provided on a personal desktop computer with a touch screen monitor. Participant responses to the query component of P3P determined the content of the multimedia educational and coaching intervention. The intervention was tailored to race, age, and personal factors reported as influencing the decision. Prepilot usability testing was conducted using a \"think aloud\" interview to identify navigation and content challenges. These issues were addressed prior to deployment in the clinic. A clinical pilot was conducted in an academic medical center where men sought consultation and treatment for LPC. Completion time, missing data, and acceptability were measured. RESULTS: Prepilot testing included 4 men with a past diagnosis of LPC who had completed therapy. Technical navigation issues were documented along with confusing content language. A total of 30 additional men with a recent diagnosis of LPC completed the P3P program in clinic prior to consulting with a urologist regarding treatment options. In a mean time of 46 minutes (SD 13 minutes), participants completed the P3P query and intervention components. Of a possible 4560 items for 30 participants, 22 (0.5%) were missing. Acceptability was reported as high overall. The sections of the intervention reported as most useful were the statistics graphs, priority information topics, and annotated external website links. CONCLUSIONS: The P3P intervention is a feasible and usable program to facilitate treatment decision making by men with newly diagnosed LPC. Testing in a multisite randomized trial with a diverse sample is warranted.\n

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\n \n\n \n \n Lawrence, S. T.; Willig, J. H.; Crane, H. M.; Ye, J.; Aban, I.; Lober, W.; Nevin, C. R.; Batey, D. S.; Mugavero, M. J.; McCullumsmith, C.; Wright, C.; Kitahata, M.; Raper, J. L.; Saag, M. S.; and Schumacher, J. E.\n\n\n \n \n \n \n Routine, self-administered, touch-screen, computer-based suicidal ideation assessment linked to automated response team notification in an HIV primary care setting.\n \n \n \n\n\n \n\n\n\n Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 50(8): 1165–1173. April 2010.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lawrence_routine_2010,\n\ttitle = {Routine, self-administered, touch-screen, computer-based suicidal ideation assessment linked to automated response team notification in an {HIV} primary care setting},\n\tvolume = {50},\n\tissn = {1537-6591},\n\tdoi = {10.1086/651420},\n\tabstract = {BACKGROUND: Human immunodeficiency virus (HIV) and AIDS continue to be associated with an underrecognized risk for suicidal ideation, attempted suicide, and completed suicide. Suicidal ideation represents an important predictor for subsequent attempted and completed suicide. We sought to implement routine screening of suicidal ideation and associated conditions using computerized patient-reported outcome (PRO) assessments.\nMETHODS: Two geographically distinct academic HIV primary care clinics enrolled patients who attended scheduled visits from December 2005 through February 2009. Touch-screen, computer-based PRO assessments were implemented into routine clinical care. Substance abuse, alcohol consumption, depression, and anxiety were assessed. The 9-item Patient Health Questionnaire assesses the frequency of suicidal ideation in the preceding 2 weeks. A response of "nearly every day" triggered an automated page to predetermined clinic personnel, who completed more detailed self-harm assessments.\nRESULTS: Overall, 1216 patients (740 from the University of Alabama at Birmingham and 476 from the University of Washington) completed the initial PRO assessment during the study period. Patients were predominantly white (646 [53\\%]) and male (959 [79\\%]), with a mean age (+/- standard deviation) of 44 +/- 10 years. Among surveyed patients, 170 (14\\%) endorsed some level of suicidal ideation, whereas 33 (3\\%) admitted suicidal ideation nearly every day. In multivariable analysis, suicidal ideation risk was lower with advancing age (odds ratio [OR], 0.74 per 10 years; 95\\% confidence interval [CI], 0.58-0.96) and was increased with current substance abuse (OR, 1.88; 95\\% CI, 1.03-3.44) and more-severe depression (OR, 3.91 for moderate depression [95\\% CI, 2.12-7.22] and 25.55 for severe depression [95\\% CI, 12.73-51.30]).\nDISCUSSION: Suicidal ideation was associated with current substance abuse and depression. The use of novel technologies to incorporate routine self-reported screening for suicidal ideation and other health domains allows for timely detection and intervention for this life-threatening condition.},\n\tlanguage = {eng},\n\tnumber = {8},\n\tjournal = {Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America},\n\tauthor = {Lawrence, Sarah T. and Willig, James H. and Crane, Heidi M. and Ye, Jiatao and Aban, Inmaculada and Lober, William and Nevin, Christa R. and Batey, D. Scott and Mugavero, Michael J. and McCullumsmith, Cheryl and Wright, Charles and Kitahata, Mari and Raper, James L. and Saag, Micheal S. and Schumacher, Joseph E.},\n\tmonth = apr,\n\tyear = {2010},\n\tpmid = {20210646},\n\tpmcid = {PMC2841210},\n\tkeywords = {Adult, Alabama, Animals, Automation, Computers, Depressive Disorder, Female, HIV Infections, Humans, Male, Middle Aged, Suicide, Surveys and Questionnaires, Telemedicine, Washington},\n\tpages = {1165--1173},\n}\n\n

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\n BACKGROUND: Human immunodeficiency virus (HIV) and AIDS continue to be associated with an underrecognized risk for suicidal ideation, attempted suicide, and completed suicide. Suicidal ideation represents an important predictor for subsequent attempted and completed suicide. We sought to implement routine screening of suicidal ideation and associated conditions using computerized patient-reported outcome (PRO) assessments. METHODS: Two geographically distinct academic HIV primary care clinics enrolled patients who attended scheduled visits from December 2005 through February 2009. Touch-screen, computer-based PRO assessments were implemented into routine clinical care. Substance abuse, alcohol consumption, depression, and anxiety were assessed. The 9-item Patient Health Questionnaire assesses the frequency of suicidal ideation in the preceding 2 weeks. A response of \"nearly every day\" triggered an automated page to predetermined clinic personnel, who completed more detailed self-harm assessments. RESULTS: Overall, 1216 patients (740 from the University of Alabama at Birmingham and 476 from the University of Washington) completed the initial PRO assessment during the study period. Patients were predominantly white (646 [53%]) and male (959 [79%]), with a mean age (+/- standard deviation) of 44 +/- 10 years. Among surveyed patients, 170 (14%) endorsed some level of suicidal ideation, whereas 33 (3%) admitted suicidal ideation nearly every day. In multivariable analysis, suicidal ideation risk was lower with advancing age (odds ratio [OR], 0.74 per 10 years; 95% confidence interval [CI], 0.58-0.96) and was increased with current substance abuse (OR, 1.88; 95% CI, 1.03-3.44) and more-severe depression (OR, 3.91 for moderate depression [95% CI, 2.12-7.22] and 25.55 for severe depression [95% CI, 12.73-51.30]). DISCUSSION: Suicidal ideation was associated with current substance abuse and depression. The use of novel technologies to incorporate routine self-reported screening for suicidal ideation and other health domains allows for timely detection and intervention for this life-threatening condition.\n

\n\n\n

\n \n\n \n \n Van Eaton, E. G.; McDonough, K.; Lober, W. B.; Johnson, E. A.; Pellegrini, C. A.; and Horvath, K. D.\n\n\n \n \n \n \n Safety of using a computerized rounding and sign-out system to reduce resident duty hours.\n \n \n \n\n\n \n\n\n\n Academic Medicine: Journal of the Association of American Medical Colleges, 85(7): 1189–1195. July 2010.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{van_eaton_safety_2010,\n\ttitle = {Safety of using a computerized rounding and sign-out system to reduce resident duty hours},\n\tvolume = {85},\n\tissn = {1938-808X},\n\tdoi = {10.1097/ACM.0b013e3181e0116f},\n\tabstract = {PURPOSE: To determine whether changing sign-out practices and decreasing the time spent in rounding and recopying patient data affect patient safety. Responding to limited resident duty hours, the University of Washington launched a computerized rounding and sign-out system ("UW Cores"). The system shortened duty hours by facilitating sign-out, decreasing rounding time, and sharply reducing the time spent in prerounds data recopying.\nMETHOD: This 14-week, randomized, crossover study involved 14 inpatient resident teams (6 general surgery, 8 internal medicine) at two hospitals. The authors measured resident-reported deviations in expected care that occurred during cross-coverage, medical errors, and institutionally reported adverse drug events (ADEs).\nRESULTS: The mean number of resident-reported deviations from expected care per 1,000 patient-days did not differ significantly between the control and UW Cores groups: 14.29 and 13.81, respectively (P = .85). The mean number of reported incidents involving errors was 6.33 per 1,000 patient-days for the control group and 5.61 per 1,000 patient-days for the UW Cores group (P = .68). The odds ratio of a reported overnight medical error under the UW Cores system was 1.01 (95\\% CI: 0.64, 1.60; P = .96). The odds ratio of an ADE while a resident is on an intervention team was 1.10 (95\\% CI: 0.69, 1.74; P = .70).\nCONCLUSIONS: Managing information for sign-out and rounding with the UW Cores system, to reduce time spent in recopying patient data and in rounding on patients, improved continuity and enhanced resident efficiency without weakening systemic defenses against error or jeopardizing patient safety.},\n\tlanguage = {eng},\n\tnumber = {7},\n\tjournal = {Academic Medicine: Journal of the Association of American Medical Colleges},\n\tauthor = {Van Eaton, Erik G. and McDonough, Karen and Lober, William B. and Johnson, Eric A. and Pellegrini, Carlos A. and Horvath, Karen D.},\n\tmonth = jul,\n\tyear = {2010},\n\tpmid = {20592514},\n\tkeywords = {Continuity of Patient Care, Cross-Over Studies, Efficiency, Organizational, General Surgery, Hospitals, University, Humans, Internal Medicine, Internship and Residency, Medical Errors, Odds Ratio, Personnel Staffing and Scheduling, Quality of Health Care, Washington, Workload},\n\tpages = {1189--1195},\n}\n\n

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\n \n 2009\n \n \n (3)\n \n \n

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\n \n\n \n \n Kitahata, M. M.; Gange, S. J.; Abraham, A. G.; Merriman, B.; Saag, M. S.; Justice, A. C.; Hogg, R. S.; Deeks, S. G.; Eron, J. J.; Brooks, J. T.; Rourke, S. B.; Gill, M. J.; Bosch, R. J.; Martin, J. N.; Klein, M. B.; Jacobson, L. P.; Rodriguez, B.; Sterling, T. R.; Kirk, G. D.; Napravnik, S.; Rachlis, A. R.; Calzavara, L. M.; Horberg, M. A.; Silverberg, M. J.; Gebo, K. A.; Goedert, J. J.; Benson, C. A.; Collier, A. C.; Van Rompaey, S. E.; Crane, H. M.; McKaig, R. G.; Lau, B.; Freeman, A. M.; Moore, R. D.; and NA-ACCORD Investigators\n\n\n \n \n \n \n Effect of early versus deferred antiretroviral therapy for HIV on survival.\n \n \n \n\n\n \n\n\n\n The New England Journal of Medicine, 360(18): 1815–1826. April 2009.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{kitahata_effect_2009,\n\ttitle = {Effect of early versus deferred antiretroviral therapy for {HIV} on survival},\n\tvolume = {360},\n\tissn = {1533-4406},\n\tdoi = {10.1056/NEJMoa0807252},\n\tabstract = {BACKGROUND: The optimal time for the initiation of antiretroviral therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection is uncertain.\nMETHODS: We conducted two parallel analyses involving a total of 17,517 asymptomatic patients with HIV infection in the United States and Canada who received medical care during the period from 1996 through 2005. None of the patients had undergone previous antiretroviral therapy. In each group, we stratified the patients according to the CD4+ count (351 to 500 cells per cubic millimeter or {\\textgreater}500 cells per cubic millimeter) at the initiation of antiretroviral therapy. In each group, we compared the relative risk of death for patients who initiated therapy when the CD4+ count was above each of the two thresholds of interest (early-therapy group) with that of patients who deferred therapy until the CD4+ count fell below these thresholds (deferred-therapy group).\nRESULTS: In the first analysis, which involved 8362 patients, 2084 (25\\%) initiated therapy at a CD4+ count of 351 to 500 cells per cubic millimeter, and 6278 (75\\%) deferred therapy. After adjustment for calendar year, cohort of patients, and demographic and clinical characteristics, among patients in the deferred-therapy group there was an increase in the risk of death of 69\\%, as compared with that in the early-therapy group (relative risk in the deferred-therapy group, 1.69; 95\\% confidence interval [CI], 1.26 to 2.26; P{\\textless}0.001). In the second analysis involving 9155 patients, 2220 (24\\%) initiated therapy at a CD4+ count of more than 500 cells per cubic millimeter and 6935 (76\\%) deferred therapy. Among patients in the deferred-therapy group, there was an increase in the risk of death of 94\\% (relative risk, 1.94; 95\\% CI, 1.37 to 2.79; P{\\textless}0.001).\nCONCLUSIONS: The early initiation of antiretroviral therapy before the CD4+ count fell below two prespecified thresholds significantly improved survival, as compared with deferred therapy.},\n\tlanguage = {eng},\n\tnumber = {18},\n\tjournal = {The New England Journal of Medicine},\n\tauthor = {Kitahata, Mari M. and Gange, Stephen J. and Abraham, Alison G. and Merriman, Barry and Saag, Michael S. and Justice, Amy C. and Hogg, Robert S. and Deeks, Steven G. and Eron, Joseph J. and Brooks, John T. and Rourke, Sean B. and Gill, M. John and Bosch, Ronald J. and Martin, Jeffrey N. and Klein, Marina B. and Jacobson, Lisa P. and Rodriguez, Benigno and Sterling, Timothy R. and Kirk, Gregory D. and Napravnik, Sonia and Rachlis, Anita R. and Calzavara, Liviana M. and Horberg, Michael A. and Silverberg, Michael J. and Gebo, Kelly A. and Goedert, James J. and Benson, Constance A. and Collier, Ann C. and Van Rompaey, Stephen E. and Crane, Heidi M. and McKaig, Rosemary G. and Lau, Bryan and Freeman, Aimee M. and Moore, Richard D. and {NA-ACCORD Investigators}},\n\tmonth = apr,\n\tyear = {2009},\n\tpmid = {19339714},\n\tpmcid = {PMC2854555},\n\tkeywords = {Adult, Anti-Retroviral Agents, CD4 Lymphocyte Count, Confounding Factors, Epidemiologic, Drug Administration Schedule, Female, HIV, HIV Infections, Humans, Male, Middle Aged, Proportional Hazards Models, RNA, Viral, Risk, Survival Analysis},\n\tpages = {1815--1826},\n}\n\n

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\n BACKGROUND: The optimal time for the initiation of antiretroviral therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection is uncertain. METHODS: We conducted two parallel analyses involving a total of 17,517 asymptomatic patients with HIV infection in the United States and Canada who received medical care during the period from 1996 through 2005. None of the patients had undergone previous antiretroviral therapy. In each group, we stratified the patients according to the CD4+ count (351 to 500 cells per cubic millimeter or \\textgreater500 cells per cubic millimeter) at the initiation of antiretroviral therapy. In each group, we compared the relative risk of death for patients who initiated therapy when the CD4+ count was above each of the two thresholds of interest (early-therapy group) with that of patients who deferred therapy until the CD4+ count fell below these thresholds (deferred-therapy group). RESULTS: In the first analysis, which involved 8362 patients, 2084 (25%) initiated therapy at a CD4+ count of 351 to 500 cells per cubic millimeter, and 6278 (75%) deferred therapy. After adjustment for calendar year, cohort of patients, and demographic and clinical characteristics, among patients in the deferred-therapy group there was an increase in the risk of death of 69%, as compared with that in the early-therapy group (relative risk in the deferred-therapy group, 1.69; 95% confidence interval [CI], 1.26 to 2.26; P\\textless0.001). In the second analysis involving 9155 patients, 2220 (24%) initiated therapy at a CD4+ count of more than 500 cells per cubic millimeter and 6935 (76%) deferred therapy. Among patients in the deferred-therapy group, there was an increase in the risk of death of 94% (relative risk, 1.94; 95% CI, 1.37 to 2.79; P\\textless0.001). CONCLUSIONS: The early initiation of antiretroviral therapy before the CD4+ count fell below two prespecified thresholds significantly improved survival, as compared with deferred therapy.\n

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\n \n\n \n \n Kim, E.; Stolyar, A.; Lober, W. B.; Herbaugh, A. L.; Shinstrom, S. E.; Zierler, B. K.; Soh, C. B.; and Kim, Y.\n\n\n \n \n \n \n Challenges to using an electronic personal health record by a low-income elderly population.\n \n \n \n\n\n \n\n\n\n Journal of Medical Internet Research, 11(4): e44. October 2009.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{kim_challenges_2009,\n\ttitle = {Challenges to using an electronic personal health record by a low-income elderly population},\n\tvolume = {11},\n\tissn = {1438-8871},\n\tdoi = {10.2196/jmir.1256},\n\tabstract = {BACKGROUND: Electronic personal health records (PHRs) are increasingly recognized and used as a tool to address various challenges stemming from the scattered and incompatible personal health information that exists in the contemporary US health care system. Although activity around PHR development and deployment has increased in recent years, little has been reported regarding the use and utility of PHRs among low-income and/or elderly populations.\nOBJECTIVE: The aim was to assess the use and utility of PHRs in a low-income, elderly population.\nMETHODS: We deployed a Web-based, institution-neutral PHR system, the Personal Health Information Management System (PHIMS), in a federally funded housing facility for low-income and elderly residents. We assessed use and user satisfaction through system logs, questionnaire surveys, and user group meetings.\nRESULTS: Over the 33-month study period, 70 residents participated; this number was reduced to 44 by the end of the study. Although the PHIMS was available for free and personal assistance and computers with Internet connection were provided without any cost to residents, only 13\\% (44/330) of the eligible residents used the system, and system usage was limited. Almost one half of the users (47\\%, 33/70) used the PHIMS only on a single day. Use was also highly correlated with the availability of in-person assistance; 77\\% of user activities occurred while the assistance was available. Residents' ability to use the PHR system was limited by poor computer and Internet skills, technophobia, low health literacy, and limited physical/cognitive abilities. Among the 44 PHIMS users, 14 (32\\%) responded to the questionnaire. In this selected subgroup of survey participants, the majority (82\\%, 9/11) used the PHIMS three times or more and reported that it improved the quality of overall health care they received.\nCONCLUSIONS: Our findings suggest that those who can benefit the most from a PHR system may be the least able to use it. Disparities in access to and use of computers, the Internet, and PHRs may exacerbate health care inequality in the future.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {Journal of Medical Internet Research},\n\tauthor = {Kim, Eung-Hun and Stolyar, Anna and Lober, William B. and Herbaugh, Anne L. and Shinstrom, Sally E. and Zierler, Brenda K. and Soh, Cheong B. and Kim, Yongmin},\n\tmonth = oct,\n\tyear = {2009},\n\tpmid = {19861298},\n\tpmcid = {PMC2802566},\n\tkeywords = {Adult, Aged, Aged, 80 and over, Delivery of Health Care, Education, Nursing, Graduate, Electronic Health Records, Female, Health Services for the Aged, Humans, Internet, Male, Medical Records Systems, Computerized, Middle Aged, Patient Participation, Poverty, Young Adult},\n\tpages = {e44},\n}\n\n

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\n BACKGROUND: Electronic personal health records (PHRs) are increasingly recognized and used as a tool to address various challenges stemming from the scattered and incompatible personal health information that exists in the contemporary US health care system. Although activity around PHR development and deployment has increased in recent years, little has been reported regarding the use and utility of PHRs among low-income and/or elderly populations. OBJECTIVE: The aim was to assess the use and utility of PHRs in a low-income, elderly population. METHODS: We deployed a Web-based, institution-neutral PHR system, the Personal Health Information Management System (PHIMS), in a federally funded housing facility for low-income and elderly residents. We assessed use and user satisfaction through system logs, questionnaire surveys, and user group meetings. RESULTS: Over the 33-month study period, 70 residents participated; this number was reduced to 44 by the end of the study. Although the PHIMS was available for free and personal assistance and computers with Internet connection were provided without any cost to residents, only 13% (44/330) of the eligible residents used the system, and system usage was limited. Almost one half of the users (47%, 33/70) used the PHIMS only on a single day. Use was also highly correlated with the availability of in-person assistance; 77% of user activities occurred while the assistance was available. Residents' ability to use the PHR system was limited by poor computer and Internet skills, technophobia, low health literacy, and limited physical/cognitive abilities. Among the 44 PHIMS users, 14 (32%) responded to the questionnaire. In this selected subgroup of survey participants, the majority (82%, 9/11) used the PHIMS three times or more and reported that it improved the quality of overall health care they received. CONCLUSIONS: Our findings suggest that those who can benefit the most from a PHR system may be the least able to use it. Disparities in access to and use of computers, the Internet, and PHRs may exacerbate health care inequality in the future.\n

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\n \n\n \n \n Fann, J. R.; Berry, D. L.; Wolpin, S.; Austin-Seymour, M.; Bush, N.; Halpenny, B.; Lober, W. B.; and McCorkle, R.\n\n\n \n \n \n \n Depression screening using the Patient Health Questionnaire-9 administered on a touch screen computer.\n \n \n \n\n\n \n\n\n\n Psycho-Oncology, 18(1): 14–22. January 2009.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{fann_depression_2009,\n\ttitle = {Depression screening using the {Patient} {Health} {Questionnaire}-9 administered on a touch screen computer},\n\tvolume = {18},\n\tissn = {1099-1611},\n\tdoi = {10.1002/pon.1368},\n\tabstract = {OBJECTIVE: To (1) evaluate the feasibility of touch screen depression screening in cancer patients using the Patient Health Questionnaire-9 (PHQ-9), (2) evaluate the construct validity of the PHQ-9 using the touch screen modality, and (3) examine the prevalence and severity of depression using this screening modality.\nMETHODS: The PHQ-9 was placed in a web-based survey within a study of the clinical impact of computerized symptom and quality of life screening. Patients in medical oncology, radiation oncology, and hematopoietic stem cell transplantation (HSCT) clinics used the program on a touch screen computer in waiting rooms prior to therapy (T1) and during therapy (T2). Responses of depressed mood or anhedonia (PHQ-2 cardinal depression symptoms) triggered additional items. PHQ-9 scores were provided to the oncology team in real time.\nRESULTS: Among 342 patients enrolled, 33 (9.6\\%) at T1 and 69 (20.2\\%) at T2 triggered the full PHQ-9 by endorsing at least one cardinal symptom. Feasibility was high, with at least 97\\% completing the PHQ-2 and at least 96\\% completing the PHQ-9 when triggered and a mean completion time of about 2 min. The PHQ-9 had good construct validity. Medical oncology patients had the highest percent of positive screens (12.9\\%) at T1, while HSCT patients had the highest percent (30.5\\%) at T2. Using this method, 21 (6.1\\%) at T1 and 54 (15.8\\%) at T2 of the total sample had moderate to severe depression.\nCONCLUSIONS: The PHQ-9 administered on a touch screen computer is feasible and provides valid depression data in a diverse cancer population.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Psycho-Oncology},\n\tauthor = {Fann, Jesse R. and Berry, Donna L. and Wolpin, Seth and Austin-Seymour, Mary and Bush, Nigel and Halpenny, Barbara and Lober, William B. and McCorkle, Ruth},\n\tmonth = jan,\n\tyear = {2009},\n\tpmid = {18457335},\n\tpmcid = {PMC2610244},\n\tkeywords = {Adult, Aged, Aged, 80 and over, Computers, Depression, Feasibility Studies, Female, Humans, Male, Mass Screening, Middle Aged, Neoplasms, Prevalence, Psychological Tests, Reproducibility of Results, Washington},\n\tpages = {14--22},\n}\n\n

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\n \n 2008\n \n \n (5)\n \n \n

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\n \n\n \n \n Lober, W. B.; Quiles, C.; Wagner, S.; Cassagnol, R.; Lamothes, R.; Alexis, D. R. P.; Joseph, P.; Sutton, P.; Puttkammer, N.; and Kitahata, M. M.\n\n\n \n \n \n \n Three years experience with the implementation of a networked electronic medical record in Haiti.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,434–438. November 2008.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_three_2008,\n\ttitle = {Three years experience with the implementation of a networked electronic medical record in {Haiti}},\n\tissn = {1942-597X},\n\tabstract = {Since 2005 we have been developing and implementing an electronic medical record (EMR) that supports both individual and population health care of HIV-infected patients in Haiti. Unreliable electrical power and network infrastructure, cultural differences, variable levels of experience and computer literacy, and the geographic dispersion of the team remain challenges, but the system is now implemented in about 40 sites nationwide providing antiretroviral therapy, and includes records for about 18,600 patients. The need to support country-wide monitoring and evaluation drove early architectural decisions to support linking systems under conditions of network uncertainty. We have found surprising end user acceptance of the system, with the adoption of interactive EMR usage exceeding our expectations and timeline.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Lober, William B. and Quiles, Christina and Wagner, Steve and Cassagnol, Rachelle and Lamothes, Roges and Alexis, Don Rock Pierre and Joseph, Patrice and Sutton, Perri and Puttkammer, Nancy and Kitahata, Mari M.},\n\tmonth = nov,\n\tyear = {2008},\n\tpmid = {18999283},\n\tpmcid = {PMC2655963},\n\tkeywords = {CIRG\\_Selected, Decision Support Systems, Clinical, Electronic Health Records, HIV Infections, Hawaii, Internet, Medical Record Linkage, Technology Assessment, Biomedical, Telemedicine},\n\tpages = {434--438},\n}\n\n

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\n \n\n \n \n Kitahata, M. M.; Rodriguez, B.; Haubrich, R.; Boswell, S.; Mathews, W. C.; Lederman, M. M.; Lober, W. B.; Van Rompaey, S. E.; Crane, H. M.; Moore, R. D.; Bertram, M.; Kahn, J. O.; and Saag, M. S.\n\n\n \n \n \n \n Cohort profile: the Centers for AIDS Research Network of Integrated Clinical Systems.\n \n \n \n\n\n \n\n\n\n International Journal of Epidemiology, 37(5): 948–955. October 2008.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{kitahata_cohort_2008,\n\ttitle = {Cohort profile: the {Centers} for {AIDS} {Research} {Network} of {Integrated} {Clinical} {Systems}},\n\tvolume = {37},\n\tissn = {1464-3685},\n\tshorttitle = {Cohort profile},\n\tdoi = {10.1093/ije/dym231},\n\tlanguage = {eng},\n\tnumber = {5},\n\tjournal = {International Journal of Epidemiology},\n\tauthor = {Kitahata, Mari M. and Rodriguez, Benigno and Haubrich, Richard and Boswell, Stephen and Mathews, W. Christopher and Lederman, Michael M. and Lober, William B. and Van Rompaey, Stephen E. and Crane, Heidi M. and Moore, Richard D. and Bertram, Michael and Kahn, James O. and Saag, Michael S.},\n\tmonth = oct,\n\tyear = {2008},\n\tpmid = {18263650},\n\tpmcid = {PMC2597168},\n\tkeywords = {Acquired Immunodeficiency Syndrome, Adolescent, Adult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Cohort Studies, Cooperative Behavior, Delivery of Health Care, Integrated, Female, Humans, Male, Medical Record Linkage, Middle Aged, Research Design, Treatment Outcome},\n\tpages = {948--955},\n}\n\n

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\n \n\n \n \n Painter, I. S.; Hills, R. A.; Lober, W. B.; Randels, K. M.; Sibley, J.; and Webster, E.\n\n\n \n \n \n \n Extending functionality of and demonstrating integrated surveillance for public health within a prototype regional health information exchange.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,969. November 2008.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{painter_extending_2008,\n\ttitle = {Extending functionality of and demonstrating integrated surveillance for public health within a prototype regional health information exchange},\n\tissn = {1942-597X},\n\tabstract = {At the HIMSS 2008 conference we demonstrated how multi-jurisdictional public health surveillance and monitoring processes could be supported and expedited through integration with a prototype health information exchange.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Painter, Ian S. and Hills, Rebecca A. and Lober, William B. and Randels, Kelly M. and Sibley, Jim and Webster, Eric},\n\tmonth = nov,\n\tyear = {2008},\n\tpmid = {18999244},\n\tkeywords = {Forms and Records Control, Medical Record Linkage, Pilot Projects, Public Health Informatics, Regional Medical Programs, Systems Integration, Washington},\n\tpages = {969},\n}\n\n

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\n \n\n \n \n Wolpin, S.; Berry, D.; Austin-Seymour, M.; Bush, N.; Fann, J. R.; Halpenny, B.; Lober, W. B.; and McCorkle, R.\n\n\n \n \n \n \n Acceptability of an Electronic Self-Report Assessment Program for patients with cancer.\n \n \n \n\n\n \n\n\n\n Computers, informatics, nursing: CIN, 26(6): 332–338. December 2008.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@article{wolpin_acceptability_2008,\n\ttitle = {Acceptability of an {Electronic} {Self}-{Report} {Assessment} {Program} for patients with cancer},\n\tvolume = {26},\n\tissn = {1538-9774},\n\tdoi = {10.1097/01.NCN.0000336464.79692.6a},\n\tabstract = {Eliciting symptom and quality of life information from patients is an important component of medical and nursing care processes. Traditionally, this information has been collected with paper and pencil. However, this approach presents several barriers, including delays in receiving information, difficulty in integrating responses with electronic records, and the time required to manually score questionnaires for measurement purposes. One solution that addresses many of these barriers is the adoption of computerized screening for symptom and quality-of-life information. This research explored the acceptability of asking symptom and quality-of-life questions using the Electronic Self Report Assessment-Cancer program on wireless laptops equipped with touch-screen format. Acceptability data were explored with respect to whether any differences may be attributed to demographics and symptom and quality-of-life levels, such as depression and cognitive and emotional functioning. This evaluation used descriptive and univariate statistics to examine data from 342 participants from the ongoing ESRA-C randomized clinical trial. Research participants for the ESRA-C study were recruited from the Seattle Cancer Care Alliance, a consortium among the University of Washington Medical Center, Fred Hutchinson Cancer Research Center, and Children's Hospital and Regional Medical Center in Seattle, WA. The sample consisted of 342 adult participants who completed both baseline and follow-up survey sessions. Medical oncology represented the largest recruitment group (45.3\\%), followed by stem cell transplant (34.5\\%) and radiation oncology (20.2\\%). The primary finding was that patients were generally able to use ESRA-C quickly and without difficulty in a real-world clinical setting and that they were overall quite satisfied with the ESRA-C program. Significant differences were found in several acceptability areas with respect to demographics and quality of life measures such as age, sex, and severe distress. This analysis confirms that the ESRA-C application for collecting symptom and quality of life information is easy for patients to use and acceptable across a range of user characteristics. We intend to build on our work by using the survey platform in other modalities while ensuring that the patient's preferences are considered at all times.},\n\tlanguage = {eng},\n\tnumber = {6},\n\tjournal = {Computers, informatics, nursing: CIN},\n\tauthor = {Wolpin, Seth and Berry, Donna and Austin-Seymour, Mary and Bush, Nigel and Fann, Jesse R. and Halpenny, Barbara and Lober, William B. and McCorkle, Ruth},\n\tmonth = dec,\n\tyear = {2008},\n\tpmid = {19047882},\n\tpmcid = {PMC3189855},\n\tkeywords = {Adult, Computers, Humans, Neoplasms, Patient Satisfaction, Quality of Life, Self-Assessment},\n\tpages = {332--338},\n}\n\n

\n

\n\n\n

\n Eliciting symptom and quality of life information from patients is an important component of medical and nursing care processes. Traditionally, this information has been collected with paper and pencil. However, this approach presents several barriers, including delays in receiving information, difficulty in integrating responses with electronic records, and the time required to manually score questionnaires for measurement purposes. One solution that addresses many of these barriers is the adoption of computerized screening for symptom and quality-of-life information. This research explored the acceptability of asking symptom and quality-of-life questions using the Electronic Self Report Assessment-Cancer program on wireless laptops equipped with touch-screen format. Acceptability data were explored with respect to whether any differences may be attributed to demographics and symptom and quality-of-life levels, such as depression and cognitive and emotional functioning. This evaluation used descriptive and univariate statistics to examine data from 342 participants from the ongoing ESRA-C randomized clinical trial. Research participants for the ESRA-C study were recruited from the Seattle Cancer Care Alliance, a consortium among the University of Washington Medical Center, Fred Hutchinson Cancer Research Center, and Children's Hospital and Regional Medical Center in Seattle, WA. The sample consisted of 342 adult participants who completed both baseline and follow-up survey sessions. Medical oncology represented the largest recruitment group (45.3%), followed by stem cell transplant (34.5%) and radiation oncology (20.2%). The primary finding was that patients were generally able to use ESRA-C quickly and without difficulty in a real-world clinical setting and that they were overall quite satisfied with the ESRA-C program. Significant differences were found in several acceptability areas with respect to demographics and quality of life measures such as age, sex, and severe distress. This analysis confirms that the ESRA-C application for collecting symptom and quality of life information is easy for patients to use and acceptable across a range of user characteristics. We intend to build on our work by using the survey platform in other modalities while ensuring that the patient's preferences are considered at all times.\n

\n\n\n

\n \n\n \n \n Doctor, J. N.; Baseman, J. G.; Lober, W. B.; Davies, J.; Kobayashi, J.; Karras, B. T.; and Fuller, S.\n\n\n \n \n \n \n Time-tradeoff utilities for identifying and evaluating a minimum data set for time-critical biosurveillance.\n \n \n \n\n\n \n\n\n\n Medical Decision Making: An International Journal of the Society for Medical Decision Making, 28(3): 351–358. June 2008.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{doctor_time-tradeoff_2008,\n\ttitle = {Time-tradeoff utilities for identifying and evaluating a minimum data set for time-critical biosurveillance},\n\tvolume = {28},\n\tissn = {0272-989X},\n\tdoi = {10.1177/0272989X08317011},\n\tabstract = {BACKGROUND: Researchers and policy makers are interested in identifying, implementing, and evaluating a national minimum data set for biosurveillance. However, work remains to be done to establish methods for measuring the value of such data.\nPURPOSE: The purpose of this article is to establish and evaluate a method for measuring the utility of biosurveillance data.\nMETHOD: The authors derive an expected utility model in which the value of data may be determined by trading data relevance for time delay in receiving data. In a sample of 23 disease surveillance practitioners, the authors test if such tradeoffs are sensitive to the types of data elements involved (chief complaint v. emergency department [ED] log of visit) and proportional changes to the time horizon needed for receiving data (24 v. 48 h). In addition, they evaluate the logical error rate: the proportion of responses that scored less relevant data as having higher utility.\nRESULTS: Utilities of chief complaints were significantly higher than ED log of visit, F(1, 21)= 5.60, P {\\textless} 0.05, suggesting the method is sensitive. Further utilities did not depend on time horizon used in the exercise, F(1, 21) = 0.00, P = ns. Of 92 time tradeoffs elicited, there were 5 logical errors (i.e., 5\\% logical error rate).\nCONCLUSIONS: In this article, the authors establish a time-tradeoff exercise for valuing biosurveillance data. Empirically, the method shows initial promise for evaluating a minimum data set for biosurveillance. Future applications of this approach may prove useful in disease surveillance planning and evaluation.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Medical Decision Making: An International Journal of the Society for Medical Decision Making},\n\tauthor = {Doctor, Jason N. and Baseman, Janet G. and Lober, William B. and Davies, Jac and Kobayashi, John and Karras, Bryant T. and Fuller, Sherrilynne},\n\tmonth = jun,\n\tyear = {2008},\n\tpmid = {18480039},\n\tkeywords = {Adult, Biometry, Communicable Diseases, Disease Outbreaks, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Models, Statistical, Population Surveillance, Public Health, Time Factors, United States, Washington},\n\tpages = {351--358},\n}\n\n

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\n \n 2007\n \n \n (3)\n \n \n

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\n \n\n \n \n Rodriguez, C. V.; Lober, W. B.; Sibley, J.; Webster, E.; Painter, I.; and Karras, B. T.\n\n\n \n \n \n \n Integrating public health applications with commercial EMRs.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,1095. October 2007.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{rodriguez_integrating_2007,\n\ttitle = {Integrating public health applications with commercial {EMRs}},\n\tissn = {1942-597X},\n\tabstract = {At HIMSS 2007, we demonstrated how three processes of public health agencies could be facilitated through use of a prototype health information exchange, satisfying the AHIC biosurveillance use case.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Rodriguez, C. V. and Lober, W. B. and Sibley, J. and Webster, E. and Painter, I. and Karras, B. T.},\n\tmonth = oct,\n\tyear = {2007},\n\tpmid = {18694192},\n\tkeywords = {Humans, Influenza, Human, Information Systems, Medical Records Systems, Computerized, Population Surveillance, Public Health Informatics, Systems Integration, Tuberculosis},\n\tpages = {1095},\n}\n\n

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\n \n\n \n \n Kim, E.; Stolyar, A.; Lober, W. B.; Herbaugh, A. L.; Shinstrom, S. E.; Zierler, B. K.; Soh, C. B.; and Kim, Y.\n\n\n \n \n \n \n Usage patterns of a personal health record by elderly and disabled users.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,409–413. October 2007.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{kim_usage_2007,\n\ttitle = {Usage patterns of a personal health record by elderly and disabled users},\n\tissn = {1942-597X},\n\tabstract = {Personal Health Records (PHRs) are increasingly recognized as a strategy to improve patient-provider communication, availability of health information, and quality of care, by making the delivery of care more patient-centered. However, not much is known about the effects of self-managing personal health information (PeHI), patients' perception of PeHI and patient workflow around PeHI management. We studied PHR use in a low-income, elderly and/or disabled population for 18 months, and describe how the PHR was used through an analysis of database access server log data. Some patients may not keep their PHR up-to-date because they don't value, can't access, or don't understand certain categories of their health information. Understanding of usage patterns can guide the development and maintenance of more usable and pragmatic PHR systems.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Kim, Eung-Hun and Stolyar, Anna and Lober, William B. and Herbaugh, Anne L. and Shinstrom, Sally E. and Zierler, Brenda K. and Soh, Cheong B. and Kim, Youngmin},\n\tmonth = oct,\n\tyear = {2007},\n\tpmid = {18693868},\n\tpmcid = {PMC2655817},\n\tkeywords = {Adult, Aged, Disabled Persons, Female, Humans, Internet, Male, Medical Records, Medical Records Systems, Computerized, Middle Aged, Patient Access to Records, Self Care, Washington},\n\tpages = {409--413},\n}\n\n

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\n \n\n \n \n Crane, H. M.; Lober, W.; Webster, E.; Harrington, R. D.; Crane, P. K.; Davis, T. E.; and Kitahata, M. M.\n\n\n \n \n \n \n Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients.\n \n \n \n\n\n \n\n\n\n Current HIV research, 5(1): 109–118. January 2007.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{crane_routine_2007,\n\ttitle = {Routine collection of patient-reported outcomes in an {HIV} clinic setting: the first 100 patients},\n\tvolume = {5},\n\tissn = {1873-4251},\n\tshorttitle = {Routine collection of patient-reported outcomes in an {HIV} clinic setting},\n\tdoi = {10.2174/157016207779316369},\n\tabstract = {BACKGROUND: Information from patient-reported outcomes (PROs) can enhance patient-provider communication and facilitate clinical research. However, there are barriers to collecting PROs within a clinic. Recent technological advances may help overcome these barriers. We examined the feasibility of using a web-based application on tablet PCs with touch screens to collect PROs in a busy, multi-provider, outpatient HIV clinical care setting.\nMETHODS: Patients presenting for routine care were asked to complete a touch-screen-based assessment containing 62 to 111 items depending on patient responses. The assessment included instruments measuring body morphology abnormalities, depression, symptom burden, medication adherence, drug/alcohol/tobacco use, and health-related quality of life.\nRESULTS: Of 136 patients approached to participate in the study, 106 patients (78\\%) completed the assessment, 6 (4\\%) started but did not complete it, and 24 (18\\%) refused. Of those who completed the assessment, the mean age was 48 years, and 29\\% reported a history of injection drug use. The median time to complete the assessment was 12 minutes. The prevalence of lipoatrophy was 51\\%, the prevalence of lipohypertrophy was 69\\%, and the prevalence of moderate or severe depression was 51\\%. We found that 25\\% of those receiving highly active antiretroviral therapy noted missing a dose of their antiretroviral medications in the prior 4 days.\nCONCLUSIONS: Collection of PROs using touch-screen-based, internet technology was feasible in a busy HIV clinic. We found a high prevalence of body morphology abnormalities, depression, and poor adherence. Touch-screen-based collection of PROs is a promising tool to facilitate research and clinical care.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Current HIV research},\n\tauthor = {Crane, Heidi M. and Lober, William and Webster, Eric and Harrington, Robert D. and Crane, Paul K. and Davis, Thomas E. and Kitahata, Mari M.},\n\tmonth = jan,\n\tyear = {2007},\n\tpmid = {17266562},\n\tkeywords = {Adult, Aged, CD4 Lymphocyte Count, Female, HIV Infections, Health Status, Humans, Male, Middle Aged, Patient Compliance, Quality of Life, Treatment Outcome},\n\tpages = {109--118},\n}\n\n

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\n \n 2006\n \n \n (3)\n \n \n

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\n \n\n \n \n Lober, W. B.; Zierler, B.; Herbaugh, A.; Shinstrom, S. E.; Stolyar, A.; Kim, E. H.; and Kim, Y.\n\n\n \n \n \n \n Barriers to the use of a personal health record by an elderly population.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,514–518. 2006.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_barriers_2006,\n\ttitle = {Barriers to the use of a personal health record by an elderly population},\n\tissn = {1942-597X},\n\tabstract = {Personal health records(PHRs) are proposed as a strategy to make health care delivery increasingly patient-centered. Yet little work has been done in understanding the workflows of patients in their own homes, or influence of access, cognitive, physical, or literacy barriers on workflow and outcomes of using health records. Many populations may require assistance in using PHRs to improve their health out-comes. We studied PHR use by an elderly and disabled population and describe those barriers encountered by our patients.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Lober, W. B. and Zierler, B. and Herbaugh, A. and Shinstrom, S. E. and Stolyar, A. and Kim, E. H. and Kim, Y.},\n\tyear = {2006},\n\tpmid = {17238394},\n\tpmcid = {PMC1839577},\n\tkeywords = {Access to Information, Aged, Aged, 80 and over, Attitude to Computers, CIRG Selected, Data Collection, Disabled Persons, Feasibility Studies, Female, Humans, Male, Medical Records Systems, Computerized, Middle Aged, Public Housing, Washington},\n\tpages = {514--518},\n}\n\n

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\n \n\n \n \n Karras, B. T.; Wolpin, S.; Lober, W. B.; Bush, N.; Fann, J. R.; and Berry, D. L.\n\n\n \n \n \n \n Electronic Self-report Assessment–Cancer (ESRA-C): Working towards an integrated survey system.\n \n \n \n\n\n \n\n\n\n Studies in Health Technology and Informatics, 122: 514–518. 2006.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{karras_electronic_2006,\n\ttitle = {Electronic {Self}-report {Assessment}--{Cancer} ({ESRA}-{C}): {Working} towards an integrated survey system},\n\tvolume = {122},\n\tissn = {0926-9630},\n\tshorttitle = {Electronic {Self}-report {Assessment}--{Cancer} ({ESRA}-{C})},\n\tabstract = {The Clinical Informatics Research Group and Biobehavioral Nursing and Health Systems at the University of Washington are working with interdisciplinary teams to improve patient care and tracking of patient-reported symptoms and outcomes by creating an extensible web-based survey and intervention platform. The findings and cumulative experience from these processes have led to incremental improvements and variations in each new implementation of the platform. This paper presents progress in the first year of a three-year NIH study entitled Electronic Self Report Assessment--Cancer (ESRA-C). The project's goals are to enhance and evaluate the web-based computerized patient self-reporting and assessment system at the Seattle Cancer Care Alliance. Preliminary work and lessons learned in the modification of the platform and enhancements to the system will be described.},\n\tlanguage = {eng},\n\tjournal = {Studies in Health Technology and Informatics},\n\tauthor = {Karras, Bryant T. and Wolpin, Seth and Lober, William B. and Bush, Nigel and Fann, Jesse R. and Berry, Donna L.},\n\tyear = {2006},\n\tpmid = {17102311},\n\tkeywords = {Automation, Data Collection, Health Surveys, Humans, Neoplasms, Nursing Informatics, Quality of Life, Washington},\n\tpages = {514--518},\n}\n\n

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\n \n\n \n \n Berry, D. L.; Wolpin, S. E.; Lober, W. B.; Ellis, W. J.; Russell, K. J.; and Davison, B. J.\n\n\n \n \n \n \n Actual use and perceived usefulness of a web-based, decision support program for men with prostate cancer.\n \n \n \n\n\n \n\n\n\n Studies in Health Technology and Informatics, 122: 781–782. 2006.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{berry_actual_2006,\n\ttitle = {Actual use and perceived usefulness of a web-based, decision support program for men with prostate cancer},\n\tvolume = {122},\n\tissn = {0926-9630},\n\tabstract = {The purpose of this pilot study was to develop and test the Personal Patient Profile-Prostate (P4), a customized, Internet-based decision support system for men with localized prostate cancer. In a sample of 30 men, the P4 program was successfully implemented in a clinical setting. Men reported the program useful and web-logs documented a high use rate of menu-driven components of the intervention.},\n\tlanguage = {eng},\n\tjournal = {Studies in Health Technology and Informatics},\n\tauthor = {Berry, Donna L. and Wolpin, Seth E. and Lober, William B. and Ellis, William J. and Russell, Kenneth J. and Davison, B. Joyce},\n\tyear = {2006},\n\tpmid = {17102377},\n\tkeywords = {Decision Support Systems, Clinical, Humans, Internet, Male, Patient Satisfaction, Prostatic Neoplasms, Surveys and Questionnaires},\n\tpages = {781--782},\n}\n\n

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\n \n 2005\n \n \n (8)\n \n \n

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\n \n\n \n \n Lumley, T.; Sebestyen, K.; Lober, W. B.; and Painter, I.\n\n\n \n \n \n \n An open source environment for the statistical evaluation of outbreak detection methods.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,1037. 2005.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lumley_open_2005,\n\ttitle = {An open source environment for the statistical evaluation of outbreak detection methods},\n\tissn = {1942-597X},\n\tabstract = {We describe the design and initial steps to implementation of a computational framework for evaluating outbreak detection methods. The framework will include components for combining simulated and historical data to create artificial outbreaks and components that implement various outbreak detection algorithms. The first algorithms to be implemented are the three Cumulative Sums (cusum) methods described in the CDC Early Aberration Reporting System.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Lumley, Thomas and Sebestyen, Krisztian and Lober, William B. and Painter, Ian},\n\tyear = {2005},\n\tpmid = {16779324},\n\tpmcid = {PMC1560726},\n\tkeywords = {Algorithms, Disease Outbreaks, Humans, Models, Statistical, Population Surveillance, Programming Languages, Public Health Informatics},\n\tpages = {1037},\n}\n\n

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\n \n\n \n \n Van Eaton, E. G.; Horvath, K. D.; Lober, W. B.; Rossini, A. J.; and Pellegrini, C. A.\n\n\n \n \n \n \n A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours.\n \n \n \n\n\n \n\n\n\n Journal of the American College of Surgeons, 200(4): 538–545. April 2005.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{van_eaton_randomized_2005,\n\ttitle = {A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours},\n\tvolume = {200},\n\tissn = {1072-7515},\n\tdoi = {10.1016/j.jamcollsurg.2004.11.009},\n\tabstract = {BACKGROUND: Adoption of limits on resident work hours prompted us to develop a centralized, Web-based computerized rounding and sign-out system (UWCores) that securely stores sign-out information; automatically downloads patient data (vital signs, laboratories); and prints them to rounding, sign-out, and progress note templates. We tested the hypothesis that this tool would positively impact continuity of care and resident workflow by improving team communication involving patient handovers and streamlining inefficiencies, such as hand-copying patient data during work before rounds ("prerounds").\nSTUDY DESIGN: Fourteen inpatient resident teams (6 general surgery, 8 internal medicine) at two teaching hospitals participated in a 5-month, prospective, randomized, crossover study. Data collected included number of patients missed on resident rounds, subjective continuity of care quality and workflow efficiency with and without UWCores, and daily self-reported prerounding and rounding times and tasks.\nRESULTS: UWCores halved the number of patients missed on resident rounds (2.5 versus 5 patients/team/month, p = 0.0001); residents spent 40\\% more of their prerounds time seeing patients (p = 0.36); residents reported better sign-out quality (69.6\\% agree or strongly agree); and improved continuity of care (66.1\\% agree or strongly agree). UWCores halved the portion of prerounding time spent hand-copying basic data (p {\\textless} 0.0001); it shortened team rounds by 1.5 minutes/patient (p = 0.0006); and residents reported finishing their work sooner using UWCores (82.1\\% agree or strongly agree).\nCONCLUSIONS: This system enhances patient care by decreasing patients missed on resident rounds and improving resident-reported quality of sign-out and continuity of care. It decreases by up to 3 hours per week (range 1.5 to 3) the time used by residents to complete rounds; it diverts prerounding time from recopying data to more productive tasks; and it facilitates meeting the 80-hour work week requirement by helping residents finish their work sooner.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {Journal of the American College of Surgeons},\n\tauthor = {Van Eaton, Erik G. and Horvath, Karen D. and Lober, William B. and Rossini, Anthony J. and Pellegrini, Carlos A.},\n\tmonth = apr,\n\tyear = {2005},\n\tpmid = {15804467},\n\tkeywords = {Continuity of Patient Care, Cross-Over Studies, Efficiency, Organizational, General Surgery, Humans, Internal Medicine, Internship and Residency, Medical Records Systems, Computerized, Patient Care, Prospective Studies, Workload},\n\tpages = {538--545},\n}\n\n

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\n BACKGROUND: Adoption of limits on resident work hours prompted us to develop a centralized, Web-based computerized rounding and sign-out system (UWCores) that securely stores sign-out information; automatically downloads patient data (vital signs, laboratories); and prints them to rounding, sign-out, and progress note templates. We tested the hypothesis that this tool would positively impact continuity of care and resident workflow by improving team communication involving patient handovers and streamlining inefficiencies, such as hand-copying patient data during work before rounds (\"prerounds\"). STUDY DESIGN: Fourteen inpatient resident teams (6 general surgery, 8 internal medicine) at two teaching hospitals participated in a 5-month, prospective, randomized, crossover study. Data collected included number of patients missed on resident rounds, subjective continuity of care quality and workflow efficiency with and without UWCores, and daily self-reported prerounding and rounding times and tasks. RESULTS: UWCores halved the number of patients missed on resident rounds (2.5 versus 5 patients/team/month, p = 0.0001); residents spent 40% more of their prerounds time seeing patients (p = 0.36); residents reported better sign-out quality (69.6% agree or strongly agree); and improved continuity of care (66.1% agree or strongly agree). UWCores halved the portion of prerounding time spent hand-copying basic data (p \\textless 0.0001); it shortened team rounds by 1.5 minutes/patient (p = 0.0006); and residents reported finishing their work sooner using UWCores (82.1% agree or strongly agree). CONCLUSIONS: This system enhances patient care by decreasing patients missed on resident rounds and improving resident-reported quality of sign-out and continuity of care. It decreases by up to 3 hours per week (range 1.5 to 3) the time used by residents to complete rounds; it diverts prerounding time from recopying data to more productive tasks; and it facilitates meeting the 80-hour work week requirement by helping residents finish their work sooner.\n

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\n \n\n \n \n Dockrey, M. R.; Lober, W. B.; Wolpin, S. E.; Rae, L. J.; and Berry, D. L.\n\n\n \n \n \n \n Distributed health assessment and intervention research software framework.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,940. 2005.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{dockrey_distributed_2005,\n\ttitle = {Distributed health assessment and intervention research software framework},\n\tissn = {1942-597X},\n\tabstract = {The DHAIR software system is a database-driven, web-based survey platform. It implements the delivery of survey instruments in packaged assessments, creation and editing of those assessments, researcher access to the results of the survey application, and a flexible authorization framework.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Dockrey, M. R. and Lober, W. B. and Wolpin, S. E. and Rae, L. J. and Berry, D. L.},\n\tyear = {2005},\n\tpmid = {16779227},\n\tpmcid = {PMC1560572},\n\tkeywords = {Data Collection, Health Surveys, Internet, Software},\n\tpages = {940},\n}\n\n

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\n \n\n \n \n Stolyar, A.; Lober, W. B.; Drozd, D. R.; and Sibley, J.\n\n\n \n \n \n \n Feasibility of data exchange with a Patient-centered Health Record.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,1123. 2005.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{stolyar_feasibility_2005,\n\ttitle = {Feasibility of data exchange with a {Patient}-centered {Health} {Record}},\n\tissn = {1942-597X},\n\tabstract = {A patient-centered health record is a personal health record that is patient-owned, patient-managed, and that represents the health information important to patients in the ways they prefer to represent it. The Patient-centered Health Record (PcHR) was developed to address these needs. Integration with traditional electronic health records adds significant value, and we used a national showcase to demonstrate the feasibility of exchanging health information through document level interoperability with commercial enterprise clinical systems.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Stolyar, A. and Lober, W. B. and Drozd, D. R. and Sibley, J.},\n\tyear = {2005},\n\tpmid = {16779410},\n\tpmcid = {PMC1560649},\n\tkeywords = {Access to Information, Feasibility Studies, Humans, Medical Records Systems, Computerized, Ownership, Patient-Centered Care, Systems Integration},\n\tpages = {1123},\n}\n\n

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\n \n\n \n \n Tran, D. T.; Zhang, X.; Stolyar, A.; and Lober, W. B.\n\n\n \n \n \n \n Patient-centered design for a personal health record system.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,1140. 2005.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{tran_patient-centered_2005,\n\ttitle = {Patient-centered design for a personal health record system},\n\tissn = {1942-597X},\n\tabstract = {Our objective for this project was to design a user interface (UI) for a patient-centered personal health record system that models how patients view their health information. We assessed user needs, examined how patients label and categorize health information, and evaluated two user interfaces that we designed for the Patient-Centered Health Record (PcHR) system. Our design process focused on discovering useful content and ensuring that the UI was intuitive, easy to use, and helpful for users.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Tran, D. T. and Zhang, X. and Stolyar, A. and Lober, W. B.},\n\tyear = {2005},\n\tpmid = {16779426},\n\tpmcid = {PMC1560647},\n\tkeywords = {Access to Information, Attitude to Computers, Health Services Needs and Demand, Humans, Medical Records Systems, Computerized, Ownership, Patient-Centered Care, Surveys and Questionnaires, User-Computer Interface},\n\tpages = {1140},\n}\n\n

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\n \n\n \n \n Drozd, D. R.; Lober, W. B.; Kitahata, M. M.; Smith, K. I.; and Van Rompaey, S. E.\n\n\n \n \n \n \n Developing a relational XML schema for sharing HIV clinical data.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,943. 2005.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{drozd_developing_2005,\n\ttitle = {Developing a relational {XML} schema for sharing {HIV} clinical data},\n\tissn = {1942-597X},\n\tabstract = {Access to multi-site clinical data regarding treatment and outcomes of HIV-infected patients in routine care is required to support clinical research to improve the treatment of HIV. As part of the NIAID-funded CFAR Network of Integrated Clinical Systems (CNICS), we have developed a relational XML Schema to extend the existing observational research repository and to integrate real-time clinical information from electronic medical records (EMRs) at six Centers for AIDS Research (CFAR) into the repository. The schema will aid the expansion of the research repository beyond the initial sites, and the development process may facilitate the use of multi-site repositories to study other chronic diseases.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Drozd, D. R. and Lober, W. B. and Kitahata, M. M. and Smith, K. I. and Van Rompaey, S. E.},\n\tyear = {2005},\n\tpmid = {16779230},\n\tpmcid = {PMC1560526},\n\tkeywords = {Databases as Topic, HIV Infections, Humans, Information Systems, Medical Record Linkage, Medical Records Systems, Computerized, Programming Languages, United States},\n\tpages = {943},\n}\n\n

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\n \n\n \n \n Rae, L. J.; Lober, W. B.; Wolpin, S. E.; Dockrey, M. R.; Ellis, W. J.; and Berry, D. L.\n\n\n \n \n \n \n Acceptability of an Internet treatment decision support program for men with prostate cancer.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,1091. 2005.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{rae_acceptability_2005,\n\ttitle = {Acceptability of an {Internet} treatment decision support program for men with prostate cancer},\n\tissn = {1942-597X},\n\tabstract = {We have implemented a customized Internet decision support system designed to engage men in the decision-making process for the management of localized prostate cancer. The system is delivered to patients in the patient education room of the UWMC Prostate Oncology Center. The system interactively guides the patient through a series of surveys, and delivers multi-media interaction modeling and decision support output, both of which are customized for the patient's preferences. The system is currently implemented on an open source platform.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Rae, L. J. and Lober, W. B. and Wolpin, S. E. and Dockrey, M. R. and Ellis, W. J. and Berry, D. L.},\n\tyear = {2005},\n\tpmid = {16779378},\n\tpmcid = {PMC1560672},\n\tkeywords = {Decision Making, Humans, Internet, Male, Patient Education as Topic, Patient Participation, Patient Satisfaction, Prostatic Neoplasms},\n\tpages = {1091},\n}\n\n

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\n \n\n \n \n Van Eaton, E. G.; Lober, W. B.; Pellegrini, C. A.; and Horvath, K. D.\n\n\n \n \n \n \n User-driven design of a computerized rounding and sign-out application.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,1145. 2005.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{van_eaton_user-driven_2005,\n\ttitle = {User-driven design of a computerized rounding and sign-out application},\n\tissn = {1942-597X},\n\tabstract = {Clinical information systems depend on close integration to workflow for success. We describe a method for user-driven design that guided our development of a computerized rounding and sign-out system. The resulting system supported clinical workflow sufficiently well that it spontaneously attracted new users, required no training, and is currently used by 95\\% of the house staff at two academic medical centers.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Van Eaton, E. G. and Lober, W. B. and Pellegrini, C. A. and Horvath, K. D.},\n\tyear = {2005},\n\tpmid = {16779431},\n\tpmcid = {PMC1560729},\n\tkeywords = {Hospital Information Systems, Humans, Internet, Internship and Residency, Medical Records Systems, Computerized, Personnel Staffing and Scheduling Information Systems, Task Performance and Analysis, User-Computer Interface},\n\tpages = {1145},\n}\n\n

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\n \n 2004\n \n \n (5)\n \n \n

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\n \n\n \n \n Mandl, K. D.; Overhage, J. M.; Wagner, M. M.; Lober, W. B.; Sebastiani, P.; Mostashari, F.; Pavlin, J. A.; Gesteland, P. H.; Treadwell, T.; Koski, E.; Hutwagner, L.; Buckeridge, D. L.; Aller, R. D.; and Grannis, S.\n\n\n \n \n \n \n Implementing syndromic surveillance: a practical guide informed by the early experience.\n \n \n \n\n\n \n\n\n\n Journal of the American Medical Informatics Association: JAMIA, 11(2): 141–150. April 2004.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{mandl_implementing_2004,\n\ttitle = {Implementing syndromic surveillance: a practical guide informed by the early experience},\n\tvolume = {11},\n\tissn = {1067-5027},\n\tshorttitle = {Implementing syndromic surveillance},\n\tdoi = {10.1197/jamia.M1356},\n\tabstract = {Syndromic surveillance refers to methods relying on detection of individual and population health indicators that are discernible before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. Syndromic surveillance systems are being developed locally, regionally, and nationally. The efforts have been largely directed at facilitating the early detection of a covert bioterrorist attack, but the technology may also be useful for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who are currently planning deployment of such systems in their regions.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Journal of the American Medical Informatics Association: JAMIA},\n\tauthor = {Mandl, Kenneth D. and Overhage, J. Marc and Wagner, Michael M. and Lober, William B. and Sebastiani, Paola and Mostashari, Farzad and Pavlin, Julie A. and Gesteland, Per H. and Treadwell, Tracee and Koski, Eileen and Hutwagner, Lori and Buckeridge, David L. and Aller, Raymond D. and Grannis, Shaun},\n\tmonth = apr,\n\tyear = {2004},\n\tpmid = {14633933},\n\tpmcid = {PMC353021},\n\tkeywords = {Bioterrorism, Confidentiality, Disease Outbreaks, Health Insurance Portability and Accountability Act, Humans, Medical Informatics Applications, Population Surveillance, Public Health, United States},\n\tpages = {141--150},\n}\n\n

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\n \n\n \n \n Lober, W. B.; Baer, A.; Karras, B. T.; and Duchin, J. S.\n\n\n \n \n \n \n Collection and integration of clinical data for surveillance.\n \n \n \n\n\n \n\n\n\n Studies in Health Technology and Informatics, 107(Pt 2): 1211–1215. 2004.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_collection_2004,\n\ttitle = {Collection and integration of clinical data for surveillance},\n\tvolume = {107},\n\tissn = {0926-9630},\n\tabstract = {OBJECTIVE: The syndromic surveillance project at Public Health-Seattle \\& King County incorporates several data sources, including emergency department and primary care visit data collected and normalized through an automated mechanism. We describe significant changes made in this "second generation" of our system to improve data quality while complying with privacy and state public health reporting regulations.\nMETHODS/RESULTS: The system uses de-identified visit and patient numbers to assure data accuracy, while shielding patient identity. Presently, we have 124,000 basic visit records (used to generate stratified denominators), and 29,000 surveillance records, from four emergency departments and a primary care clinic network. The system is capable of producing syndrome-clustered data sets for analysis.\nDISCUSSION: We have incorporated data collection techniques such as automated querying, report parsing, and HL7 electronic data interchange. We are expanding the system to include greater population coverage, and developing an understanding how to implement data collections more rapidly at individual hospital sites, as well as how best to prepare the data for analysis.},\n\tlanguage = {eng},\n\tnumber = {Pt 2},\n\tjournal = {Studies in Health Technology and Informatics},\n\tauthor = {Lober, William B. and Baer, Atar and Karras, Bryant T. and Duchin, Jeffery S.},\n\tyear = {2004},\n\tpmid = {15361005},\n\tkeywords = {Bioterrorism, Computer Systems, Data Collection, Disease Notification, Disease Outbreaks, Electronic Data Processing, Emergency Service, Hospital, Humans, Population Surveillance, Public Health Informatics, Software Design, Washington},\n\tpages = {1211--1215},\n}\n\n

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\n \n\n \n \n Lober, W. B.; Trigg, L.; and Karras, B.\n\n\n \n \n \n \n Information system architectures for syndromic surveillance.\n \n \n \n\n\n \n\n\n\n MMWR supplements, 53: 203–208. September 2004.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_information_2004,\n\ttitle = {Information system architectures for syndromic surveillance},\n\tvolume = {53},\n\tissn = {2380-8942},\n\tabstract = {INTRODUCTION: Public health agencies are developing the capacity to automatically acquire, integrate, and analyze clinical information for disease surveillance. The design of such surveillance systems might benefit from the incorporation of advanced architectures developed for biomedical data integration. Data integration is not unique to public health, and both information technology and academic research should influence development of these systems.\nOBJECTIVES: The goal of this paper is to describe the essential architectural components of a syndromic surveillance information system and discuss existing and potential architectural approaches to data integration.\nMETHODS: This paper examines the role of data elements, vocabulary standards, data extraction, transport and security, transformation and normalization, and analysis data sets in developing disease-surveillance systems. It then discusses automated surveillance systems in the context of biomedical and computer science research in data integration, both to characterize existing systems and to indicate potential avenues of investigation to build systems that support public health practice.\nRESULTS: The Public Health Information Network (PHIN) identifies best practices for essential architectural components of a syndromic surveillance system. A schema for classifying biomedical data-integration software is useful for classifying present approaches to syndromic surveillance and for describing architectural variation.\nCONCLUSIONS: Public health informatics and computer science research in data-integration systems can supplement approaches recommended by PHIN and provide information for future public health surveillance systems.},\n\tlanguage = {eng},\n\tjournal = {MMWR supplements},\n\tauthor = {Lober, William B. and Trigg, L. and Karras, B.},\n\tmonth = sep,\n\tyear = {2004},\n\tpmid = {15717393},\n\tkeywords = {Bioterrorism, Communicable Diseases, Emerging, Disease Outbreaks, Humans, Population Surveillance, Public Health Administration, Public Health Informatics},\n\tpages = {203--208},\n}\n\n

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\n \n\n \n \n Van Eaton, E. G.; Horvath, K. D.; Lober, W. B.; and Pellegrini, C. A.\n\n\n \n \n \n \n Organizing the transfer of patient care information: the development of a computerized resident sign-out system.\n \n \n \n\n\n \n\n\n\n Surgery, 136(1): 5–13. July 2004.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{van_eaton_organizing_2004,\n\ttitle = {Organizing the transfer of patient care information: the development of a computerized resident sign-out system},\n\tvolume = {136},\n\tissn = {0039-6060},\n\tshorttitle = {Organizing the transfer of patient care information},\n\tdoi = {10.1016/j.surg.2004.04.018},\n\tabstract = {BACKGROUND: The problem of safe and efficient transfer of care has increased over the years as new and complex diagnostic tools and more complex treatment options became available. Traditionally, residents ensured continuity of care by working long hours and minimizing the transfer of significant diagnostic or therapeutic responsibilities to other providers. The new 80-hour workweek has curtailed that practice and increased the pressure on trainees for workflow efficiency. We report on a study of information-handling routines among residents for the separate tasks of transfer of care ("sign-out") and daily patient care work (ward work). Using these results, an institution-wide computerized system was developed to centralize information-handling tasks and facilitate the management and transfer of patient care information.\nSTUDY DESIGN: House staff from 31 resident-run inpatient and consult services at 2 teaching hospitals described current methods of maintaining patient information used during ward rounds and during sign-out. A subgroup of 28 residents then participated in the design of a computerized resident sign-out system to centralize patient information and produce lists for rounding and transferring care duties. Accuracy, flexibility, and portability were identified as key elements by the design team.\nRESULTS: Analysis of the type of information handled by residents caring for inpatients at our institution demonstrated common elements across many services. Most services used a paper patient list to manage both nightly sign-out and daily ward work, which required repeated recopying of patient data during the day. Utilizing medical information systems tools and rapid application development concepts, we constructed a computerized resident sign-out system ("UWCores"). This system combines the patient sign-out and daily ward work information in one central location. We believed this would improve the quality of information transferred during sign-out and enhance resident efficiency. During the design process, we identified rules that govern the type of clinical information that should be automatically versus manually updated. We observed an immediate acceptance by all residents and services that tried the system.\nCONCLUSIONS: This study shows that by combining downloaded patient data from hospital systems with resident-entered patient details, a computerized resident sign-out system can be a feasible, powerful, and popular tool. While its effect on patient safety and resident efficiency await the results of further studies, our study shows that this tool rapidly captured the attention of resident physicians and became widely used as a valuable means to centralize and organize sign-out and daily ward work information.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {Surgery},\n\tauthor = {Van Eaton, Erik G. and Horvath, Karen D. and Lober, William B. and Pellegrini, Carlos A.},\n\tmonth = jul,\n\tyear = {2004},\n\tpmid = {15232532},\n\tkeywords = {Continuity of Patient Care, General Surgery, Humans, Internship and Residency, Medical Records Systems, Computerized, Patient Care, Patient Transfer},\n\tpages = {5--13},\n}\n\n

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\n BACKGROUND: The problem of safe and efficient transfer of care has increased over the years as new and complex diagnostic tools and more complex treatment options became available. Traditionally, residents ensured continuity of care by working long hours and minimizing the transfer of significant diagnostic or therapeutic responsibilities to other providers. The new 80-hour workweek has curtailed that practice and increased the pressure on trainees for workflow efficiency. We report on a study of information-handling routines among residents for the separate tasks of transfer of care (\"sign-out\") and daily patient care work (ward work). Using these results, an institution-wide computerized system was developed to centralize information-handling tasks and facilitate the management and transfer of patient care information. STUDY DESIGN: House staff from 31 resident-run inpatient and consult services at 2 teaching hospitals described current methods of maintaining patient information used during ward rounds and during sign-out. A subgroup of 28 residents then participated in the design of a computerized resident sign-out system to centralize patient information and produce lists for rounding and transferring care duties. Accuracy, flexibility, and portability were identified as key elements by the design team. RESULTS: Analysis of the type of information handled by residents caring for inpatients at our institution demonstrated common elements across many services. Most services used a paper patient list to manage both nightly sign-out and daily ward work, which required repeated recopying of patient data during the day. Utilizing medical information systems tools and rapid application development concepts, we constructed a computerized resident sign-out system (\"UWCores\"). This system combines the patient sign-out and daily ward work information in one central location. We believed this would improve the quality of information transferred during sign-out and enhance resident efficiency. During the design process, we identified rules that govern the type of clinical information that should be automatically versus manually updated. We observed an immediate acceptance by all residents and services that tried the system. CONCLUSIONS: This study shows that by combining downloaded patient data from hospital systems with resident-entered patient details, a computerized resident sign-out system can be a feasible, powerful, and popular tool. While its effect on patient safety and resident efficiency await the results of further studies, our study shows that this tool rapidly captured the attention of resident physicians and became widely used as a valuable means to centralize and organize sign-out and daily ward work information.\n

\n\n\n

\n \n\n \n \n Berry, D. L.; Trigg, L. J.; Lober, W. B.; Karras, B. T.; Galligan, M. L.; Austin-Seymour, M.; and Martin, S.\n\n\n \n \n \n \n Computerized symptom and quality-of-life assessment for patients with cancer part I: development and pilot testing.\n \n \n \n\n\n \n\n\n\n Oncology Nursing Forum, 31(5): E75–83. September 2004.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{berry_computerized_2004,\n\ttitle = {Computerized symptom and quality-of-life assessment for patients with cancer part {I}: development and pilot testing},\n\tvolume = {31},\n\tissn = {1538-0688},\n\tshorttitle = {Computerized symptom and quality-of-life assessment for patients with cancer part {I}},\n\tdoi = {10.1188/04.ONF.E75-E83},\n\tabstract = {PURPOSE/OBJECTIVES: To develop and test an innovative computerized symptom and quality-of-life (QOL) assessment for patients with cancer who are evaluated for and treated with radiation therapy.\nDESIGN: Descriptive, longitudinal prototype development and cross-sectional clinical data.\nSETTING: Department of radiation oncology in an urban, academic medical center.\nSAMPLE: 101 outpatients who were evaluated for radiation therapy, able to communicate in English (or through one of many interpreters available at the University of Washington), and competent to understand the study information and give informed consent. Six clinicians caring for the patients in the sample were enrolled.\nMETHODS: Iterative prototype development was conducted using a standing focus group of clinicians. The software was developed based on survey markup language and implemented in a wireless, Web-based format. Patient participants completed the computerized assessment prior to consultation with the radiation physician. Graphical output pages with flagged areas of symptom distress or troublesome QOL issues were made available to consulting physicians and nurses.\nMAIN RESEARCH VARIABLES: Pain intensity, symptoms, QOL, and demographics.\nINSTRUMENTS: Computerized versions of a 0 to 10 Pain Intensity Numerical Scale (PINS), Symptom Distress Scale, and Short Form-8.\nFINDINGS: Focus group recommendations included clinician priorities of brevity, flexibility, and simplicity for both input interface and output and that the assessment output contain color graphic display. Patient participants included 45 women and 56 men with a mean age of 52.7 years (SD = 13.8). Fewer than half of the participants (40\\%) reported using a computer on a regular basis (weekly or daily). Completion time averaged 7.8 minutes (SD = 3.7). Moderate to high levels of distress were reported more often for fatigue, pain, and emotional issues than for other symptoms or concerns.\nCONCLUSIONS: Computerized assessment of cancer symptoms and QOL is technically possible and feasible in an ambulatory cancer clinic. A wireless, Web-based system facilitates access to results and data entry and retrieval. The symptom and QOL profiles of these patients new to radiation therapy were comparable to other samples of outpatients with cancer.\nIMPLICATIONS FOR NURSING: The ability to capture an easily interpreted illustration of a patients symptom and QOL experience in less than 10 minutes is a potentially useful adjunct to traditional face-to-face interviewing. Ultimately, electronic patient-generated data could produce automated red flags directed to the most appropriate clinicians (e.g., nurse, pain specialist, social worker, nutritionist) for further evaluation. Such system enhancement could greatly facilitate oncology nurses coordination role in caring for complex patients with cancer.},\n\tlanguage = {eng},\n\tnumber = {5},\n\tjournal = {Oncology Nursing Forum},\n\tauthor = {Berry, Donna L. and Trigg, Lisa J. and Lober, William B. and Karras, Bryant T. and Galligan, Mary L. and Austin-Seymour, Mary and Martin, Stephanie},\n\tmonth = sep,\n\tyear = {2004},\n\tpmid = {15378104},\n\tkeywords = {Academic Medical Centers, Adult, Aged, Computer Literacy, Cross-Sectional Studies, Female, Focus Groups, Humans, Internet, Longitudinal Studies, Male, Middle Aged, Neoplasms, Pain Measurement, Pilot Projects, Quality of Life, Radiation Oncology, Radiotherapy, Self-Assessment, Software, Software Design, Surveys and Questionnaires, Washington},\n\tpages = {E75--83},\n}\n\n

\n

\n\n\n

\n PURPOSE/OBJECTIVES: To develop and test an innovative computerized symptom and quality-of-life (QOL) assessment for patients with cancer who are evaluated for and treated with radiation therapy. DESIGN: Descriptive, longitudinal prototype development and cross-sectional clinical data. SETTING: Department of radiation oncology in an urban, academic medical center. SAMPLE: 101 outpatients who were evaluated for radiation therapy, able to communicate in English (or through one of many interpreters available at the University of Washington), and competent to understand the study information and give informed consent. Six clinicians caring for the patients in the sample were enrolled. METHODS: Iterative prototype development was conducted using a standing focus group of clinicians. The software was developed based on survey markup language and implemented in a wireless, Web-based format. Patient participants completed the computerized assessment prior to consultation with the radiation physician. Graphical output pages with flagged areas of symptom distress or troublesome QOL issues were made available to consulting physicians and nurses. MAIN RESEARCH VARIABLES: Pain intensity, symptoms, QOL, and demographics. INSTRUMENTS: Computerized versions of a 0 to 10 Pain Intensity Numerical Scale (PINS), Symptom Distress Scale, and Short Form-8. FINDINGS: Focus group recommendations included clinician priorities of brevity, flexibility, and simplicity for both input interface and output and that the assessment output contain color graphic display. Patient participants included 45 women and 56 men with a mean age of 52.7 years (SD = 13.8). Fewer than half of the participants (40%) reported using a computer on a regular basis (weekly or daily). Completion time averaged 7.8 minutes (SD = 3.7). Moderate to high levels of distress were reported more often for fatigue, pain, and emotional issues than for other symptoms or concerns. CONCLUSIONS: Computerized assessment of cancer symptoms and QOL is technically possible and feasible in an ambulatory cancer clinic. A wireless, Web-based system facilitates access to results and data entry and retrieval. The symptom and QOL profiles of these patients new to radiation therapy were comparable to other samples of outpatients with cancer. IMPLICATIONS FOR NURSING: The ability to capture an easily interpreted illustration of a patients symptom and QOL experience in less than 10 minutes is a potentially useful adjunct to traditional face-to-face interviewing. Ultimately, electronic patient-generated data could produce automated red flags directed to the most appropriate clinicians (e.g., nurse, pain specialist, social worker, nutritionist) for further evaluation. Such system enhancement could greatly facilitate oncology nurses coordination role in caring for complex patients with cancer.\n

\n\n\n

\n\n\n\n\n\n

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\n \n 2003\n \n \n (4)\n \n \n

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\n \n \n

\n \n\n \n \n Lober, W. B.; Trigg, L. J.; Karras, B. T.; Bliss, D.; Ciliberti, J.; Stewart, L.; and Duchin, J. S.\n\n\n \n \n \n \n Syndromic surveillance using automated collection of computerized discharge diagnoses.\n \n \n \n\n\n \n\n\n\n Journal of Urban Health: Bulletin of the New York Academy of Medicine, 80(2 Suppl 1): i97–106. June 2003.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@article{lober_syndromic_2003,\n\ttitle = {Syndromic surveillance using automated collection of computerized discharge diagnoses},\n\tvolume = {80},\n\tissn = {1099-3460},\n\tdoi = {10.1007/pl00022320},\n\tabstract = {The Syndromic Surveillance Information Collection (SSIC) system aims to facilitate early detection of bioterrorism attacks (with such agents as anthrax, brucellosis, plague, Q fever, tularemia, smallpox, viral encephalitides, hemorrhagic fever, botulism toxins, staphylococcal enterotoxin B, etc.) and early detection of naturally occurring disease outbreaks, including large foodborne disease outbreaks, emerging infections, and pandemic influenza. This is accomplished using automated data collection of visit-level discharge diagnoses from heterogeneous clinical information systems, integrating those data into a common XML (Extensible Markup Language) form, and monitoring the results to detect unusual patterns of illness in the population. The system, operational since January 2001, collects, integrates, and displays data from three emergency department and urgent care (ED/UC) departments and nine primary care clinics by automatically mining data from the information systems of those facilities. With continued development, this system will constitute the foundation of a population-based surveillance system that will facilitate targeted investigation of clinical syndromes under surveillance and allow early detection of unusual clusters of illness compatible with bioterrorism or disease outbreaks.},\n\tlanguage = {eng},\n\tnumber = {2 Suppl 1},\n\tjournal = {Journal of Urban Health: Bulletin of the New York Academy of Medicine},\n\tauthor = {Lober, William B. and Trigg, Lisa J. and Karras, Bryant T. and Bliss, David and Ciliberti, Jack and Stewart, Laurie and Duchin, Jeffrey S.},\n\tmonth = jun,\n\tyear = {2003},\n\tpmid = {12791784},\n\tpmcid = {PMC3456541},\n\tkeywords = {Bioterrorism, Data Collection, Databases as Topic, Disease Notification, Disease Outbreaks, Humans, Medical Records Systems, Computerized, Patient Discharge, Public Health Informatics, Sentinel Surveillance, United States},\n\tpages = {i97--106},\n}\n\n

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\n\n\n\n\n\n

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\n \n\n \n \n Travers, D. A.; Waller, A.; Haas, S. W.; Lober, W. B.; and Beard, C.\n\n\n \n \n \n \n Emergency Department data for bioterrorism surveillance: electronic data availability, timeliness, sources and standards.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,664–668. 2003.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@article{travers_emergency_2003,\n\ttitle = {Emergency {Department} data for bioterrorism surveillance: electronic data availability, timeliness, sources and standards},\n\tissn = {1942-597X},\n\tshorttitle = {Emergency {Department} data for bioterrorism surveillance},\n\tabstract = {Emergency Department (ED) data are a key component of bioterrorism surveillance systems. Little research has been done to examine differences in ED data capture and entry across hospitals, regions and states. The purpose of this study was to describe the current state of ED data for use in bioterrorism surveillance in 2 regions of the country. We found that chief complaint (CC) data are available electronically in 54\\% of the North Carolina EDs surveyed, and in 100\\% of the Seattle area EDs. Over half of all EDs reported that CCs are recorded in free text form. Though all EDs have electronic diagnosis data, less than half report that diagnoses are coded within 24 hours of the ED visit.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Travers, Debbie A. and Waller, Anna and Haas, Stephanie W. and Lober, William B. and Beard, Carmen},\n\tyear = {2003},\n\tpmid = {14728256},\n\tpmcid = {PMC1479948},\n\tkeywords = {Bioterrorism, Data Collection, Disease Notification, Emergency Service, Hospital, Hospital Information Systems, Humans, Medical Records Systems, Computerized, North Carolina, Population Surveillance, Vocabulary, Controlled, Washington},\n\tpages = {664--668},\n}\n\n

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\n\n\n\n\n\n

\n\n\n

\n \n\n \n \n Lober, W. B.; Bliss, D.; Dockrey, M. R.; Davidson, A. J.; and Karras, B. T.\n\n\n \n \n \n \n Communicable disease case entry using PDAs and public wireless networks.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,916. 2003.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@article{lober_communicable_2003,\n\ttitle = {Communicable disease case entry using {PDAs} and public wireless networks},\n\tissn = {1942-597X},\n\tabstract = {Concerns about detecting and responding to attacks with biowarfare agents have resulted in the development of deployable case reporting systems, e.g. RSVP. We implement a proof of concept web-based information system to be used securely from personal digital assistants over public wireless networks, by public health field workers for routine and emergent case reporting. The system collects data for a local health jurisdiction, provides content- and event-based notification, and forwards case reports to the Colorado State communicable disease reporting system (CEDRS). We believe this demonstrates a useful integration of portable and web-based technologies with public health practice.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Lober, W. B. and Bliss, D. and Dockrey, M. R. and Davidson, A. J. and Karras, B. T.},\n\tyear = {2003},\n\tpmid = {14728422},\n\tpmcid = {PMC1480186},\n\tkeywords = {Colorado, Communicable Diseases, Computers, Handheld, Disease Notification, Humans, Internet, Pilot Projects, Population Surveillance, User-Computer Interface},\n\tpages = {916},\n}\n\n

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\n \n\n \n \n Payne, T. H.; Gaster, B.; Mineer, D.; Mazurk, J.; Dunnington, N.; Zehner, J.; Lober, B.; Van Eaton, E.; and McCormick, W.\n\n\n \n \n \n \n Creating a note classification scheme for a multi-institutional electronic medical record.\n \n \n \n\n\n \n\n\n\n AMIA ... Annual Symposium proceedings. AMIA Symposium,968. 2003.\n \n\n\n\n
\n\n\n\n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@article{payne_creating_2003,\n\ttitle = {Creating a note classification scheme for a multi-institutional electronic medical record},\n\tissn = {1942-597X},\n\tabstract = {How notes are categorized in an electronic medical record (EMR) influences how rapidly users can locate documents and enter new ones, whether algorithmic search for chart deficiencies is possible, and the ease of incorporating collections of existing notes. We balanced these competing needs when developing a note classification scheme for the Online Record of Clinical Activity (ORCA) electronic medical record at the University of Washington.},\n\tlanguage = {eng},\n\tjournal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},\n\tauthor = {Payne, Thomas H. and Gaster, Barak and Mineer, Durline and Mazurk, Jim and Dunnington, Nancy and Zehner, Jacquie and Lober, Bill and Van Eaton, Erik and McCormick, Wayne},\n\tyear = {2003},\n\tpmid = {14728472},\n\tpmcid = {PMC1480190},\n\tkeywords = {Academic Medical Centers, Forms and Records Control, Hospital Information Systems, Humans, Medical Record Linkage, Medical Records Systems, Computerized, Software, Washington},\n\tpages = {968},\n}\n\n

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\n \n 2002\n \n \n (3)\n \n \n

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\n \n \n

\n \n\n \n \n Lober, W. B.; Karras, B. T.; Wagner, M. M.; Overhage, J. M.; Davidson, A. J.; Fraser, H.; Trigg, L. J.; Mandl, K. D.; Espino, J. U.; and Tsui, F.\n\n\n \n \n \n \n Roundtable on bioterrorism detection: information system-based surveillance.\n \n \n \n\n\n \n\n\n\n Journal of the American Medical Informatics Association: JAMIA, 9(2): 105–115. April 2002.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_roundtable_2002,\n\ttitle = {Roundtable on bioterrorism detection: information system-based surveillance},\n\tvolume = {9},\n\tissn = {1067-5027},\n\tshorttitle = {Roundtable on bioterrorism detection},\n\tdoi = {10.1197/jamia.m1052},\n\tabstract = {During the 2001 AMIA Annual Symposium, the Anesthesia, Critical Care, and Emergency Medicine Working Group hosted the Roundtable on Bioterrorism Detection. Sixty-four people attended the roundtable discussion, during which several researchers discussed public health surveillance systems designed to enhance early detection of bioterrorism events. These systems make secondary use of existing clinical, laboratory, paramedical, and pharmacy data or facilitate electronic case reporting by clinicians. This paper combines case reports of six existing systems with discussion of some common techniques and approaches. The purpose of the roundtable discussion was to foster communication among researchers and promote progress by 1) sharing information about systems, including origins, current capabilities, stages of deployment, and architectures; 2) sharing lessons learned during the development and implementation of systems; and 3) exploring cooperation projects, including the sharing of software and data. A mailing list server for these ongoing efforts may be found at http://bt.cirg.washington.edu.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Journal of the American Medical Informatics Association: JAMIA},\n\tauthor = {Lober, William B. and Karras, Bryant Thomas and Wagner, Michael M. and Overhage, J. Marc and Davidson, Arthur J. and Fraser, Hamish and Trigg, Lisa J. and Mandl, Kenneth D. and Espino, Jeremy U. and Tsui, Fu-Chiang},\n\tmonth = apr,\n\tyear = {2002},\n\tpmid = {11861622},\n\tpmcid = {PMC344564},\n\tkeywords = {Bioterrorism, CIRG\\_Selected, Humans, Medical Informatics Applications, Population Surveillance, United States},\n\tpages = {105--115},\n}\n\n

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\n\n\n\n\n\n

\n\n\n

\n \n\n \n \n Karras, B. T.; Huq, S. H.; Bliss, D.; and Lober, W. B.\n\n\n \n \n \n \n \n National Pharmaceutical Stockpile drill analysis using XML data collection on wireless Java phones.\n \n \n \n \n\n\n \n\n\n\n Proceedings. AMIA Symposium,365–369. 2002.\n \n\n\n\n
\n\n\n\n \n \n $\"National$ Paper\n \n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@article{karras_national_2002,\n\ttitle = {National {Pharmaceutical} {Stockpile} drill analysis using {XML} data collection on wireless {Java} phones},\n\tissn = {1531-605X},\n\turl = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2244171/pdf/procamiasymp00001-0406.pdf},\n\tabstract = {This study describes an informatics effort to track subjects through a National Pharmaceutical Stockpile (NPS) distribution drill. The drill took place in Seattle on 1/24/2002. Washington and the State Department of Health are among the first in the nation to stage a NPS drill testing the distribution of medications to mock patients, thereby testing the treatment capacity of the plan given a post-anthrax exposure scenario. The goal of the Public Health Informatics Group at the University of Washington (www.phig.washington.edu) was to use informatics approaches to monitor subject numbers and elapsed time. This study compares accuracy of time measurements using a mobile phone Java application to traditional paper recording in a live drill of the NPS. Pearson correlation = 1.0 in 2 of 3 stations. Differences in last station measurements can be explained by delay in recording of the exit time. We discuss development of the application itself and lessons learned. (MeSH Bioterrorism, Informatics, Public Health)},\n\tlanguage = {eng},\n\tjournal = {Proceedings. AMIA Symposium},\n\tauthor = {Karras, B. T. and Huq, S. Huq and Bliss, D. and Lober, W. B.},\n\tyear = {2002},\n\tpmid = {12463848},\n\tpmcid = {PMC2244171},\n\tkeywords = {Anti-Bacterial Agents, Bioterrorism, Cell Phone, Civil Defense, Communicable Disease Control, Data Collection, Disaster Planning, Government Agencies, Humans, Point-of-Care Systems, Programming Languages, Public Health Administration, Public Health Informatics, State Government, Washington},\n\tpages = {365--369},\n}\n\n

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\n\n\n\n\n\n

\n\n\n

\n \n\n \n \n Karras, B. T.; O'Carroll, P.; Oberle, M. W.; Masuda, D.; Lober, W. B.; Robins, L. S.; Kim, S.; Schaad, D. C.; and Scott, C. S.\n\n\n \n \n \n \n Development and evaluation of public health informatics at University of Washington.\n \n \n \n\n\n \n\n\n\n Journal of public health management and practice: JPHMP, 8(3): 37–43. May 2002.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{karras_development_2002,\n\ttitle = {Development and evaluation of public health informatics at {University} of {Washington}},\n\tvolume = {8},\n\tissn = {1078-4659},\n\tdoi = {10.1097/00124784-200205000-00006},\n\tabstract = {Public Health Informatics (PHI) education began at the University of Washington (UW) with a Summer Institute in 1995. The Biomedical and Health Informatics graduate program, which is housed in the School of Medicine, is an interdisciplinary, multi-school program. It demonstrates the UW's cooperative efforts in advancing informatics, encompassing the schools of public health, medicine, nursing, dentistry, pharmacy, information and graduate schools in computer science. This article provides an overview of the developmental milestones related to activities in PHI and describes the evaluation strategy and assessment plan for PHI training at the UW (http://phig.washington.edu).},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Journal of public health management and practice: JPHMP},\n\tauthor = {Karras, Bryant Thomas and O'Carroll, Patrick and Oberle, Mark W. and Masuda, David and Lober, William B. and Robins, Lynne S. and Kim, Sara and Schaad, Doug C. and Scott, Craig S.},\n\tmonth = may,\n\tyear = {2002},\n\tpmid = {15156623},\n\tkeywords = {Curriculum, Educational Measurement, Humans, Medical Informatics, Program Evaluation, Public Health, Universities, Washington},\n\tpages = {37--43},\n}\n

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\n\n\n\n\n\n

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\n \n 2001\n \n \n (1)\n \n \n

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\n \n \n

\n \n\n \n \n Lober, W. B.; Trigg, L. J.; Bliss, D.; and Brinkley, J. M.\n\n\n \n \n \n \n \n IML: An image markup language.\n \n \n \n \n\n\n \n\n\n\n Proceedings. AMIA Symposium,403–407. 2001.\n \n\n\n\n
\n\n\n\n \n \n $\"IML:$ Paper\n \n \n\n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@article{lober_iml_2001,\n\ttitle = {{IML}: {An} image markup language},\n\tissn = {1531-605X},\n\tshorttitle = {{IML}},\n\turl = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2243617/pdf/procamiasymp00002-0442.pdf},\n\tabstract = {Image Markup Language is an extensible markup language (XML) schema used to describe both image metadata and annotations. It describes both data pertaining to an entire image, and data that are tied to specific regions or features of the image. Developed for a specific domain in Medical Education, this pa-per describes extensions to take advantage of the Dublin Core metadata standard, and of an XML schema for vector graphics representation. We have developed a prototype system of open source tools implementing an authoring system, a client system, and an image annotation database which can be queried though the Web.},\n\tlanguage = {eng},\n\tjournal = {Proceedings. AMIA Symposium},\n\tauthor = {Lober, W. B. and Trigg, L. J. and Bliss, D. and Brinkley, J. M.},\n\tyear = {2001},\n\tpmid = {11825219},\n\tpmcid = {PMC2243617},\n\tkeywords = {Diagnostic Imaging, Humans, Programming Languages, Software},\n\tpages = {403--407},\n}\n\n

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\n \n 1997\n \n \n (1)\n \n \n

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\n \n\n \n \n Bey, T. A.; Walter, F. G.; Lober, W.; Schmidt, J.; Spark, R.; and Schlievert, P. M.\n\n\n \n \n \n \n \n Loxosceles arizonica bite associated with shock.\n \n \n \n \n\n\n \n\n\n\n Annals of Emergency Medicine, 30(5): 701–703. November 1997.\n \n\n\n\n
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@article{bey_loxosceles_1997,\n\ttitle = {Loxosceles arizonica bite associated with shock},\n\tvolume = {30},\n\tissn = {0196-0644},\n\turl = {https://pdf.sciencedirectassets.com/272873/1-s2.0-S0196064405X70858/1-s2.0-S0196064497700921/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEMv%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJGMEQCIDLKw8FNGgMOciyeyEMy%2BQ5psbgEWPvvK2y5zjh7GQZ6AiAdVZR1Qs%2Ft%2BlP8iJxw5UiGTVeLwvDR9f2qK0okEJ1ZWiq0AwhkEAIaDDA1OTAwMzU0Njg2NSIMC1YsNptzs0vhandOKpEDPJMEteueNN0FnwW%2Fca51EDIY2VPG0sjXsBccTHVG3tewnGHDzE4BdiIOmI9SBfimAMjfXDoa%2FZx6Vy23bSjxXUdG5FeU0amh9DqChgCoPiU8H8b3qAwJ7JT%2FUpTPVrDaGlAkpOW0ka3OVBQEio5VIwoDznZRSrw6PTFa99cmCJMIJi3bEtUCsmOYsKVMILc%2FOZ%2BiqndeJ1KdBtr%2BW20WYHa4Muc3ehx6qnOtBCAadXUK3hvlVlq7sh7usy4njp5RMDDmSxpueb6vqf2rrx3%2BonZcq6CrM5YZlf3Es%2FTvqfSZRtsZ3FcTFpnwxIF43d9hh4geGb4mHn97fyyAJfZu8ybzToOjpnw9aroaglUxpSGqYgEFJeSCnm7UQOB7My3Z2xV1AX%2FtMmis6rE5uz%2FII5x61g4zlnA18GmgbRih%2Bf9jEG0R3xfHibd6s%2BU4fMsnpn4MYU9f%2BXOSWaFNXtiBN1D0ZiqxyxMZ9sDSj6EuheCMZFCtbhD5VRmM8nSKQ7FiayOgq6J1fP9OP5ruRTvwqJkwqfys8QU67AE9SDF9HkbaRn4su%2BSAtzKefbyiTJTJbz79pEXy1aZMh%2BGY9ClMCX2JwRcSlmBCLmVI2JPTCJJWELAJa1ZkZGyO08OTkrWv3MwX3PRHFsg4UQjdkhMS6ngW3JWm0FHpA27V8Dz0lDBGxGf0tHGiLL100wb6aJCEbhkwxQGF%2B6tYIgv%2BlD2crufhAqYCloqJWYb1gRzT3I%2FdULY%2Fwzi6ACCnT%2Fl5i4X3E3OG7%2B30EeXV4T2rS9BHBS9U4TK2Htqe7%2FqoeUzaeIJYy4%2FtDkmRWelfQk%2Br1%2BU8MDie%2FRPHEK4epOvGZQiZErkgxUb2kg%3D%3D&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20200124T194448Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTY2Z6GW3OM%2F20200124%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=6271860958f25861caace21c7af669679e624e3117bbb3bb12a388e6756f6698&hash=52af8b46abb842b0dd5fc74ab0a438e4d880e5089f7a62b23056604be4d4d3b6&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S0196064497700921&tid=spdf-242d13ad-ba8b-4a5a-9834-dd14b16e358f&sid=844d24293e08504656187b4786f9f24812a4gxrqa&type=client},\n\tdoi = {10.1016/s0196-0644(97)70092-1},\n\tabstract = {Envenomation by the brown recluse spider (Loxosceles reclusa) is associated with shock, significant hemolysis, renal insufficiency, and disseminated intravascular coagulation (DIC). Shock has never been associated with envenomation by L arizonica, a related species indigenous to Arizona, southern California, and northwestern Mexico. We report the case of a 13-year-old girl, bitten by a specimen of L arizonica (the spider was identified by an entomologist), in whom shock and a typical cutaneous lesion developed. She did not experience renal insufficiency or disseminated intravascular coagulation. Infectious causes of shock were excluded. She recovered completely with supportive care.},\n\tlanguage = {eng},\n\tnumber = {5},\n\tjournal = {Annals of Emergency Medicine},\n\tauthor = {Bey, T. A. and Walter, F. G. and Lober, W. and Schmidt, J. and Spark, R. and Schlievert, P. M.},\n\tmonth = nov,\n\tyear = {1997},\n\tpmid = {9360587},\n\tkeywords = {Adolescent, Animals, Female, Humans, Shock, Spider Bites, Spiders},\n\tpages = {701--703},\n}\n\n

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