Nevin Manimala

Appl Clin Inform. 2024 Jul 17. doi: 10.1055/a-2368-3514. Online ahead of print.

ABSTRACT

BACKGROUND: Health informatics (HI) is a growing field of study, yet sparse data is available on the characteristics of undergraduate health informatics programs in the United States (U.S.). The lack of a central location for U.S. HI undergraduate program data has led to a gap in information to support current efforts to promote academic standards in the field and attract potential students.

OBJECTIVES: The objective of this study was to perform an environment scan of colleges and universities within the U.S. and Puerto Rico to identify undergraduate programs in HI including majors, minors, and undergraduate level certificates.

METHODS: Potential institutions offering HI programs were identified from the National Center for Education Statistics (NCES), Commission for Accreditation of Health Informatics and Health Information Management Education (CAHIIM), the Association of University Programs in Health Administration (AUPHA), the Healthcare Information and Management Systems Society (HIMSS), and the American Health Information Management Association (AHIMA). Publicly available materials for these institutions were reviewed, and data were captured for identified HI programs including geographic location; college or school in which the program was offered; type of degree (if applicable); program title; total credits to complete the program; delivery format; and source of data.

RESULTS: 83 HI programs were identified from 60 institutions and 26 states. The primary finding of this environment scan was that inconsistencies exist among U.S. HI undergraduate programs including variations in offering college/school, title of program, number of credits required, delivery formats, CIP codes, and the type of information published on university/college websites.

CONCLUSION: This environment scan was a first step in exploring the characteristics of undergraduate HI programs within the U.S. Further research is needed on the curricular similarities and differences among the programs, the administrative methods of these interdisciplinary programs, and the information most needed by current and potential undergraduate students.

PMID:39019476 | DOI:10.1055/a-2368-3514

J Am Acad Orthop Surg. 2024 Jul 15. doi: 10.5435/JAAOS-D-24-00164. Online ahead of print.

ABSTRACT

PURPOSE: Physician and surgeon involvement in industry has received considerable attention in recent decades. In this study, we outline the perspective of the general US population regarding (1) disclosure, (2) ownership, and (3) compensation between physicians/surgeons and industry. We hypothesize that the general population would be largely supportive of the physician/surgeon-industry relationship.

METHODS: An online, survey-based, descriptive study was conducted through a crowdsourcing platform, Amazon Mechanical Turk. Survey respondents were presented with a seven-item questionnaire inquiring about the physician/surgeon and industry relationship. An “attention check” question was included; those who failed this question were excluded. Descriptive statistics were used to assess the data and a McNemar chi-squared test for paired, dichotomous data.

RESULTS: A total of 993 respondents were included. Survey responses are summarized in Table 1. 70.6% of respondents stated that it was “important” or “extremely important” to disclose that the patient be informed whether implants used in surgery had been developed by the operating surgeon. 71.1% of respondents reported that it was “important” or “extremely important” to disclose partial ownership within industry. Seventy-one percent of respondents stated it was “important” or “extremely important” to disclose royalty payments pertaining to surgical implants. 95.6% of respondents suggested that it was acceptable for surgeons to accept free airfare and lodging, and 95.2% of respondents stated that it was acceptable for the surgeon to be compensated for time away from practice to learn about new equipment.

DISCUSSION: In our survey of 993 respondents, we found that relationships with industry are considered acceptable if appropriate disclosure is given to patients. We also found that although respondents suggested that physicians and surgeons may be influenced by a free meal, compensation for trips to try new equipment and time spent away from practice is considered appropriate.

LEVEL OF EVIDENCE: 2c, Ecological studies.

PMID:39018577 | DOI:10.5435/JAAOS-D-24-00164

Appl Physiol Nutr Metab. 2024 Jul 17. doi: 10.1139/apnm-2024-0142. Online ahead of print.

ABSTRACT

This randomized, placebo-controlled, double-blind, parallel trial investigated whether generally healthy adult, non-elite runners would have a greater time-to-exhaustion during submaximal treadmill running with probiotic versus placebo supplementation. It was hypothesized that the probiotic would impact training progression by reducing gastrointestinal (GI) and cold/flu symptoms. Participants who typically ran ≥24 km/week, ran or cross-trained 3-5 days per week, and had a maximal oxygen intake (VO2 max) in the 60-85th percentile were enrolled. VO2 max was used to establish individualized workload settings (85% of VO2 max) for the submaximal endurance tests at baseline and following 6 weeks of supplementation with a probiotic (Lactobacillus helveticus Lafti L10, 5×109 CFU/capsule/day) or placebo. Participants self-reported GI and cold/flu symptoms and physical activity via daily and weekly questionnaires. Outcomes were tested using a linear model to determine if mean response values adjusted for baseline differed between groups. Twenty-eight participants (n=14/group), aged 255 years (meanSD) with a body mass index of 233 kg/m2, completed the study. At the final visit the probiotic group had a lower time-to-exhaustion versus the placebo group (P=0.01) due to an increase in time-to-exhaustion with the placebo (1344±188 to 1565±219 seconds, P=0.01) with no change with the probiotic (1655±230 to 1547±215 seconds, P=0.23). During the intervention, the probiotic group completed fewer aerobic training sessions per week (P=0.02) and trained at a lower intensity (P=0.007) versus the placebo group. Few GI and cold/flu symptoms were reported with no differences between groups. Time-to-exhaustion increased in the placebo group, possibly due to differences in training habits.

PMID:39018571 | DOI:10.1139/apnm-2024-0142

Am J Respir Crit Care Med. 2024 Jul 17. doi: 10.1164/rccm.202405-0958LE. Online ahead of print.

NO ABSTRACT

PMID:39018563 | DOI:10.1164/rccm.202405-0958LE

JMIR Form Res. 2024 Jul 17;8:e48434. doi: 10.2196/48434.

ABSTRACT

BACKGROUND: Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition.

OBJECTIVE: This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic.

METHODS: An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network.

RESULTS: In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6%, n=103) and highly educated, with 57.1% (n=68) having a university degree. Slightly more than half (57.1%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before (“prepandemic period”) and after (“postpandemic period”) March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=-3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=-2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=-2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001).

CONCLUSIONS: During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures.

PMID:39018551 | DOI:10.2196/48434

Health Rep. 2024 Jul 17;35(7):14-27. doi: 10.25318/82-003-x202400700002-eng.

ABSTRACT

BACKGROUND: Mental health disparity is associated with diverse characteristics, such as gender, socioeconomic status, Indigenous identity, immigrant status, race, disability, and sexual orientation. However, intersectional studies on women’s mental health have been rare, particularly during the COVID-19 pandemic period.

METHODS: Using data from two cycles of the Canadian Community Health Survey (2019 annual data and data from September to December 2020), self-reported mental health outcomes before the COVID-19 pandemic (sample size was 64,880) and during the second wave of the pandemic in the fall of 2020 (sample size of 27,246) were analyzed.

RESULTS: After sociodemographic factors were controlled for, women and girls had higher odds of poorer self-perceived mental health and worsened mental health compared with before the COVID-19 pandemic than men and boys. Compared with 2019, the gender gap in negative self-perceived mental health increased during the pandemic. The number and type of intersections of specific socioeconomic characteristics also had an impact on mental health outcomes. During the pandemic, women and girls with the following characteristics were more likely to report low self-perceived mental health, compared with women and girls with no intersections: those with a disability (7.8 times); or who are lesbian, gay, or bisexual or have another sexual orientation than heterosexual (5.6); or who are Indigenous (3.6).

INTERPRETATION: The intersections of gender and other sociodemographic characteristics increased the odds of negative self-perceived mental health.

PMID:39018524 | DOI:10.25318/82-003-x202400700002-eng

Health Rep. 2024 Jul 17;35(7):3-13. doi: 10.25318/82-003-x202400700001-eng.

ABSTRACT

BACKGROUND: Most individuals prefer to spend their final moments of life outside a hospital setting. This study compares the places of care and death of long-term care (LTC) home residents in Ontario in the last 90 days of life, according to LTC home rurality.

DATA AND METHODS: This retrospective cohort study was conducted using health administrative data from ICES (formerly known as the Institute for Clinical Evaluative Sciences). The study population, which was identified through algorithms, included all Ontario LTC home residents with a dementia diagnosis who died between April 1, 2014, and March 31, 2019. The location of death was categorized as in an acute care hospital, an LTC home, a subacute care facility, or the community. Places of care included emergency department visits and hospitalizations in the last 90 days of life. Statistical tests were used to evaluate differences in location of death and places of care by rurality.

RESULTS: Of the 65,375 LTC home residents with dementia, 49,432 (75.6%) died in an LTC home. Residents of LTC homes in the most urban areas were less likely to die in an LTC home than those in more rural homes (adjusted relative risk: 0.84; 95% confidence interval: 0.83 to 0.85). A higher proportion of residents of the most urban LTC homes had at least one hospitalization in the last 90 days of life compared with rural residents (23.7% versus 9.9% palliative hospitalizations and 28.3% versus 15.9% non-palliative hospitalizations [p ⟨ 0.001]).

INTERPRETATION: Individuals with dementia residing in urban LTC homes are more likely to receive care in the hospital and to die outside a LTC home than their counterparts living in rural LTC homes. The findings of this work will inform efforts to improve end-of-life care for older adults with dementia living in LTC homes.

PMID:39018523 | DOI:10.25318/82-003-x202400700001-eng

J Clin Oncol. 2024 Jul 17:JCO2400178. doi: 10.1200/JCO.24.00178. Online ahead of print.

ABSTRACT

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Although dose-dense adjuvant chemotherapy administered once every 2 weeks leads to superior outcomes compared with standard regimens once every 3 weeks, the observed improvement is largely limited to studies using the suboptimal paclitaxel schedule once every 3 weeks as control. PANTHER is an international phase III trial which compared sequential epirubicin/cyclophosphamide and docetaxel administered either once every 2 or once every 3 weeks, with tailored dosing at the dose-dense schedule according to hematologic toxicity. In this end-of-study analysis, the median follow-up was 10.3 years. Compared with standard adjuvant chemotherapy, dose-dense treatment improved breast cancer recurrence-free survival (hazard ratio [HR], 0.80 [95% CI, 0.65 to 0.98]; P = .030), event-free survival (HR, 0.78 [95% CI, 0.65 to 0.94]; P = .009), and distant disease-free survival (HR, 0.79 [95% CI, 0.64 to 0.98]; P = .030) while the improvement in overall survival was not statistically significant (HR, 0.82 [95% CI, 0.65 to 1.04]; P = .109). To our knowledge, this is the first trial that confirms the benefit of a dose-dense regimen over a control regimen containing docetaxel once every 3 weeks.

PMID:39018515 | DOI:10.1200/JCO.24.00178

JCO Clin Cancer Inform. 2024 Jul;8:e2400037. doi: 10.1200/CCI.24.00037.

ABSTRACT

PURPOSE: Patient outcomes may differ from randomized trial averages. We aimed to predict benefit from FOLFOXIRI versus infusional fluorouracil, leucovorin, and oxaliplatin/fluorouracil, leucovorin, and irinotecan (FOLFOX/FOLFIRI), both plus bevacizumab, in patients with metastatic colorectal cancer (mCRC).

METHODS: A Cox model with prespecified clinical, molecular, and laboratory variables was developed in 639 patients from the TRIBE2 trial for predicting 2-year mortality. Data from the CHARTA (n = 232), TRIBE1 (n = 504), and CAIRO5 (liver-only mCRC, n = 287) trials were used for external validation and heterogeneity of treatment effects (HTE) analysis. This involves categorizing patients into risk groups and assessing treatment effects across these groups. Performance was assessed by the C-index and calibration plots. The C-for-benefit was calculated to assess evidence for HTE. The c-for-benefit is specifically designed for HTE analysis. Like the commonly known c-statistic, it summarizes the discrimination of a model. Values over 0.5 indicate evidence for HTE.

RESULTS: In TRIBE2, the overoptimism-corrected C-index was 0.66 (95% CI, 0.63 to 0.69). At external validation, the C-index was 0.69 (95% CI, 0.64 to 0.75), 0.68 (95% CI, 0.64 to 0.72), and 0.65 (95% CI, 0.65 to 0.66), in CHARTA, TRIBE1, and CAIRO5, respectively. Calibration plots indicated slight underestimation of mortality. The c-for-benefit indicated evidence for HTE in CHARTA (0.56, 95% CI, 0.48 to 0.65), but not in TRIBE1 (0.49, 95% CI, 0.44 to 0.55) and CAIRO5 (0.40, 95% CI, 0.32 to 0.48).

CONCLUSION: Although 2-year mortality could be reasonably estimated, the HTE analysis showed that clinically available variables did not reliably identify which patients with mCRC benefit from FOLFOXIRI versus FOLFOX/FOLFIRI, both plus bevacizumab, across the three studies.

PMID:39018510 | DOI:10.1200/CCI.24.00037

J Am Med Inform Assoc. 2024 Jul 17:ocae194. doi: 10.1093/jamia/ocae194. Online ahead of print.

ABSTRACT

OBJECTIVES: This work presents the development and evaluation of coordn8, a web-based application that streamlines fax processing in outpatient clinics using a “human-in-the-loop” machine learning framework. We demonstrate the effectiveness of the platform at reducing fax processing time and producing accurate machine learning inferences across the tasks of patient identification, document classification, spam classification, and duplicate document detection.

METHODS: We deployed coordn8 in 11 outpatient clinics and conducted a time savings analysis by observing users and measuring fax processing event logs. We used statistical methods to evaluate the machine learning components across different datasets to show generalizability. We conducted a time series analysis to show variations in model performance as new clinics were onboarded and to demonstrate our approach to mitigating model drift.

RESULTS: Our observation analysis showed a mean reduction in individual fax processing time by 147.5 s, while our event log analysis of over 7000 faxes reinforced this finding. Document classification produced an accuracy of 81.6%, patient identification produced an accuracy of 83.7%, spam classification produced an accuracy of 98.4%, and duplicate document detection produced a precision of 81.0%. Retraining document classification increased accuracy by 10.2%.

DISCUSSION: coordn8 significantly decreased fax-processing time and produced accurate machine learning inferences. Our human-in-the-loop framework facilitated the collection of high-quality data necessary for model training. Expanding to new clinics correlated with performance decline, which was mitigated through model retraining.

CONCLUSION: Our framework for automating clinical tasks with machine learning offers a template for health systems looking to implement similar technologies.

PMID:39018499 | DOI:10.1093/jamia/ocae194