Searched for: school:SOM
Department/Unit:Population Health
Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff
McNeely, Jennifer; Kumar, Pritika C; Rieckmann, Traci; Sedlander, Erica; Farkas, Sarah; Chollak, Christine; Kannry, Joseph L; Vega, Aida; Waite, Eva A; Peccoralo, Lauren A; Rosenthal, Richard N; McCarty, Dennis; Rotrosen, John
BACKGROUND:Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. METHODS:Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices (Graham et al. in J Contin Educ Health Prof 26(1):13-24, 2006). RESULTS:Factors affecting implementation based on KTA elements were identified from participant narratives. Identifying the problem: Participants consistently agreed that having knowledge of a patient's substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach. Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual's own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment. Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial. CONCLUSIONS:Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers.
PMCID:5890352
PMID: 29628018
ISSN: 1940-0640
CID: 3036682
Maximizing the Public Health Benefits from Climate Action
Thurston, George D; De Matteis, Sara; Murray, Kris; Scheelbeek, Pauline; Scovronick, Noah; Budolfson, Mark; Spears, Dean; Vineis, Paolo
PMID: 29512384
ISSN: 1520-5851
CID: 2975192
Baseline antibody profiles predict toxicity in melanoma patients treated with immune checkpoint inhibitors
Gowen, Michael F; Giles, Keith M; Simpson, Danny; Tchack, Jeremy; Zhou, Hua; Moran, Una; Dawood, Zarmeena; Pavlick, Anna C; Hu, Shaohui; Wilson, Melissa A; Zhong, Hua; Krogsgaard, Michelle; Kirchhoff, Tomas; Osman, Iman
BACKGROUND:Immune checkpoint inhibitors (anti-CTLA-4, anti-PD-1, or the combination) enhance anti-tumor immune responses, yielding durable clinical benefit in several cancer types, including melanoma. However, a subset of patients experience immune-related adverse events (irAEs), which can be severe and result in treatment termination. To date, no biomarker exists that can predict development of irAEs. METHODS:We hypothesized that pre-treatment antibody profiles identify a subset of patients who possess a sub-clinical autoimmune phenotype that predisposes them to develop severe irAEs following immune system disinhibition. Using a HuProt human proteome array, we profiled baseline antibody levels in sera from melanoma patients treated with anti-CTLA-4, anti-PD-1, or the combination, and used support vector machine models to identify pre-treatment antibody signatures that predict irAE development. RESULTS:We identified distinct pre-treatment serum antibody profiles associated with severe irAEs for each therapy group. Support vector machine classifier models identified antibody signatures that could effectively discriminate between toxicity groups with > 90% accuracy, sensitivity, and specificity. Pathway analyses revealed significant enrichment of antibody targets associated with immunity/autoimmunity, including TNFα signaling, toll-like receptor signaling and microRNA biogenesis. CONCLUSIONS:Our results provide the first evidence supporting a predisposition to develop severe irAEs upon immune system disinhibition, which requires further independent validation in a clinical trial setting.
PMCID:5880088
PMID: 29606147
ISSN: 1479-5876
CID: 3025242
DO GOAL-DIRECTED OR OUTCOME-BASED FINANCIAL INCENTIVES PROMOTE PATIENTS' WEIGHT LOSS? THE FIREWORK INTERVENTION PROTOCOL [Meeting Abstract]
Orstad, Stephanie L.; Ladapo, Joseph A.; Wittleder, Sandra; Hernandez, Christina; Cuevas, Miguel A.; Sweat, Victoria; Jay, Melanie
ISI:000431185202288
ISSN: 0883-6612
CID: 3113882
Engagement and outcomes among older adults with mobile health (mHealth) cardiac rehabilitation: pilot study [Meeting Abstract]
Grant, E.; Hochman, J.; Summapund, J.; Zhong, H.; Guo, Y.; Estrin, D.; Troxel, A.; Whiteson, J.; Sweeney, G.; Blaum, C.; Dodson, J. A.
ISI:000430468400836
ISSN: 0002-8614
CID: 3084872
Cardiologist perspectives on shared-decision-making in the treatment of older adults after acute myocardial infarction [Meeting Abstract]
Grant, E.; Dickson, V.; Matlock, D.; Summapund, J.; Chaudhry, S.; Katz, S.; Blaum, C.; Dodson, J. A.
ISI:000430468400413
ISSN: 0002-8614
CID: 3084942
Characterizing E-cigarette Use in Older Smokers with Mental Illness [Meeting Abstract]
Wang, J.; Gravely, A.; Sherman, S.; Rogers, E.; Fu, S.
ISI:000430468400968
ISSN: 0002-8614
CID: 3084822
Hearing Loss in Emergency Departments: A Pilot Study [Meeting Abstract]
Echevarria, J.; Mangold, M.; Weinstein, B.; Blustein, J.; Chodosh, J.
ISI:000430468400816
ISSN: 0002-8614
CID: 3084882
Long-Run Trends in Antidepressant Use Among Youths After the FDA Black Box Warning
Kafali, Nilay; Progovac, Ana; Hou, Sherry Shu-Yeu; Cook, Benjamin Lê
OBJECTIVE:In October 2004, the Food and Drug Administration directed pharmaceutical companies to issue a black box warning about the potential link between the use of antidepressants and suicidal ideation among children. This study analyzed long-run trends in antidepressant use among children before and after the black box warning for those with and without severe psychological impairment. METHODS:The analysis used data from the Medical Expenditure Panel Survey for children ages five to 17, covering years 2000-2011 (N=75,819). The study used multivariate probit models to compare the changes in the rate of any antidepressant use in the early (2004-2007) and late (2008-2011) postwarning years with the rate in the prewarning years (2002-2003). Recycled predictions methods were used to estimate yearly predicted probabilities of use. RESULTS:After adjustment for all covariates, there was a .5% statistically significant decline in the probability of using any antidepressants during the early postwarning years (2004-2007) compared with prewarning years. In the long run (2008-2011), however, there was no statistically significant difference. Five years after the black box warning, the adjusted rates of use increased to their prewarning levels (2.29% in 2003 and 2.26% in 2009). The initial impact of the warning differed between the severe and nonsevere populations, with a significant effect on those with nonsevere psychological impairment. CONCLUSIONS:The return to the rates before the black box warning raises concern that the impact of the warning may have dissipated over time. More frequent updates of the warning might be necessary.
PMCID:5942898
PMID: 29241433
ISSN: 1557-9700
CID: 5723942
Transethnic Evaluation Identifies Low-Frequency Loci Associated With 25-Hydroxyvitamin D Concentrations
Hong, Jaeyoung; Hatchell, Kathryn E; Bradfield, Jonathan P; Bjonnes, Andrew; Chesi, Alessandra; Lai, Chao-Qiang; Langefeld, Carl D; Lu, Lingyi; Lu, Yingchang; Lutsey, Pamela L; Musani, Solomon K; Nalls, Mike A; Robinson-Cohen, Cassianne; Roizen, Jeffery D; Saxena, Richa; Tucker, Katherine L; Ziegler, Julie T; Arking, Dan E; Bis, Joshua C; Boerwinkle, Eric; Bottinger, Erwin P; Bowden, Donald W; Gilsanz, Vicente; Houston, Denise K; Kalkwarf, Heidi J; Kelly, Andrea; Lappe, Joan M; Liu, Yongmei; Michos, Erin D; Oberfield, Sharon E; Palmer, Nicholette D; Rotter, Jerome I; Sapkota, Bishwa; Shepherd, John A; Wilson, James G; Basu, Saonli; de Boer, Ian H; Divers, Jasmin; Freedman, Barry I; Grant, Struan F A; Hakanarson, Hakon; Harris, Tamara B; Kestenbaum, Bryan R; Kritchevsky, Stephen B; Loos, Ruth J F; Norris, Jill M; Norwood, Arnita F; Ordovas, Jose M; Pankow, James S; Psaty, Bruce M; Sanghera, Dharambir K; Wagenknecht, Lynne E; Zemel, Babette S; Meigs, James; Dupuis, Josée; Florez, Jose C; Wang, Thomas; Liu, Ching-Ti; Engelman, Corinne D; Billings, Liana K
Context:Vitamin D inadequacy is common in the adult population of the United States. Although the genetic determinants underlying vitamin D inadequacy have been studied in people of European ancestry, less is known about populations with Hispanic or African ancestry. Objective:The Trans-Ethnic Evaluation of Vitamin D (TRANSCEN-D) genomewide association study (GWAS) consortium was assembled to replicate genetic associations with 25-hydroxyvitamin D [25(OH)D] concentrations from the Study of Underlying Genetic Determinants of Vitamin D and Highly Related Traits (SUNLIGHT) meta-analyses of European ancestry and to identify genetic variants related to vitamin D concentrations in African and Hispanic ancestries. Design:Ancestry-specific (Hispanic and African) and transethnic (Hispanic, African, and European) meta-analyses were performed with Meta-Analysis Helper software (METAL). Patients or Other Participants:In total, 8541 African American and 3485 Hispanic American (from North America) participants from 12 cohorts and 16,124 European participants from SUNLIGHT were included in the study. Main Outcome Measures:Blood concentrations of 25(OH)D were measured for all participants. Results:Ancestry-specific analyses in African and Hispanic Americans replicated single nucleotide polymorphisms (SNPs) in GC (2 and 4 SNPs, respectively). An SNP (rs79666294) near the KIF4B gene was identified in the African American cohort. Transethnic evaluation replicated GC and DHCR7 region SNPs. Additionally, the transethnic analyses revealed SNPs rs719700 and rs1410656 near the ANO6/ARID2 and HTR2A genes, respectively. Conclusions:Ancestry-specific and transethnic GWASs of 25(OH)D confirmed findings in GC and DHCR7 for African and Hispanic American samples and revealed findings near KIF4B, ANO6/ARID2, and HTR2A. The biological mechanisms that link these regions with 25(OH)D metabolism warrant further investigation.
PMCID:6276579
PMID: 29325163
ISSN: 1945-7197
CID: 3985502