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Context: Social Determinants of Health (SDOH) contribute significantly to health outcomes such as chronic disease management and screening test completion. Electronic medical record (EMR) data can provide insight into individual-level SDOH factors for a patient population. Objective: To determine which patient-level SDOH factors are correlated with attainment of quality metrics (diabetes control and colorectal screening) in a rural community Study Design and Analysis: Cross-sectional analysis assessing patient- entered SDOH questionnaires for patients who do not meet the above quality metrics compared to those who do meet quality metrics Setting or Dataset: Epic EMR data was collected on Sparta, WI eligible patients from 7/1/2019 to 12/31/2020 Population Studied: Sparta, WI adults age 18-75 with diabetes type 1 or 2 diagnosis (503 patients) and adults age 50-75 eligible for colon cancer screening (2162 patients) Intervention/Instrument: Chi-square test of Epic EMR patient-entered SDOH data comparing patients not meeting quality metrics to those patients meeting quality metrics, controlling for patient-level variables such as age, sex, race, marital status with logistic regression model. Outcome Measures: SDOH questionnaires in Epic EMR (tobacco use, alcohol use, stress, transportation concerns, food insecurity, social isolation, intimate partner violence, dental care, diet and exercise). Patient SDOH answers are divided into at-risk and no risk groups. Results: Patients not meeting diabetes control measures are more likely to give at-risk SDOH responses in the following categories: financial concerns (26.5% vs 14.7%, p-value 0.0134) and food insecurity (18.0% vs 8.0%, p-value 0.0184). Patients not meeting colorectal screening measures are more likely to give at-risk SDOH answers in the following categories: financial concerns (16.4% vs 9.7%, p-value 0.0034), food insecurity (11.5% vs 4.4%, p-value Conclusions: Patients' high-risk answers to SDOH questions regarding financial concerns, food insecurity, depression and transportation concerns may be correlated with lower attainment of quality outcomes such as diabetes control and/or colorectal screening. Use of individual-level EMR data may be useful to generate local quality improvement initiatives. Further study of different patient populations is warranted., Presenters Jessica Sosso, MD, MPH, Michelle Lampman, PhD, Karen Fischer, Gerald Sobolik, MBA, Randy Foss, MD, Matthew Bernard, MD, FAAFP, Gregory Garrison, MD, MSc, Susan Laabs, Summer Allen, MD, Thomas [...]

Malignant mesothelioma (MM) is an aggressive cancer primarily diagnosed on the basis of histological criteria.sup.1. The 2015 World Health Organization classification subdivides mesothelioma tumors into three histological types: epithelioid, biphasic and sarcomatoid MM. MM is a highly complex and heterogeneous disease, rendering its diagnosis and histological typing difficult and leading to suboptimal patient care and decisions regarding treatment modalities.sup.2. Here we have developed a new approach--based on deep convolutional neural networks--called MesoNet to accurately predict the overall survival of mesothelioma patients from whole-slide digitized images, without any pathologist-provided locally annotated regions. We validated MesoNet on both an internal validation cohort from the French MESOBANK and an independent cohort from The Cancer Genome Atlas (TCGA). We also demonstrated that the model was more accurate in predicting patient survival than using current pathology practices. Furthermore, unlike classical black-box deep learning methods, MesoNet identified regions contributing to patient outcome prediction. Strikingly, we found that these regions are mainly located in the stroma and are histological features associated with inflammation, cellular diversity and vacuolization. These findings suggest that deep learning models can identify new features predictive of patient survival and potentially lead to new biomarker discoveries. Deep convolutional neural networks predict survival of mesothelioma patients and identify histological features associated with outcome that transcend current histological classifications., Author(s): Pierre Courtiol [sup.1] , Charles Maussion [sup.1] , Matahi Moarii [sup.1] , Elodie Pronier [sup.1] , Samuel Pilcer [sup.1] , Meriem Sefta [sup.1] , Pierre Manceron [sup.1] , Sylvain [...]

Most pancreatic neuroendocrine tumors (PNETs) do not produce excess hormones and are therefore considered 'non-functional'.sup.1-3. As clinical behaviors vary widely and distant metastases are eventually lethal.sup.2,4, biological classifications might guide treatment. Using enhancer maps to infer gene regulatory programs, we find that non-functional PNETs fall into two major subtypes, with epigenomes and transcriptomes that partially resemble islet [alpha]- and [beta]-cells. Transcription factors ARX and PDX1 specify these normal cells, respectively.sup.5,6, and 84% of 142 non-functional PNETs expressed one or the other factor, occasionally both. Among 103 cases, distant relapses occurred almost exclusively in patients with ARX.sup.+PDX1.sup.- tumors and, within this subtype, in cases with alternative lengthening of telomeres. These markedly different outcomes belied similar clinical presentations and histology and, in one cohort, occurred irrespective of MEN1 mutation. This robust molecular stratification provides insight into cell lineage correlates of non-functional PNETs, accurately predicts disease course and can inform postoperative clinical decisions. Epigenetic states reminiscent of the cell of origin define clinically relevant markers for stratification of patients with pancreatic neuroendocrine cancer., Author(s): Paloma Cejas [sup.1] [sup.2] [sup.3] [sup.15] , Yotam Drier [sup.4] [sup.5] [sup.15] , Koen M. A. Dreijerink [sup.6] [sup.7] , Lodewijk A. A. Brosens [sup.8] , Vikram Deshpande [sup.5] [...]

Objectives To investigate the impact of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) on a variety of infant health outcomes using recent South Carolina Vital Statistics data (2004-2012). Methods To account for non-random WIC participation, the study relies on a maternal fixed effects estimation, due to the availability of unique maternally linked data. Results The results indicate that WIC participation is associated with an increase in birth weight and length of gestation, decrease in the probability of low birth weight, prematurity, and Neonatal Intensive Care Unit admission. Additionally, addressing gestational bias and accounting for the length of gestation, WIC participation is associated with a decrease in the probability of delivering a low weight infant and a small for gestational age infant among black mothers. Conclusions for Practice Accounting for non-random program participation, the study documents a large improvement in birth outcomes among infants of WIC participating mothers. Even in the context of somewhat restrictive gestation-adjusted specification, the positive impact of WIC remains within the subsample of black mothers., Author(s): Lyudmyla Sonchak[sup.1] Author Affiliations: (1) Department of Economics, SUNY Oswego, 13126, Oswego, NYUSA Significance This study adds to the current literature in several ways. First, we consider a longer [...]

Flaviviral infections result in a wide spectrum of clinical outcomes, ranging from asymptomatic infection to severe disease. Although the correlates of severe disease have been explored.sup.1-4, the pathophysiology that differentiates symptomatic from asymptomatic infection remains undefined. To understand the molecular underpinnings of symptomatic infection, the blood transcriptomic and metabolomic profiles of individuals were examined before and after inoculation with the live yellow fever viral vaccine (YF17D). It was found that individuals with adaptive endoplasmic reticulum (ER) stress and reduced tricarboxylic acid cycle activity at baseline showed increased susceptibility to symptomatic outcome. YF17D infection in these individuals induced maladaptive ER stress, triggering downstream proinflammatory responses that correlated with symptomatic outcome. The findings of the present study thus suggest that the ER stress response and immunometabolism underpin symptomatic yellow fever and possibly even other flaviviral infections. Modulating either ER stress or metabolism could be exploited for prophylaxis against symptomatic flaviviral infection outcome. Flaviviruses can cause either symptomatic or asymptomatic infection. Here, symptomatic flavivirus infection associated with a live-attenuated yellow fever viral vaccine was linked to the cellular state before vaccination., Author(s): Kuan Rong Chan [sup.1] , Esther Shuyi Gan [sup.1] [sup.2] , Candice Yuen Yue Chan [sup.1] [sup.3] , Cui Liang [sup.4] , John Zhong Heng Low [sup.5] , Summer [...]

In an article in the January/February 2000 issue of Society titled 'Race and Mortality,' I explained the statistical pattern, inherent in other than highly irregular risk distributions, whereby the rarer [...]

Mapping a certain disease into a system of disabling attributes allows researchers to compare diseases within a common framework. To quantify the total burden of morbidity (e.g., morbidity attributable to [...]

Summary This article focuses on priorities and challenges for practitioners working with teenage and young adult (TYA) patients aged 16 to 24 years old in the UK. It examines the [...]

Mental health clinicians have a duty to provide quality health care. By providing evidence of the impact of their intervention and support, outcome measures demonstrate the effectiveness of collaborative work [...]

In 1793, when yellow fever reached Philadelphia, killing hundreds of people, nobody knew its cause. But there was no shortage of theories. Based on these, a few desperate physicians devised [...]

Advances in recent treatments for HIV/AIDS patients have shown dramatic outcomes in extending the incubation period and AIDS survival time, while also providing significant improvements in the quality of patients' lives. A compartmental model is proposed to analyse the effects of the various treatment regimens which have been introduced. The results produced are in good agreement with routinely collected data relating to levels of HIV/AIDS incidence and prevalence in the UK homosexual population. Some parameter values within the model are obtained from surveys, census results, etc, but others are derived using a maximum likelihood estimation procedure. Finally, the model is used to project levels of incidence and prevalence over the next few years, and to investigate several possible scenarios. Journal of the Operational Research Society (2006) 57, 1413-1424. doi:10.1057/palgrave.jors.2602120 Keywords: HIV/AIDS; compartmental model; treatment effects; maximum likelihood

It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions. J Am Diet Assoc. 2006;106: 2073-2082.

Objective: Few studies focus on the outcome of patients after they drop out of substance-use disorder (SUD) treatment, and there appear to be no prior studies of the long-term outcomes of these patients. The aim of this study is to determine how well such patients do after dropping out of treatment and to identify predictors of differential outcomes. Method: Patients in 15 residential SUD treatment programs were assessed at treatment entry and at 5-year follow-up on their frequency and severity of substance use, expectancies and beliefs about substance use, and social resources and stressors. Patients who dropped out and stayed out of treatment (n = 193) were compared with those who completed treatment (n = 3,204). Predictors of 5-year SUD problems among dropouts were identified. Results: In general, dropouts and treatment completers did not differ significantly on their levels of SUD problems at 5 years. At baseline, patients who dropped out reported more involvement in 12-step organizations and greater cognitive impairment and more closely identified with the label 'drug addict' than 'alcoholic.' Lower severity of SUD, lower self-efficacy, fewer positive substance-use expectancies, and less stress from social networks predicted fewer SUD problems at 5 years among dropouts. Conclusions: In addition to focusing on substance use, providers should address the adequacy of patients' social support and counter positive substance-use expectancies at the earliest stages of treatment before patients drop out., DROPOUT RATES FROM SUBSTANCE-USE disorder (SUD) treatment programs range from 10% to 30% depending on the sample and the setting (De Leon, 1991; Marlatt et al., 1997; Mertens and Weisner, [...]

The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise (SEE) and the Outcome Expectations for Exercise (OEE) scales in a sample of 166 older women post--hip fracture. There was some evidence of validity of the SEE and OEE based on confirmatory factor analysis and Rasch model testing, criterion based and convergent validity, and evidence of internal consistency based on alpha coefficients and separation indices and reliability based on [R.sup.2] estimates. Rasch model testing demonstrated that some items had high variability. Based on these findings suggestions are made for how items could be revised and the scales improved for future use. Keywords: self-efficacy; outcome expectations; hip fracture; exercise; motivation

This study investigated changes in hope among 155 youths (ages 10 to 17 years) placed in a residential treatment facility over a 6-month period. The child and adolescent participants met criteria for a range of emotional and behavioral disorders and received interventions hypothesized to improve hopeful thinking. Hope scores significantly improved over 6 months of treatment. The positive changes in hope were not moderated by ethnicity or sex. For Agency hope scores (i.e., willpower), those with higher levels of psychopathology at admission demonstrated significantly more improvement in agency thinking over the course of 6 months. Keywords: residential care, hope theory, clinical outcomes

OBJECTIVE. We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. METHODS. We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty. The program included 2 interactive seminar sessions (2.5 hours each) that reviewed national asthma guidelines, communication skills, and key educational messages. Format included short lectures, case discussions, and a video modeling communication techniques. We collected information on parent perceptions of physicians' communication, the child's asthma symptoms, and patients' asthma health care utilization. We used multivariate regression models to determine differences between control and intervention groups. RESULTS. A total of 101 primary care providers and a random sample of 870 of their asthma patients participated. After 1 year, we completed follow-up telephone interviews with the parents of 731 of the 870 patients. Compared to control subjects, parents reported that physicians in the intervention group were more likely to inquire about patients' concerns about asthma, encourage patients to be physically active, and set goals for successful treatment. Patients of physicians that attended the program had a greater decrease in days limited by asthma symptoms (8.5 vs 15.6 days), as well as decreased emergency department asthma visits (0.30 vs 0.55 visits per year). CONCLUSIONS. The Physician Asthma Care Education program was used in a range of locations and was effective in improving parent-reported provider communication skills, the number of clays affected by asthma symptoms, and asthma health care use. Patients with more frequent asthma symptoms and higher health care utilization at baseline were more likely to benefit from their physician's participation in the program. Key Words asthma knowledge, pediatric providers, educational intervention Abbreviations CME--continuing medication education ED--emergency department PACE--Physician Asthma Care Education IQR--interquartile range OR--odds ratio CI--confidence interval, ALTHOUGH continuing medical education (CME) have been evaluated rigorously regarding outcomes for patients, (1) some studies have shown that well-designed CME can have a significant effect on patients' health status [...]

Predicting at the time of discovery the prognosis and metastatic potential of cancer is a major challenge in current clinical research. Numerous recent studies searched for gene expression signatures that outperform traditionally used clinical parameters in outcome prediction. Finding such a signature will free many patients of the suffering and toxicity associated with adjuvant chemotherapy given to them under current protocols, even though they do not need such treatment. A reliable set of predictive genes also will contribute to a better understanding of the biological mechanism of metastasis. Several groups have published lists of predictive genes and reported good predictive performance based on them. However, the gene lists obtained for the same clinical types of patients by different groups differed widely and had only very few genes in common. This lack of agreement raised doubts about the reliability and robustness of the reported predictive gene lists, and the main source of the problem was shown to be the small number of samples that were used to generate the gene lists. Here, we introduce a previously undescribed mathematical method, probably approximately correct (PAC) sorting, for evaluating the robustness of such lists. We calculate for several published data sets the number of samples that are needed to achieve any desired level of reproducibility. For example, to achieve a typical overlap of 50% between two predictive lists of genes, breast cancer studies would need the expression profiles of several thousand early discovery patients. DNA microarray gene expression data | outcome prediction in cancer | probably approximately correct sorting | predictive gene list | robustness

Impact on quality of care given to patients, when the hospitals have increased admissions, is analyzed.

J Neurol Neurosurg Psychiatry 2003;74:1680-1684 Objectives: To evaluate the results of treatment of patients with a ruptured intracranial aneurysm treated by a single experienced vascular neurosurgeon in the period prior [...]

Although evidence suggests that asthma onset occurs early in childhood, many standard asthma outcome measures are either impractical or unreliable in preschool-aged children. In this population, for instance, patient history and symptom reports rely on the observations of caregivers, who tend to underreport their child's asthma symptoms. Furthermore, the use of conventional measures of pulmonary function such as spirometry may be impractical in very young children. Recent clinical studies have used a variety of techniques to measure symptoms, pulmonary function, and cellular mediators of inflammation. Outcomes such as discontinuation and exacerbation rates, frequency of daytime and nocturnal symptoms, and caregiver assessments of quality of life can be useful measures in evaluating outcomes in young children with asthma. Some measures, such as plethysmography and inflammatory marker analysis, may be suitable options for assessing pulmonary function and predicting asthma susceptibility in preschool-aged children. Indeed, altered levels of inflammatory markers, including immunoglobulin E, interleukin-10, and exhaled nitric oxide, may be useful tools in diagnosing asthma, evaluating interventions, and assessing future risks for asthma symptomatology in very young children. Whether 1 or more of these outcome measures will prove useful clinically in improving the diagnosis and management of childhood asthma remains uncertain, although early research results are encouraging. Pediatrics 2002;109:393-398; outcomes, asthma, pediatric, diagnosis, treatment., ABBREVIATIONS. ENO, exhaled nitric oxide; DWAS, days without asthma symptoms; FE[V.sub.1] forced expiratory volume in 1 second; sRAW, specific airway resistance; LTRA, leukotriene receptor antagonist; IgE, immunoglobulin E; IL-10, interleukin-10; [...]

Byline: Martin Hughes (1), Fiona N. MacKirdy (2), John Norrie (3), Ian S. Grant (2) Keywords: Critical care Length of stay Outcome Abstract: Objectives: To assess the numbers, characteristics and outcome for patients requiring long-term intensive care. Design and setting: Observational cohort study in 23 Scottish intensive care units over a 3-year period. Patients and participants: 323 patients with an ICU stay of 30 days or more. Measurements and results: Although representing only 1.6% of patients, those with long stays occupied 15.7% of bed-days. Hospital survival among these patients was 59.9%. With the available data it was not possible to discriminate survivors from non-survivors. Conclusions: Since these patients have a relatively high hospital survival, resources should not be withheld from them on the basis of prolonged ICU stay alone, even in countries with limited ICU provision. Author Affiliation: (1) 121 Terregles Avenue, Glasgow, G41 4DG, Scotland, UK (2) Scottish Intensive Care Society Audit Group, Victoria Infirmary, Glasgow, Scotland, UK (3) Robertson Centre For Biostatistics, University of Glasgow, Glasgow, Scotland, UK (4) Intensive Care Unit, Western General Hospital, Edinburgh, Scotland, UK Article History: Received Date: 05/07/2000 Accepted Date: 31/01/2001 Article note: Final revision received: 23 January 2001 Electronic Publication

Despite their benefits, there is little evidence that outcome data are being widely used by program managers or field level supervisors. Three interdependent factors that facilitate the use of outcome data are well-constructed reports, and organizational culture that supports learning and outcome achievement, and managerial skills in interpreting data and taking relevant action. This article describes an outcome reporting package and training oriented toward frontline supervisors to help them use outcome data, shape a learning culture, interpret data, and take focused action toward improving outcomes for children and families.