Browsing by Subject "General & Internal Medicine"

Now showing 1 - 15 of 15
  • Thumbnail Image
    ItemOpen Access
    Bleeding risk with ischemic stroke therapy - Reply
    (JAMA - Journal of the American Medical Association, 2012-10-03) Xian, Y; Liang, L; Peterson, ED
  • Thumbnail Image
    ItemOpen Access
    Comparison of US Federal and Foundation Funding of Research for Sickle Cell Disease and Cystic Fibrosis and Factors Associated With Research Productivity.
    (JAMA network open, 2020-03-02) Farooq, Faheem; Mogayzel, Peter J; Lanzkron, Sophie; Haywood, Carlton; Strouse, John J
    Importance:Sickle cell disease (SCD) and cystic fibrosis (CF) are severe autosomal recessive disorders associated with intermittent disease exacerbations that require hospitalizations, progressive chronic organ injury, and substantial premature mortality. Research funding is a limited resource and may contribute to health care disparities, especially for rare diseases that disproportionally affect economically disadvantaged groups. Objective:To compare disease-specific funding between SCD and CF and the association between funding and research productivity. Design, Setting, and Participants:This cross-sectional study examined federal and foundation funding, publications indexed in PubMed, clinical trials registered in ClinicalTrials.gov, and new drug approvals from January 1, 2008, to December 31, 2018, in an estimated US population of approximately 90 000 individuals with SCD and approximately 30 000 individuals with CF. Main Outcomes and Measures:Federal and foundation funding, publications indexed in PubMed, clinical trial registrations, and new drug approvals. Results:From 2008 through 2018, federal funding was greater per person with CF compared with SCD (mean [SD], $2807 [$175] vs $812 [$147]; P < .001). Foundation expenditures were greater for CF than for SCD (mean [SD], $7690 [$3974] vs $102 [$13.7]; P < .001). Significantly more research articles (mean [SD], 1594 [225] vs 926 [157]; P < .001) and US Food and Drug Administration drug approvals (4 vs 1) were found for CF compared with SCD, but the total number of clinical trials was similar (mean [SD], 27.3 [6.9] vs 23.8 [6.3]; P = .22). Conclusions and Relevance:The findings show that disparities in funding between SCD and CF may be associated with decreased research productivity and novel drug development for SCD. Increased federal and foundation funding is needed for SCD and other diseases that disproportionately affect economically disadvantaged groups to address health care disparities.
  • Thumbnail Image
    ItemOpen Access
  • Thumbnail Image
    ItemOpen Access
    Effect of a Community Agency-Administered Nurse Home Visitation Program on Program Use and Maternal and Infant Health Outcomes: A Randomized Clinical Trial.
    (JAMA network open, 2019-11) Dodge, Kenneth A; Goodman, W Benjamin; Bai, Yu; O'Donnell, Karen; Murphy, Robert A
    Importance:Postnatal home visitation to support parenting and infant healthy development is becoming increasingly common based on university efficacy studies, but effectiveness when disseminated by communities is not clear. Objective:To test implementation and impact of the Family Connects (FC) program when administered by a community agency. Design, Setting, and Participants:In this randomized clinical trial, births were randomly assigned to receive FC or treatment as usual. Independent evaluation was conducted through parent interviews and review of health and child protective services records. Interviewers were blind to the experimental condition of participants, and participants were blind about the purpose of the interview as an intervention evaluation. A total of 936 consecutive residential births at Duke University Hospital from January 1, 2014, through June 30, 2014, were included. Data were analyzed preliminarily for reporting to funders in early 2015 before all birth-record covariates were scored and were analyzed more comprehensively in mid-2019 after administrative birth and child protective service records became available. Interventions:The goals of the FC brief universal program were to assess family-specific needs, complete brief interventions, and connect families with community resources. Community agencies and families were aligned through an electronic data system. Main Outcomes and Measures:Case records documented program penetration and quality. The primary outcome was child protective services investigations for maltreatment. Secondary outcomes were the number of sustained community connections, maternal mental health, parenting behavior, infant well-child care visits and maternal postpartum care compliance, and emergency health care utilization. Results:Of 936 births, 451 infants (48.2%) were female and 433 (46.3%) were from racial/ethnic minority groups. In all, 456 births (46.5%) were randomized to the intervention and 480 (53.5%) were randomized to the control. All analyses were based on intention to treat. The impact analysis included 158 intervention families and 158 control families. Intervention penetration was 76%, adherence to the protocol was 90%, and independent agreement in scoring (κ) was 0.75. Nurses identified and addressed minor problems for 52% of families and connected an additional 42% to community resources. Analysis of the primary outcome of child abuse investigations revealed a mean (SD) of 0.10 (0.30) investigations for the intervention group vs 0.18 (0.56) investigations for the control group (b = -0.09; 90% CI, -0.01 to -0.12; 95% CI, -0.18 to 0.01; P = .07). The intervention group's rate of possible maternal anxiety or depression was 18.2% vs 25.9% for the control group (b = -7.70; 90% CI, -15.2 to -0.1; 95% CI, -16.6 to 1.3; P = .09). Conclusions and Relevance:This study indicates that a nurse home visitation program for families of newborns can be implemented by a community agency with high penetration and quality. Other communities could benefit from wider dissemination of the program provided that quality remains strong and evaluation continues. Trial Registration:ClinicalTrials.gov identifier: NCT01843036.
  • Thumbnail Image
    ItemOpen Access
    Effect of Home Testing of International Normalized Ratio on Clinical Events (vol 363, pg 1608, 2010)
    (NEW ENGLAND JOURNAL OF MEDICINE, 2011-01-06) Matchar, David B
  • Thumbnail Image
    ItemOpen Access
    Efficacy of Hyperbaric Oxygen for Carbon Monoxide Poisoning.
    (Chest, 2018-03) Moon, Richard E; Hampson, Neil B
  • Thumbnail Image
    ItemOpen Access
    IMPLEMENTATION OF HOSPITAL BASED CLINICAL PERFORMANCE METRICS TEACHING SESSIONS FOR MEDICINE RESIDENTS ON DUKE GENERAL MEDICINE
    (JOURNAL OF GENERAL INTERNAL MEDICINE, 2013-06-01) Gallagher, David; Setji, Noppon P; Bae, Jonathan
  • Thumbnail Image
    ItemOpen Access
    Inconsistencies in Colonic Tattooing Practice: Differences in Reported and Actual Practices at a Tertiary Medical Center.
    (Southern medical journal, 2019-04) Spaete, Joshua P; Zheng, Jiayin; Chow, Shein-Chung; Burbridge, Rebecca A; Garman, Katherine S
    OBJECTIVES:Accurate localization of a colonic lesion is crucial to successful resection. Although colonic tattooing is a widely accepted technique to mark lesions for future identification surgery or repeat colonoscopy, no consensus guidelines exist. The objective of this study was to determine whether the current tattooing practice at a tertiary medical center differs from recommendations in the literature and self-reported provider practice. METHODS:The study consisted of an observational retrospective chart review of patients who received colonic tattoos, as well as a provider survey of reported tattooing practices at a tertiary academic medical center. A total of 747 patients older than 18 years of age who underwent colonoscopy with tattoo were included. Forty-four gastroenterologists performing endoscopy were surveyed on tattooing techniques. RESULTS:In the majority of cases, neither the number of tattoos, location of the tattoo nor the distance from the lesion was specified within the report. Following the index procedure, a tattoo was detected in 75% of surgical resections and 73% of endoscopies. At the time of surgery, however, the tattoo and/or the lesion was detected approximately 94% of the time. Twenty-five endoscopists (56.8%) completed the survey. Differences were seen the between the chart review and reported practice. Most providers report placing ≥2 marks (87.2%); however, chart review revealed that only 56.2 % were tattooed with ≥2 marks. CONCLUSIONS:Variation exists between the reported tattooing practice and actual practice. Despite this, most tattoos are identified at the time of surgery or repeat endoscopy. Further research is needed to determine whether a standardized approach to tattooing and reporting could improve localization at repeat endoscopy.
  • Thumbnail Image
    ItemOpen Access
    Lethal Talk.
    (Journal of general internal medicine, 2018-06) Brown, J Trig
  • Thumbnail Image
    ItemOpen Access
    Molding Idle Musings Into Art: What Reflective Writing Does for Me?
    (Journal of pain and symptom management, 2019-04) Brown, J Trig
  • Thumbnail Image
    ItemOpen Access
    Physical Activity, Sedentary Behavior, and Retirement: The Multi-Ethnic Study of Atherosclerosis.
    (American journal of preventive medicine, 2018-06) Jones, Sydney A; Li, Quefeng; Aiello, Allison E; O'Rand, Angela M; Evenson, Kelly R
    Physical activity and sedentary behavior are major risk factors for chronic disease. These behaviors may change at retirement, with implications for health in later life. The study objective was to describe longitudinal patterns of moderate to vigorous and domain-specific physical activity and TV watching by retirement status.Participants in the Multi-Ethnic Study of Atherosclerosis (n=6,814) were recruited from six U.S. communities and were aged 45-84 years at baseline. Retirement status and frequency and duration of domain-specific physical activity (recreational walking, transport walking, non-walking leisure activity, caregiving, household, occupational/volunteer) and TV watching were self-reported at four study exams (2000 to 2012). Fixed effect linear regression models were used to describe longitudinal patterns in physical activity and TV watching by retirement status overall and stratified by socioeconomic position. Analyses were conducted in 2017.Of 4,091 Multi-Ethnic Study of Atherosclerosis participants not retired at baseline, 1,012 (25%) retired during a median of 9 years follow-up. Retirement was associated with a 10% decrease (95% CI= -15%, -5%) in moderate to vigorous physical activity and increases of 13% to 29% in recreational walking, household activity, and TV watching. Among people of low socioeconomic position, the magnitude of association was larger for moderate to vigorous physical activity. Among people of high socioeconomic position, the magnitude of association was larger for non-walking leisure and household activity.The retirement transition was associated with changes in physical activity and TV watching. To inform intervention development, future research is needed on the determinants of behavior change after retirement, particularly among individuals of low socioeconomic position.
  • Thumbnail Image
    ItemOpen Access
    Poor Adherence to Risk Stratification Guidelines Results in Overuse of Venous Thromboembolism Prophylaxis in Hospitalized Older Adults.
    (Journal of hospital medicine, 2018-06) Pavon, Juliessa M; Sloane, Richard J; Pieper, Carl F; Colón-Emeric, Cathleen S; Cohen, Harvey J; Gallagher, David; Morey, Miriam C; McCarty, Midori; Ortel, Thomas L; Hastings, Susan N
  • Thumbnail Image
    ItemOpen Access
    Stroke center designation and mortality-reply: In reply
    (JAMA - Journal of the American Medical Association, 2011-04-27) Ying, X; Eric D., P
  • Thumbnail Image
    ItemOpen Access
    THE EFFECT OF RILUZOLE ON INTRAMEDULLARY LESION LENGTH AND DTI, RATIONALE AND DESIGN OF RISCIS MRI-SUBSTUDY
    (JOURNAL OF NEUROTRAUMA, 2018-08-01) Aarabi, Bizhan; Fehlings, Michael G; Robertson, Claudia S; Shaffrey, Christopher; Kurpad, Shekar; Ray, Wilson Z
  • Thumbnail Image
    ItemOpen Access
    VALIDATION OF THE 4-ITEM SCREENING COMPONENT OF THE TAPS TOOL TO IDENTIFY UNHEALTHY SUBSTANCE USE AMONG PRIMARY CARE PATIENTS
    (JOURNAL OF GENERAL INTERNAL MEDICINE, 2017-04-01) Schwartz, Robert; Gryczynski, Jan; McNeely, Jennifer; Wu, Litzy; Sharma, Gaurav; King, Jacquie; Jelstrom, Eve M; Nordeck, Courtney; Sharma, Anjalee; Mitchell, Shannon; O'Grady, Kevin; Svikis, Dace; Cathers, Lauretta; Subramaniam, Geetha