Retrospective Study of Thrombosis in Hospitalized Patients with COVID-19 in Rural North Carolina.

Background: Some patients with COVID-19 develop life-threatening thrombotic complications including myocardial infarction, deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, and ischemic stroke. These inflammatory and hypercoagulable states have been well documented in patient cohorts from metropolitan areas, but not in more rural populations, nor has a data-driven treatment plan been developed for thrombotic COVID-19 patients. Methods: We undertook a retrospective case-control study of COVID-19-positive patients to analyze the impact of thrombosis on various clinical endpoints including terminal diagnosis and disease severity. Prevalence and impact of thrombosis were determined using medical records from 2237 COVID-19-positive patients hospitalized in Cumberland County, North Carolina. Odds ratios for terminal diagnosis, death, ICU admission, and ventilation were calculated based on thrombosis status, D-dimer level, or type of antithrombotic treatment. Results: Terminal diagnosis [OR 1.81; 95% CI (1.10, 2.98)], ICU admission [2.25; (1.33, 3.81)], and ventilation [2.46; (1.45, 4.18)] were all more likely in thrombotic patients (N = 97) compared to nonthrombotic patients (N = 2140) after adjusting for age. D-dimer levels were associated with death overall, but not among thrombotic patients. Treatments that combined antiplatelet and anticoagulant drugs appeared to be more efficacious than anticoagulants alone in preventing death and severe disease. Limitations: Patient medical history prior to hospitalization was not evaluated. Conclusion: In this cohort, those with thrombosis are at increased risk for adverse outcomes including death and severe disease. Antithrombotic therapy that includes antiplatelet drugs provides improved outcomes. Higher-powered prospective trials will be necessary to confirm any potential merits of antiplatelet therapy.

Neonatal Abstinence Syndrome in North Carolina: Incidence and Characteristics among Infants and Mothers.

BACKGROUND Neonatal abstinence syndrome (NAS) is a complex disorder characterized by withdrawal symptoms secondary to in utero exposure to drugs capable of producing physical dependence. The objective of this study was to determine the incidence of NAS, as well as infant and maternal characteristics associated with NAS in North Carolina (NC).METHODS This retrospective, cross-sectional, observational study used the State Inpatient Database (SID) to compare the incidence rates of NAS for NC for the year 2016 to historical data (years 2000 to 2013). A multivariable logistic regression model including available covariates of interest was constructed.RESULTS Overall NAS incidence rate (IR) for NC was found to be 9.7 per 1,000 live births, a 32.3-fold increase since 2000 (IR=0.3 in 2000). The multivariable logistic regression model suggested race group (both black [OR 0.11; 95% CI: 0.08, 0.16] and 'other' [OR 0.43; 95% CI: 0.31, 0.61] vs white), ethnicity [OR 0.43; 95% CI: 0.31, 0.61], insurance group (both 'other/self-pay' [OR 0.35; 95% CI: 0.24, 0.52] and 'private insurance' [OR 0.07; 95% CI: 0.05, 0.10] vs Medicaid/Medicare), region (Piedmont [OR 0.62; 95% CI: 0.50, 0.79] vs Mountain), income quartile (both 4th [OR 0.45; 95% CI: 0.26, 0.79] and 3rd [OR 0.70; 95% CI: 0.50, 0.96] vs 1st), county population size (50k-249k [OR 0.54; 95% CI: 0.34, 0.86] vs ≥1 million), birth weight [OR 0.87; 95% CI: 0.78, 0.98], and length of stay [OR 1.23; 95% CI: 1.20, 1.26] as potentially important predictors of NAS.LIMITATIONS Only hospitals providing data to the SID for 2016 were included and ICD-9 codes, in use at the time of data collection, were used.CONCLUSIONS The incidence of NAS has increased in NC in 2016 compared to prior years spanning back to 2000. Specific infant and maternal characteristics including race, ethnicity, payer type, geographic region, county population, parental income status, birth weight, and length appear to be associated with an infant bearing the diagnosis of NAS.

Relationship between pre-training wellness scores and internal and external training loads in a Division I women's lacrosse team.

This study examined the relationship between pre-training wellness scores and internal and external training load outputs during the preparation phase of a Division I women's collegiate lacrosse team. Athletes (n = 27) logged daily wellness (sleep, energy, stress, and how their muscles felt), session ratings of perceived exertion, and training metrics for 13 weeks. Load metrics were collected with microtechnology units. Repeated measures mixed linear models were constructed to evaluate the relationships between wellness and training load. The largest effects observed indicated: improved sleep was predictive of increased total distance (by as much as 310.5 m, 95%CI 36.7-584.3), high-intensity distance (by as much as 72.7 m, 95%CI 17.2-128.3), and Athlete Load (by as much as 6.8AU, 95%CI 1.8-11.8); more energy was predictive of increased total distance (by as much as 323.6 m, 95%CI 52.2-594.9) and Athlete Load (by as much as 5.6AU. 95%CI 0.6-10.5). For each one-unit increase in overall wellness score, total distance (3.5 m, 95%CI 1.2-15.1) and Athlete Load (0.2AU, 95%CI 0.0-0.3) increased. Pre-training wellness scores and sub-scores are predictive of external load training output. Monitoring athlete wellness systematically can help coaches with decision-making relevant to training and game performance.

A study of statistics knowledge among nurse faculty in schools with research doctorate programs.

Statistics knowledge is essential for nursing faculty in both teaching and research roles. In the teaching role when discussing nursing research, nursing faculty are confronted with statistical concepts and statistical methods applications. Knowledge of fundamental statistical concepts is needed so that nursing faculty can understand and critically evaluate the literature. The purpose of this study was to assess nursing faculty knowledge of fundamental statistical concepts. A probability sample with a 7.7% response rate yielded participation from 164 nursing faculty from 26 accredited schools. Results showed that most faculty members (91.5%) read peer-reviewed health-related scientific journal articles. On average, nursing faculty answered 5.1 (SD = 1.6) out of 8 statistical knowledge questions correctly. Problematic concepts included randomization (43.3% correct), and interpreting a confidence interval (42.7%) and odds ratio (33.5%). The results of this study may be used to improve statistics education and training for future nursing faculty and strengthen scholarship for nursing faculty conducting research.

Naloxone coprescription in U.S. ambulatory care centers and emergency departments.

OBJECTIVES: The rise in both drug overdoses and deaths owing to opioids has been increasing for at least 2 decades in the United States. Naloxone-prescribing programs have been in use since the mid-2000s with a guideline to manage their use being published in 2012. This study seeks to determine the national prevalence of naloxone coprescribing within U.S. ambulatory care centers and emergency departments (EDs). METHODS: This study was a retrospective, cross-sectional, observational analysis of data collected by the Centers for Disease Control and Prevention (CDC) in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey: Emergency Department Summary during the years 2012-2016. All survey participants aged 18 years or older with documented opioid use-with the exception of codeine, dihydrocodeine, and opioid-containing cough syrups-were included. Variables of interest that were available in the data were summarized. RESULTS: Naloxone was coprescribed with opioids in less than 0.1% of visits. Despite 5 years of data combined across 2 national surveys including 48,158 adults with documented opioid use, further analyses of naloxone coprescription could not be performed owing to the limited number of such coprescriptions. Among the factors previously documented to increase the risk of opioid overdose, concurrent benzodiazepine use (18.7%) was the most reported, followed by history of substance use disorder (1.6%) and history of overdose (< 0.1%). CONCLUSION: Using nationally representative data collected by the CDC from ambulatory care centers and EDs, we found that naloxone was coprescribed with opioids in only less than 0.1% of visits. Future research is warranted to determine whether current practices have adapted to meet the standards set by the 2016 CDC guidelines.

Frequency of asthma education in primary care in the years 2007-2010.

OBJECTIVE: Recent research suggests that health disparities persist among asthmatic patients and receipt of asthma education, though recent guidelines have highlighted the importance of receiving asthma education. The purpose of this study was to identify trends in the receipt of asthma education as well as to identify disparities in asthma education using the most recently available data in National Ambulatory Medical Care Survey, 2007-2010. METHODS: Weighted chi-square tests were conducted to identify associations between asthma education and variables of interest. A weighted multivariate logistic regression model was subsequently constructed to jointly assess the association of factors of interest on receipt of asthma education. Submission to the Campbell University Institutional Review Board resulted in expedited approval. RESULTS: The percentage of patients who receive asthma education remains quite low. After adjusting for all variables of interest: no statistically significant difference in receipt of asthma education between year groups (2007-2008, 2009-2010) was found (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.52-1.34); patients seen by pediatricians (vs. internal medicine physicians) and Hispanic or Latino patients (vs. non-Hispanic or Latino patients) were more likely to receive asthma education (OR 2.72, 95% CI 1.11-6.66 and OR 2.33, 95% CI 1.18-4.60, respectively); and patients not prescribed a controller medication were less likely to receive asthma education than those who were (OR 0.56, 95% CI 0.37-0.82). CONCLUSIONS: Combined with previously published results, it appears the provision of asthma education continues to be low, despite proven benefits. Additionally, some patient and physician characteristics may be associated with the delivery of asthma education.

Racial and Ethnic Disparities in Infant Mortality in North Carolina, 2008-2009.

BACKGROUND: This study was designed to investigate whether racial and ethnic disparities in infant mortality still exist in North Carolina and to examine predictors of infant mortality using the North Carolina Vital Statistics Dataverse. METHODS: This was a retrospective, cross-sectional, observational study that included all 257,543 births in North Carolina in 2008-2009. Infant mortality was assessed based on birth records included in the database. Infant births and deaths were summarized by demographic and maternal/infant characteristics. A multivariate logistic regression model was constructed to jointly assess predictors of infant mortality. RESULTS: The overall infant mortality rate in North Carolina was 0.8%. Adjusting for confounders through the construction and assessment of a multivariate logistic regression model, statistically significant associations were found between infant mortality and each of the following: maternal race (both black and 'other' versus white), infant sex, both premature and preterm gestation (versus full term), birth weight (both low and high versus normal), maternal education (both less than high school graduate and more than high school versus college graduate), prenatal care (both intermediate and inadequate versus adequate), and maternal tobacco use. LIMITATIONS: Maternal race was limited to white, black, and other. Data on socioeconomic status, maternal medical risk factors, and quality of prenatal care were not available. At the time of the analysis, data for years beyond 2009 were limited. CONCLUSIONS: Racial disparities in infant mortality persist in North Carolina; specifically, infants of nonwhite mothers have a higher mortality rate than do infants of white mothers. Other factors that continue to play a significant role in infant mortality in North Carolina include preterm and premature births, male infant sex, low birth weight, maternal education less than college graduate, maternal tobacco use, and less than adequate prenatal care.

Ethnic and Racial Disparities in the Association between Type II Diabetes Mellitus and Dementia.

Evidence in the literature suggests an association between Type 2 Diabetes Mellitus (T2DM) and dementia, but this relationship has not been studied in the most recently available nationally representative datasets. This retrospective, observational, cross-sectional study of adults (60+ years of age) seeks to investigate this association across racial and ethnic groups in the most recently available National Ambulatory Medical Care Survey (NAMCS) datasets. A multivariable logistic regression model is employed to investigate the association between T2DM and the diagnosis of dementia and assess disparities in racial and ethnic groups, while controlling for available covariates of interest. The analysis found no evidence of a relationship between T2DM and dementia even after adjusting for available covariates of interest (OR 1.13, 95% CI = 0.81-1.57). However, evidence of differences in the proportion with dementia was observed between ethnicities and race groups. Hispanic/Latinos were found to have more than double the odds of dementia compared to Non-Hispanic/Latinos (OR 2.08, 95% CI = 1.05-4.14), while the Other race group had 74% lower odds of dementia compared to the White race group (OR 0.26, 95% CI = 0.10-0.64). This study suggests that disparities in the risk of dementia remain for ethnic/racial groups. As minority populations continue to grow, educational and preventative measures for both diabetes and dementia are vital public health priorities. Perceptions of cognitive impairment, its association with T2DM, and the interventions needed to address the deficits may vary by culture and ethnic background; therefore, specific characteristics relevant to these populations should be further evaluated.

Vaccine hesitancy for COVID19: what is the role of statistical literacy?

Introduction: Vaccination is an important measure used to control the spread of COVID19. The estimation of risk versus benefit of vaccination is based on the understanding of information about the vaccine. Statistics are frequently part of communications about COVID19. Individuals that do not have an adequate foundation of statistical knowledge may not be able to properly assess associated risks and benefits. This study aims to assess the association between statistical literacy and hesitation to receive the COVID19 vaccine. Methods: A nationally representative sample of 2,138 adults, recruited through CINT United States, Inc., (Lawrenceville, NJ; http://www.cint.com), completed an internet survey in the summer of 2021. This survey collected demographic measures and information about COVID19 vaccination status. The competency of respondents on various basic statistical concepts was assessed along with the corresponding confidence of respondents in their answers. A multivariable logistic regression model was constructed to assess the relationship between vaccine hesitancy and statistical literacy while controlling for covariates of interest. Results: Statistical literacy was found to have a negligible association with COVID19 vaccine hesitancy (OR 1.01; 95% CI 1.00-1.02). In addition, differences in the proportion receiving the COVID19 vaccine between political affiliations, income levels, race groups, and ethnicities were observed. Discussion: The statistical knowledge of the general American public is not commensurate with the need to be literate in basic statistical concepts in the data-driven world in which we live. An effective way to stem vaccine hesitancy may rely on increased statistical knowledge to not be biased by preconceived beliefs shaped by misinformation.

Trauma Functioning and Well-Being in Children Who Receive Mental Health Aid after Natural Disaster or War.

Background: There is worldwide consensus that providing secondary prevention to promote resilience and prevent mental health concerns after a disaster is important. However, data supporting this kind of intervention is largely lacking. The current study evaluates the effectiveness of OperationSAFE, an early intervention for children after community-wide trauma. Methods: Secondary data analyses of data collected during 158 OperationSAFE camps (a five day camp with a curriculum focused on coping with stressors) in five countries and ten disasters between 2015 and 2020 were performed. Data on child trauma-related functioning/well-being were collected by an OperationSAFE in-house developed symptom checklist and completed by counselors about children on the first and last day of the 5-day camp. Results: A total of 16,768 children participated in the camps (mean age 9.4 ± 2.36; 50% male). Trauma-related functioning/well-being improved from day 1 to day 5 (b = 8.44 ± 0.04; p < 0.0001). Older children improved more (b = 0.22 ± 0.01; p < 0.0001). Children in man-made ongoing trauma (war/refugees) situations responded stronger than those after natural disasters (b = 2.24 ± 0.05; p < 0.0001). Negligible effects for gender and the number of days between a traumatic event and the start of camp were found. Conclusions: This is the first study to show in a large and diverse sample that secondary prevention to promote resilience and prevent mental health concerns after a disaster for children is associated with improvements in trauma-related functioning/well-being. Delaying delivery of the intervention did not affect outcomes. Given the uncontrolled nature of the study and lack of long-term outcomes, more studies are needed to corroborate the current findings.

A comparative cross-sectional assessment of statistical knowledge of faculty across five health science disciplines.

INTRODUCTION: The purpose of this study was to compare statistical knowledge of health science faculty across accredited schools of dentistry, medicine, nursing, pharmacy, and public health. METHODS: A probability sample of schools was selected, and all faculty at each selected school were invited to participate in an online statistical knowledge assessment that covered fundamental topics including randomization, study design, statistical power, confidence intervals, multiple testing, standard error, regression outcome, and odds ratio. RESULTS: A total of 708 faculty from 102 schools participated. The overall response rate was 6.5%. Most (94.2%) faculty reported reading the peer-reviewed health-related literature. Respondents answered 66.2% of questions correctly across all questions and disciplines. Public health had the highest performance (80.7%) and dentistry the lowest (53.3%). CONCLUSIONS: Knowledge of statistics is essential for critically evaluating evidence and understanding the health literature. These study results identify a gap in knowledge by educators tasked with training the next generation of health science professionals. Recommendations for addressing this gap are provided.

Assessing Changes in Statin Prescribing Patterns Surrounding the 2013 American College of Cardiology/American Heart Association Lipid Guidelines.

PURPOSE: The American College of Cardiology (ACC) and the American Heart Association (AHA) introduced new lipid guidelines in late 2013 that were a vast departure from older guidelines. Concerns were raised regarding the likely increase in the number of adults who would be eligible for lipid-lowering therapy, namely moderate to high intensity statins. We sought to determine whether, in the first year after the ACC/AHA guideline release, more patients were prescribed statins, prescribed moderate- to high-intensity statins, and eligible for statins compared with the previous year. METHODS: This study was a retrospective, cross-sectional, observational analysis of National Ambulatory Medical Care Survey collected by the Centers for Disease Control and Prevention during the years 2013 and 2014. Survey participants who were younger than 40 years or older than 75 years, were pregnant, or had triglyceride levels ≥400 mg/dL were excluded. Descriptive analyses and χ2 tests of homogeneity (and associated odds ratios [ORs] and CIs) were constructed and reported. FINDINGS: Compared with 2013, a higher percentage of patients in 2014 were prescribed a statin and were eligible to receive a statin. In fact, patients in 2014 were significantly more likely to be prescribed a statin (OR = 1.22; 95% CI, 1.00-1.48) and to be eligible for a statin (OR = 9.26, 95% CI 7.54-11.37) compared with 2013. Although a higher percentage of patients in 2014 were prescribed a higher-intensity statin, the difference was not statistically significant (OR = 1.17; 95% CI, 0.90-1.52). IMPLICATIONS: In the first year after the ACC/AHA guideline introduction, more patients in the United States were prescribed a statin. However, it is unclear whether the new guidelines were strictly adhered to regarding intensity of statin therapy.

A cross-sectional assessment of statistical knowledge among pharmacy faculty.

INTRODUCTION: The debate about the optimal level of research methods incorporated in doctor of pharmacy curricula is ongoing. Yet relatively little has been published about the research-based knowledge of the faculty in these programs. This study seeks to assess pharmacy faculty members' knowledge of fundamental statistical concepts. METHODS: A cross-sectional survey included a random sample of US-based pharmacy schools. Invitations were sent to faculty in each selected pharmacy school to participate in the online survey comprised of demographic questions and a multiple-choice statistics knowledge assessment covering eight fundamental biostatistics concepts. Each question had three answer options, with an additional fourth 'opt-out' option for those wishing to avoid guessing. RESULTS: The random sample of selected pharmacy schools resulted in email invitations sent to 2036 faculty from 30 pharmacy schools. The final study sample consisted of 139 pharmacy faculty members with a mean of 10.2 years of experience as a faculty member. Over 95% of pharmacy faculty reported that they read peer-reviewed scientific journal articles, while nearly 99% said the understanding of statistics was either 'somewhat important' (35%) or 'very important' (64%) in their role as a researcher. Pharmacy faculty achieved a mean of 5.1 correct responses out of eight knowledge-based questions. CONCLUSIONS: Pharmacy faculty provided correct responses to 64% of the items about fundamental statistical concepts. These study results are useful for making decisions about biostatistics education and curriculum content, particularly as pharmacy programs continue to incorporate a prominent role for research.

Gender disparities in patient education provided during patient visits with a diagnosis of coronary heart disease.

BACKGROUND: Cardiovascular disease is the leading cause of death in females in the United States. Prior studies have reported that females receive less patient education and preventive counseling for cardiovascular disease as compared with males. The American Heart Association and others have embarked on several initiatives over the last 20 years to narrow this disparity of care. The primary objective of this study was to determine whether a gender disparity remains in the provision of patient education among patients diagnosed with coronary heart disease, a form of cardiovascular disease. The secondary objective was to determine whether there is an association between the provision of patient education and sociodemographic variables and risk factors. METHODS: This was a retrospective, cross-sectional, observational study of adults (⩾18 years) diagnosed with coronary heart disease who participated in National Ambulatory Medical Care Survey between the years 2005 and 2014, inclusive. Chi-square tests of independence were performed to address the primary objective. A multivariable logistic regression model was constructed to assess the association between gender and provision of patient education while adjusting for sociodemographic variables and risk factors of interest. RESULTS: A total raw survey sample size of 17,332 patient visits meeting the study inclusion/exclusion criteria was utilized. Patients were predominately white, male, non-Hispanic, and ⩾75 years of age. Females had 0.86 times the odds of receiving patient education compared with males (95% confidence interval = 0.78-0.95, p = 0.0024). After adjusting for covariates of interest, gender remained statistically significant in the multivariable logistic model. In addition, the variables "other payer" (vs private insurance), tobacco use, primary care physician type, obesity, hyperlipidemia, and hypertension were found to be statistically significantly associated with the provision of patient education (p < 0.05) in the multivariable analysis. CONCLUSION: In the data analyzed, gender disparities exist, as evidenced by a greater proportion of males receiving patient education than females, among coronary heart disease patients during visits seeking medical care. The acceptability of these findings in terms of overall patient management and treatment goals requires further evaluation.

An evaluation of gout visits in the United States for the years 2007 to 2011.

BACKGROUND: This study analyzed visits for and factors associated with gout and gout medication treatment trends for the years 2007-2011 in the United States given the introduction of febuxostat, the first new treatment option for gout in over 40 years, which was introduced to the market in 2009. METHODS: This study was a retrospective, cross-sectional, observational study of patients age 20 and older seen by providers who participated in the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey Outpatient Department (NHAMCS-OPD) or Emergency Department (NHAMCS-ED) in the United States. The outcome of interest was visits for gout diagnosis and visits where a gout medication was prescribed. RESULTS: Approximately 1.2% of visits had a diagnosis of gout. There was a significant increase in the percentage of visits with a diagnosis of gout in years 2009-2011 compared to 2007-2008, which remained after adjusting for covariates of interest. Groups more likely to have a visit with gout included those ≥65 and 45-64 (both as compared to those 20-44), the African-American and 'Other' race groups (as compared to Caucasians) and those on a diuretic. Groups less likely to have a visit with gout included females, Hispanic/Latinos, those with insurance type of 'Other' and Medicaid (both as compared to private insurance) and visits to a hospital emergency setting (as compared to physician's office visits). CONCLUSION: Although there was a significant increase in visits where gout is diagnosed across study years, the overall percentage of visits with a gout diagnosis is low in the US population. Treatment trends over the study years has remained consistent, with the introduction of febuxostat appearing to have little impact for the study years through 2011.

Study of the Association Between Serum Vitamin D Levels and Prostate Cancer.

INTRODUCTION: Vitamin D has been suggested as a marker for prostate cancer risk, but prior study results are conflicting. This study evaluated the association of prostate cancer diagnosis with vitamin D levels as well as with each of the following variables of interest: age, race group, military service, smoking status, and alcohol use. METHODS: A total of 11,547 adult males aged 18 or older who participated in the National Health and Nutrition Examination Survey for years 2001-2010 were included in this retrospective, cross-sectional, observational study. National Health and Nutrition Examination Survey is an annual, nationally representative sample of noninstitutionalized civilian adult and child residents of the United States. Active duty military are excluded from the survey. Subjects were excluded if they answered "don't know" or "refused" to vitamin D or prostate cancer survey questions. χ2 analyses were performed to analyze associations between diagnosis of prostate cancer and variables of interest. The military service variable was developed on the basis of the response to survey question "Did you ever serve in the Armed Forces of the United States?" A multivariable logistic regression model included all the variables of interest that were available in the database. All analyses were appropriately weighted for extrapolation to average annual population-based estimates for the years included in the study. RESULTS: Two percent had a diagnosis of prostate cancer, whereas 72% had less than 75 nmol/L of vitamin D. Unadjusted χ2 test results suggested those with a vitamin D level of <75 nmol/L, <65 years of age and consuming at least one alcoholic drink per day were significantly less likely to be diagnosed with prostate cancer although smokers and those with military service were significantly more likely to be diagnosed with prostate cancer. However, after adjusting for covariates included in the multivariable logistic regression model, only the following covariates remained significant: men <65 years old were less likely to be diagnosed with prostate cancer (odds ratio [OR] = 0.07, 95% confidence interval [CI] = 0.04-0.12), although those with military service and non-Hispanic blacks were more likely to be diagnosed with prostate cancer (OR = 1.66, 95% CI = 1.09-2.53 and OR 1.73, 95% CI 1.28-2.33, respectively). No other factors in the model, including vitamin D level, retained significance. CONCLUSION: Among the documented risk factors for prostate cancer from the available data, age, military service, and race group were significantly associated with prostate cancer diagnosis. Further study on a larger cohort with prostate cancer is needed to better assess for associations.

A Retrospective Cross-sectional Analysis of Health Education Disparities in Patients With Diabetes Using Data From the National Ambulatory Medical Care Survey.

Purpose The purpose of this study was to determine if there was an association between receipt of diet/nutrition, exercise, and weight loss education in adult patients with a primary diagnosis of diabetes with various demographic and socioeconomic variables using data from the National Ambulatory Medical Care Survey (NAMCS) for the years 2008 to 2011. Methods This retrospective, cross-sectional, observational study design included patients ≥ 18 years of age with diabetes in the NAMCS between 2008 and 2011, inclusive. A series of weighted multivariable logistic regression models was constructed to evaluate predictors of diet/nutrition, exercise, and weight loss education. Odds ratios and 95% confidence intervals were reported. Results Among patients included in this study (n = 3027), 35.6% received diet/nutrition education, 21.8% received exercise education, and 13.6% received weight loss education. From the multivariable analyses, visits using "other" payment type, visits with Medicaid, and visits occurring in non-Metropolitan Statistical Areas were significantly less likely to receive diet/nutrition education; visits using other payment type, visits in non-Metropolitan Statistical Areas, and visits by those ≥ 65 and 45-64 years of age were significantly less likely to receive exercise education. No significant disparities in the receipt of weight loss education were found. Conclusion These findings indicate that although only approximately one third or fewer patients diagnosed with diabetes were receiving diet/nutrition, exercise, or weight loss education, there appeared to be limited disparities among the groups studied. Education rates appear to be trending upward over time, to be slightly improved as compared with previous studies, and to include fewer disparities.

Development of a Diverse Learning Experience for Diverse Psychiatry Resident Needs: A Four-Year Biological Psychiatry Curriculum Incorporating Principles of Neurobiology, Psychopharmacology, and Evidence-Based Practice.

OBJECTIVE: A clinically relevant approach to patient care grounded in neurobiological constructs and evidence based practice which emphasizes a relevant psychopharmacology is needed to optimally train psychiatry residents. METHODS: We implemented a biological psychiatry course that now incorporates neurobiology, psychopharmacology, and evidence-based practice in conjunction with a Research Domain Criteria (RDoC) perspective. A survey launched prior to course implementation and following each class session, served as the outcome metric of residents' attitudes toward the new curriculum and followed a baseline attitudinal survey designed to evaluate the program. RESULTS: Greater than 90% of the psychiatry residents at Duke University who took the attitudinal survey agreed or strongly agreed with needing a course that helped them develop an understanding of neurobiology, psychopharmacology, and evidence-based practice concepts. Most residents also indicated a less than adequate understanding of the neurobiology and psychopharmacology of psychiatric disorders prior to sessions. CONCLUSION: Our biological psychiatry curriculum was associated with enthusiasm among residents regarding the incorporation of neurobiology, psychopharmacology, and evidence-based practice into course topics and discussions. A biological psychiatry curriculum with integrated neurobiology and psychopharmacology built on an evidence base approach is possible, well-received, and needed in training of future psychiatrists.

Comparison of calcification specificity in digital mammography using soft-copy display versus screen-film mammography.

OBJECTIVE: The purpose of this study was to compare specificity in the interpretation of calcifications in soft-copy reviewing of digital mammograms versus hard-copy reviewing of screen-film mammograms. MATERIALS AND METHODS: A total of 130 consecutive cases with calcifications (44 malignant and 86 benign) that had been evaluated with needle or surgical biopsy were collected. Both screen-film mammography and soft-copy digital mammography were obtained in the same patients under existing research protocols using Fischer Imaging's SenoScan (n = 71), Lorad's digital mammography system (n = 35), and GE Healthcare's Senographe 2000D (n = 24). Eight trained radiologists scored all lesions--cropped or masked to display just the region of interest--both on screen-film and soft-copy digital mammography with a month between reviews to reduce the effects of learning and memory. A 5-point malignancy scale was used, with 1 as definitely not, 2 as probably not, 3 as possibly, 4 as probably, and 5 as definitely. Reviewers were randomly assigned condition order, and images within each condition were randomly ordered. Repeated measures analysis of variance was used to test for differences between conditions in specificity computed via nonparametric receiver operating characteristic (ROC) study separately for each reviewer and condition. RESULTS: Across all reviewers, the mean specificity for 1 or 2 versus 3, 4, or 5 was 0.803 for screen-film mammography (range, 0.413-0.938; SD +/- 0.166) and 0.833 for soft-copy image (range, 0.375-0.951; SD +/- 0.187). Although not statistically significant (Student's t test p values from 0.19 to 0.99 across all cut points), numeric values of specificity were consistently higher for soft-copy versus screen-film mammography. No statistical significance in specificity was seen using all possible cut points in the 5-point scale, although the primary analysis used the cutpoint for differentiation between benign and malignant cases as 1 or 2 versus 3, 4, or 5. CONCLUSION: No statistically significant difference was shown in specificity achievable using soft-copy digital versus screen-film mammography in this study.