1, 2, 3, Stop the Bleed: Analysis of a Bleeding Control Educational Course

Hemorrhaging, or uncontrolled bleeding, accounts for 40% of preventable deaths in the United States that occur after a traumatic injury. The Stop the Bleed campaign was launched in 2015 by the White House National Security Council to educate the public about methods to control and stop bleeding as well as empower individuals to take action if a traumatic accident occurs. The goal of this study was to evaluate the effectiveness of the “Stop the Bleed” bleeding control course to increase knowledge about the topic as well as increase confidence to take action and use the techniques that were taught during the course appropriately. Data was collected via a cross sectional pre-post survey design. At baseline, the participants were asked basic knowledge questions about bleeding control and techniques to use as well as how confident they felt using those skills. After being presented the bleeding control material and practicing the techniques in the hands-on portion of the course, the participants were asked to complete a post-test with similar questions to that of the pre-test. De-identified responses were collected to analyze the changes in the overall knowledge scores and overall confidence scores with the use of the paired-t statistical test on SPSS. The participants (N=32) were employees within the Thomas Jefferson University Campus Security department. The overall score for the knowledge-based questions were analyzed from pre to post and showed that the changes were statistically significant (8.163,

Prevalence of Asthma Severities in Children and Adolescents in a Wilmington, DE Hospital

Asthma affects over 24 million individuals in the US and the prevalence of the condition is increasing in the US and worldwide. The prevalence of severe persistent asthma, which incurs a significant health and economic burden, is still poorly understood in children and adolescents. We aimed to define the prevalence of asthma severities in children and adolescents in an urban hospital setting as a function of age, sex, race, and ethnicity by assessing prescribed medications as a proxy for asthma severity according to NIH guidelines for care. We found that a plurality of patients across all age groups, sexes, races, and ethnicities were severe persistent asthmatics. We also found that younger individuals as well as those who are African American have higher odds of being moderate to severe asthmatics. This information can be used to generate hypotheses for future studies and can be used to better address patient needs. In addition, these results suggest that a health disparity among African Americans exists that is consistent with other aspects of the condition. To reduce the prevalence of asthma in all populations, future research should place a greater emphasis on identifying more indicative risk factors for prevention, finding strategies to identify asthma at an earlier age, and developing more effective and personalized therapeutics

Use of International Classification of Diseases, Ninth Revision Codes for Obesity: Trends in the United States from an Electronic Health Record-Derived Database.

Obesity is a potentially modifiable risk factor for many diseases, and a better understanding of its impact on health care utilization, costs, and medical outcomes is needed. The ability to accurately evaluate obesity outcomes depends on a correct identification of the population with obesity. The primary objective of this study was to determine the prevalence and accuracy of International Classification of Diseases, Ninth Revision (ICD-9) coding for overweight and obesity within a US primary care electronic health record (EHR) database compared against actual body mass index (BMI) values from recorded clinical patient data; characteristics of patients with obesity who did or did not receive ICD-9 codes for overweight/obesity also were evaluated. The study sample included 5,512,285 patients in the database with any BMI value recorded between January 1, 2014, and June 30, 2014. Based on BMI, 74.6% of patients were categorized as being overweight or obese, but only 15.1% of patients had relevant ICD-9 codes. ICD-9 coding prevalence increased with increasing BMI category. Among patients with obesity (BMI ≥30 kg/m2), those coded for obesity were younger, more often female, and had a greater comorbidity burden than those not coded; hypertension, dyslipidemia, type 2 diabetes mellitus, and gastroesophageal reflux disease were the most common comorbidities. KEY FINDINGS: US outpatients with overweight or obesity are not being reliably coded, making ICD-9 codes undependable sources for determining obesity prevalence and outcomes. BMI data available within EHR databases offer a more accurate and objective means of classifying overweight/obese status

Medicinal Cannabis Use in Sickle Cell Anemia

Approximately 100,000 Americans suffer from sickle cell anemia (SCA), a severe hereditary form of anemia in which red blood cells can mutate into a sickled shape causing severe pain crises that can lead to ED visits, hospitalization, and negatively impact multiple organ systems. Pain crises greatly impact the quality of life for SCA patients. Living with SCA can be stressful and often affects patients’ mental health, causing anxiety or depression (National Heart, Lung, and Blood Institute, 2016). Opioids have been a treatment mainstay for the severe pain caused by SCA but the side effects of opioids, plus the risk of dependence, are issues that have led both patients and researchers to consider medicinal cannabis as a treatment option. While there is limited research addressing the treatment of sickle cell pain with cannabis some research does suggest that cannabis could have a beneficial effect on the management of both chronic pain and acute pain (Choo, Feldstein Ewing, & Lovejoy, 2016; Kroenke & Cheville, 2017). The aim of this study is to evaluate the association between medicinal cannabis use and quality of life for individuals with SCA. The primary goal of this pilot study is to gather a cohort of participants and administer a baseline survey that will be used in a larger study. The goal of the larger study is to assess the impact of medicinal cannabis available through Pennsylvania’s Department of Health-approved dispensaries in Philadelphia on the quality of life for individuals with sickle cell anemia (SCA)

Stereotactic Radiosurgery Practice Patterns for Brain Metastases in the United States: A National Survey

Background: Stereotactic radiosurgery (SRS) has emerged as an important modality for the treatment of intracranial metastases. There are currently few established guidelines delineating indications for SRS use and fewer still regarding plan evaluation in the treat- ment of multiple brain metastases. Methods: An 18 question electronic survey was distributed to radiation oncologists at National Cancer Institute (NCI) designated cancer centers in the US (60). Centers without radiation oncologists were excluded. Physicians who indicated that they do not prescribe SRS were excluded from the remaining survey questions. Sign test and Chi-square test were used to determine if responses differed significantly from random distribution. Results: 116 of the 697 radiation oncologists surveyed completed the questionnaire, representing 51 institutions. 62% reported treating patients with brain metastases using SRS. Radiation oncologists prescribing SRS most commonly treat CNS (66.2%) and lung (49.3%) malignancies. SRS was used more frequently for \u3c10 brain metastases (73.7%; p\u3c.0001) and whole brain radiation therapy (WBRT) for \u3e10 brain metastases (82.5%; p\u3c.0001). The maximum number of lesions physicians were willing to treat with SRS without WBRT was 1-4 (40.4%) and 5-10 (42.4%) (p\u3c.0001 compared to 11-15, 16-20 and no limit). The most important criteria for choosing SRS or WBRT were number of lesions (p\u3c.0001) and performance status (p=.016). The most common margin for SRS was 0 mm (49.1%; p=.0021). The most common dose constraints other than critical structure was conformity index (84.2%) and brain V12 (61.4%). The LINAC was the most common treatment modality (54.4%) and mono-isocenter technique for multiple brain metastases was commonly used (43.9%; p=.23). Most departments do not have a policy for brain metastases treatment (64.9%; p=.024). Conclusions: This is one of the first national surveys assessing the use of SRS for brain metastases in clinical practice. These data highlight some clinical considerations for physicians treating brain metastases with SRS. Summary: This is among the first national surveys to assess the use of SRS for brain metastases in clinical practice. Specifically, radiation oncologist reported increasingly using SRS instead of WBRT for treating \u3c10 metastases, with the LINAC being the most common modality. Further, treatment parameters considered the most important included 0 mm margins, conformity index, brain V12, and mono- isocenter technique for multiple brain metastases. These results may provide context regarding the use of SRS for brain metastases in clinical practice

Improved cardiac management with a disease management program incorporating comprehensive lipid profiling.

Abstract The objective of this study was to evaluate the improved effectiveness of a disease management treatment protocol incorporating comprehensive lipid profiling and targeted lipid care based on lipid profile findings in patients with ischemic heart disease (IHD) or congestive heart failure (CHF) enrolled in a managed care plan. This retrospective cohort study, conducted over a 2-year period, compared outcomes between patients with a standard lipid profile to those evaluated with a comprehensive lipid profile. All adult members of the WellMed Medical Management, Inc. managed care health plan diagnosed with IHD or CHF, and continuously enrolled between July 1, 2006 and June 30, 2008, were included in the study. Cases were defined as those who had at least 1 comprehensive lipid test (the VAP [vertical auto profile] ultracentrifuge test) during this period (n=1767); they were compared to those who had no lipid testing or traditional standard lipid testing only (controls, n=289). Univariate statistics were analyzed to describe the groups, and bivariate t tests or chi-squares examined differences between the 2 cohorts. Multivariate regression analyses were performed to control for potential confounders. The results show that the case group had lower total costs ($4852.62 vs.$7413.18; P=0.0255), fewer inpatient stays (13.1% vs. 18.3% of controls; P=0.0175) and emergency department visits (11.9% vs. 15.6% of controls; P=0.0832). Prescription use and frequency of lipid measurement suggested improved control resulting from a targeted approach to managing specific dyslipidemias. A treatment protocol incorporating a comprehensive lipid profile appears to improve care and reduce utilization and costs in a disease management program for cardiac patients. (Population Health Management 2012;15:46-51)

Healthy Steps for Older Adults (HSOA) - A Falls Prevention Program Outcome Evaluation

Fall prevention is an increasingly important area in the realm of public health and prevention medicine. Falls continue to be the leading cause of fatal injury and the most common cause of non-fatal trauma-related hospital admissions among older adults in the United States, causing over 2.8 million injuries, over 800,000 hospitalizations, and more than 27,000 deaths annually (NCOA, 2018).As the average age of the population increases, the need for programs that inform the public about their risks of falls has begun to increase. The following study is an evaluation of one such program, Healthy Steps for Older Adults (HSOA). Twenty individuals ages 58 and older were recruited to partake in a two-day informational and interactive session designed to teach those participants about falls, to help them evaluate their own risk of falls, and to provide solutions to reduce fall risk. Questionnaires given a at the start of the intervention on day one, at the conclusion of the intervention on day two, and four weeks after completing the program were used to assess changes in knowledge about falls and fall risk and behavior changes to reduce risks of falling. Participants also completed a “Physical Skill screening” on the second day that included three exercises to identify their relative fall risk. Out of the twenty participants, fourteen responded to the follow-up phone interview. Of those fourteen individuals, 85.71% changed at least one behavior to help reduce their risk of falls by the time they were contacted to complete the four-week post-intervention follow-up questionnaire, and the program is therefore an effective falls-prevention program based on our definition (at least 50% of participants changed at least one behavior to reduce their risk of falls). Additional analysis supports the claim that there may be a lower limit age for which the program is effective, and that being placed in a moderate or high risk fall category may be associated with increased likelihood of making a positive behavior change to reduce fall risk. However, more data is needed to establish statistical significance. Areas of concern reflect a suggested need to incorporate family members into the intervention, establish a standardized benchmark for determining program effectiveness, and improve comparability between pre- and post-intervention questionnaires. Overall, the program by our definition was successful, but specific limitations regarding the logistical implementation and evaluation of the program should be addressed if the program were to be run again

Adjuvant and salvage radiation therapy after prostatectomy : investigating beliefs and practices of radiation oncologists

Evidence regarding adjuvant radiation therapy (ART) and salvage radiation therapy (SRT) following radical prostatectomy (RP) for prostate cancer is inconsistent. The study objectives were to collect survey information on Italian radiation oncologists' (RO) beliefs regarding the use of ART and SRT following RP and to compare the results of Italian RO with those of American RO available from an analogous survey