Hospital Resource Utilization among Patients with Chronic Obstructive Pulmonary Disease - An Analysis of 2002 - 2005 Healthcare Cost and Utilization Project Data

Objective: The objective of this study is to develop a national assessment of the length of stay (LOS), total costs, and in-hospital mortality among patients with chronic obstructive pulmonary disease (COPD), using retrospective data derived from Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP)

Burden of Colorectal Cancer among the elderly Medicare beneficiaries in West Virginia A comparative analysis with national data

West Virginia (WV) which is one of the most rural states in the nation, had the highest colorectal cancer (CRC) mortality rate in United States (US) in 2009. There is a paucity of epidemiologic studies that have decrypt the reasons for this high CRC mortality, or have systematically examined the burden of, and disparities among the population of elderly with CRC from a rural settings such as from WV. This series of retrospective cohort studies was conducted to examine the receipt of CRC treatment and the associated survivorship, comorbidity burden, and healthcare expenditures among Medicare beneficiaries with CRC identified from the West Virginia Cancer Registry Medicare linked (WVCR Medicare); and to compare them with national estimated derived from the Surveillance, Epidemiology, and End Results Medicare (SEER Medicare) data. These studies examined CRC treatment patterns, receipt of minimally appropriate CRC treatment (MACT), healthcare expenditures in the initial phase of care, and CRC specific and all cause mortality in the 36 month period following the CRC diagnosis in the two study cohorts. The associations of specific pre-existing chronic conditions with the treatment receipt, healthcare expenditures, and survivorship was also explored. In the first study, it was observed that the characteristics of the two study cohorts were significantly different with those from WVCR Medicare having higher comorbidity burden, and living in non-metro areas. Although a higher proportion of beneficiaries from WVCR Medicare were diagnosed in the earlier stages of CRC (when it can still be treated effectively) as compared to their national counterparts from SEER Medicare, they exhibited CRC poor survivorship. This poor survivorship was possibly due to the lower likelihood of beneficiaries from WVCR Medicare of receiving MACT as compared to the beneficiaries identified from SEER Medicare; as observed in the study results. In study two, which studied the pre-existing chronic conditions among the WVCR Medicare beneficiaries with CRC, no substantial evidence was found to conclude that beneficiaries with CRC and comorbidities were treated less aggressively as compared to those without comorbidities; as reported by some other studies. Only a few conditions were found to be negatively associated with CRC specific mortality, but almost all the chronic conditions were negatively associated with all--cause mortality among beneficiaries from WVCR Medicare. The results from study three showed that after adjusting for the regional variation in cost-of-living across the different counties included in the study, the difference in total healthcare expenditures between the beneficiaries with CRC from a rural area such as in WV and their national counterparts can be believed to be mainly driven due to the differential treatment receipt and the high comorbidity burden. These studies can serve as a good case-studies to elucidate the receipt of CRC treatment and the associated health outcomes in a CRC population that is aging, is sicker, belongs to lower socio-economic status, and is from a rural setting. Future research is necessary to determine if similar associations are observed in other rural areas in the nation, and also to better understand the implementation of and receipt of guideline recommended CRC care and the associated health outcomes among beneficiaries with CRC from such areas

Depression treatment in individuals with cancer: a comparative analysis with cardio-metabolic conditions

A clear picture of the current state of nationwide depression treatment practices in individuals with cancer and depression does not exist in the United States (US). Therefore, the primary objective of this study was to examine rates of any depression treatment among individuals with cancer and depression in the US. To better understand the relationship between any treatment for depression and presence of cancer, we used a comparison group of individuals with cardio-metabolic conditions owing to the similar challenges faced in management of depression in individuals with these conditions. We used a retrospective cross-sectional design and data from multiple years of the Medical Expenditure Panel Survey, a nationally representative household-survey on healthcare utilization and expenditures. Study sample consisted of adults aged 21 or older with self-reported depression and cancer (n=528) or self-reported depression and diabetes, heart disease or hypertension (n=1643). Depression treatment comprised of any use of antidepres- sants and/or any use of mental health counseling services. Treatment rates for depression were 78.0% and 81.7% among individuals with cancer and cardio-metabolic conditions respectively. After controlling for socio-demographic, access-to-care, number of physician-visits, health-status, and lifestyle risk-factors related variables; individuals with cancer were less likely to report any treatment for depression (Adjusted Odds Ratio=0.67; 95% Confidence Interval=0.49, 0.92) compared to individuals with cardio-metabolic conditions (P≤0.01). Our findings highlight the possibility that competing demands may crowd out treatment for depression and that cancer diagnosis may be a barrier to depression treatment

CANDI Store: An Infrastructure for Neuroimage Storage and Processing

In order to support the local data management need for neuroimaging researchers at UMass Medical School within the Child and Adolescent NeuroDevelopment Initiative (CANDI) and beyond, we have implemented a XNAT (xnat.org) instance called CANDIStore. XNAT is an open source imaging informatics platform, developed by the Neuroinformatics Research Group at Washington University. It facilitates common management, productivity, and quality assurance tasks for imaging and associated data. Located securely within the medical school firewall, CANDIStore offers a comprehensive set of image management tools. Users can be authenticated based against their UMass credentials, create private projects, manage research team access, DICOM \u27push\u27 directly to CANDIStore from the MRI imaging console, manage demographic and additional subject variables, and perform automated analysis and processing pipelines. CANDIStore is an essential adjunct to the daily operations of neuroimaging research

Rat Model of Pre-Motor Parkinson's Disease: Behavioral and MRI Characterization.

Background: Parkinson's disease (PD) is a chronic, progressive, neurodegenerative disorder with currently no known cure. PD has a significant impact on quality of life of the patients, as well as, the caregivers and family members. It is the second most common cause of chronic neurological disability in US and Europe. According to National Parkinson's Foundation, there are almost 1 million patients in the Unites States and 50,000 to 60,000 new cases of PD are diagnosed each year. The total number of cases of PD is predicted to double by 2030. The annual cost associated with this disease is estimated to be $10.8 billion in the United States, including the cost of treatment and the cost of the disability. Although it is primarily thought of as a movement-disorder and is clinically diagnosed based on motor symptoms, non-motor symptoms such as cognitive and emotional deficits are thought to precede the clinical diagnosis by almost 20 years. By the time of clinical diagnosis, there is 80% loss in the dopamine content in the striatum and 50% degeneration of the substantia nigra dopamine cells. The research presented in this thesis was an attempt to develop an animal model of PD in its pre-motor stages. Such a model would allow us to develop pre-clinical markers for PD, and facilitate the development and testing of potential treatment strategies for the non-motor symptoms of the disorder. Specific Aims: There were five specific aims for this research: * The first specific aim dealt with development of a rat model of PD with slow, progressive onset of motor deficits, determination of timeline for future studies, and quantification the dopamine depletion in this model at a pre-motor stage. * The second and the third specific aims focused on testing for emotional (aversion) deficits and cognitive (executive functioning) deficits in this rat model at the 3 week timepoint determined during specific aim 1. * The fourth specific aim was to determine the brain network changes associated with the behavioral changes observed our rat model using resting state connectivity as a measure. * The fifth and the final specific aim was to test sodium butyrate, a drug from the histone deacetylase inhibitor family, as a potential treatment option for cognitive deficits in PD. Results: The 6-hydroxy dopamine based stepwise striatal lesion model of pre-motor PD, developed during this research, exhibits delayed onset of Parkinsonian gait like symptoms by week 4 after the lesions. At 3 weeks post lesion (3WKPD), the rats exhibit 27% reduction in striatal dopamine and 23%reduction in substantia nigra dopamine cells, with lack of any apparent motor deficits. The 3WKPD rats also exhibited changes in aversion. The fMRI study with the aversive scent pointed towards possible amygdala dysfunction sub-serving the aversion deficits. The executive function deficits tested using a rat analog of the Wisconsin card sorting test, divulged an extra-dimensional set shifting deficit in the 3WKPD rats similar to those reported in PD patients. The resting state connectivity study indicated significant changes in the 3WKPD rats compared to age matched controls. We observed increased overall connectivity of the motor cortex and increased CPu connectivity with prefrontal cortex, cingulate cortex, and hypothalamus in the 3WKPD rats compared to the controls. These observations parallel the observations in unmedicated early-stage PD patients. We also observed negative correlation between amygdala and prefrontal cortex as reported in humans. This negative correlation was lost in 3WKPD rats. Sodium butyrate treatment, tested in the cognitive deficit study, was able to ameliorate the extra-dimensional set shifting deficit observed in this model. This treatment also improved the attentional set formation. Conclusion: Taken together, our observations indicate that, the model of pre-motor stage PD developed during this research is a very high face validity rat model of late Braak stage 2 or early Braak stage 3 PD. Sodium butyrate was able to alleviate the cognitive deficits observed in our rat model. Hence, along with the prior reports of anti-depressant and neuroprotective effects of this drug, our results point towards a possible treatment strategy for the non-motor deficits of PD

Structure-centered portal for child psychiatry research

The real world needs of the clinical community require a domain-specific solution to integrate disparate information available from various web-based resources for data, materials, and tools into routine clinical and clinical research setting. We present a child-psychiatry oriented portal as an effort to deliver a knowledge environment wrapper that provides organization and integration of multiple information and data sources. Organized semantically by resource context, the portal groups information sources by context type, and permits the user to interactively narrow or broaden the scope of the information resources that are available and relevant to the specific context. The overall objective of the portal is to bring information from multiple complex resources into a simple single uniform framework and present it to the user in a single window format

Audit of principal investigator's compliance for submission of continue review application and decisions taken on lapses in validity of approval by the Institutional Ethics Committee at tertiary oncology center in Navi Mumbai

Context: A failure to obtain continued Institutional Ethics Committee (IEC) approval for the study before the expiry date assigned by the IEC is considered as “lapse of the IEC approval” to continue the study at the site by the Investigator. Considering this, we had conducted an audit of principal investigators (PI's) compliance for Continuing Review Application (CRA) submission timelines and decision taken on the lapses in the validity of IEC approval continuation. Aim: The aim of this study is to assess the pre- and post-policy trends of non-compliance management of delayed CRA submission and compare the PI's compliance for submission of CRA between Investigator Initiated trial (IIT) and Pharma studies. Setting and Design: The present study was a retrospective audit of CRAs of ongoing projects submitted by PIs to IEC, ACTREC. Materials and Methods: The data from total 199 CRAs submitted for review to the IEC between the year January 2016 and December-2017 were collected and maintained in Microsoft Excel sheet, and later, the data were exported into the SPSS software version 21 for the analysis. Statistical Analysis: All categorical data were presented in numbers and percentage. The first primary objective was assessed by calculating the duration between the dates of approval for any study to the date of next CRA submission. The CRAs submitted after the project expiry date were considered as a lapse in following the IEC SOP. Results: This retrospective audit revealed that CRA reminder sent by the IEC to the PI played an important role in compliance w. r. t timely in following the IEC SOPof the CRA by the PI. As a result, overall, 90% of CRAs showed compliance in submitting CRAs to IEC in both IIT and Pharma study. The number of lapses were reduced to 7 in the postpolicy period as compared to 15 lapses in the prepolicy period. Conclusion: This retrospective audit reveals that CRA reminder sent by the IEC to the PI played an important role in improving the compliance of PIs in submitting CRA to IEC. Each IEC should develop the policy to minimize the delays in CRA submission by the PI and prevent lapses in following the IEC SOP