Browsing by Author "Regenstrief Institute, School of Medicine"

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    AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia with Helicobacter pylori
    (ScienceDirect, 2022) Hung, Kenneth W.; Maratt, Jennifer K.; Cho, Won Kyoo; Shah, Brijen J.; Anjou, Chioma I.; Leiman, David A.; Regenstrief Institute, School of Medicine
    Gastric cancer is the third leading cause of cancer-related deaths worldwide, with more than 1 million incident cases diagnosed globally. 1 Non-cardia intestinal-type gastric cancer, the most common subtype of gastric cancer, develops through the Correa cascade in which chronic inflammation of normal gastric mucosa leads to atrophic gastritis, followed by gastric intestinal metaplasia (GIM), dysplasia, and ultimately gastric cancer. 2 GIM has an estimated prevalence of 4.8% in the United States based on an analysis of gastric biopsies from a large pathology database, but higher rates of GIM have been reported in certain racial and ethnic groups (14.8% in Asian Americans, 18.2% in Native Americans, 25.5% in African Americans, and 29.5% in Hispanic Americans). 3 ,4 Additional risk factors for GIM include tobacco use, autoimmune gastritis, and living or immigrating from an endemic area. The annual risk of progression from GIM to non-cardia intestinal-type gastric cancer is 0.16%, and factors such as persistent Helicobacter pylori infection, family history, anatomic extent and location of GIM, and histologic subtypes may confer increased risk of progression to gastric cancer. 5 Studies of U.S. endoscopists show variation in the management of patients with GIM, including use and interval for endoscopic surveillance, prompting the development of guidelines for the management of GIM.
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    Association Between Menorrhagia and Risk of Intrauterine Device-Related Uterine Perforation and Device Expulsion: Results from the APEX-IUD Study
    (ScienceDirect, 2022) Getahun, Darios; Fassett, Michael J.; Gatz, Jennifer; Armstrong, Mary Anne; Peipert, Jeffrey F.; Raine-Bennett, Tina; Reed, Susan D.; Zhou, Xiaolei; Schoendorf, Juliane; Postlethwaite, Debbie; Shi, Jiaxiao M.; Saltus, Catherine W.; Wang, Jinyi; Xie, Fagen; Chiu, Vicki Y.; Merchant, Maqdooda; Alabaster, Amy; Ichikawa, Laura E.; Hunter, Shannon; Im, Theresa M.; Takhar, Harpreet S.; Ritchey, Mary E.; Chillemi, Giulia; Pisa, Federica; Asiimwe, Alex; Anthony, Mary S.; Regenstrief Institute, School of Medicine
    Background Intrauterine devices are effective contraception, and one levonorgestrel-releasing device is also indicated for treatment of heavy menstrual bleeding (menorrhagia). Objective To compare the incidence of intrauterine device expulsion and uterine perforation in women with and without a diagnosis of menorrhagia within the 12 months before device insertion. Study Design Retrospective cohort study conducted in 3 integrated healthcare systems (Kaiser Permanente Northern California, Southern California, and Washington) and a healthcare information exchange (Regenstrief Institute) in the United States, using electronic health records. Nonpostpartum women aged ≤50 years with intrauterine device (e.g., levonorgestrel or copper) insertions from 2001–2018 without a delivery in the prior 12 months were studied in this analysis. Recent menorrhagia diagnosis (i.e., recorded ≤12 months before insertion) was ascertained from International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes. Study outcomes—device expulsion and device-related uterine perforation (complete or partial)—were ascertained from electronic medical records and validated in data sources. Cumulative incidence and crude incidence rates with 95% confidence intervals were estimated. Cox proportional hazards models estimated crude and adjusted hazard ratios using propensity score overlap weighting (13-16 variables) and 95% confidence intervals. Results Among 228,834 nonpostpartum women, mean age was 33.1 years, 44.4% were White, and 31,600 (13.8%) had a recent menorrhagia diagnosis. Most women had a levonorgestrel-releasing device (96.4% of those with and 78.2% of those without a menorrhagia diagnosis). Women with a menorrhagia diagnosis were likely to be older, obese, and have dysmenorrhea or fibroids. Women with vs. without a menorrhagia diagnosis had a higher intrauterine device expulsion rate (40.01 vs. 10.92 per 1,000 person-years), especially evident in the few months after insertion. Women with a menorrhagia diagnosis had higher cumulative incidence (95% confidence interval) of expulsion (7.00% [6.70%, 7.32%] at 1 year, 12.03% [11.52%, 12.55%] at 5 years) vs. without (1.77% [1.70%, 1.84%] at 1 year, 3.69% [3.56%, 3.83%] at 5 years). Risk of expulsion was increased for women with a menorrhagia diagnosis vs. without (adjusted hazard ratio, 2.84 [95% confidence interval: 2.66, 3.03]). Perforation rate was low overall (<1/1,000 person-years) but higher in women with a diagnosis of menorrhagia vs. without (0.98 vs. 0.63 per 1,000 person-years). Cumulative incidence (95% confidence interval) of uterine perforation was slightly higher for women with a menorrhagia diagnosis (0.09% [0.06%, 0.14%] at 1 year, 0.39% [0.29%, 0.53%] at 5 years) vs. without (0.07% [0.06%, 0.08%], at 1 year, 0.28% [0.24%, 0.33%] at 5 years). Risk of perforation was slightly increased in women with a menorrhagia diagnosis vs. without (adjusted hazard ratio, 1.53; 95% confidence interval, 1.10, 2.13). Conclusion The risk of expulsion is significantly higher in women with a recent diagnosis of menorrhagia. Patient education and counseling regarding potential expulsion risk is recommended at insertion. The absolute risk of perforation for women with a recent diagnosis of menorrhagia is very low. Increased expulsion and perforation rates observed are likely due to causal factors of menorrhagia.
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    Naturalistic Decision Making in Everyday Self-care Among Older Adults With Heart Failure
    (Wolters Kluwer, 2020-12-23) Daley, Carly N.; Cornet, Victor P.; Toscos, Tammy R.; Bolchini, Davide P.; Mirro, Michael J.; Holden, Richard J.; Regenstrief Institute, School of Medicine
    BACKGROUND: Every day, older adults living with heart failure make decisions regarding their health that may ultimately affect their disease trajectory. Experts describe these decisions as instances of naturalistic decision making influenced by the surrounding social and physical environment and involving shifting goals, high stakes, and the involvement of others. OBJECTIVE: This study applied a naturalistic decision-making approach to better understand everyday decision making by older adults with heart failure. METHODS: We present a cross-sectional qualitative field research study using a naturalistic decision-making conceptual model and critical incident technique to study health-related decision making. The study recruited 24 older adults with heart failure and 14 of their accompanying support persons from an ambulatory cardiology center. Critical incident interviews were performed and qualitatively analyzed to understand in depth how individuals made everyday health-related decisions. RESULTS: White, male (66.7%), older adults' decision making accorded with a preliminary conceptual model of naturalistic decision making occurring in phases of monitoring, interpreting, and acting, both independently and in sequence, for various decisions. Analyses also uncovered that there are barriers and strategies affecting the performance of these phases, other actors can play important roles, and health decisions are made in the context of personal priorities, values, and emotions. CONCLUSIONS: Study findings lead to an expanded conceptual model of naturalistic decision making by older adults with heart failure. In turn, the model bears implications for future research and the design of interventions grounded in the realities of everyday decision making.