Background In neuroscience clinical research studies, much time and effort are devoted to deciding what data collect developing collection forms management systems capture the data. Many investigators receiving funding from National Institute of Neurological Disorders Stroke (NINDS), Institutes Health (NIH), required share their once studies complete, but multitude definitions formats make it extremely difficult aggregate or perform meta-analyses across studies. Purpose an assist accelerate...

ContextThe prevalence of medical disorders is high among substance abuse patients, yet services are seldom provided in coordination with treatment.ObjectiveTo examine differences treatment outcomes and costs between integrated independent models care as well the effect a subgroup patients abuse–related conditions (SAMCs).DesignRandomized controlled trial conducted April 1997 December 1998.Setting PatientsAdult men women (n = 592) who were admitted to large health maintenance organization...

Substance abuse and health problems seem to be inextricably related. Yet, prior research on the conditions related substance is largely focused alcohol from patients treated in publicly funded programs, inpatients, general population.This study compares prevalence of medical psychiatric among 747 3690 demographically matched controls same maintenance organization, examines whether any heightened for (relative controls) varies according demographic subgroups type substance.Approximately one...

Risk scores used in early warning systems exist for general inpatients and patients with suspected infection outside the intensive care unit (ICU), but their relative performance is incompletely characterized.To compare of tools to determine points-based risk among all hospitalized patients, including those without infection, identifying at death and/or ICU transfer.In a cohort design, retrospective analysis prospectively collected data was conducted 21 California 7 Illinois hospitals...

To estimate the impact of each six types acute organ dysfunction (hepatic, renal, coagulation, neurologic, cardiac, and respiratory) on long-term mortality after surviving sepsis hospitalization.Multicenter, retrospective study.Twenty-one hospitals within an integrated healthcare delivery system in Northern California.Thirty thousand one hundred sixty-three patients admitted through emergency department between 2010 2013, with follow-up April 2015.None.Acute was quantified using modified...

Unhealthy alcohol use is a major contributor to the global burden of disease and injury. The US Preventive Services Task Force has recommended screening intervention in general medical settings since 2004. Yet less than one six adults report health care professionals discussing with them. Little known about methods for increasing implementation; different staffing models may be related implementation effectiveness. This trial compared delivery screening, brief referral specialty treatment...

<h3>Importance</h3> Excessive alcohol consumption is associated with increased incidence of several medical conditions, but few nonveteran, population-based studies have assessed levels use across conditions. <h3>Objective</h3> To examine associations between conditions and in a sample primary care patients using electronic health record data. <h3>Design, Setting, Participants</h3> This cross-sectional study used separate multinomial logistic regression models to estimate adjusted 26 2 720...

Nontuberculous mycobacterial (NTM) pulmonary disease prevalence is increasing.To determine the association between use of inhaled corticosteroids and likelihood NTM infection among individuals with treated airway disease.We conducted a case-control study subjects without (based on respiratory cultures) 2000 2010 in northern California. We quantified corticosteroids, other medications, healthcare within 6 months identification. used 1:10 matching conditional logistic regression to evaluate...

This study examined the efficacy of Motivational Interviewing (MI) to reduce hazardous drinking and drug use among adults in treatment for depression.Randomized controlled trial based a large outpatient psychiatry program an integrated health care system Northern California. The sample consisted 307 participants ages 18 over who reported drinking, (primarily cannabis) or misuse prescription drugs prior 30 days, scored ≥5 on Patient Health Questionnaire (PHQ-9). Participants were randomized...

Rationale: Sepsis commonly results in elevated serum troponin levels and increased risk for postsepsis cardiovascular complications; however, the association between during sepsis complications after is unclear.Objectives: To evaluate 1 year events.Methods: We analyzed adults aged ⩾40 years without preexisting disease within 5 years, admitted with across 21 hospitals from 2011 to 2017. Peak I were grouped as normal (⩽0.04 ng/ml) or tertiles of abnormal (>0.04 ⩽0.09 ng/ml, >0.09 ⩽0.42 >0.42...

Background: Practice patterns and outcomes associated with the use of oral anticoagulation for arterial thromboembolism prevention following a hospitalization new-onset atrial fibrillation (AF) during sepsis are unclear. Methods: Retrospective, observational cohort study patients ≥40 years age discharged alive AF across 21 hospitals in Kaiser Permanente Northern California health care delivery system, 2011 to 2018. Primary were ischemic stroke/transient attack (TIA), safety outcome major...

Objectives: To investigate the dynamic changes in multiple planes and parameters of aortic root region at different phases cardiac cycle patients with regurgitation (AR) using multi-detector row computed tomography (MDCT). provide more reference information research foundation for preoperative MDCT evaluation undergoing Transcatheter Aortic Valve Replacement (TAVR). Methods: Using MDCT, measurements were taken annulus (AA), left ventricular outflow tract (LVOT), sinotubular junction (STJ)...

Suicide rates in the United States have increased steadily over past twenty years, a trend coinciding with rising use of mental health services across country. To help patients before suicide attempt, systems must be able to screen for risk and take action at large scale. Recently, powerful machine learning (ML) models emerged that can accurately predict attempts by using historical electronic record (EHR) data, yet there exists no standardized framework implementing these care delivery....

Given that suicide rates have been increasing over the past decade and demand for mental health care is at an all-time high, targeted prevention efforts are needed to identify individuals seeking initiate outpatient services who high risk suicide. Suicide prediction models developed using encounters, but their performance among intake appointments has not directly examined.

Alcohol withdrawal syndrome (AWS) is a common inpatient diagnosis managed primarily with benzodiazepines. Concerns about the adverse effects associated benzodiazepines have spurred interest in using benzodiazepine-sparing treatments.To evaluate changes outcomes after implementation of AWS order set that included adjunctive therapies (eg, gabapentin, valproic acid, clonidine, and dexmedetomidine).This difference-in-differences quality improvement study was conducted among 22 899 adult...

Susceptibility and severity of COVID-19 infection vary widely. Prior exposure to endemic coronaviruses, common in young children, may protect against SARS-CoV-2. We evaluated risk severe among adults with without children a large, integrated healthcare system. Adults 0-5 years were matched 1:1 6-11 years, 12-18 those based upon propensity score factors for COVID-19. infections, hospitalizations, need intensive care unit (ICU) assessed 3,126,427 adults, whom 24% (N = 743,814) had 18 or...

To examine how parental limit setting, family conflict, and perception of experience influence severity alcohol drug problems, important gender differences in these relationships, we interviewed consecutive intakes, aged 12 to 18 years, at 4 chemical dependency programs a large group-model nonprofit health maintenance organization (HMO) (n=419). The Family Conflict, Limit Setting, Positive Experience scales correlated with substance dependence (p&lt;0.01, p&lt;0.01, p&lt;0.05, respectively)....

Background Unhealthy alcohol use frequently co‐occurs with psychiatric disorders; however, little is known about the relationship between disorders and consumption levels . Understanding varying of unhealthy among individuals a variety in primary care would provide valuable insight for tailoring interventions. Methods We conducted cross‐sectional study 2,720,231 adult patients screened 2014 2017 at Kaiser Permanente Northern California, using electronic health record data. Alcohol level was...

<h3>Importance</h3> Research has shown that higher activation and engagement with health care is associated better self-management. To our knowledge, the linkage intervention (LINKAGE) first to engage patients receiving addiction treatment using electronic record a patient approach. <h3>Objective</h3> examine effects of an aiming link care. <h3>Design, Setting, Participants</h3> A nonrandomized clinical trial evaluating LINKAGE vs usual by applying alternating 3-month off-and-on design over...

To determine whether novel measures of contextual factors from multi-site electronic health record (EHR) audit log data can explain variation in clinical process outcomes.We selected one widely-used outcome: emergency department (ED)-based team time to deliver tissue plasminogen activator (tPA) patients with acute ischemic stroke (AIS). We evaluated Epic (that tracks EHR user-interactions) for 3052 AIS aged 18+ who received tPA after presenting an ED at three Northern California systems...

International Spinal Cord Injury (SCI) Data Sets include core, basic, and extended data sets. To date, 13 sets have been published on the Web site of Society (ISCoS; www.iscos.org.uk), several more are forthcoming. The constituted elements, which may be appropriate to use in trials conducted test novel therapeutic candidates including neuroprotective drugs, various cell types, rehabilitative strategies devices. National Institute Neurological Disorders Stroke (NINDS), Institutes Health...

The findings of this cohort study suggest that suicide risk models can accurately stratify but will generate additional workload for clinicians.The degree added depends on the threshold selected, strategy responding to repeated alerts per patient, and overlap electronic with risks already identified by treating clinicians.Selecting a also relative importance avoiding false-negative false-positive errors.Without estimates these factors, attempts design system respond be hampered.However,...

Objectives To evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes 18-month health among adults with hypertension type 2 diabetes (T2D). Design A population-based observational study using electronic records data. Setting An integrated healthcare system that implemented system-wide screening, BI referral to treatment adult care. Participants Adult patients (N=72 979) or T2D (N=19 642) who screened positive for unhealthy use 2014 2017....