A5018267511- Sepsis Diagnosis and Treatment
- Intensive Care Unit Cognitive Disorders
- Emergency and Acute Care Studies
- Healthcare Policy and Management
- Family and Patient Care in Intensive Care Units
- Viral-associated cancers and disorders
- Primary Care and Health Outcomes
- Antibiotic Use and Resistance
- Long-Term Effects of COVID-19
- COVID-19 and healthcare impacts
- Clinical Reasoning and Diagnostic Skills
- Hemoglobinopathies and Related Disorders
- Child and Adolescent Health
- Liver Disease Diagnosis and Treatment
- Cardiac, Anesthesia and Surgical Outcomes
- Global Cancer Incidence and Screening
- Health Systems, Economic Evaluations, Quality of Life
- Health Policy Implementation Science
- Geriatric Care and Nursing Homes
- Bladder and Urothelial Cancer Treatments
- Healthcare cost, quality, practices
- Palliative Care and End-of-Life Issues
- Food Security and Health in Diverse Populations
- COVID-19 epidemiological studies
- Respiratory Support and Mechanisms
Wake Forest University
2023-2025
META Group
2025
Analysis Group (United States)
2025
Atrium Medical Cente
2018-2023
Carolinas Medical Center
2020-2022
University of Puerto Rico at Carolina
2022
Levine Cancer Institute
2014-2019
Carolinas Healthcare System
2014-2019
Center for Outcomes Research and Clinical Epidemiology
2019
Baylor College of Medicine
2011-2016
OBJECTIVES: The prevalence and disease burden of nonalcoholic fatty liver (NAFLD) are increasing. Nonetheless, little is known about the processes related to identification, diagnosis, referral patients with NAFLD in routine clinical care. METHODS: Using automated data, we isolated a random sample Veterans Administration facility who had ≥2 alanine transaminase (ALT) values >40 IU/ml >6 months apart absence any positive results for hepatitis C RNA, B surface antigen, or screens excess...
Pandemics disrupt traditional health care operations by overwhelming system resource capacity but also create opportunities for innovation.
OBJECTIVES: To evaluate whether a nurse navigator-led, multicomponent Sepsis Transition And Recovery program improves 30-day mortality and readmission outcomes after sepsis hospitalization. Desig n: Multisite pragmatic randomized clinical trial. SETTING: Three hospitals in North Carolina from January 2019 to March 2020. PATIENTS: Eligible patients hospitalized for suspected deemed high-risk or by validated internal risk models. INTERVENTIONS: Patients were receive usual care alone (i.e.,...
To evaluate real-world implications of updated Surviving Sepsis Campaign (SSC) recommendations for antibiotic timing.
BACKGROUND AND OBJECTIVES: NICUs vary in the quality of care delivered to very low birth weight (VLBW) infants. NICU performance on 1 measure only modestly predicts others. Composite measurement delivery may provide a more comprehensive assessment quality. The objective our study was develop robust composite indicator provided VLBW infants that accurately discriminates among NICUs. METHODS: We developed indicator, Baby-MONITOR, based 9 measures chosen by panel experts. Measures were...
Rationale: Postsepsis care recommendations target specific deficits experienced by sepsis survivors in elements such as optimization of medications, screening for functional impairments, monitoring common and preventable causes health deterioration, consideration palliative care. However, few data are available regarding the application these clinical practice.Objectives: To quantify delivery postsepsis patients discharged after hospital admission evaluate association between receipt reduced...
Rationale: Prone positioning is an appealing therapeutic strategy for nonintubated hypoxic patients with coronavirus disease (COVID-19), but its effectiveness remains to be established in randomized controlled trials. Objectives: To identify contextual factors relevant the conduct of a definitive clinical trial evaluating prone COVID-19. Methods: We conducted cluster pilot at quaternary care teaching hospital. Five inpatient medical service teams were randomly allocated two treatment arms:...
Rapid delivery of antibiotics is a cornerstone sepsis therapy, although time targets for specific components antibiotic are unknown. We quantified intervals comprising the task and evaluated association between interval delays hospital mortality among patients treated in emergency department suspected sepsis.Retrospective cohort.Twelve hospitals Southeastern United States from 2014 to 2017.Twenty-four thousand ninety-three encounters 20,026 adults with 12 departments.We divided...
To describe trends in national resource utilization for pediatric skin and soft tissue infection (SSTI) hospitalizations.This was a cross-sectional analysis of hospital discharges from 1997 to 2009 within the Healthcare Cost Utilization Project Kids' Inpatient Database children with isolated SSTIs. Outcomes examined included patient characteristics, number hospitalizations, including length stay (LOS), charges, performance incision drainage (I&D). Trends were assessed by using linear...
HIV increases the risk of progression to hepatic fibrosis and cirrhosis among individuals coinfected with hepatitis C virus (HCV). However, impact HIV-related immune suppression on hepatocellular carcinoma (HCC) is currently unknown.We used Veterans Affairs Clinical Case Registry identify patients infection between 1985 2010 HCV coinfection (positive RNA or genotype test) 1995 2010. The outcome was incident HCC as indicated by International Classification Diseases, 9th revision, Modification...
Research suggests that cumulative measurement of HIV exposure is associated with mortality, AIDS, and AIDS-defining malignancies. However, the relationship between non-AIDS-defining malignancies (NADMs) remains unclear. The aim this study was to evaluate effect different measures on NADM hazard among HIV-infected male veterans.We performed a retrospective cohort using Veterans Affairs Clinical Case Registry data from 1985 2010. We analyzed (recent RNA, % undetectable copy-years viremia)...
Summary Background In practice, nonalcoholic fatty liver disease (NAFLD) is diagnosed based on elevated enzymes and confirmatory biopsy or abdominal imaging. Neither method feasible in identifying individuals with NAFLD a large‐scale healthcare system. Aim To develop validate an algorithm to identify patients using automated data. Methods Using the Veterans Administration Corporate Data Warehouse, we identified who had persistent ALT elevation (≥2 values ≥40 IU/mL ≥6 months apart) did not...
Sepsis ranks among the "Big Three" conditions most prone to harmful diagnostic errors. Despite its high prevalence and severity, health systems lack effective contextually tailored strategies optimize accuracy for sepsis. The purpose of this study is understand factors related sepsis using principles tools safety implementation science. This a multi-site involving 20 hospitals across four states in United States. primary objectives are (1) describe hospital-level variability barriers...
To examine the discrimination, calibration, and algorithmic fairness of Epic End Life Care Index (EOL-CI). We assessed EOL-CI's performance by estimating area under receiver operating characteristic curve (AUC), sensitivity, positive negative predictive values in community-dwelling adults ≥65 years age a single health system Southeastern United States. Algorithmic was examined comparing model's across sex, race, ethnicity subgroups. Using machine learning approach, we also explored local...
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does study add? Men with prostate cancer who choose active surveillance may experience anxiety depression. Higher related to uncertainty surrounding has been shown increase likelihood choosing treatment in absence a clinical indication. Certain characteristics, including physician influence neurotic personality, also risk psychological distress. Our identified particular areas that affect degree...
Bladder cancer is the fifth most commonly diagnosed and expensive adult in average healthcare costs incurred per patient USA. However, little known about factors influencing patients' treatment decisions, quality of life, responses to impairments. The main focus this paper better understand impact muscle invasive bladder on life its added implications for primary caregivers providers. In paper, we discuss options, side effects, challenges that patients family face different phases along...
BackgroundThe incidence of Hodgkin lymphoma (HL) has increased since introduction combined antiretroviral therapy (cART). While HIV-related HL is highly associated with EBV, the causes underlying rising remain unclear. The aim this study was to evaluate effect immune reconstitution on among a cohort HIV-infected male veterans ever receiving cART. MethodsWe performed retrospective utilizing data from Veterans Affairs HIV Clinical Case Registry 1985-2010. cases were identified using ICD-9...
Abstract Introduction More than 70,000 new cases of bladder cancer are diagnosed in the United States annually; with 75% being non-muscle-invasive (NMIBC). Research examining sexual dysfunction survivors is limited, and previous studies have focused on cystectomy patients. Aims To evaluate impact NMIBC survivors. Methods Mixed-methods data collection integrated a quantitative survey (Study 1; n = 117) semi-structured qualitative interviews 2; 26) from non-overlapping sample We performed...
To examine whether high performance on one measure of quality is associated with others and to develop a data-driven explanatory model neonatal intensive care unit (NICU) performance.We conducted cross-sectional data analysis statewide perinatal database. Risk-adjusted NICU ranks were computed for each 8 measures selected based expert input. Correlations across tested using the Pearson correlation coefficient. Exploratory factor was used determine underlying factors driving...