8 results on '"Norton, Jenna M."'
Search Results
2. Development and Validation of a Pragmatic Electronic Phenotype for CKD.
- Author
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Norton JM, Ali K, Jurkovitz CT, Kiryluk K, Park M, Kawamoto K, Shang N, Navaneethan SD, Narva AS, and Drawz P
- Subjects
- Adult, Aged, Aged, 80 and over, Albuminuria urine, Creatinine urine, Electronic Health Records, Female, Humans, Male, Middle Aged, Phenotype, Proteinuria urine, Renal Insufficiency, Chronic genetics, Renal Insufficiency, Chronic urine, Sensitivity and Specificity, Urinalysis, Glomerular Filtration Rate, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic physiopathology
- Abstract
Background and Objectives: Poor identification of individuals with CKD is a major barrier to research and appropriate clinical management of the disease. We aimed to develop and validate a pragmatic electronic (e-) phenotype to identify patients likely to have CKD., Design, Setting, Participants, & Measurements: The e-phenotype was developed by an expert working group and implemented among adults receiving in- or outpatient care at five healthcare organizations. To determine urine albumin (UA) dipstick cutoffs for CKD to enable use in the e-phenotype when lacking urine albumin-to-creatinine ratio (UACR), we compared same day UACR and UA results at four sites. A sample of patients, spanning no CKD to ESKD, was randomly selected at four sites for validation via blinded chart review., Results: The CKD e-phenotype was defined as most recent eGFR <60 ml/min per 1.73 m
2 with at least one value <60 ml/min per 1.73 m2 >90 days prior and/or a UACR of ≥30 mg/g in the most recent test with at least one positive value >90 days prior. Dialysis and transplant were identified using diagnosis codes. In absence of UACR, a sensitive CKD definition would consider negative UA results as normal to mildly increased (KDIGO A1), trace to 1+ as moderately increased (KDIGO A2), and ≥2+ as severely increased (KDIGO A3). Sensitivity, specificity, and diagnostic accuracy of the CKD e-phenotype were 99%, 99%, and 98%, respectively. For dialysis sensitivity was 94% and specificity was 89%. For transplant, sensitivity was 97% and specificity was 91%., Conclusions: The CKD e-phenotype provides a pragmatic and accurate method for EHR-based identification of patients likely to have CKD., (Copyright © 2019 by the American Society of Nephrology.)- Published
- 2019
- Full Text
- View/download PDF
3. Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients.
- Author
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Kimmel PL, Fwu CW, Abbott KC, Moxey-Mims MM, Mendley S, Norton JM, and Eggers PW
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Cohort Studies, Female, Humans, Infant, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic therapy, Male, Mental Disorders epidemiology, Middle Aged, Renal Dialysis, Retrospective Studies, Young Adult, Hospital Mortality, Hospitalization statistics & numerical data, Kidney Failure, Chronic complications, Kidney Failure, Chronic mortality, Mental Disorders complications
- Abstract
Background and Objectives: Limited existing data on psychiatric illness in ESKD patients suggest these diseases are common and burdensome, but under-recognized in clinical practice., Design, Setting, Participants, & Measurements: We examined hospitalizations with psychiatric diagnoses using inpatient claims from the first year of ESKD in adult and pediatric Medicare recipients who initiated treatment from 1996 to 2013. We assessed associations between hospitalizations with psychiatric diagnoses and all-cause death after discharge in adult dialysis patients using multivariable-adjusted Cox proportional hazards regression models., Results: In the first ESKD year, 72% of elderly adults, 66% of adults and 64% of children had at least one hospitalization. Approximately 2% of adults and 1% of children were hospitalized with a primary psychiatric diagnosis. The most common primary psychiatric diagnoses were depression/affective disorder in adults and children, and organic disorders/dementias in elderly adults. Prevalence of hospitalizations with psychiatric diagnoses increased over time across groups, primarily from secondary diagnoses. 19% of elderly adults, 25% of adults and 15% of children were hospitalized with a secondary psychiatric diagnosis. Hazards ratios of all-cause death were higher in all dialysis adults hospitalized with either primary (1.29; 1.26 to 1.32) or secondary (1.11; 1.10 to 1.12) psychiatric diagnoses than in those hospitalized without psychiatric diagnoses., Conclusions: Hospitalizations with psychiatric diagnoses are common in pediatric and adult ESKD patients, and are associated with subsequent higher mortality, compared with hospitalizations without psychiatric diagnoses. The prevalence of hospitalizations with psychiatric diagnoses likely underestimates the burden of mental illness in the population., (Copyright © 2019 by the American Society of Nephrology.)
- Published
- 2019
- Full Text
- View/download PDF
4. How Community Engagement Is Enhancing NIDDK Research.
- Author
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Kimmel PL, Jefferson N, Norton JM, and Star RA
- Subjects
- Apolipoprotein L1 genetics, Humans, National Institute of Diabetes and Digestive and Kidney Diseases (U.S.), Precision Medicine, Residence Characteristics, United States, Biomedical Research, Nephrology
- Published
- 2019
- Full Text
- View/download PDF
5. Rebuilding the Pipeline of Investigators in Nephrology Research in the United States.
- Author
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Norton JM, Ketchum CJ, Rankin TL, and Star RA
- Subjects
- United States, Biomedical Research statistics & numerical data, Nephrology statistics & numerical data, Workforce statistics & numerical data
- Published
- 2018
- Full Text
- View/download PDF
6. Overcoming Translational Barriers in Acute Kidney Injury: A Report from an NIDDK Workshop.
- Author
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Zuk A, Palevsky PM, Fried L, Harrell FE Jr, Khan S, McKay DB, Devey L, Chawla L, de Caestecker M, Kaufman JS, Thompson BT, Agarwal A, Greene T, Okusa MD, Bonventre JV, Dember LM, Liu KD, Humphreys BD, Gossett D, Xie Y, Norton JM, Kimmel PL, and Star RA
- Subjects
- Animals, Congresses as Topic, Disease Models, Animal, Humans, National Institute of Diabetes and Digestive and Kidney Diseases (U.S.), United States, Acute Kidney Injury therapy, Translational Research, Biomedical
- Abstract
AKI is a complex clinical condition associated with high mortality, morbidity, and health care costs. Despite improvements in methodology and design of clinical trials, and advances in understanding the underlying pathophysiology of rodent AKI, no pharmacologic agent exists for the prevention or treatment of AKI in humans. To address the barriers that affect successful clinical translation of drug targets identified and validated in preclinical animal models of AKI in this patient population, the National Institute of Diabetes and Digestive and Kidney Diseases convened the "AKI Outcomes: Overcoming Barriers in AKI" workshop on February 10-12, 2015. The workshop used a reverse translational medicine approach to identify steps necessary to achieve clinical success. During the workshop, breakout groups were charged first to design feasible, phase 2, proof-of-concept clinical trials for delayed transplant graft function, prevention of AKI (primary prevention), and treatment of AKI (secondary prevention and recovery). Breakout groups then were responsible for identification of preclinical animal models that would replicate the pathophysiology of the phase 2 proof-of-concept patient population, including primary and secondary end points. Breakout groups identified considerable gaps in knowledge regarding human AKI, our understanding of the pathophysiology of AKI in preclinical animal models, and the fidelity of cellular and molecular targets that have been evaluated preclinically to provide information regarding human AKI of various etiologies. The workshop concluded with attendees defining a new path forward to a better understanding of the etiology, pathology, and pathophysiology of human AKI., (Copyright © 2018 by the American Society of Nephrology.)
- Published
- 2018
- Full Text
- View/download PDF
7. Complementary Initiatives from the NIDDK to Advance Kidney Health.
- Author
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Norton JM, Ketchum CJ, Narva AS, Star RA, and Rodgers GP
- Subjects
- Humans, Medical Informatics, Pragmatic Clinical Trials as Topic, Precision Medicine, United States, Biomedical Research methods, National Institute of Diabetes and Digestive and Kidney Diseases (U.S.), Nephrology methods, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic therapy
- Published
- 2017
- Full Text
- View/download PDF
8. Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care.
- Author
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Narva AS, Norton JM, and Boulware LE
- Subjects
- Humans, Patient Education as Topic, United States, Patient-Centered Care, Renal Insufficiency, Chronic therapy, Self Care
- Abstract
Patient education is associated with better patient outcomes and supported by international guidelines and organizations, but a range of barriers prevent widespread implementation of comprehensive education for people with progressive kidney disease, especially in the United States. Among United States patients, obstacles to education include the complex nature of kidney disease information, low baseline awareness, limited health literacy and numeracy, limited availability of CKD information, and lack of readiness to learn. For providers, lack of time and clinical confidence combine with competing education priorities and confusion about diagnosing CKD to limit educational efforts. At the system level, lack of provider incentives, limited availability of practical decision support tools, and lack of established interdisciplinary care models inhibit patient education. Despite these barriers, innovative education approaches for people with CKD exist, including self-management support, shared decision making, use of digital media, and engaging families and communities. Education efficiency may be increased by focusing on people with progressive disease, establishing interdisciplinary care management including community health workers, and providing education in group settings. New educational approaches are being developed through research and quality improvement efforts, but challenges to evaluating public awareness and patient education programs inhibit identification of successful strategies for broader implementation. However, growing interest in improving patient-centered outcomes may provide new approaches to effective education of people with CKD., (Copyright © 2016 by the American Society of Nephrology.)
- Published
- 2016
- Full Text
- View/download PDF
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