276 results on '"Barr ML"'
Search Results
2. Impact of Fruit and Fruit Juice on Death and Disease Incidence: A Sex-Specific Longitudinal Analysis of 18 603 Adults.
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Xu, X, Grafenauer, S, Barr, ML, Schutte, AE, Xu, X, Grafenauer, S, Barr, ML, and Schutte, AE
- Abstract
BACKGROUND: The health benefits of fruits are well established, but fruit juice has been more controversial. Fruit and juice are often ingested with other foods, which prompted our investigation to determine whether fruit consumed as juice may negate the beneficial effects of consuming whole fruit in people with cardiovascular disease. METHODS AND RESULTS: We retrospectively analyzed data from a population-based study in Australia (the 45 and Up Study) linked with hospitalization and mortality data up to September 2018. Kaplan-Meier survival estimates and Cox proportional hazards models were used to examine effects of fruit, fruit juice, and the combination of fruit and fruit juice in relation to death and disease incidence among men and women living with cardiovascular disease. A total of 7308 deaths occurred among 18 603 participants diagnosed with cardiovascular disease over a 13-year follow-up. After multivariable adjustment, inadequate fruit intake (hazard ratio [HR], 1.12 [95% CI, 1.01-1.24]) and high fruit juice intake (HR, 1.26 [95% CI, 1.12-1.41]) predicted all-cause mortality in women. Also, high fruit juice intake plus either adequate fruit intake (HR, 1.18 [95% CI, 1.02-1.37]) or inadequate fruit intake (HR, 1.43 [95% CI, 1.21-1.69]) predicted mortality in women. No relationships were found in men after multivariable adjustments. Also, we found no prognostic value for fruit and fruit juice intake on disease incidence. CONCLUSIONS: In adults with cardiovascular disease, we found that fruit juice (in combination with adequate or inadequate fruit intake) predicted mortality in women but not in men. These effects became less clear when focusing on disease incidence.
- Published
- 2023
3. Different Types of Long-Term Milk Consumption and Mortality in Adults with Cardiovascular Disease: A Population-Based Study in 7236 Australian Adults over 8.4 Years.
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Xu, X, Kabir, A, Barr, ML, Schutte, AE, Xu, X, Kabir, A, Barr, ML, and Schutte, AE
- Abstract
Most studies disregard long-term dairy consumption behaviour and how it relates to mortality. We examined four different types of long-term milk consumption, namely whole milk, reduced fat milk, skim milk and soy milk, in relation to mortality among adults diagnosed with cardiovascular disease (CVD). A retrospective population-based study was conducted in Australia (the 45 and Up Study) linking baseline (2006-2009) and follow-up data (2012-2015) to hospitalisation and mortality data up to 30 September 2018. A total of 1,101 deaths occurred among 7236 participants with CVD over a mean follow-up of 8.4 years. Males (Hazard Ratio, HR = 0.69, 95% CI (0.54; 0.89)) and females (HR = 0.59 (0.38; 0.91)) with long-term reduced fat milk consumption had the lowest risk of mortality compared to counterparts with long-term whole milk consumption. Among participants with ischemic heart disease, males with a long-term reduced fat milk consumption had the lowest risk of mortality (HR = 0.63, 95% CI: 0.43; 0.92). We conclude that among males and females with CVD, those who often consume reduced fat milk over the long-term present with a 31-41% lower risk of mortality than those who often consume whole milk, supporting dairy advice from the Heart Foundation of replacing whole milk with reduced fat milk to achieve better health.
- Published
- 2022
4. General practitioner follow-up after hospitalisation in Central and Eastern Sydney, Australia: access and impact on health services
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Barr, ML, Welberry, H, Hall, J, Comino, EJ, Harris, E, Harris-Roxas, BF, Jackson, T, Donnelly, D, Harris, MF, Barr, ML, Welberry, H, Hall, J, Comino, EJ, Harris, E, Harris-Roxas, BF, Jackson, T, Donnelly, D, and Harris, MF
- Abstract
Objectives General practitioner (GP) follow-up after a hospital admission is an important indicator of integrated care. We examined the characteristics of patients who saw a GP within 2 weeks of hospital discharge in the Central and Eastern Sydney (CES) region, Australia, and the relationship between GP follow-up and subsequent hospitalisation. Methods This data linkage study used a cohort of 10 240 people from the 45 and Up Study who resided in CES and experienced an overnight hospitalisation in the 5 years following recruitment (2007–14). Characteristics of participants who saw a GP within 2 weeks of discharge were compared with those who did not using generalised linear models. Time to subsequent hospitalisation was compared for the two groups using Cox proportional hazards regression models stratified by prior frequency of GP use. Results Within 2 weeks of discharge, 64.3% participants saw a GP. Seeing a GP within 2 weeks of discharge was associated with lower rates of rehospitalisation for infrequent GP users (i.e. <8 visits in year before the index hospitalisation; hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.70–0.97) but not frequent GP users (i.e. ≥8 plus visits; HR 1.02; 95% CI 0.90–1.17). Conclusion The effect of seeing a GP on subsequent hospitalisation was protective but differed depending on patient care needs. What is known about the topic? There is general consensus among healthcare providers that primary care is a significant source of ongoing health care provision. What does this paper add? This study explored the relationship between GP follow-up after an uncomplicated hospitalisation and its effect on rehospitalisation. What are the implications for practitioners? Discharge planning and the transfer of care from hospital to GP through discharge arrangements have substantial benefits for both patients and the health system.
- Published
- 2020
5. Do general practice management and/or team care arrangements reduce avoidable hospitalisations in Central and Eastern Sydney, Australia?
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Welberry, H, Barr, ML, Comino, EJ, Harris-Roxas, BF, Harris, E, Dutton, S, Jackson, T, Donnelly, D, Harris, MF, Welberry, H, Barr, ML, Comino, EJ, Harris-Roxas, BF, Harris, E, Dutton, S, Jackson, T, Donnelly, D, and Harris, MF
- Abstract
Background: The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management program was introduced to Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The program supports General Practitioners (GP)s claiming for up to one general practice management plan (GPMP) and one team care arrangement (TCA) every year and the patient claiming for up to five private allied health visits. We describe the profile of participants who claimed for GPMPs and/or TCAs in Central and Eastern Sydney (CES) and explore if GPMPs and/or TCAs are associated with fewer emergency hospitalisations (EH)s or potentially preventable hospitalisations (PPH)s over the following 5 years. Methods: This research used the CES Primary and Community Health Cohort/Linkage Resource (CES-P&CH) based on the 45 and Up Study to identify a community-dwelling population in the CES region. There were 30,645 participants recruited within the CES area at baseline. The CES-P&CH includes 45 and Up Study questionnaire data linked to MBS data for the period 2006-2014. It also includes data from the Admitted Patient Data Collection, Emergency Department Data Collection and Deaths Registry linked by the NSW Centre for Health Record Linkage. Results: Within a two-year health service utilisation baseline period 22% (5771) of CES participants had at least one claim for a GPMP and/or TCA. Having at least one claim for a GPMP and/or TCA was closely related to the socio-demographic and health needs of participants with higher EHs and PPHs in the 5 years that followed. However, after controlling for confounding factors such as socio-demographic need, health risk, health status and health care utilization no significant difference was found between having claimed for a GPMP and/or TCA during the two-year health service utilisation baseline period and EHs or PPHs in the subsequent 5 years.
- Published
- 2019
6. Understanding the use and impact of allied health services for people with chronic health conditions in Central and Eastern Sydney, Australia: a five-year longitudinal analysis
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Barr, ML, Welberry, H, Comino, EJ, Harris-Roxas, BF, Harris, E, Lloyd, J, Whitney, S, O'Connor, C, Hall, J, Harris, MF, Barr, ML, Welberry, H, Comino, EJ, Harris-Roxas, BF, Harris, E, Lloyd, J, Whitney, S, O'Connor, C, Hall, J, and Harris, MF
- Abstract
AIM: To describe the characteristics of people in Central and Eastern Sydney (CES), NSW, who had a General Practice Management Plan (GPMP) and claimed for at least one private allied health service item; and to examine if allied health service use results in less hospitalisations over a five-year period. BACKGROUND: The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management programme was introduced to the Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The programme supports general practitioners claiming up to one GPMP and one Team Care Arrangement every year, and the patient additionally claiming for up to five private allied health services visits. METHODS: A prospective longitudinal study was conducted. The sample consisted of 5771 participants in CES who had a GPMP within a two-year health service utilisation baseline period (2007-2009). The analysis used the 45 and Up Study questionnaire data linked to the MBS, hospitalisation, death and emergency department data for the period 2006-2014. FINDINGS: Of the eligible participants, 43% (2460) had at least one allied health service item claim in the subsequent 12 months. Allied health services were reported as physiotherapy, podiatry and other allied health services. The highest rates of allied health service use were among participants aged 85 years and over (49%). After controlling for confounding factors, a significant difference was found between having claimed for five or more physiotherapy services and emergency admissions (HR: 0.83; 95% CI: 0.72-0.95) and potentially preventable hospitalisations (HR: 0.79; 95% CI: 0.64-0.96) in the subsequent five years. Use of allied health service items was well targeted towards those with chronic and complex care needs, and use of physiotherapy services was associated with less avoidable hospitalisations.
- Published
- 2019
7. Thyroid dysfunction in children exposed to iodinated contrast media
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Barr, ML, Chiu, HK, Li, N, Yeh, MW, Rhee, CM, Casillas, J, Iskander, PJ, and Leung, AM
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endocrine system ,endocrine system diseases - Abstract
© 2016 by the Endocrine Society. Context: Iodinated contrast media (ICM) is routinely used in imaging studies and contains several 100-fold the recommended daily allowance of iodine. Objective: To determine whether children exposed to ICM have a higher risk of iodine-induced thyroid dysfunction. Design: This was a single-institution case-control study, examining patients with incident thyroid dysfunction aged less than 18 years from 2001 to 2015. Cases were matched 1:1 to euthyroid controls by age, sex, and race. Setting: This was a single-institution case-control study occurring at tertiary care center. Participants: Cases were defined as those with thyroid dysfunction (by International Classification of Diseases, Ninth Revision diagnosis codes and/or 2 consecutive abnormal serum TSH values≤6mo apart). We analyzed 870 cases matched to 870 controls (64% female, 51% White). Main Outcomes Measures: Using conditional logistic regression, the association between ICM exposure and the primary outcome, thyroid dysfunction, occurring within 2 years of exposure was assessed. Results: Sixty-nine patients received ICM, including 53 (6%) among cases and 16 (2%) among controls. The risk of incident hypothyroidism was significantly higher after ICM exposure (odds ratio 2.60;95%confidence interval, 1.43-4.72; P≤.01). The median interval between exposureand onset of hypothyroidism was 10.8 months (interquartile range, 6.6 -17.9). In hypothyroid cases, the median serum TSH concentration was 6.5 mIU/L (interquartile range, 5.8 -9.6). Conclusions: ICM exposure increases the risk of incident hypothyroidism in pediatric patients. Children receiving ICM should be monitored for iodine-induced thyroid dysfunction, particularly during the first year after exposure.
- Published
- 2016
8. Developing a weighting strategy to include mobile phone numbers into an ongoing population health survey using an overlapping dual-frame design with limited benchmark information
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Barr, ML, Ferguson, RA, Hughes, PJ, Steel, DG, Barr, ML, Ferguson, RA, Hughes, PJ, and Steel, DG
- Abstract
Background: In 2012 mobile phone numbers were included into the ongoing New South Wales Population Health Survey (NSWPHS) using an overlapping dual-frame design. Previously in the NSWPHS the sample was selected using random digit dialing (RDD) of landline phone numbers. The survey was undertaken using computer assisted telephone interviewing (CATI). The weighting strategy needed to be significantly expanded to manage the differing probabilities of selection by frame, including that of children of mobile-only phone users, and to adjust for the increased chance of selection of dual-phone users. This paper describes the development of the final weighting strategy to properly combine the data from two overlapping sample frames accounting for the fact that population benchmarks for the different sampling frames were not available at the state or regional level. Methods: Estimates of the number of phone numbers for the landline and mobile phone frames used to calculate the differing probabilities of selection by frame, for New South Wales (NSW) and by stratum, were obtained by apportioning Australian estimates as none were available for NSW. The weighting strategy was then developed by calculating person selection probabilities, selection weights, applying a constant composite factor to the dual-phone users sample weights, and benchmarking to the latest NSW population by age group, sex and stratum. Results: Data from the NSWPHS for the first quarter of 2012 was used to test the weighting strategy. This consisted of data on 3395 respondents with 2171 (64%) from the landline frame and 1224 (36%) from the mobile frame. However, in order to calculate the weights, data needed to be available for all core weighting variables and so 3378 respondents, 2933 adults and 445 children, had sufficient data to be included. Average person weights were 3.3 times higher for the mobile-only respondents, 1.3 times higher for the landline-only respondents and 1.7 times higher for dual-phone u
- Published
- 2014
9. Inclusion of mobile telephone numbers into an ongoing population health survey in New South Wales, Australia, using an overlapping dual-frame design: Impact on the time series
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Barr, ML, Ferguson, RA, Steel, DG, Barr, ML, Ferguson, RA, and Steel, DG
- Abstract
Background: Since 1997, the NSW Population Health Survey (NSWPHS) had selected the sample using random digit dialing of landline telephone numbers. When the survey began coverage of the population by landline phone frames was high (96%). As landline coverage in Australia has declined and continues to do so, in 2012, a sample of mobile telephone numbers was added to the survey using an overlapping dual-frame design. Details of the methodology are published elsewhere. This paper discusses the impacts of the sampling frame change on the time series, and provides possible approaches to handling these impacts. Methods. Prevalence estimates were calculated for type of phone-use, and a range of health indicators. Prevalence ratios (PR) for each of the health indicators were also calculated using Poisson regression analysis with robust variance estimation by type of phone-use. Health estimates for 2012 were compared to 2011. The full time series was examined for selected health indicators. Results: It was estimated from the 2012 NSWPHS that 20.0% of the NSW population were mobile-only phone users. Looking at the full time series for overweight or obese and current smoking if the NSWPHS had continued to be undertaken only using a landline frame, overweight or obese would have been shown to continue to increase and current smoking would have been shown to continue to decrease. However, with the introduction of the overlapping dual-frame design in 2012, overweight or obese increased until 2011 and then decreased in 2012, and current smoking decreased until 2011, and then increased in 2012. Our examination of these time series showed that the changes were a consequence of the sampling frame change and were not real changes. Both the backcasting method and the minimal coverage method could adequately adjust for the design change and allow for the continuation of the time series. Conclusions: The inclusion of the mobile telephone numbers, through an overlapping dual-frame design
- Published
- 2014
10. Inclusion of mobile phone numbers into an ongoing population health survey in New South Wales, Australia: Design, methods, call outcomes, costs and sample representativeness
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Barr, ML, Van Ritten, JJ, Steel, DG, Thackway, SV, Barr, ML, Van Ritten, JJ, Steel, DG, and Thackway, SV
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Background: In Australia telephone surveys have been the method of choice for ongoing jurisdictional population health surveys. Although it was estimated in 2011 that nearly 20% of the Australian population were mobile-only phone users, the inclusion of mobile phone numbers into these existing landline population health surveys has not occurred. This paper describes the methods used for the inclusion of mobile phone numbers into an existing ongoing landline random digit dialling (RDD) health survey in an Australian state, the New South Wales Population Health Survey (NSWPHS). This paper also compares the call outcomes, costs and the representativeness of the resultant sample to that of the previous landline sample. Methods. After examining several mobile phone pilot studies conducted in Australia and possible sample designs (screening dual-frame and overlapping dual-frame), mobile phone numbers were included into the NSWPHS using an overlapping dual-frame design. Data collection was consistent, where possible, with the previous years' landline RDD phone surveys and between frames. Survey operational data for the frames were compared and combined. Demographic information from the interview data for mobile-only phone users, both, and total were compared to the landline frame using χ§ssup§2§esup§ tests. Demographic information for each frame, landline and the mobile-only (equivalent to a screening dual frame design), and the frames combined (with appropriate overlap adjustment) were compared to the NSW demographic profile from the 2011 census using χ§ssup§2§esup§ tests. Results: In the first quarter of 2012, 3395 interviews were completed with 2171 respondents (63.9%) from the landline frame (17.6% landline only) and 1224 (36.1%) from the mobile frame (25.8% mobile only). Overall combined response, contact and cooperation rates were 33.1%, 65.1% and 72.2% respectively. As expected from previous research, the demographic profile of the mobile-only phone respondents diff
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- 2012
11. Living-related pediatric lobar transplantation
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Luciani, GIOVANNI BATTISTA, Barr, Ml, and Starnes, V. A.
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living-related donor ,pediatric ,lung transplantation ,lobar transplantation ,cistic fibrosis ,congenital heart disease - Published
- 1997
12. Identifying risk factors for developing obesity: a record linkage longitudinal study in metropolitan Sydney using the 45 and Up Study.
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Vuong K, Kabir A, Conway DP, Williamson M, Harris MF, and Barr ML
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- Humans, Male, Female, Longitudinal Studies, Middle Aged, Risk Factors, Aged, Australia epidemiology, Smoking epidemiology, Overweight epidemiology, Obesity epidemiology, Body Mass Index
- Abstract
Background: Primary care clinicians have key responsibilities in obesity prevention and weight management., Aims: We aimed to identify risk factors for developing obesity among people aged ≥45 years., Methods: We conducted a record linkage longitudinal study of residents of metropolitan Sydney, Australia using data from the: (1) 45 and Up Study at baseline (2005-2009) and first follow-up (2012-2015); (2) Medicare claims; (3) Pharmaceutical Benefits Scheme; and (4) deaths registry. We examined risk factors for developing obesity (body mass index [BMI]: 30-40) at follow-up, separately for people within the: (1) healthy weight range (BMI 18.5-<25) and (2) overweight range (BMI 25-<30) at baseline. Covariates included demographics, modifiable behaviours, health status, allied health use, and medication use. Crude and adjusted relative risks were estimated using Poisson regression modelling., Results: At follow-up, 1.1% (180/16,205) of those in the healthy weight range group, and 12.7% (1,939/15,266) of those in the overweight range group developed obesity. In both groups, the following were associated with developing obesity: current smoking at baseline, physical functioning limitations, and allied health service use through team care planning, while any alcohol consumption and adequate physical activity were found to be associated with a lower risk of developing obesity. In the healthy weight group, high psychological distress and the use of antiepileptics were associated with developing obesity. In the overweight group, female sex and full-time work were associated with developing obesity, while older age was found to be associated with a lower risk of developing obesity., Conclusions: These findings may inform the targeting of preventive interventions for obesity in clinical practice and broader public health programs., (© The Author(s) 2024. Published by Oxford University Press.)
- Published
- 2024
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13. The Scratch-Collapse Test: A Systematic Review and Statistical Analysis.
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Jain NS, Zukotynski B, Barr ML, Cortez A, and Benhaim P
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- Humans, Nerve Compression Syndromes diagnosis, Cubital Tunnel Syndrome diagnosis, Cubital Tunnel Syndrome surgery, Peroneal Neuropathies diagnosis, Sensitivity and Specificity, Carpal Tunnel Syndrome diagnosis, Carpal Tunnel Syndrome surgery
- Abstract
Background: The scratch-collapse test (SCT) is a provocative maneuver used to diagnose compressive neuropathies. Despite multiple studies supporting its use, the SCT remains a controversial point in the literature in regard to its exact clinical application. We performed a systematic review and statistical analysis to provide statistical data on SCT outcomes and elucidate its role in diagnosing compressive conditions., Methods: We performed a systematic review of the literature according to Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. We extracted data of patients with outcomes on the SCT (yes/no) and on an accepted gold standard examination (electrodiagnostic studies). These data were analyzed using a statistical software program to generate the sensitivity and specificity values of the pooled data, as well as kappa agreement statistics., Results: For patients with carpal tunnel, cubital tunnel, peroneal, and pronator compressive neuropathies, the overall sensitivity of the SCT was 38%, and the specificity was 94%, with the kappa statistic approximately 0.4. Sensitivity and specificity values were higher for cubital tunnel syndrome and peroneal compression syndrome but lower for carpal tunnel syndrome. Pronator syndrome was also examined, but the data were inadequate for analysis., Conclusions: The SCT is a useful adjunct in the armament of diagnostic tools for the hand surgeon. Given its low sensitivity and high specificity, SCT should be used as a confirmatory test, rather than as a diagnostic screening test. More analyses are needed to identify subtler applications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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14. The Scratch-Collapse Test: Are Electrodiagnostic Changes Measurable?
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Jain NS, Miller A, Barr ML, Gajewski CR, Pflibsen L, Azari KK, and Benhaim P
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- Humans, Female, Male, Middle Aged, Adult, Retrospective Studies, Aged, Carpal Tunnel Syndrome diagnosis, Carpal Tunnel Syndrome physiopathology, Neural Conduction physiology, Electrodiagnosis methods, Electromyography methods
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Introduction: Carpal tunnel syndrome is commonly managed by hand and upper extremity surgeons. Though electrodiagnostics are considered the gold standard diagnosis, the scratch collapse test (SCT) was introduced to address uncertainty, despite remains controversial. To address this, we sought to identify if the SCT can correlate with EDS studies if the SCT can identify actual changes in measures of nerves., Methods: We reviewed patients who underwent electrodiagnostic studies (EDX) and SCT for carpal tunnel syndrome (CTS). Demographic data as well as sensorimotor amplitudes, latencies, and velocities on nerve conduction and electromyography were collected. Analogous values based on SCT findings were analyzed for statistical significance., Results: Three hundred fifty patients with CTS were included. Sensory and motor velocities and amplitudes were significantly lower in patients with a positive SCT. Motor values were independent of age, though younger patients had larger measured changes. Obese patients did not show any motor EDX changes with the scratch collapse test, though thinner patients did. All changes were seen in nerve conduction only., Conclusions: Carpal tunnel can be a difficult problem to diagnose as one study does not singularly determine the condition. The SCT was introduced to facilitate easier diagnosis. We demonstrate that the SCT correlates with changes on nerve conduction studies, especially in relation to decreased amplitudes and velocities, suggesting that it does identify changes in nerve with compression, specifically axonal, and myelin damage. These findings support the use of the SCT maneuver to evaluate and diagnose in appropriate patients., Competing Interests: Disclosures: All authors have no financial interests including products, devices, or drugs associated with this manuscript. There are no commercial associations that might pose or create a conflict of interest with information presented in this submitted manuscript such as consultancies, stock ownership, or patent licensing arrangements. All sources of funds supporting the completion of this manuscript are under the auspices of the University of California Los Angeles. Conflicts of interest and sources of funding: All authors declare no conflict of interest, financial, personal, or otherwise, in this work for the authors or their families. No funding resources were used in the process of this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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15. Tendon Transfers, Nerve Grafts, and Nerve Transfers for Isolated Radial Nerve Palsy: A Systematic Review and Analysis.
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Jain NS, Barr ML, Kim D, and Jones NF
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- Humans, Range of Motion, Articular, Tendon Transfer methods, Nerve Transfer methods, Radial Neuropathy surgery, Radial Nerve surgery, Radial Nerve injuries
- Abstract
Background: Isolated radial nerve palsy is a debilitating injury that may potentially be reconstructed with either tendon transfers, nerve grafts, or nerve transfers. Currently, there is no consensus on the optimal technique for reconstruction. We performed a systematic review and analysis to determine which surgical intervention provides the best clinical outcomes., Methods: A systematic review was conducted according to PRISMA guidelines. Twenty-nine papers met inclusion criteria. Grading scales of function and strength were converted into a tripartite scoring system to compare outcomes between techniques. χ
2 analyses were performed with a P value < .05., Results: Seven hundred fifty-four patients were analyzed. Tendon transfers resulted in the highest percentage of good outcomes (82%) and the lowest percentage of poor outcomes (9%). Tendon transfers were superior to nerve grafts and nerve transfers for restoration of wrist extension. Nerve transfers for wrist extension were superior to nerve transfers for finger extension. Nerve grafts and nerve transfers had equivalent rates of good and poor clinical outcomes., Conclusions: This study analyzed reported outcomes of tendon transfers, nerve grafts, and nerve transfers for reconstruction of isolated radial nerve palsy. On pooled analysis, tendon transfers had higher rates of superior clinical outcomes as compared with nerve transfers and nerve grafts. Tendon transfers should be considered first-line reconstruction for isolated radial nerve palsy as nerve-based reconstruction is less predictable and reproducible., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors have no financial interests, including products, devices, or drugs associated with this manuscript. There are no commercial associations that might pose or create a conflict of interest with information presented in this submitted manuscript such as consultancies, stock ownership, or patent licensing arrangements. All sources of funds supporting the completion of this manuscript are under the auspices of the University of California Los Angeles.- Published
- 2024
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16. Fascial Lengthening at the Time of Surgical Release for de Quervain's Tenosynovitis to Prevent Postsurgical Tendon Subluxation.
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Jain NS, Barr ML, Miller A, DeLong MR, Orr S, and Benhaim P
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Background: De Quervain's tenosynovitis is a relatively common, painful condition. Although commonly managed nonoperatively, some patients have recalcitrant disease, necessitating surgical release. Traditional surgical release for de Quervain's tenosynovitis with simple retinacular release can leave patients susceptible to first dorsal extensor compartment tendon subluxation. We present a stair-step flap technique that releases the first dorsal compartment while simultaneously preventing postoperative tendon subluxation via fascial lengthening., Methods: All patients over the past decade who underwent surgical release with this technique were collected. Preoperative characteristics, surgical details, and postoperative outcomes were reviewed and aggregated as summary statistics., Results: A total of 101 patients were found. Of these, 35 patients had isolated first dorsal compartment release. Tourniquet time for the total group was 1 hour and that for the isolated first dorsal compartment release subgroup was 20 minutes. The average follow-up was 590 days for the total group and only 440 days for the isolated first dorsal compartment release subgroup. No patients who underwent our novel technique experienced subluxation of the tendons postoperatively. One patient required oral antibiotics for a superficial cellulitis, and 1 patient had recurrent symptoms due to excessive scarring that resolved with scar massage and steroid injection. No patient required repeat operations., Conclusion: Our study demonstrates that first dorsal compartment release with a stair-step incision allows for closure of the compartment with a very loose sheath without subluxation and simultaneously provides satisfactory decompression. This procedure is safe and efficacious and can be considered a useful modification to traditional retinacular release alone., Level of Evidence: Level III., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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17. At What Time Interval After a Sharp Nerve Laceration Is Primary Nerve Repair No Longer Possible?
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Jain NS, Barr ML, and Jones NF
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Purpose: The timeframe after a sharp nerve injury when nerve grafting becomes required remains unclear. A retrospective analysis was performed to determine the timeframe when primary repair of a sharp nerve laceration can no longer be performed and grafting becomes necessary., Methods: All sharp nerve injuries in three regions of the hands and upper extremity-major nerves, common digital nerves, and proper digital nerves-treated between 2016 and 2021 were reviewed. Time from injury to repair, need for nerve grafting, length of graft, age, and associated injuries were collected and analyzed., Results: A total of 313 nerve lacerations were included. Predictors of the need for grafting included time from injury to repair and level of injury. The odds ratio of time from injury in predicting the need for grafting was 1.04 for proper digital nerves, 1.05 for common digital nerves, and 1.18 for major nerves. Age and other injuries were not associated with increased rates of grafting. Only level of injury was associated with length of graft needed., Conclusions: Patients with sharp major nerve injuries required grafting more frequently after several days from injury, whereas primary repair of common and proper digital nerves could be achieved up to two weeks or greater after injury. This suggests that the window for primary neurorrhaphy may be as short as two days after injury for major nerve injuries, much shorter than for common and proper digital nerve injuries., Type of Study/level of Evidence: Prognostic IV., (Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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18. Impact of Fruit and Fruit Juice on Death and Disease Incidence: A Sex-Specific Longitudinal Analysis of 18 603 Adults.
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Xu X, Grafenauer S, Barr ML, and Schutte AE
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- Male, Humans, Adult, Female, Fruit and Vegetable Juices, Retrospective Studies, Proportional Hazards Models, Incidence, Vegetables, Fruit, Cardiovascular Diseases epidemiology
- Abstract
Background: The health benefits of fruits are well established, but fruit juice has been more controversial. Fruit and juice are often ingested with other foods, which prompted our investigation to determine whether fruit consumed as juice may negate the beneficial effects of consuming whole fruit in people with cardiovascular disease., Methods and Results: We retrospectively analyzed data from a population-based study in Australia (the 45 and Up Study) linked with hospitalization and mortality data up to September 2018. Kaplan-Meier survival estimates and Cox proportional hazards models were used to examine effects of fruit, fruit juice, and the combination of fruit and fruit juice in relation to death and disease incidence among men and women living with cardiovascular disease. A total of 7308 deaths occurred among 18 603 participants diagnosed with cardiovascular disease over a 13-year follow-up. After multivariable adjustment, inadequate fruit intake (hazard ratio [HR], 1.12 [95% CI, 1.01-1.24]) and high fruit juice intake (HR, 1.26 [95% CI, 1.12-1.41]) predicted all-cause mortality in women. Also, high fruit juice intake plus either adequate fruit intake (HR, 1.18 [95% CI, 1.02-1.37]) or inadequate fruit intake (HR, 1.43 [95% CI, 1.21-1.69]) predicted mortality in women. No relationships were found in men after multivariable adjustments. Also, we found no prognostic value for fruit and fruit juice intake on disease incidence., Conclusions: In adults with cardiovascular disease, we found that fruit juice (in combination with adequate or inadequate fruit intake) predicted mortality in women but not in men. These effects became less clear when focusing on disease incidence.
- Published
- 2023
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19. Wassel VI Thumb Duplication With Triphalangeal Radial and Ulnar Thumbs: Anatomy and Surgical Reconstruction.
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Barr ML, Jain NS, and Jones NF
- Abstract
A 6-year-old otherwise healthy girl presented with a Wassel VI duplication of the left thumb metacarpal and triphalangeal radial and ulnar thumbs. The patient underwent successful thumb reconstruction by transposition of the distal ulnar thumb onto the radial thumb metacarpal. To the best of our knowledge, this case report represents the first published anatomical dissection and surgical reconstruction of a Wassel VI duplication with triphalangeal radial and ulnar thumbs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2023
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20. The Role of Antibiotic Prophylaxis in Primary and Secondary Implant-Based Breast Augmentation: A Systematic Review and Meta-Analysis.
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Villanueva KG, Barr ML, Klingbeil KD, Tranfield W, and Festekjian J
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- Female, Humans, Observational Studies as Topic, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis, Mammaplasty adverse effects, Plastic Surgery Procedures, Surgical Wound Infection prevention & control
- Abstract
Background: The administration of antibiotic prophylaxis for implant-based breast augmentation (IBBA) is commonplace among many plastic surgeons. However, the current literature lacks evidence-based recommendations to support this practice. Although few studies have demonstrated a reduction in surgical site infection (SSI) and capsular contracture (CC) with antibiotics, these studies were underpowered and poorly designed. The aim of this study was to provide an updated comprehensive analysis of the literature to revisit the benefit of antibiotic prophylaxis., Methods: A comprehensive literature search of PubMed, Embase, Web of Science, and Cochrane was performed from January 1989 to January 2022. Observational studies and randomized controlled trials (RCTs) involving primary and secondary IBBA and use of antibiotic prophylaxis were included. Primary outcomes included SSI and CC. Study quality and risk of bias were evaluated using standardized tools. A meta-analysis was performed for eligible studies. Trial Sequential Analysis was used to assess the need for future RCTs., Results: A total of 5 studies (3 observational and 2 RCTs) with 2383 patients were included in this study. Rates of SSI ranged from 0% to 2.3%, whereas CC ranged from 0% to 53%. Antibiotic prophylaxis showed no benefit for both SSI (odds ratio, 1.77; 95% confidence interval, 0.76-4.13) and CC (odds ratio, 0.46; 95% confidence interval, 0.00-45.72). Trial Sequential Analysis demonstrated that further high-quality RCTs are needed., Conclusions: Antibiotic prophylaxis for IBBA failed to demonstrate improvements in SSI and CC in this comprehensive review. Current evidence was shown to be of low quality because of heterogeneity and high risk for bias. Further high-quality multicentered RCTs are warranted to fully evaluate the role of antibiotic prophylaxis for IBBA., Competing Interests: Conflicts of interest and sources of funding: All authors have no financial interests including products, devices, or drugs associated with this manuscript. There are no commercial associations that might pose or create a conflict of interest with information presented in this submitted manuscript such as consultancies, stock ownership, or patent licensing arrangements. All sources of funds supporting the completion of this manuscript are under the auspices of the University of California Los Angeles., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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21. Assessing the Effect of Time from Injection of Collagenase to Manipulation on Success Rates in Dupuytren Disease.
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Nagarkar P, Jain NS, Barr ML, Tang C, Lee D, Chang I, Delong MR, and Benhaim P
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Purpose: Dupuytren disease can be managed with an injection of collagenase Clostridium histolyticum enzyme followed by manual manipulation. Although the recommended time from injection to manipulation is 24-72 hours, patient and physician schedules may not accommodate this time frame. Therefore, we sought to study the impact of time from injection to manipulation on outcomes and complications of collagenase injection., Methods: We performed a review of 309 patients who underwent an injection of collagenase Clostridium histolyticum for Dupuytren disease with manipulation at two, five, or seven days after injection. We compared preinjection and postinjection contracture angles as well as frequency of skin tears and tendon ruptures., Results: Of the 309 patients, 207 underwent manipulation at two days, 32 at five days, and 70 at seven days. Patients had similar preinjection contracture angles. All patients demonstrated improvement in contracture after manipulation. Rates of skin tears and tendon ruptures were similar in all three groups. Significant predictors of complications included number of cords injected and history of previous collagenase injection, but not history of previous Dupuytren diagnosis., Conclusions: Although collagenase injection for Dupuytren disease is typically performed with plans for manipulation at 24-72 hours, postinjection manipulation could be performed as late as seven days without adversely affecting the frequency of skin and tendon complications., Type of Study/level of Evidence: Prognostic IV., (Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
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- 2023
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22. Proximal Plate Migration After Internal Fixation of a Pediatric Distal Radius Fracture.
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Barr ML, Jain NS, Bunting H, and Benhaim P
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- Humans, Male, Child, Adult, Fracture Fixation, Internal adverse effects, Bone Plates adverse effects, Open Fracture Reduction adverse effects, Wrist Fractures, Radius Fractures surgery
- Abstract
We present a case of a 26-year-old right-hand-dominant male stage manager who underwent open reduction internal fixation of right open both-bone forearm fractures at the age of 13. The patient presented 13 years and 8 months later with proximal hardware migration, soft tissue erosion, and subsequent hardware exposure. The patient underwent hardware removal with resolution of pain and improvement in range of motion. To the best of our knowledge, this complication has not been published before.
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- 2023
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23. Diet quality and eating behaviors of college-attending young adults with food addiction.
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Wattick RA, Olfert MD, Hagedorn-Hatfield RL, Barr ML, Claydon E, and Brode C
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- Humans, Young Adult, Universities, Feeding Behavior psychology, Diet, Surveys and Questionnaires, Eating, Food Addiction, Feeding and Eating Disorders
- Abstract
Background: College students are heavily influenced by their food environment and are an important population in which to study food addiction. This mixed-methods study aimed to examine diet quality and eating behaviors of college students with food addiction., Methods: Students attending a large university in November 2021 were invited to complete an online survey that measured food addiction, eating styles, eating disorder symptoms, diet quality, and anticipated feelings after eating. Kruskal-Wallis H determined differences between those with and without food addiction in mean scores of quantitative variables. Participants who met the symptom threshold for the presence of food addiction were invited to participate in an interview that elicited more information. Quantitative data was analyzed using JMP Pro Version 16.0 and qualitative data was thematically analyzed using NVIVO Pro Software Version 12.0., Results: Respondents (n = 1645) had a 21.9 % prevalence of food addiction. Individuals with mild food addiction had the highest scores in cognitive restraint. Those with severe food addiction had the highest scores in uncontrolled eating, emotional eating, and eating disorder symptoms. Individuals with food addiction showed significantly higher negative expectancies for healthy and junk food, lower intake of vegetables, higher intakes of added sugars and saturated fat. Interview participants had problems with sweets and carbohydrates most often and described eating until physically ill, eating in response to negative emotions, dissociation while eating, and strong negative feelings after eating., Conclusion: Findings contribute to the understanding of the behaviors, emotions, and perceptions surrounding food by this population, providing potential behaviors and cognitions to target for treatment., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2023. Published by Elsevier Ltd.)
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- 2023
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24. Early life influences on the development of food addiction in college attending young adults.
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Wattick RA, Olfert MD, Claydon E, Hagedorn-Hatfield RL, Barr ML, and Brode C
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- Humans, Young Adult, Adult, Diet psychology, Food Preferences psychology, Attitude, Anxiety, Food Addiction epidemiology
- Abstract
Purpose: There is little investigation into the causes of food addiction. The aim of this study was to determine the impact of early life influences on the development of food addiction in college-attending young adults aged 18-29., Methods: This study utilized a sequential explanatory mixed-methods research design. College-attending young adults were invited to complete an online survey measuring Adverse Childhood Experiences (ACEs), food addiction, depression, anxiety, stress, and demographic information. Correlations between food addiction and the other variables were analyzed and significant variables were placed into a nominal logistic regression model to predict the development of food addiction. Participants who met the criteria for food addiction were invited to participate in interviews to examine their childhood eating environment and when their symptoms emerged. Interviews were transcribed and thematically analyzed. Quantitative analysis was conducted using JMP Pro Version 16.0 and qualitative analysis was conducted using NVIVO Software Version 12.0., Results: Survey respondents (n = 1645) had an overall 21.9% prevalence of food addiction. Significant correlations were observed between food addiction and ACEs, depression, anxiety, stress, and sex (p < .01 for all). Depression was the only significant predictor of the development of food addiction (OR = 3.33 95% CI 2.19, 5.05). The most common eating environment described by interview participants (n = 36) was an emphasis on diet culture, ideal body image, and restrictive environments. Symptoms frequently emerged after transitioning into college and having the ability to make their own food choices., Conclusion: These results show the impact of early life eating environments and young adulthood mental health on the development of food addiction. These findings contribute to the understanding of underlying causes of food addiction., Level of Evidence: Level V, Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees., (© 2023. The Author(s).)
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- 2023
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25. Smoking cessation on discharge summaries.
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Sitas F, Harris-Roxas B, White SL, Haigh FA, Barr ML, and Harris MF
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- Humans, Patient Discharge, Delivery of Health Care, Smoking, Referral and Consultation, Smoking Prevention, Smoking Cessation
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- 2023
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26. Community-Based Participatory Research: Partnering with College Students to Develop a Tailored, Wellness-Focused Intervention for University Campuses.
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Barr ML and McNamara J
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- Young Adult, Humans, Universities, Students, Health Promotion methods, Community-Based Participatory Research, Quality of Life
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College students face unique challenges with leading healthful lifestyles. Using a community-based participatory research approach, college student research partners at two land-grant universities collected data and developed a tailored intervention to improve the well-being of college students. To inform the design of the program, college students were trained to conduct a needs assessment that included a campus-wide survey on the health behaviors of college students, environmental audits of health policies and food pantries on campus, and stakeholder interviews with campus health professionals. Outcomes of the needs assessment data highlighted university students ranked their health as "good" but nutrition health as "fair/poor." Low or very low food security was self-reported by 36.9% of participants and had an overall diet quality score of 47.6 ± 10.1 out of 100. Health professional interview data indicated campuses provide healthful resources to students, but students are not aware those resources exist. Utilizing the needs assessment data previously mentioned, the nominal group technique was then used for student research partners to collaboratively determine the best intervention approaches and develop a wellness program. Student partners identified (1) education, (2) sharing of campus resources, and (3) incentives as important areas of intervention. Using the data collected, the student research partners developed a program titled, The College Cooking Connection, to address health-related quality of life in college students. Using a community-based participatory research approach to program planning, educators and researchers have a greater likelihood of addressing the current needs of the population they are targeting and developing a successful intervention to meet those health concerns. This study aims to partner with young adult university students to understand the college environment and allow the target community to be involved with the development of intervention programs for their campus.
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- 2022
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27. Frequent users of health services among community-based older Australians: Characteristics and association with mortality.
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Williamson M, Barr ML, Kabir A, Comino EJ, Goodger B, Harris-Roxas BF, Crozier AM, Jackson T, Finch J, and Harris MF
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- Humans, Aged, Australia epidemiology, Cohort Studies, Health Services, Emergency Service, Hospital, Quality of Life, Community Health Services
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Objectives: To investigate characteristics of frequent users of general practice (GP; ≥21 visits in a year), medical specialist (≥10 visits), emergency department (ED; ≥2 presentations) and hospital services (≥2 overnight hospitalisations) and the association with mortality for people aged over 75 years., Methods: The study included residents from Central and Eastern Sydney, Australia, aged over 75 years who participated in a large community-dwelling cohort study. Demographic, social and health characteristics data were extracted from the 45 and Up Study survey. Health service (GP, medical specialist, ED and hospitalisations) use and mortality data were extracted from linked administrative data. We calculated adjusted prevalence ratios to identify independent characteristics associated with frequent users of services at baseline (approx. 2008) and adjusted hazard ratios to assess the association between frequent users of services and mortality., Results: Frequent users of services (GPs, medical specialists, EDs and hospitals) were more likely to be associated with ever having had heart disease and less likely to be associated with reporting good quality of life. Characteristics varied by service type. Frequent users of services were 1.5-2.0 times more likely to die within 7 years compared to those who were less frequent service users after controlling for all significant factors., Conclusions: Our analysis found that frequent service users aged over 75 years had poorer quality of life, more complex health conditions and higher mortality and so their health service use was not inappropriate. However, better management of these frequent service users may lead to better health outcomes., (© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)
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- 2022
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28. Commentary: Lungs across borders: American lungs in Canadian patients.
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Bowdish ME and Barr ML
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- Humans, United States, Canada, Lung
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- 2022
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29. Persistent Median Artery Thrombosis Causing a Bifid Median Nerve and Carpal Tunnel Syndrome: A Case Report.
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Barr ML, Jain NS, Ghareeb PA, and Benhaim P
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- Adult, Arteries, Female, Humans, Median Nerve abnormalities, Median Nerve diagnostic imaging, Median Nerve surgery, Wrist, Carpal Tunnel Syndrome etiology, Carpal Tunnel Syndrome surgery, Thrombosis complications, Thrombosis diagnostic imaging, Thrombosis surgery
- Abstract
Case: In this report, we describe a 41-year-old woman with symptoms concerning for acute carpal tunnel syndrome. Operative exploration resulted in resection of an aneurysmal, thrombosed, persistent median artery seen on preoperative imaging and full recovery by the patient., Conclusion: A persistent median artery is an uncommon congenital hand condition resulting from the failure of the median artery to regress, which can then travel through the carpal tunnel and be associated with a bifid median nerve, irritation of the nerve, and need for surgical exploration if it thromboses, which is rare. This should be considered in patients with acute median nerve compression, without other etiologies., Competing Interests: Disclosures: All authors have no financial interests including products, devices, or drugs associated with this manuscript. There are no commercial associations that might pose or create a conflict of interest with information presented in this submitted manuscript such as consultancies, stock ownership, or patent licensing arrangements. All sources of funds supporting the completion of this manuscript are under the auspices of the University of California Los Angeles. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B938)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)
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- 2022
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30. Qualitative Case Study: A Pilot Program to Improve the Integration of Care in a Vulnerable Inner-City Community.
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Williamson MF, Song HJ, Dougherty L, Parcsi L, and Barr ML
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Introduction: There is a strong correlation between vulnerable populations and poor health outcomes. Growing evidence suggests that person-centred interventions using 'link workers' can support communities to navigate and engage with health and community services, leading to improved health service access. We describe the initial phase and qualitative evaluation of a Healthy Living Program, supported by a link worker role. The Program aimed to improve health service access for residents of an Australian inner-city suburb., Methods: To inform future program development, semi-structured interviews were conducted with clients and stakeholders (n = 21). The interviews were analysed thematically to understand program impact, success factors, constraints and potential improvements., Results: Key themes relating to impacts were a new model of working with community, improved access to services, and responsiveness to community need. Key factors for success included being a trusted, consistent presence, having knowledge of the community and health system, and successful engagement with the community and stakeholders. The constraints included difficulty influencing health system change and lack of community input. Suggested improvements were expanding the service, enhancing health system change and increasing community involvement., Conclusion: Knowledge gained from this study will inform future integrated approaches in health districts to address health inequities in areas of need., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)
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- 2022
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31. "There's a Lot of Like, Contradicting Stuff"-Views on Healthy Living during Pregnancy and Postpartum.
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McNamara JA, Mena NZ, Wright A, and Barr ML
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- Female, Healthy Lifestyle, Humans, Mothers, Obesity, Pregnancy, Overweight, Postpartum Period
- Abstract
The transition from pregnancy through early postpartum can be a particularly vulnerable time for women as they adjust to the changes of motherhood. This study aimed to provide a detailed account of additional health challenges that mothers are facing throughout motherhood during the pandemic. Data obtained can be utilized to create tailored interventions to aid women during their reproductive years. A sequential approach was utilized, collecting health-related information via survey and subsequent focus groups or interviews to further examine health experiences during pregnancy or postpartum. Fifty-seven participants completed the online survey, 73.5% were postpartum. The healthy eating index of the cohort was low, 50.5 ± 10.3%. Prior to pregnancy, 54.5% were classified as overweight/obese. Following pregnancy, 71.1% were classified as overweight or obese. Emergent qualitative themes from focus groups (n = 3) and interviews (n = 6) included (1) value and desire for healthy eating, (2) desire to make well-informed health-based decisions, and (3) role of social networks during pregnancy and postpartum. Pregnant/postpartum women desire to lead a healthy lifestyle but experience barriers to accomplishing intended goals. Upstream resources and policies that promote healthy living for pregnant/postpartum women can reduce chronic disease throughout the lifespan following childbirth.
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- 2022
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32. Pediatric Living Lung Donor Transplant Candidates: Psychiatric Status of Utilized and Non-Utilized Donors.
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Hong BA, Schuller D, Yusen RD, and Barr ML
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- Adult, Child, Graft Survival, Humans, Living Donors, Lung, United States, Lung Transplantation, Tissue and Organ Procurement
- Abstract
Living donor lung (lobar) transplantation has greatly decreased in the past decade due to the success of the lung allocation score (LAS) system, instituted in 2005 by the Organ Procurement and Transplantation Network (OPTN). Between 1993 and 2006, 460 living lung donor transplants were performed in the United States with 369 donations occurring at the University of Southern California and Washington University in St. Louis. These two centers accounted for over 80% of all living donor lung transplants between 1994 and 2006. All potential donors received a psychological/psychiatric evaluation as part of the donor selection process, which is standard practice in the United States, Europe, and Asia. Utilized and non-utilized lung donors were compared in terms of their psychiatric history and present status. Results indicated that 31% (N = 54) of the total sample had a lifetime prevalence of a psychiatric disorder, which is less than that the 46% lifetime rate for the general population (Kessler in Arch Gen Psychiatry 62:593-602, 2005). This study did find that psychiatric history or status was not exclusion factor for transplant surgery in either group. This observation about psychiatric issues in potential living lung donors should be useful to transplant centers who utilize adult live donors of any solid organ type for pediatric recipients and in Japan where live donor lung transplants still represent a significant proportion of lung transplants (Date in J Thorac Dis 8: S631-S636, 2016)., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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33. Different Types of Long-Term Milk Consumption and Mortality in Adults with Cardiovascular Disease: A Population-Based Study in 7236 Australian Adults over 8.4 Years.
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Xu X, Kabir A, Barr ML, and Schutte AE
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- Adult, Animals, Australia epidemiology, Female, Humans, Male, Milk, Prospective Studies, Retrospective Studies, Cardiovascular Diseases
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Most studies disregard long-term dairy consumption behaviour and how it relates to mortality. We examined four different types of long-term milk consumption, namely whole milk, reduced fat milk, skim milk and soy milk, in relation to mortality among adults diagnosed with cardiovascular disease (CVD). A retrospective population-based study was conducted in Australia (the 45 and Up Study) linking baseline (2006-2009) and follow-up data (2012-2015) to hospitalisation and mortality data up to 30 September 2018. A total of 1,101 deaths occurred among 7236 participants with CVD over a mean follow-up of 8.4 years. Males (Hazard Ratio, HR = 0.69, 95% CI (0.54; 0.89)) and females (HR = 0.59 (0.38; 0.91)) with long-term reduced fat milk consumption had the lowest risk of mortality compared to counterparts with long-term whole milk consumption. Among participants with ischemic heart disease, males with a long-term reduced fat milk consumption had the lowest risk of mortality (HR = 0.63, 95% CI: 0.43; 0.92). We conclude that among males and females with CVD, those who often consume reduced fat milk over the long-term present with a 31-41% lower risk of mortality than those who often consume whole milk, supporting dairy advice from the Heart Foundation of replacing whole milk with reduced fat milk to achieve better health.
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- 2022
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34. Life of a vegetarian college student: Health, lifestyle, and environmental perceptions.
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Olfert MD, Barr ML, Mathews AE, Horacek TM, Riggsbee K, Zhou W, and Colby SE
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- Health Behavior, Humans, United States, Universities, Young Adult, Diet, Vegetarian psychology, Life Style, Students, Vegetarians
- Abstract
Objective To examine health behavior and environmental perception differences among vegetarian and nonvegetarian students. Participants: First-year university students (n = 1078) from eight United States universities. Methods : Data were obtained from base 2015 and followup 2016 assessments. Vegetarians and nonvegetarians were compared for anthropometrics, lifestyle behaviors, and campus environmental perceptions (CEPS). Results : Vegetarians had smaller waist circumference, lower systolic blood pressure, higher fruit and vegetable consumption, lower percentage of energy obtained from fat, and higher perceived stress. Vegetarians expressed a lower rating of perceptions of health policies on campus. Conclusion : A clear difference in indicators of physical health does not appear, however, vegetarian students show positive dietary patterns which can promote positive health outcomes. Further, vegetarians had lower perceptions of health policies on campus. Results can be used by administrators to ensure policies are in place to support health of students as currently vegetarian students see limitations in the environmental health policies.
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- 2022
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35. Early onset of deep sternal wound infection after cardiac surgery is associated with decreased survival: A propensity weighted analysis.
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Elsayed RS, N Carey J, Cohen RG, Barr ML, Baker CJ, Starnes VA, and Bowdish ME
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- Cohort Studies, Female, Humans, Male, Retrospective Studies, Risk Factors, Sternum surgery, Cardiac Surgical Procedures adverse effects, Surgical Wound Infection
- Abstract
Objectives: To compare outcomes after the development of early (≤30 days) versus delayed (>30 days) deep sternal wound infection (DSWI) after cardiac surgery., Methods: Between 2005 and 2016, 64 patients were treated surgically for DSWI following cardiac surgery. Thirty-three developed early DSWI, while 31 developed late DSWI. The mean follow-up was 34.1 ± 32.3 months., Results: Survival for the entire cohort at 1, 3, and 5 years was 93.9%, 85.1%, and 80.8%, respectively. DSWI diagnosed early and attempted medical management was strongly associated with overall mortality (hazard ratio [HR], 25.0 and 9.9; 95% confidence intervals [CIs], 1.18-52.8 and 1.28-76.5; p-value .04 and .04, respectively). Survival was 88.1%, 77.0%, 70.6% and 100%, 94.0% and 94.0% at 1, 3, and 5 years in the early and late DSWI groups, respectively (log-rank = 0.074). Those diagnosed early were more likely to have a positive wound culture (odds ratio [OR], 0.06; 95% CI, 0.01-0.69; p = .024) and diagnosed late were more likely to be female (OR, 8.75; 95% CI, 2.0-38.4; p = .004) and require an urgent DSWI procedure (OR, 9.25; 95% CI, 1.86-45.9; p = .007). Both early diagnosis of DSWI and initial attempted medial management were strongly associated with mortality (HR, 7.48; 95% CI, 1.38-40.4; p = .019 and HR, 7.76; 95% CI, 1.67-35.9; p = .009, respectively)., Conclusions: Early aggressive surgical therapy for DSWI after cardiac surgery results in excellent outcomes. Those diagnosed with DSWI early and who have failed initial medical management have increased mortality., (© 2021 Wiley Periodicals LLC.)
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- 2021
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36. Losses, Gains, and Changes to the Food Environment in a Rural Kentucky County during the COVID-19 Pandemic.
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Barr ML, Martin C, Luecking C, and Cardarelli K
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- Adult, Aged, Female, Focus Groups, Health Behavior, Health Knowledge, Attitudes, Practice, Humans, Kentucky, Male, Middle Aged, Nutritive Value, Qualitative Research, COVID-19, Diet, Healthy, Food Supply, Poverty, Rural Population
- Abstract
The COVID-19 pandemic has caused alterations to be made in the way many people access, prepare, and consume food. Rural communities are particularly impacted due to pre-existing structural vulnerabilities, i.e., poverty, lack of infrastructure, and limited fresh food options. This study aimed to characterize experiences of one rural Appalachian community's changes to the food environment during the pandemic. In April 2021, six focus groups were conducted with residents of Laurel County, Kentucky. Using grounded theory, we identified losses, gains, and overall changes to the community food environment since the onset of COVID-19. Seventeen Laurel Countians (17 female; ages 30-74) participated in the six focus groups. Three main themes emerged regarding food environment changes-(1) modifications of community food and nutrition resources, (2) expansion and utilization of online food ordering, and (3) implications of the home food environment. Rural communities faced considerable challenges during the COVID-19 pandemic, in part, due to gaps in existing infrastructure and loss of pre-existing resources. This study illustrates the complexity of changes occurring during COVID-19. Using the preliminary data obtained, we can better understand pre-existing issues in Laurel County and suggestions for future programming to address the inequitable access and response during public health emergencies and beyond.
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- 2021
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37. Exploring Perceived Importance of a Novel Emergency Food Program during COVID-19 and Program Recipient Characteristics.
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Barr ML, OoNorasak K, Hughes K, Batey L, Jackson K, Marshall H, and Stephenson T
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- Adult, Child, Female, Food Supply, Humans, Income, Meals, Middle Aged, Pandemics, SARS-CoV-2, COVID-19, Food Assistance
- Abstract
Following rising unemployment rates and consequent loss of income due to COVID-19, many people have been seeking meal assistance. This study examines the impact of a community-based free meal distribution program during the pandemic in Kentucky, reviewing characteristics of recipients of the program. Demographics, health behaviors, food insecure classification, and rating of importance of the meal program were collected. Qualitative feedback on the impact of the program was collected via open response. Of the 92 participants using the meal service, the cohort was female, Black, 43 years of age (43.5 ± 15.0 years), with a household income under 30,000 USD before COVID, decreased income since COVID, and were food insecure. Recipients rated the importance of the service as 8.7 ± 1.8 (of 10), and those with children indicated the importance as 4.2 ± 1.1 (of 5). Qualitative data on program importance highlighted four response categories including "changed habits", "mental wellbeing", "provided resources", and "other". In response to the COVID-19 pandemic, many individuals have struggled. Meal assistance programs are a fundamental asset in the community that have seen marketed demand since COVID-19. Collaboration with, and evaluation of, meal assistance programs can be valuable for continued programmatic funding support.
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- 2021
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38. Equivalent outcomes with minimally invasive and sternotomy mitral valve repair for degenerative mitral valve disease.
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Bowdish ME, Elsayed RS, Tatum JM, Cohen RG, Mack WJ, Abt B, Yin V, Barr ML, and Starnes VA
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- Humans, Minimally Invasive Surgical Procedures, Mitral Valve surgery, Thoracotomy, Treatment Outcome, Mitral Valve Insufficiency surgery, Sternotomy
- Abstract
Background: Debate continues in regard to the optimal surgical approach to the mitral valve for degenerative disease., Methods: Between February 2004 and July 2015, 363 patients underwent mitral valve repair for degenerative mitral valve disease via either sternotomy (sternotomy, n = 109) or small right anterior thoracotomy (minimally invasive, n = 259). Survival, need for mitral valve reoperation, and progression of mitral regurgitation more than two grades were compared between cohorts using time-based statistical methods and inverse probability weighting., Results: Survival at 1, 5, and 10 years were 99.2, 98.3, and 96.8 for the sternotomy group and 98.1, 94.9, and 94.9 for the minimally invasive group (hazard ratio: 0.39, 95% confidence interval [CI] 0.11-1.30, p = .14). The cumulative incidence of need for mitral valve reoperation with death as a competing outcome at 1, 3, and 5 years were 2.7%, 2.7%, and 2.7% in the sternotomy cohort and 1.5%, 3.3%, and 4.1% for the minimally invasive group (subhazard ratio (SHR) 1.17, 95% CI: 0.33-4.20, p = .81). Cumulative incidence of progression of mitral regurgitation more than two grades with death as a competing outcome at 1, 3, and 5 years were 5.5%, 14.4%, and 44.5% for the sternotomy cohort and 4.2%, 9.7%, and 20.5% for the minimally invasive cohort (SHR: 0.67, 95% CI: 0.28-1.63, p = .38). Inverse probability weighted time-based analyses based on preoperative cohort assignment also demonstrated equivalent outcomes between surgical approaches., Conclusions: Minimally invasive and sternotomy mitral valve repair in patients with degenerative mitral valve disease is associated with equivalent survival and repair durability., (© 2021 Wiley Periodicals LLC.)
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- 2021
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39. General practitioner follow-up after hospitalisation in Central and Eastern Sydney, Australia: access and impact on health services.
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Barr ML, Welberry H, Hall J, Comino EJ, Harris E, Harris-Roxas BF, Jackson T, Donnelly D, and Harris MF
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- Australia epidemiology, Follow-Up Studies, Hospitalization, Humans, Primary Health Care, General Practitioners
- Abstract
Objectives General practitioner (GP) follow-up after a hospital admission is an important indicator of integrated care. We examined the characteristics of patients who saw a GP within 2 weeks of hospital discharge in the Central and Eastern Sydney (CES) region, Australia, and the relationship between GP follow-up and subsequent hospitalisation. Methods This data linkage study used a cohort of 10240 people from the 45 and Up Study who resided in CES and experienced an overnight hospitalisation in the 5 years following recruitment (2007-14). Characteristics of participants who saw a GP within 2 weeks of discharge were compared with those who did not using generalised linear models. Time to subsequent hospitalisation was compared for the two groups using Cox proportional hazards regression models stratified by prior frequency of GP use. Results Within 2 weeks of discharge, 64.3% participants saw a GP. Seeing a GP within 2 weeks of discharge was associated with lower rates of rehospitalisation for infrequent GP users (i.e. <8 visits in year before the index hospitalisation; hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.70-0.97) but not frequent GP users (i.e. ≥8 plus visits; HR 1.02; 95% CI 0.90-1.17). Conclusion The effect of seeing a GP on subsequent hospitalisation was protective but differed depending on patient care needs. What is known about the topic? There is general consensus among healthcare providers that primary care is a significant source of ongoing health care provision. What does this paper add? This study explored the relationship between GP follow-up after an uncomplicated hospitalisation and its effect on rehospitalisation. What are the implications for practitioners? Discharge planning and the transfer of care from hospital to GP through discharge arrangements have substantial benefits for both patients and the health system.
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- 2021
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40. Use of a Bluetooth tablet-based technology to improve outcomes in lung transplantation: A pilot study.
- Author
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Schenkel FA, Barr ML, McCloskey CC, Possemato T, O'Conner J, Sadeghi R, Bembi M, Duong M, Patel J, Hackmann AE, and Ganesh S
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- Humans, Patient Discharge, Patient Readmission, Pilot Projects, Retrospective Studies, Technology, Aftercare, Lung Transplantation
- Abstract
The impact of remote patient monitoring platforms to support the postoperative care of solid organ transplant recipients is evolving. In an observational pilot study, 28 lung transplant recipients were enrolled in a novel postdischarge home monitoring program and compared to 28 matched controls during a 2-year period. Primary endpoints included hospital readmissions and total days readmitted. Secondary endpoints were survival and inflation-adjusted hospital readmission charges. In univariate analyses, monitoring was associated with reduced readmissions (incidence rate ratio [IRR]: 0.56; 95% confidence interval [CI]: 0.41-0.76; P < .001), days readmitted (IRR: 0.46; 95% CI: 0.42-0.51; P < .001), and hospital charges (IRR: 0.52; 95% CI: 0.51-0.54; P < .001). Multivariate analyses also showed that remote monitoring was associated with lower incidence of readmission (IRR: 0.38; 95% CI: 0.23-0.63; P < .001), days readmitted (IRR: 0.14; 95% CI: 0.05-0.37; P < .001), and readmission charges (IRR: 0.11; 95% CI: 0.03-0.46; P = .002). There were 2 deaths among monitored patients compared to 6 for controls; however, this difference was not significant. This pilot study in lung transplant recipients suggests that supplementing postdischarge care with remote monitoring may be useful in preventing readmissions, reducing subsequent inpatient days, and controlling hospital charges. A multicenter, randomized control trial should be conducted to validate these findings., (© 2020 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.)
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- 2020
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41. Successful weight loss after bariatric surgery in Appalachian state regardless of food access ranking score.
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Barr ML, Tabone LE, Brode C, Szoka N, and Olfert
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- Female, Humans, Middle Aged, Retrospective Studies, Treatment Outcome, United States, Weight Loss, West Virginia, Bariatric Surgery, Gastric Bypass, Laparoscopy, Obesity, Morbid surgery
- Abstract
Background: Following bariatric surgery, an explicit dietary regimen is required to facilitate and maintain successful weight loss. Without adequate access to healthy foods, weight maintenance can be hindered., Objective: Examine influence degree of food access has on Appalachian bariatric surgery patient weight loss outcomes., Setting: Appalachian University hospital, United States., Methods: A retrospective chart review was used to examine the influence of food accessibility on weight loss outcomes in an Appalachian bariatric surgery patient population at a large tertiary hospital in West Virginia between 2013 and 2017. Demographic characteristics, health and family history, and 1-year surgery outcomes were collected. A state-specific food accessibility score was calculated for each patient address using the geographic information system. Patients were assigned a food access ranking score (FARS) between 0 (low food access) and 4 (high food access) based on criteria of quantity, quality, income, and vehicle access., Results: Patients (n = 369) were predominately married (60.5%), white (92.4%), female (77.8%), and underwent laparoscopic Roux-en-Y gastric bypass surgery (75.9%), with a mean age of 45 years. Most patients had low FARS (M = 1.67 ± .73; 72.6%). Nonwhite patients (P = .03) with a preoperative diagnosis of depression (P = .02) or without a family history of obesity (P = .01) were found to be in the lower FARS categories. FARS was not indicative of weight loss post surgery (P > .05)., Conclusions: Food accessibility in West Virginia was not associated with bariatric surgery weight outcomes at 1-year post operation. Lower food access was associated with nonwhite race/ethnicity, diagnosed depression at baseline, and no family history of obesity. Future studies should include more extended follow-up data collection and mixed-method approaches to capture perceptions of food access and its impact on the patients' postoperative journey., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2020
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42. eB4CAST Approach Improves Science Communication With Stakeholders in a College-Based Health Program.
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Olfert MD, Barr ML, Hagedorn RL, Wattick RA, Zhou W, Horacek TM, Mathews AE, Kattelmann KK, Kidd T, White AA, Brown ON, Morrell JS, Franzen-Castle L, Shelnutt KP, Byrd-Bredbenner C, Tolar-Peterson T, Greene GW, and Colby SE
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- Educational Status, Health Promotion, Humans, Communication, Universities
- Abstract
Communicating scientific results with community partners is often lacking in intervention programs, thus eB4CAST was developed to facilitate impact sharing. This article investigated using the eB4CAST dissemination tool to communicate impact from a campus-based obesity prevention program. Data from Get Fruved RCT university sites collected at baseline were used to generate eB4CAST reports. Experts ( n = 13) and RCT sites ( n = 15) were asked to provide feedback on eB4CAST reports based on appeal, understanding, and clarity. On all Likert items, participants rated above 7 on each (out of 10). Positive responses from open-ended questions included eB4CAST reports being clear, visually appealing, and aid in program understanding. Overall, eB4CAST was successful in relaying data and information for the Get Fruved program, thus a means for science communication that could be used in interventions. Utilizing infographics to report data and information is a feasible way to disseminate and communicate in a cost-effective, timely manner., (Copyright © 2020 Olfert, Barr, Hagedorn, Wattick, Zhou, Horacek, Mathews, Kattelmann, Kidd, White, Brown, Morrell, Franzen-Castle, Shelnutt, Byrd-Bredbenner, Tolar-Peterson, Greene and Colby.)
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- 2020
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43. Learn first, practice second approach to increase health professionals' nutrition-related knowledge, attitudes and self-efficacy.
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Santella ME, Hagedorn RL, Wattick RA, Barr ML, Horacek TM, and Olfert MD
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- Adult, Attitude of Health Personnel, Diet, Mediterranean, Feeding Behavior, Female, Humans, Male, West Virginia, Health Knowledge, Attitudes, Practice, Health Personnel, Nutritional Physiological Phenomena, Self Efficacy
- Abstract
Health professionals generally have positive attitudes towards the role of nutrition in medicine, but limited knowledge and low self-efficacy for incorporating it into routine care. To assess the effectiveness of a "learn first, practice second" intervention on the nutrition-related knowledge, attitudes, and self-efficacy of multidisciplinary health professionals, the present approach consisted of 16 weeks of online education and 2 weeks of cultural immersion in Tuscany, Italy. Data was captured via online surveys at Baseline, Post-education, Post-immersion, and Follow Up. Repeated measures ANOVA with irregular spacing was used, followed by Dunnett's or Cochran-Mantel-Haenszel testing. Results indicate significantly improved participant nutrition knowledge (nonzero correlation p = .0136, means score p = .0075) and self-efficacy (T0-T1 p < .0001, T0-T2 p < .0001, T0-T3 p = .0002), with differences in attitude trending towards significance ( p = .0764). Findings from this study suggest that a combination of online education and hands on learning experiences can be beneficial for increasing health professionals' nutrition knowledge, confidence, and potentially attitude.
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- 2020
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44. Psychological Diagnoses and Weight Loss among Appalachian Bariatric Surgery Patients.
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Barr ML, Brode C, Tabone LE, Cox SJ, and Olfert MD
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- Appalachian Region, Bariatric Surgery, Comorbidity, Depressive Disorder, Major complications, Female, Humans, Male, Middle Aged, Obesity, Morbid complications, Obesity, Morbid surgery, Psychometrics, Retrospective Studies, Surveys and Questionnaires, Depressive Disorder, Major diagnosis, Obesity, Morbid psychology
- Abstract
Background: The relationship between presurgical psychopathology and weight loss following bariatric surgery is complex; previous research has yielded mixed results. The current study investigates the relationship among presurgical mental health diagnoses, symptom severity, and weight loss outcomes in an Appalachian population, where obesity-related comorbidities are prominent., Methods: A retrospective chart review was performed on bariatric surgery patients in an accredited Appalachian centered academic hospital in northern West Virginia between 2013 and 2015 ( n = 347). Data extraction included basic demographics, anthropometrics (percent excess weight loss (%EWL)) at six-month, one-year, and two-year postoperative visits, and two validated psychological questionnaires (Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI)) from patient's presurgical psychological evaluation., Results: Average patient population was 92.5% Caucasian, 81.5% female, 45 ± 11.5 years old, and 84.1% who underwent laparoscopic Roux-en-Y gastric bypass surgery with the remaining having laparoscopic sleeve gastrectomy. At baseline, no differences were detected in weight, excess body weight, or body mass index between surgery types. Average baseline BDI-II score was 10.1 ± 8.68 (range 0-41) and BAI score was 6.1 ± 6.7 (range 0-36), and this was not significantly different by surgery at baseline. Both baseline psychological scores were in the "minimal" severity range. BDI-II was positively related to BMI of patients at baseline ( p = 0.01). Both BDI-II and BAI were not significantly related to %EWL across follow-up., Conclusion: Other than baseline weight, BDI-II and BAI scores were not related to %EWL outcomes in patients receiving bariatric surgery in the Appalachian region. Future work should examine mixed methods approaches to capture prospective and longitudinal data to more thoroughly delve into mental health aspects of our Appalachian patients and improve efforts to recapture postoperative patients who may have been lost to follow-up., Competing Interests: The authors state that they have no conflicts of interest to declare., (Copyright © 2020 Makenzie L. Barr et al.)
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- 2020
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45. Virtual Surgical Planning for Mandibular Reconstruction With the Fibula Free Flap: A Systematic Review and Meta-analysis.
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Barr ML, Haveles CS, Rezzadeh KS, Nolan IT, Castro R, Lee JC, Steinbacher D, and Pfaff MJ
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- Fibula transplantation, Humans, Free Tissue Flaps, Mandibular Reconstruction methods, Surgery, Computer-Assisted
- Abstract
Background: The fibula free flap (FFF) remains the criterion standard for complex mandibular reconstruction. Surgeons have incorporated virtual surgical planning (VSP) into the reconstructive algorithm with the assertion that VSP increases operative efficiency and may improve clinical outcomes. To date, no large-scale studies have analyzed these claims. This study examines the literature and tests the hypothesis that VSP improves operative efficiency, clinical outcomes, and accuracy when compared with traditional techniques., Methods: A systematic review was performed to identify articles utilizing VSP and traditional techniques for FFF-based mandibular reconstruction. Two reviewers independently assessed all articles for methodological quality using a validated instrument (weighted Cohen κ for interrater reliability = 0.70). Outcomes included operative time, length of stay, complications, and accuracy. Meta-analytic comparisons were performed using data from comparative studies using a random-effects model and differences of means analysis for outcomes measured on identical scales., Results: One hundred thirty-one articles were identified, and 25 met the inclusion criteria: 12 were VSP only, whereas 13 were comparative. There were 241 VSP patients and 214 traditional patients available for meta-analysis. Patients undergoing reconstruction with VSP had a significant reduction in operative time by 44.64 minutes (95% confidence interval [CI], -74.69 to -14.58 minutes; P < 0.01) and demonstrated a mean trend toward shorter hospital admission (mean difference, -1.24 days; 95% CI, -4.00 to 1.52 days; P = 0.38). There was no statistical difference between cohorts for major (odds ratio, 1.03; 95% CI, 0.46-2.31; P = 0.95) or minor complications (odds ratio, 0.97; 95% CI, 0.54-1.71; P = 0.90). Insufficient data were available for cost analysis and accuracy., Conclusions: Virtual surgical planning-guided mandibular reconstruction with FFF is associated with significantly decreased operative time and a mean trend toward shorter hospital admission. While multiple studies reported a high degree of accuracy, no standard measurement was available for meta-analysis.
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- 2020
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46. Feasibility of a mHealth Approach to Nutrition Counseling in an Appalachian State.
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Olfert MD, Barr ML, Hagedorn RL, Long DM, Haggerty TS, Weimer M, Golden J, Maurer MA, Cochran JD, Hendershot T, Whanger SL, Mason JD, and Hodder SL
- Abstract
West Virginia is a rural state with an aging population that may experience barriers to accessing nutritional and lifestyle counseling. This study examined feasibility of an online personalized nutrition tracking application, Good Measures (GM), with patients at seven health care clinics throughout the state. Fourteen healthcare providers and 64 patients 18 years or older with a Body Mass Index (BMI) greater than or equal to 30 and access to the Internet were recruited for this 12-week feasibility study. Patient participants logged meals and exercise into the GM application via smart phone, tablet, or computer and virtually engaged with a Registered Dietitian Nutritionist (RDN) in one-on-one sessions. The primary endpoint was to examine feasibility of the program by usage of the application and feedback questions regarding the benefits and challenges of the application. Participants were predominately white (92%) and female (76%). Minimal improvements in weight and systolic blood pressure were found. Participant attitude survey data declined from 4-weeks to 12-weeks of the intervention. Interestingly though, patients in a rural clinic had lesser declines in attitudes than peri-urban participants. Qualitative feedback data identified participants predominately had a positive overall feeling toward the approach. Participants expressed favorability of RDN access, the variety of foods, but did give suggestions for in-person meetings and more updating of the application. Implementing a technology approach to nutrition in rural areas of West Virginia using a mobile application with RDN access may be one strategy to address public health issues such as obesity., Competing Interests: The authors declare no conflict of interest.
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- 2019
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47. Do general practice management and/or team care arrangements reduce avoidable hospitalisations in Central and Eastern Sydney, Australia?
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Welberry H, Barr ML, Comino EJ, Harris-Roxas BF, Harris E, Dutton S, Jackson T, Donnelly D, and Harris MF
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- Aged, Aged, 80 and over, Australia, Cohort Studies, Emergency Service, Hospital statistics & numerical data, Female, Health Services Research, Humans, Male, Middle Aged, National Health Programs organization & administration, Chronic Disease therapy, General Practice organization & administration, Hospitalization statistics & numerical data, Patient Care Team organization & administration
- Abstract
Background: The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management program was introduced to Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The program supports General Practitioners (GP)s claiming for up to one general practice management plan (GPMP) and one team care arrangement (TCA) every year and the patient claiming for up to five private allied health visits. We describe the profile of participants who claimed for GPMPs and/or TCAs in Central and Eastern Sydney (CES) and explore if GPMPs and/or TCAs are associated with fewer emergency hospitalisations (EH)s or potentially preventable hospitalisations (PPH)s over the following 5 years., Methods: This research used the CES Primary and Community Health Cohort/Linkage Resource (CES-P&CH) based on the 45 and Up Study to identify a community-dwelling population in the CES region. There were 30,645 participants recruited within the CES area at baseline. The CES-P&CH includes 45 and Up Study questionnaire data linked to MBS data for the period 2006-2014. It also includes data from the Admitted Patient Data Collection, Emergency Department Data Collection and Deaths Registry linked by the NSW Centre for Health Record Linkage., Results: Within a two-year health service utilisation baseline period 22% (5771) of CES participants had at least one claim for a GPMP and/or TCA. Having at least one claim for a GPMP and/or TCA was closely related to the socio-demographic and health needs of participants with higher EHs and PPHs in the 5 years that followed. However, after controlling for confounding factors such as socio-demographic need, health risk, health status and health care utilization no significant difference was found between having claimed for a GPMP and/or TCA during the two-year health service utilisation baseline period and EHs or PPHs in the subsequent 5 years., Conclusions: The use of GPMPs and/or TCAs in the CES area appears well-targeted towards those with chronic and complex care needs. There was no evidence to suggest that the use of GPMPs and /or TCAs has prevented hospitalisations in the CES region.
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- 2019
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48. Understanding the use and impact of allied health services for people with chronic health conditions in Central and Eastern Sydney, Australia: a five-year longitudinal analysis.
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Barr ML, Welberry H, Comino EJ, Harris-Roxas BF, Harris E, Lloyd J, Whitney S, O'Connor C, Hall J, and Harris MF
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- Aged, Aged, 80 and over, Female, Health Services Accessibility, Health Services Research, Humans, Longitudinal Studies, Male, Middle Aged, National Health Programs, New South Wales, Primary Health Care, Prospective Studies, Surveys and Questionnaires, Utilization Review, Chronic Disease therapy, Disease Management, Health Services supply & distribution
- Abstract
Aim: To describe the characteristics of people in Central and Eastern Sydney (CES), NSW, who had a General Practice Management Plan (GPMP) and claimed for at least one private allied health service item; and to examine if allied health service use results in less hospitalisations over a five-year period., Background: The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management programme was introduced to the Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The programme supports general practitioners claiming up to one GPMP and one Team Care Arrangement every year, and the patient additionally claiming for up to five private allied health services visits., Methods: A prospective longitudinal study was conducted. The sample consisted of 5771 participants in CES who had a GPMP within a two-year health service utilisation baseline period (2007-2009). The analysis used the 45 and Up Study questionnaire data linked to the MBS, hospitalisation, death and emergency department data for the period 2006-2014., Findings: Of the eligible participants, 43% (2460) had at least one allied health service item claim in the subsequent 12 months. Allied health services were reported as physiotherapy, podiatry and other allied health services. The highest rates of allied health service use were among participants aged 85 years and over (49%). After controlling for confounding factors, a significant difference was found between having claimed for five or more physiotherapy services and emergency admissions (HR: 0.83; 95% CI: 0.72-0.95) and potentially preventable hospitalisations (HR: 0.79; 95% CI: 0.64-0.96) in the subsequent five years. Use of allied health service items was well targeted towards those with chronic and complex care needs, and use of physiotherapy services was associated with less avoidable hospitalisations.
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- 2019
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49. Monetary Cost of the MyPlate Diet in Young Adults: Higher Expenses Associated with Increased Fruit and Vegetable Consumption.
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Clark RL, Famodu OA, Barr ML, Hagedorn RL, Ruseski J, White JA, Warner CM, Morrell AM, Murray PJ, Olfert IM, McFadden JW, Downes MT, Colby SE, and Olfert MD
- Abstract
Background: Cost is a commonly reported barrier to healthy eating. This is a secondary research analysis designed to examine the food expenditures of young adults on a university campus following the United States Department of Agriculture (USDA) MyPlate guidelines for fruits and vegetables., Methods: Meal receipts and dietary intake were recorded weekly. Anthropometrics and clinical assessments were recorded before intervention. Researchers rated compliance based on the participant's dietary food log, receipt matching, food pictures, and reports during weekly 1-hour consultations., Results: Fifty-three young adults (18-30 years old) at-risk of, or diagnosed with, metabolic syndrome (MetS) were enrolled in the study, with 10 excluded ( n = 43) from analyses due to enrollment in a fixed cost university campus dining meal plan. A two sample t -test assessed differences in food costs and regression analysis determined associations between food cost and diet compliance while controlling for confounding factors of age, sex, and body mass index (BMI). Diet compliant subjects ( n = 38) had higher weekly food cost at $95.73 compared to noncompliant subjects ( n = 5) who spent $66.24 ( p =0.01). A regression analysis controlling for age, sex, BMI, and geographical region also indicated cost differences based on diet compliance ( p < 0.0001)., Conclusion: Results indicate an ∼$29.00 per week increase in food cost when eating the recommended amount of fruit and vegetables. These findings can contribute to research incentive design, program planning cost, and determining effective interventions to improve diet in this population.
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- 2019
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50. Increasing use of general practice management and team care arrangements over time in New South Wales, Australia.
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Welberry H, Barr ML, Comino EJ, Harris-Roxas BF, Harris E, and Harris MF
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- Aged, Aged, 80 and over, Chronic Disease, Female, Humans, Male, Middle Aged, New South Wales, Patient Care Team statistics & numerical data, Registries, General Practice statistics & numerical data, Health Care Surveys statistics & numerical data, National Health Programs statistics & numerical data, Patient Care Management methods, Patient Care Management statistics & numerical data
- Abstract
The number of older people living with chronic health conditions is increasing in Australia. The Chronic Disease Management (CDM) items program was introduced to the Medicare Benefits Schedule (MBS) to encourage a more structured approach to managing patients with chronic conditions. Initial uptake was slow and recent research has suggested that uptake is decreasing. This paper examines: person MBS CDM claims in NSW between 2006 and 2014 - using baseline survey data (2006-09) from the Sax Institute's 45 and Up Study linked to MBS and Death Registry data (2006-14) - and MBS CDM claims per 100000 population - using billing data sourced from the Medicare Australia Statistics website - to systematically examine any changes in uptake using a time-series analysis. After age adjustment, claims for initial plans increased from 11.3% in 2006 to 22.4% in 2014. Increases were also seen for allied health service claims (from 4.1% in 2006 to 20.8% in 2014) and for plan reviews (from 5.9% in 2006 to 16.0% in 2014). These increases were consistent with the MBS summary claims data. There is evidence that these plans are appropriately targeting those in most need; however, there is limited evidence of their effect. Claims for plan reviews, although increasing, are suboptimal and may indicate poor continuity of care.
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- 2019
- Full Text
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