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Clinicians frequently stress the importance of maintaining good oral health for multiple reasons, including its link to systemic health. Because periodontal treatment reduces inflammation in oral tissues, some hypothesize it may positively affect systemic outcomes by reducing inflammation in the body. A significant number of systematic reviews (SRs) and meta-analyses (MAs) have evaluated the effect of periodontal treatment on systemic outcomes. However, inconsistent findings and questionable methodological rigor make drawing conclusions difficult. We conducted a systematic review of reviews that studied the effect of nonsurgical periodontal treatment on systemic disease outcomes. We report on outcomes evaluated, categorizing them as biomarkers, and surrogate or clinical endpoints. In addition, we used A MeaSurement Tool to Access systematic Reviews 2 (AMSTAR 2) to evaluate the methodological quality of the reviews. Of the 52 studies included in our review, 21 focused on diabetes, 15 on adverse birth outcomes, 8 on cardiovascular disease, 3 each on obesity and rheumatoid arthritis, and 2 on chronic kidney disease. Across all studies, surrogate endpoints predominated as outcomes, followed by biomarkers and, rarely, actual disease endpoints. Ninety-two percent of studies had "low" or "critically low" AMSTAR 2 confidence ratings. Criteria not met most frequently included advance registration of the protocol, justification for excluding individual studies, risk of bias from individual studies being included in the review, and appropriateness of meta-analytical methods. There is a dearth of robust evidence on whether nonsurgical periodontal treatment improves systemic disease outcomes. Future reviews should adhere more closely to methodological guidelines for conducting and reporting SRs/MAs than has been the case to date. Beyond improved reviews, additional rigorous research on whether periodontal treatment affects systemic health is needed. We highlight the potential of large-scale databases containing matched medical and dental record data to inform and complement future clinical research studying the effect of periodontal treatment on systemic outcomes. [ABSTRACT FROM AUTHOR]

Objective:  Between 2008 and 2016, 23% of pregnancy-related deaths in Ohio occurred in an emergency department (ED) or outpatient setting. Prior research showed that 98% of Ohio's delivery hospitals conduct obstetric (OB) emergency simulations, whereas only 30% include ED staff. The goal of the grant was to increase the knowledge, skill, and self-efficacy of emergency medicine (EM) professionals in managing OB emergencies. In addition to EM professionals, there was high interest by obstetrics and gynecology (OB/GYN) and other professionals in the course. Therefore, the goal of the project was to increase these elements for all professionals including EM and non-EM professionals in managing OB emergencies., Study Design:  Twelve virtual training courses using simulated patient encounters and video-based skills training were conducted across Ohio on the management of OB emergencies. Scenarios focused on common causes of pregnancy-related death using data from the Ohio Pregnancy-Associated Mortality Review Committee. Pre- and posttests assessed training effectiveness., Results:  Between August 1, 2020, and June 30, 2023, 258 learners completed the course. Most were female (76.76%), White (90.61%), and under 45 years old (69.40%). Most (66.49%) were from EM, followed by OB/GYN (18.09%), and other specialties (15.43%) including family medicine and pediatric EM. Most worked in hospital settings (89.19%). Learners reported a median 10.00 (interquartile range [IQR]: 15.00) years in clinical practice. Overall, mean knowledge scores increased by 0.81 (95% confidence interval [CI]: 0.62, 1.01), after the course ( p  < 0.001). Mean knowledge scores increased by 0.90 (95% CI: 0.64, 1.16; p  < 0.001), 0.67 (95% CI: 0.24, 1.09; p  = 0.003), and 0.60 (95% CI: 0.16, 1.04; p  = 0.01) for those from EM, OB/GYN, and other specialties, respectively. Median scores for reported self-efficacy increased by 24.00 (IQR: 22.33) and self-reported skills increased by 30.42 (IQR: 22.83) points ( p  < 0.001)., Conclusion:  Virtual simulations can be effective in improving EM, OB, and other professionals' knowledge, self-efficacy, and self-reported skills in managing OB emergencies., Key Points: · Obstetric knowledge and skills can be taught effectively in a virtual environment.. · Educational interventions can use pregnancy-associated mortality data to target local patterns.. · Simulation can teach management of high-acuity, low-frequency obstetric emergencies to learners.., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Exploring the experiences of Long COVID patients who face challenges with employment may inform improvements in how healthcare systems can provide holistic care for this patient population., Objective: Understand perspectives about the impact of Long COVID on employment and well-being among patients seeking healthcare for Long COVID., Design: Qualitative study involving one-on-one interviews., Participants: Eligible participants were 18 years of age or older, spoke English, self-reported as doing well in daily life before having COVID-19, and reported that COVID-19 was still having a significant impact on their life three or more months following an acute infection., Approach: Participants were recruited from a post-COVID recovery clinic at an academic medical center. Interviews were conducted from August to September 2022., Key Results: Among all participants (N = 21), most described that they were not able to work at a capacity equivalent to their norm pre-COVID-19. For those who continued working after their COVID-19 infection, the effort and energy required for work left little capacity to participate in other life activities and made it difficult to attend recommended healthcare appointments. Participants reported financial impacts of changes in employment including loss of income and changes in insurance, which were compounded by high healthcare costs. Changes in employment resulted in emotional repercussions including feelings of loss of self-identity and fear of judgement at work. Participants discussed issues surrounding access to strategies to address challenges posed by the impact of Long COVID on employment, including strategies learned from healthcare providers to cope with Long COVID symptoms at work and efforts to seek disability benefits or workplace accommodations., Conclusions: Patients with Long COVID may face significant challenges due to changes in their ability to work. Healthcare providers can support these patients by connecting them to financial assistance resources, facilitating appropriate mental health treatment, and expediting workplace accommodation requests., (© 2024. The Author(s).)

Background: Cancer survivors are at greater risk for cardiovascular-related mortality. Mobile health (mHealth) is an increasingly prevalent strategy for health promotion, but whether it consistently improves cardiorespiratory outcomes after a cancer diagnosis is unknown. We sought to determine the effectiveness of mHealth fitness/physical activity interventions on cardiorespiratory fitness outcomes among cancer patients and survivors., Methods: Leveraging MEDLINE/PubMed, Scopus, and ClinicalTrials.gov, we identified studies through May 2023. Included studies provided a quantitative evaluation of an mHealth intervention in a primary or secondary capacity on cardiorespiratory fitness (6-minute walk test, VO 2 max, 3-minute step test, or systolic blood pressure; or any mention of cardiac measure) and were meta-analyzed (using a random effects model) if they were a randomized controlled trial with sufficient quantitative information. Four coders were involved in applying inclusion/exclusion criteria, coding using a standardized data extraction sheet, and assessing study quality, with each study coded by at least two., Results: Of 656 articles, nine (n = 392) met systematic review inclusion criteria (mean age range 19-62 years, 71.9% female, 60.9% breast cancer). Interventions included mobile apps (k = 6), smartwatches (k = 2), or a smartwatch plus a supplemental web/mobile/tablet app (k = 1); median duration of mHealth-use was 12 weeks. Seven (n = 341) fit criteria for meta-analysis. mHealth was associated with improved cardiorespiratory fitness (d = 0.33; 95% CI = 0.07-0.60) compared to a control group. Relationships remained after accounting for lipid-based outcomes (d = 0.30; 95% CI = 0.03-0.56). There was no evidence for heterogeneity or publication-bias., Conclusions: mHealth exercise interventions appear to be a viable strategy for improving cardiorespiratory fitness after a cancer diagnosis., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Purpose: This study was designed to characterize features of rapid relapse TNBC (rrTNBC), an aggressive, poor prognosis breast cancer subset using the National Cancer Database (NCDB)., Methods: Patients diagnosed with TNBC between 2010 and 2019 within NCDB were included in analyses. rrTNBC was defined as all-cause mortality ≤24 months from diagnosis. Patient demographic, tumor, and treatment association with rrTNBC were evaluated in univariate, bivariate analyses, and multiple logistic regression models. Two-part models are used to compare receipt of treatment (i.e., receipt of both chemotherapy and breast surgery) versus not in its relationship with rrTNBC., Results: Overall, 14.5% of patients were categorized as rrTNBC. Age older than 75 years (-41.3%), Black race (-1.4%), Medicare (-2.6%), and Charlson-Deyo score ≥2 (-4.9%) were associated with a lower probability of receiving both chemotherapy and breast surgery. Not receiving both treatments (vs. receiving both chemotherapy and breast surgery) was associated with a two-to-three-fold higher probability of rrTNBC among patients aged older than 75 years (16.6% vs. 6%), having Medicare (3.6% vs. 1.6%), and Charlson-Deyo score ≥2 (16.6% vs. 5.9%)., Conclusions: Age, insurance, and comorbidity were related to a lower likelihood of treatment; yet receiving treatment reduced the risk of rrTNBC threefold for each. These findings might be valuable to inform clinical care delivery, as well as future research that examines treatment protocols among diverse patients., (© 2024. The Author(s).)

Individuals who have Long COVID may have unique perspectives about COVID-19 vaccination due to the significant impact that COVID-19 has had on their lives. However, little is known about the specific vaccination perspectives among this patient population. The goal of our study was to improve our understanding of perspectives about COVID-19 vaccines among individuals with Long COVID. Interviews were conducted with patients receiving care at a post-COVID recovery clinic. Deductive thematic analysis was used to characterize participant perspectives according to the vaccine acceptance continuum framework, which recognizes a spectrum from vaccine acceptance to refusal. From interviews with 21 patients, we identified perspectives across the continuum of vaccine acceptance. These perspectives included acceptance of vaccines to prevent future illness, concerns about vaccine side effects on Long COVID symptoms, and refusal of vaccines due to perceived natural immunity. A limitation of our study is that these perspectives are specific to individuals receiving care at one post-COVID recovery clinic. In conclusion, our study demonstrates that some patients with Long COVID are uncertain about COVID-19 vaccines and boosters but may also be amenable to conversations that impact future vaccination acceptance. Patient perspectives should be considered when communicating recommendations for COVID-19 vaccinations to this population.

Purpose: Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes., Methods: Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria., Results: Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs., Conclusions: Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups., Implications for Cancer Survivors: SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities., (© 2024. The Author(s).)

Background: Little is known about how to best evaluate, diagnose, and treat long COVID, which presents challenges for patients as they seek care., Objective: Understand experiences of patients as they navigate care for long COVID., Design: Qualitative study involving interviews with patients about topics related to seeking and receiving care for long COVID., Participants: Eligible patients were at least 18 years of age, spoke English, self-identified as functioning well prior to COVID infection, and reported long COVID symptoms continued to impact their lives at 3 months or more after a COVID infection., Approach: Patients were recruited from a post-COVID recovery clinic at an academic medical center from August to September 2022. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis., Key Results: Participants (n=21) reported experiences related to elements of care coordination: access to care, evaluation, treatment, and ongoing care concerns. Some patients noted access to care was facilitated by having providers that listened to and validated their symptoms; other patients reported feeling their access to care was hindered by providers who did not believe or understand their symptoms. Patients reported confusion around how to communicate their symptoms when being evaluated for long COVID, and they expressed frustration with receiving test results that were normal or diagnoses that were not directly attributed to long COVID. Patients acknowledged that clinicians are still learning how to treat long COVID, and they voiced appreciation for providers who are willing to try new treatment approaches. Patients expressed ongoing care concerns, including feeling there is nothing more that can be done, and questioned long-term impacts on their aging and life expectancy., Conclusions: Our findings shed light on challenges faced by patients with long COVID as they seek care. Healthcare systems and providers should consider these challenges when developing strategies to improve care coordination for patients with long COVID., (© 2024. The Author(s).)

Background: Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown., Objective: We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation., Methods: We conducted semistructured interviews of >50% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis., Results: Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it., Conclusions: Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed., (©Megan E Gregory, Weidan Cao, Saurabh Rahurkar, Pallavi Jonnalagadda, James C Stock, Sanam M Ghazi, Endia Reid, Abigail L Berk, Courtney Hebert, Lang Li, Daniel Addison. Originally published in JMIR Cancer (https://cancer.jmir.org), 12.12.2023.)

Introduction: This study examines the association between hospital volume and all-cause mortality in Black women with triple negative breast cancer (TNBC) who received surgery and chemotherapy., Methods: Black women ages 18+ with stage I-III TNBC who received both surgery and chemotherapy were identified in the National Cancer Database (NCDB). Hospital volume was determined using the number of annual breast cancer cases divided by the number of years the hospital participated in the NCDB. Hospital annual volume quartiles ranged from Q 1 (lowest) to Q 4 (highest). Univariable analysis and multivariable logistic regression modeling with restricted cubic splines examined the effect of hospital volume on all-cause mortality., Results: Sixteen thousand five hundred fifty-six patients met the study criteria. All-cause mortality incidence was lower at higher volume compared to lower volume hospitals Q 1 24.1% (95% CI: 22.8 to 25.4), Q 2 21.8% (95% CI: 20.5 to 23.1), Q 3 20.9% (95% CI: 19.6 to 22.1), Q 4 19.0% (95% CI: 17.7 to 20.1), p<0.001. On multivariable analysis, treatment at the highest hospital volume quartile was associated with a 21% reduction in the odds of death compared to the lowest quartile [Q 4 Vs. Q 1 , OR=0.79 (95% CI: 0.67 to 0.92)]. For every 100-patient increase in annual volume, all-cause mortality was reduced by 4% [OR=0.96 (95% CI: 0.94 to 0.98)]. There was a significant linear dose-dependent relationship between increasing hospital volume and all-cause mortality., Conclusion: Black women treated at high-volume hospitals have lower all-cause mortality than those at low-volume hospitals. Future studies should examine the characteristics of high-volume hospitals associated with improved outcomes., (© 2023. W. Montague Cobb-NMA Health Institute.)

Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC., (© Society of Behavioral Medicine 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The COVID-19 pandemic poses a significant risk for immunosuppressed groups such as transplant patients. The purpose of this study was to improve our understanding of the impact of the COVID-19 pandemic on kidney transplant recipients, including their views on COVID-19 vaccination. Semi-structured interviews were conducted from December 2021 to August 2022 with 38 kidney transplant recipients who had an appointment with their transplant care team within the previous 6 months. We used qualitative thematic analysis to characterize the perspectives of interviewees. Regardless of COVID-19 vaccination status, most interviewees reported utilizing public health measures such as masking, hand washing, and avoiding crowds to protect themselves against COVID-19. Vaccinated interviewees ( n = 31) noted that they chose to receive a COVID-19 vaccine because of their increased risk due to their immunocompromised state. For unvaccinated interviewees ( n = 7), reasons for not receiving a COVID-19 vaccine included concerns about the safety and efficacy of the vaccine. Both vaccinated and unvaccinated interviewees expressed concerns about the lack of adequate testing of the vaccine in transplant patients and questioned if the vaccine might have unknown side effects for transplant recipients. Regardless of the vaccination status, most interviewees noted having trust in their healthcare team. Interviewees also described interpersonal tensions that arose during the pandemic, many of which surrounded vaccination and other preventive measures that were important to participants to protect their health. Together, these data demonstrate differing concerns and experiences related to the COVID-19 pandemic for vaccinated and unvaccinated transplant recipients. These findings highlight the unique needs of transplant recipients and reveal opportunities to support this vulnerable patient population in efforts to protect their health as the COVID-19 pandemic evolves.

Background: Interoperability-the exchange and integration of data across the health care system-remains a challenge despite ongoing policy efforts aimed at promoting interoperability., Objective: This study aimed to identify current challenges and opportunities to advancing interoperability across stakeholders., Methods: Primary data were collected through qualitative, semistructured interviews with stakeholders (n=24) in Ohio from July to October 2021. Interviewees were sampled using a stratified purposive sample of key informants from 4 representative groups as follows: acute care and children's hospital leaders, primary care providers, behavioral health providers, and regional health information exchange networks. Interviews focused on key informant perspectives on electronic health record implementation, the alignment of public policy with organizational strategy, interoperability implementation challenges, and opportunities for health information technology. The interviews were transcribed verbatim followed by rigorous qualitative analysis using directed content analysis., Results: The findings illuminate themes related to challenges and opportunities for interoperability that align with technological (ie, implementation challenges, mismatches in interoperability capabilities across stakeholders, and opportunities to leverage new technology and integrate social determinants of health data), organizational (ie, facilitators of interoperability and strategic alignment of participation in value-based payment programs with interoperability), and environmental (ie, policy) domains., Conclusions: Interoperability, although technically feasible for most providers, remains challenging for technological, organizational, and environmental reasons. Our findings suggest that the incorporation of end user considerations into health information technology development, implementation, policy, and standard deployment may support interoperability advancement., (©Daniel M Walker, Willi L Tarver, Pallavi Jonnalagadda, Lorin Ranbom, Eric W Ford, Saurabh Rahurkar. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 24.02.2023.)

Background: A subset of triple-negative breast cancer (TNBC) is characterized by aggressive disease, rapid relapse, and mortality within 24 months of diagnosis, termed "rapid relapse" TNBC (rrTNBC). The objective of this study is to define the association between sociodemographic variables and surgical management among rrTNBC patients in the Surveillance, Epidemiology and End Results (SEER) Program., Methods: TNBC patients diagnosed from January 1, 2010 to December 31, 2014 with local or regional disease were identified in SEER. Patients were stratified as rrTNBC, defined as disease specific mortality ≤ 24 months after diagnosis, and non-rrTNBC. Chi-squared tests, t tests, and multivariable logistic regression were used to assess the association of rapid relapse with sociodemographic variables and surgical management., Results: The cohort included 8% (1378/17,369) rrTNBCs. A higher proportion of rrTNBC patients had no surgery (11.7%) compared with non-rrTNBC (2.6%). Omission of axillary staging among patients who had surgery was 6.2% rrTNBC versus 4.5% non-rrTNBC. Black race (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05-1.43; p = 0.01; white ref), Medicaid or no insurance (Medicaid OR 1.53, 95% CI 1.31-1.79; p < 0.001; no insurance OR 1.74, 95% CI 1.31-2.32; p < 0.001; private ref), single status (OR 1.19, 95% CI 1.01-1.39; p = 0.03; married ref), no breast (OR 2.35, 95% CI 1.77-3.11; p < 0.001; mastectomy ref), and no axillary surgery (OR 1.44, 95% CI 1.13-1.83; p = 0.003 axillary surgery ref) were associated with rapid relapse., Conclusions: Medicaid or no insurance, single status, black race, and no surgery are associated with higher odds of rrTNBC in SEER. These results indicate an interplay between socioeconomic factors, clinical and genomic variables may be disproportionately contributing to worse outcomes among a subset of TNBC patients., (© 2021. Society of Surgical Oncology.)

Background: Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer Moonshot SM -funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics., Methods: Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs., Results: Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components., Conclusions: Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years., Trial Registration: Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.

Background: While researchers seek to use administrative health data to examine outcomes for individuals with sexually transmitted infections (STIs), the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes used to identify persons with chlamydia and gonorrhea have not been validated. Objectives were to determine the validity of using ICD-10-CM codes to identify individuals with chlamydia and gonorrhea., Methods: We used data from electronic health records gathered from public and private health systems from October 1, 2015, to December 31, 2016. Patients were included if they were aged 13 to 44 years and received either (1) laboratory testing for chlamydia or gonorrhea or (2) an ICD-10-CM diagnosis of chlamydia, gonorrhea, or an unspecified STI. To validate ICD-10-CM codes, we calculated positive and negative predictive values, sensitivity, and specificity based on the presence of a laboratory test result. We further examined the timing of clinical diagnosis relative to laboratory testing., Results: The positive predictive values for chlamydia, gonorrhea, and unspecified STI ICD-10-CM codes were 87.6%, 85.0%, and 32.0%, respectively. Negative predictive values were high (>92%). Sensitivity for chlamydia diagnostic codes was 10.6%, and gonorrhea was 9.7%. Specificity was 99.9% for both chlamydia and gonorrhea. The date of diagnosis occurred on or after the date of the laboratory result for 84.8% of persons with chlamydia, 91.9% for gonorrhea, and 23.5% for unspecified STI., Conclusions: Disease-specific ICD-10-CM codes accurately identify persons with chlamydia and gonorrhea. However, low sensitivities suggest that most individuals could not be identified in administrative data alone without laboratory test results., Competing Interests: Conflict of Interest and Sources of Funding: The authors report no conflicts of interest. This work was supported by a contract from the US Centers for Disease Control and Prevention (contract number: 2017-Q-67119) and a grant from the US National Library of Medicine (grant number: T15LM012502). The views expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the Centers for Disease Control and Prevention, National Library of Medicine, or the US government., (Copyright © 2020 American Sexually Transmitted Diseases Association. All rights reserved.)

Prior research on health information exchange (HIE) typically measured provider usage through surveys or they summarized the availability of HIE services in a healthcare organization. Few studies utilized user log files. Using HIE access log files, we measured HIE use in real-world clinical settings over a 7-year period (2011-2017). Use of HIE increased in inpatient, outpatient, and emergency department (ED) settings. Further, while extant literature has generally viewed the ED as the most relevant setting for HIE, the greatest change in HIE use was observed in the inpatient setting, followed by the ED setting and then the outpatient setting. Our findings suggest that in addition to federal incentives, the implementation of features that address barriers to access (eg, Single Sign On), as well as value-added services (eg, interoperability with external data sources), may be related to the growth in user-initiated HIE., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: International Classification of Diseases (ICD) codes in administrative health data are used to identify cases of disease, including sexually transmitted infections (STIs), for population health research. The purpose of this review is to examine the extant literature on the reliability of ICD codes to correctly identify STIs., Methods: We conducted a systematic review of empirical articles in which ICD codes were validated with respect to their ability to identify cases of chlamydia, gonorrhoea, syphilis or pelvic inflammatory disease (PID). Articles that included sensitivity, specificity and positive predictive value of ICD codes were the target. In addition to keyword searches in PubMed and Scopus databases, we further examined bibliographies of articles selected for full review to maximise yield., Results: From a total of 1779 articles identified, only two studies measured the reliability of ICD codes to identify cases of STIs. Both articles targeted PID, a serious complication of chlamydia and gonorrhoea. Neither article directly assessed the validity of ICD codes to identify cases of chlamydia, gonorrhoea or syphilis independent of PID. Using ICD codes alone, the positive predictive value for PID was mixed (range: 18%-79%)., Discussion and Conclusion: While existing studies have used ICD codes to identify STI cases, their reliability is unclear. Further, available evidence from studies of PID suggests potentially large variation in the accuracy of ICD codes indicating the need for primary studies to evaluate ICD codes for use in STI-related public health research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Despite efforts aimed at improving the integration of clinical data from health information exchanges (HIE) and electronic health records (EHR), interoperability remains limited. Barriers due to inefficiencies and workflow interruptions make using HIE data during care delivery difficult. Capitalizing on the development of the Fast Healthcare Interoperability Resource (FHIR) specification, we designed and developed a Chest Pain Dashboard that integrates HIE data into EHRs. This Dashboard was implemented in one emergency department (ED) of Indiana University Health in Indiana. In this paper, we present the preliminary findings from a mixed-methods evaluation of the Dashboard. A difference-in-difference analysis suggests that the ED with the Dashboard implementation resulted in a significant increase in HIE use compared to EDs without. This finding was supported by qualitative interviews. While these results are encouraging, we also identified areas for improvement. FHIR-based solutions may offer promising approaches to encourage greater accessibility and use of HIE data.

Objective: Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE., Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome., Results: Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects., Conclusions: The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.

Traumatic brain injury (TBI), spinal cord injury (SCI) and stroke are conditions of interest to public health as they can result in long-term outcomes and disabilities. Specialized registries can facilitate public health surveillance, however only 4% of hospitals in the United States actively engage in electronic reporting to these registries. We leveraged electronic claims and clinical data from a health information exchange to create a statewide TBI/SCI/Stroke registry to facilitate the study of long-term outcomes and health services utilization. The registry contains 109,943 TBI patients, 9,027 SCI patients and 117,084 stroke patients with a mean of 3 years of follow-up data after injury. Additionally, the registry contains data on individual patient encounters, prescriptions and clinical variables. The high-dimensional data with large sample sizes may present a valuable informatics resource for injury research as well as public health surveillance.

Background: Internet search is the most common activity on the World Wide Web and generates a vast amount of user-reported data regarding their information-seeking preferences and behavior. Although this data has been successfully used to examine outbreaks, health care utilization, and outcomes related to quality of care, its value in informing public health policy remains unclear., Objective: The aim of this study was to evaluate the role of Internet search query data in health policy development. To do so, we studied the public's reaction to a major societal event in the context of the 2012 Sandy Hook School shooting incident., Methods: Query data from the Yahoo! search engine regarding firearm-related searches was analyzed to examine changes in user-selected search terms and subsequent websites visited for a period of 14 days before and after the shooting incident., Results: A total of 5,653,588 firearm-related search queries were analyzed. In the after period, queries increased for search terms related to "guns" (+50.06%), "shooting incident" (+333.71%), "ammunition" (+155.14%), and "gun-related laws" (+535.47%). The highest increase (+1054.37%) in Web traffic was seen by news websites following "shooting incident" queries whereas searches for "guns" (+61.02%) and "ammunition" (+173.15%) resulted in notable increases in visits to retail websites. Firearm-related queries generally returned to baseline levels after approximately 10 days., Conclusions: Search engine queries present a viable infodemiology metric on public reactions and subsequent behaviors to major societal events and could be used by policymakers to inform policy development., (©Nir Menachemi, Saurabh Rahurkar, Mandar Rahurkar. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 23.03.2017.)

Background and Objective: The Health Information Technology for Economic and Clinical Health (HITECH) Act has distributed billions of dollars to physicians as incentives for adopting certified electronic health records (EHRs) through the meaningful use (MU) program ultimately aimed at improving healthcare outcomes. The authors examine the extent to which the MU program impacted the EHR adoption curve that existed prior to the Act., Methods: Bass and Gamma Shifted Gompertz (G/SG) diffusion models of the adoption of "Any" and "Basic" EHR systems in physicians' offices using consistent data series covering 2001-2013 and 2006-2013, respectively, are estimated to determine if adoption was stimulated during either a PrePay (2009-2010) period of subsidy anticipation or a PostPay (2011-2013) period when payments were actually made., Results: Adoption of Any EHR system may have increased by as much as 7 percentage points above the level predicted in the absence of the MU subsidies. This estimate, however, lacks statistical significance and becomes smaller or negative under alternative model specifications. No substantial effects are found for Basic systems. The models suggest that adoption was largely driven by "imitation" effects (q-coefficient) as physicians mimic their peers' technology use or respond to mandates. Small and often insignificant "innovation" effects (p-coefficient) are found suggesting little enthusiasm by physicians who are leaders in technology adoption., Conclusion: The authors find weak evidence of the impact of the MU program on EHR uptake. This is consistent with reports that many current EHR systems reduce physician productivity, lack data sharing capabilities, and need to incorporate other key interoperability features (e.g., application program interfaces)., (© The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Health information exchange (HIE), which is the transfer of electronic information such as laboratory results, clinical summaries, and medication lists, is believed to boost efficiency, reduce health care costs, and improve outcomes for patients. Stimulated by federal financial incentives, about two-thirds of hospitals and almost half of physician practices are now engaged in some type of HIE with outside organizations. To determine how HIE has affected such health care measures as cost, service use, and quality, we identified twenty-seven scientific studies, extracted selected characteristics from each, and meta-analyzed these characteristics for trends. Overall, 57 percent of published analyses reported some benefit from HIE. However, articles employing study designs having strong internal validity, such as randomized controlled trials or quasi-experiments, were significantly less likely than others to associate HIE with benefits. Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits. Furthermore, these two studies had narrower focuses than the others. Overall, little generalizable evidence currently exists regarding benefits attributable to HIE., (Project HOPE—The People-to-People Health Foundation, Inc.)

Objectives: We conducted a systematic review of the literature examining the relationship between built environments (e.g., parks, trails, sidewalks) and physical activity (PA) or obesity rates., Methods: We performed a 2-step inclusion protocol to identify empirical articles examining any form of built environment and any form of PA (or obesity rate) as the outcome. We extracted data from included abstracts for analysis by using a standard code sheet developed for this study., Results: Of 169 included articles, 89.2% reported beneficial relationships-but virtually all articles utilized simple observational study designs not suited for determining causality. Studies utilizing objective PA measures (e.g., pedometer) were 18% less likely to identify a beneficial relationship. Articles focusing on children in community settings (-14.2%), those examining direct measures of obesity (-6.2%), or those with an academic first author (-3.4%) were less likely to find a beneficial relationship., Conclusions: Policymakers at federal and local levels should encourage more rigorous scientific research to determine whether altered built environments will result in increased PA and decreased obesity rates.