Knowledge and Encounter Research Unit

College Place, United States

Knowledge and Encounter Research Unit

College Place, United States
SEARCH FILTERS
Time filter
Source Type

Mahmoud K.D.,Mayo Medical School | Mahmoud K.D.,University of Groningen | Lennon R.J.,Mayo Medical School | Ting H.H.,Mayo Medical School | And 3 more authors.
JACC: Cardiovascular Interventions | Year: 2011

Objectives: We sought to determine the circadian, weekly, and seasonal variation of coronary stent thrombosis. Background: Other adverse cardiovascular events such as acute myocardial infarction are known to have higher incidences during the early morning hours, Mondays, and winter months. Methods: The Mayo Clinic Percutaneous Coronary Intervention Registry was searched for patients admitted to our center who underwent repeat percutaneous coronary intervention in a previously stented coronary artery segment. Stent thrombosis was confirmed by angiographic review, and date and time of symptom onset were obtained from medical records. Results: We identified 124 patients with definite stent thrombosis and known date and time of symptom onset. In these patients, onset of stent thrombosis was significantly associated with time of day (p = 0.006), with a peak incidence around 7:00 am. When patients were subdivided into early stent thrombosis (0 to 30 days; n = 49), late stent thrombosis (31 to 360 days; n = 30), and very late stent thrombosis (>360 days; n = 45), only early stent thrombosis remained significantly associated with time of day (p = 0.030). No association with the day of the week was found (p = 0.509); however, onset of stent thrombosis did follow a significant seasonal pattern, with higher occurrences in the summer (p = 0.036). Conclusions: Coronary stent thrombosis occurs more often in the early morning hours. Early stent thrombosis follows a circadian rhythm with a peak at 7:00 am. This pattern was not significant in late and very late stent thrombosis. Occurrences throughout the week were equally distributed, but stent thrombosis was more likely to occur in the summer months. © 2011 American College of Cardiology Foundation.


Dorn S.D.,University of North Carolina at Chapel Hill | Shah N.D.,Knowledge and Encounter Research Unit
Digestive Diseases and Sciences | Year: 2010

Objective: To determine whether outcomes for patients admitted with UGIH differ depending on weekend versus weekday admission, and whether any such differences are mediated by discrepancies in the use and timing of endoscopy. Methods: This was a cross-sectional comparison of mortality, resource use, and the utilization and timing of esophagogastroduodenoscopy (EGD) among patients admitted with upper gastrointestinal hemorrhage (UGIH) on weekends to those admitted on a weekday. Hospitals in 31 states from the Nationwide Inpatient Sample between 1998 and 2003 were included. This resulted in 75,636 patients admitted during the week and 23,339 admitted on a weekend with UGIH. Multivariable analyses were conducted to evaluate the effect of weekend admission on UGIH outcomes. Results: Compared to patients admitted on a weekday, for those admitted on a weekend: in-hospital mortality was higher (unadjusted mortality 3.76 vs. 3.33%; P = 0.003; adjusted HR = 1.09, 95% CI = 1.00-1.18); adjusted length of stay was 1.7% longer (P = 0.0098); and adjusted in-hospital charges were 3.3% higher (P = 0.0038). Although these patients were less likely to undergo endoscopy (adjusted OR = 0.94; P = 0.004) and waited longer for this procedure (adjusted HR = 0.87; P < 0.001), these discrepancies did not fully explain their inferior outcomes. Conclusions: Weekend admission for UGIH is associated with an increased risk of death, slightly longer lengths of stay, and marginally higher in-patient charges. Discrepancies in the use and timing of endoscopy do not account for these differences. © 2009 Springer Science+Business Media, LLC.


Sim L.A.,Mayo Medical School | Elamin M.B.,Knowledge and Encounter Research Unit | Swiglo B.A.,Knowledge and Encounter Research Unit | Erwin P.J.,Mayo Clinic Libraries | Montori V.M.,Knowledge and Encounter Research Unit
International Journal of Eating Disorders | Year: 2010

Objective: Because estrogen therapies are widely prescribed for amenorrhea associated with anorexia nervosa (AN), we conducted a systematic review and meta-analyses to estimate the influence of estrogen preparations (EP) on bone mineral density in women with AN. Method: Prospective cohort studies and randomized clinical trials (RCTs) comparing the effect of EP use to no treatment or placebo on bone mineral density and bone fractures were included. Independent reviewers selected studies for inclusion and extracted study characteristics, markers of methodologic quality, and outcomes for the intentionto-treat population. Results: Using random-effects metaanalyses and inconsistency across trials using the I2 statistic, data were combined across two eligible prospective cohort studies and four RCTs; none reported effects on bone fractures. Compared with placebo or no treatment, low quality evidence found EPs have a moderate effect on bone mineral density in the lumbar spine [ES (effect size) 0.33, 95% CI (confidence interval) 0.09, 0.56; I2 = 0%)], but no significant effect on the femoral neck (ES 0.13, 95% CI -0.16, 0.43; I2 = 0%). There were no significant treatment-subgroup interactions. Discussion: In general, EPs have uncertain benefit and should be avoided by women with AN in whom the success of weight and nutritional rehabilitation is judged by menses resumption. © 2009 by Wiley Periodicals, Inc.


Caples S.M.,Center for Sleep Medicine | Rowley J.A.,Harper University Hospital | Pallanch J.F.,Mayo Medical School | Elamin M.B.,Knowledge and Encounter Research Unit | Harwick J.D.,University of Florida
Sleep | Year: 2010

A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.


Murad M.H.,Mayo Medical School | Murad M.H.,Knowledge and Encounter Research Unit | Coto-Yglesias F.,SAN security | Varkey P.,Mayo Medical School | And 2 more authors.
Medical Education | Year: 2010

Objectives Given the continuous advances in the biomedical sciences, health care professionals need to develop the skills necessary for life-long learning. Self-directed learning (SDL) is suggested as the methodology of choice in this context. The purpose of this systematic review is to determine the effectiveness of SDL in improving learning outcomes in health professionals. Methods We searched MEDLINE, EMBASE, ERIC and PsycINFO through to August 2009. Eligible studies were comparative and evaluated the effect of SDL interventions on learning outcomes in the domains of knowledge, skills and attitudes. Two reviewers working independently selected studies and extracted data. Standardised mean difference (SMD) and 95% confidence intervals (95% CIs) were estimated from each study and pooled using random-effects meta-analysis. Results The final analysis included 59 studies that enrolled 8011 learners. Twenty-five studies (42%) were randomised. The overall methodological quality of the studies was moderate. Compared with traditional teaching methods, SDL was associated with a moderate increase in the knowledge domain (SMD 0.45, 95% CI 0.23-0.67), a trivial and non-statistically significant increase in the skills domain (SMD 0.05, 95% CI 0.05 to 0.22), and a non-significant increase in the attitudes domain (SMD 0.39, 95% CI -0.03 to 0.81). Heterogeneity was significant in all analyses. When learners were involved in choosing learning resources, SDL was more effective. Advanced learners seemed to benefit more from SDL. Conclusions Moderate quality evidence suggests that SDL in health professions education is associated with moderate improvement in the knowledge domain compared with traditional teaching methods and may be as effective in the skills and attitudes domains. © Blackwell Publishing Ltd 2010.


Gallacher K.,University of Glasgow | Morrison D.,University of Glasgow | Jani B.,University of Glasgow | Macdonald S.,University of Glasgow | And 8 more authors.
PLoS Medicine | Year: 2013

Background:Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.Methods and Findings:The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.Conclusions:Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.Systematic Review Registration:International Prospective Register of Systematic Reviews CRD42011001123 Please see later in the article for the Editors' Summary. © 2013 Gallacher et al.


Mann D.M.,Mount Sinai School of Medicine | Ponieman D.,Mount Sinai School of Medicine | Montori V.M.,Knowledge and Encounter Research Unit | Arciniega J.,Mount Sinai School of Medicine | McGinn T.,Mount Sinai School of Medicine
Patient Education and Counseling | Year: 2010

Objective: To assess the impact of a decision aid on perceived risk of heart attacks and medication adherence among urban primary care patients with diabetes. Methods: We randomly allocated 150 patients with diabetes to participate in a usual primary care visit either with or without the Statin Choice tool. Participants completed a questionnaire at baseline and telephone follow-up at 3 and 6 months. Results: Intervention patients were more likely to accurately perceive their underlying risk for a heart attack without taking a statin (OR: 1.9, CI: 1.0-3.8) and with taking a statin (OR: 1.4, CI: 0.7-2.8); a decline in risk overestimation among patients receiving the decision aid accounts for this finding. There was no difference in statin adherence at 3 or 6 months. Conclusion: A decision aid about using statins to reduce coronary risk among patients with diabetes improved risk communication, beliefs, and decisional conflict, but did not improve adherence to statins. Practice implications: Decision aid enhanced communication about the risks and benefits of statins improved patient risk perceptions but did not alter adherence among patients with diabetes. © 2009 Elsevier Ireland Ltd.


Cook D.A.,Rochester College | Garside S.,McMaster University | Levinson A.J.,McMaster University | Dupras D.M.,Rochester College | And 2 more authors.
Medical Education | Year: 2010

Medical Education 2010: 44: 765-774 Objectives Educators often speak of web-based learning (WBL) as a single entity or a cluster of similar activities with homogeneous effects. Yet a recent systematic review demonstrated large heterogeneity among results from individual studies. Our purpose is to describe the variation in configurations, instructional methods and presentation formats in WBL. Methods We systematically searched MEDLINE, EMBASE, ERIC, CINAHL and other databases (last search November 2008) for studies comparing a WBL intervention with no intervention or another educational activity. From eligible studies we abstracted information on course participants, topic, configuration and instructional methods. We summarised this information and then purposively selected and described several WBL interventions that illustrate specific technologies and design features. Results We identified 266 eligible studies. Nearly all courses (89%) used written text and most (55%) used multimedia. A total of 32% used online communication via e-mail, threaded discussion, chat or videoconferencing, and 9% implemented synchronous components. Overall, 24% blended web-based and non-computer-based instruction. Most web-based courses (77%) employed specific instructional methods, other than text alone, to enhance the learning process. The most common instructional methods (each used in nearly 50% of courses) were patient cases, self-assessment questions and feedback. We describe several studies to illustrate the range of instructional designs. Conclusions Educators and researchers cannot treat WBL as a single entity. Many different configurations and instructional methods are available for WBL instructors. Researchers should study when to use specific WBL designs and how to use them effectively. © Blackwell Publishing Ltd 2010.


Jabre P.,Mayo Medical School | Jabre P.,University of Paris Descartes | Roger V.L.,Mayo Medical School | Murad M.H.,Knowledge and Encounter Research Unit | And 4 more authors.
Circulation | Year: 2011

Background-: Atrial fibrillation (AF) is a common finding in patients with myocardial infarction (MI). Atrial fibrillation is not generally perceived by clinicians as a critical event during the acute phase of MI; however, its prognostic influence in MI remains controversial. Furthermore, contradictory data exist concerning the risk of death according to AF timing. This article, a systematic review and first meta-analysis, aims to quantify the mortality risk associated with AF in MI patients and its timing. Methods and results-: A comprehensive search of several electronic databases (1970 to 2010; adults, any language) identified MI studies that evaluated mortality related to AF. Evidence was reviewed by 2 blinded reviewers with a formal assessment of the methodological quality of the studies. Adjusted odds ratios were pooled across studies using the random-effects model. The I statistic was used to assess heterogeneity. In the 43 included studies (278 854 subjects), the mortality odds ratio associated with AF was 1.46 (95% confidence interval, 1.35 to 1.58; I=76%; 23 studies). This worse prognosis persisted regardless of the timing of AF; the odds ratio of mortality for new AF with no prior history of AF was 1.37 (95% confidence interval, 1.26 to 1.49), I=28%, 9 studies), and for prior AF was 1.28 (95% confidence interval, 1.16 to 1.40; I=24%; 4 studies). The sensitivity analysis of new AF studies adjusting for confounding factors did not show a decrease in risk of death. Conclusions-: Atrial fibrillation is associated with increased risk of mortality in MI patients. New AF with no history of AF before MI remained associated with an increased risk of mortality even after adjustment for several important AF risk factors. These subsequent increases in mortality suggest that AF can no longer be considered a nonsevere event during MI. © 2011 American Heart Association, Inc.


Gallacher K.,University of Glasgow | May C.R.,University of Southampton | Montori V.M.,Knowledge and Encounter Research Unit | Mair F.S.,University of Glasgow
Annals of Family Medicine | Year: 2011

PURPOSE Our goal was to assess the burden associated with treatment among patients living with chronic heart failure and to determine whether Normalization Process Theory (NPT) is a useful framework to help describe the components of treatment burden in these patients. METHODS We performed a secondary analysis of qualitative interview data, using framework analysis, informed by NPT, to determine the components of patient "work." Participants were 47 patients with chronic heart failure managed in primary care in the United Kingdom who had participated in an earlier qualitative study about living with this condition. We identified and examined data that fell outside of the coding frame to determine if important concepts or ideas were being missed by using the chosen theoretical framework. RESULTS We were able to identify and describe components of treatment burden as distinct from illness burden using the framework. Treatment burden in chronic heart failure includes the work of developing an understanding of treatments, interacting with others to organize care, attending appointments, taking medications, enacting lifestyle measures, and appraising treatments. Factors that patients reported as increasing treatment burden included too many medications and appointments, barriers to accessing services, fragmented and poorly organized care, lack of continuity, and inadequate communication between health professionals. Patient "work" that fell outside of the coding frame was exclusively emotional or spiritual in nature. CONCLUSIONS We identified core components of treatment burden as reported by patients with chronic heart failure. The findings suggest that NPT is a theoretical framework that facilitates understanding of experiences of health care work at the individual, as well as the organizational, level. Although further exploration and patient endorsement are necessary, our findings lay the foundation for a new target for treatment and quality improvement efforts toward patientcentered care.

Loading Knowledge and Encounter Research Unit collaborators
Loading Knowledge and Encounter Research Unit collaborators