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Imperiale T.F.,Indiana University | Imperiale T.F.,The Regenstrief Institute Inc.
International Journal of Medical Informatics | Year: 2011

Purpose: To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation. Methods: We used 4 alternating 4-week periods to compare the decision tool with usual care for outpatient colonoscopy. All decision tool decisions were reviewed in real-time by gastroenterology nurses and/or physicians. Patients completed a survey about the prep process. Endoscopists blindly rated prep quality. Colonoscopy duration and findings were recorded. Results: Of 354 persons in the decision tool group, 4 prep decisions were overridden because of patient preference or prior prep failure, but none for medical reasons. Sodium phosphate was used more frequently in the decision tool group (73% vs. 41%; P<0.01). There was no difference between the decision tool and usual care groups in the composite outcome (26% vs. 30%, respectively; P=0.29), acceptable prep quality (62% vs. 56%; P=0.22), colonoscopy duration (28 vs. 30. min; P=0.17), patient satisfaction (P=0.38), or preparation tolerance (P=0.37). Conclusions: An electronic medical record-based decision tool can safely and effectively tailor the prep for colonoscopy and may improve colonoscopy efficiency and patient satisfaction. Limitations: This study was performed at a single VA medical center and endoscopy unit, relies on the presence of relevant medical conditions and laboratory data in the electronic medical record, and had a higher than expected use of sodium phosphate during usual care. © 2011 Elsevier Ireland Ltd.


Islas-Granillo H.,Autonomous University of the State of Hidalgo | Borges-Yanez S.A.,National Autonomous University of Mexico | Medina-Solis C.E.,Autonomous University of the State of Hidalgo | Casanova-Rosado A.J.,Autonomous University of Campeche | And 5 more authors.
Geriatrics and Gerontology International | Year: 2012

Aim: To determine the prevalence of root caries and the root caries index in a population of older Mexicans, and its relationship to socioeconomic, sociodemographic and dental factors. Methods: We carried out a cross-sectional study in 85 persons 60years and older living either in long-term care facilities, or independently and attending an elder day-care group. Each subject underwent an oral examination, performed by a trained and standardized dentist, to determine the root caries index and other clinical variables. Questionnaires were administered to collect socioeconomic, sociodemographic and hygiene data. Statistical analyses were performed using non-parametric tests. Results: The prevalence of root caries was 96.5%. The root caries index was 37.7%±21.7%. Statistically significant differences (P<0.05) of root caries index were observed across residential arrangements and marital statuses, and were higher in publicly funded long-term care and among single subjects (P<0.05). Those who had poor hygiene had more root caries (P<0.05); persons with a low level of schooling and who brushed their teeth less frequently also showed a difference (P<0.05). Conclusions: The prevalence of root caries was very high. The type of long-term care, marital status, schooling and oral hygiene were associated with a higher root caries index. Oral health programs and preventive caries interventions are needed for this age group in general; targeted strategies may be better focused if sociodemographic profiles are used to characterize high need groups. © 2011 Japan Geriatrics Society.


Islas-Granillo H.,Autonomous University of the State of Hidalgo | Borges-Yanez S.A.,National Autonomous University of Mexico | Lucas-Rincon S.E.,Autonomous University of the State of Hidalgo | Medina-Solis C.E.,Autonomous University of the State of Hidalgo | And 4 more authors.
Archives of Gerontology and Geriatrics | Year: 2011

The objective of this study was to determine the prevalence of edentulism in Mexican elders aged 60 years and older, and the associated risk indicators. A cross-sectional study was undertaken in 139 elders living in either of two long-term care (LTC) facilities, or attending an adult day center (ADC) in Pachuca, Mexico. A subject was edentulous when natural teeth were completely absent, determined through a clinical examination. Risk indicators were collected using questionnaires. Analyses were performed using binary logistic regression in STATA 9.0. Mean age was 79.0 ± 9.8 years. Many subjects were women (69.1%). The prevalence of edentulism was 36.7%. In multivariate analysis, after adjusting for age and sex, the variables that were inversely associated (p< 0.05) with edentulism were living with a spouse (odds ratio = OR = 0.31), and lacking health insurance (OR = 0.70). Variables associated with higher risk of being edentate were lower educational attainment (OR = 1.61), having received radiation therapy (OR = 4.49), being a smoker (OR = 4.82), and having diabetes (OR = 2.94) or other chronic illnesses (OR = 1.82) (with hypertension approaching significance, p= 0.067). In this sample of Mexican elders, diverse variables were associated with edentulism, in particular smoking and past radiotherapy. Oral health programs within and outside LTC/ADC should take into account risk factors specific to the older population. © 2010 Elsevier Ireland Ltd.


Pontigo-Loyola A.P.,Autonomous University of the State of Hidalgo | Medina-Solis C.E.,Autonomous University of the State of Hidalgo | Lara-Carrillo E.,National Autonomous University of Mexico | Patino-Marin N.,Autonomous University of San Luis Potosi | And 5 more authors.
Odontology | Year: 2014

The objective of this study is to determine the impact of socio-demographic, socioeconomic, and other risk indicators on dental fluorosis (DF) among Mexican adolescents. A cross-sectional study was carried out in 1,538 adolescents 12 and 15 years of age in semi-rural communities located at high altitude (>2,000 m) and with high concentration of fluoride in water (1.38-3.07 ppm) in Hidalgo, Mexico. DF was determined by means of Dean's Index and all teeth were examined. Remaining variables were collected using a questionnaire. The adjusted final model was performed using ordered logistic regression. After adjusting for sex, the variables associated with DF were (p < 0.05): being 12 years old (OR = 1.10) versus 15 years old; having lived the first 6 years of life in El Llano (3.07 F ppm) (OR = 3.19) or San Marcos (1.38 F ppm) (OR = 1.63) versus Tula (1.42 F ppm); having public (OR = 1.35) or private health insurance (OR = 1.36) versus those without insurance; belonging to the lower quartiles of socioeconomic position (SEP) [1st quartile (OR = 2.48), 2nd quartile (OR = 1.81), 3rd quartile (OR = 1.49)] versus the highest quartile; having drunk tap water (OR = 1.83) or from a well or spring (OR = 2.30) versus those who drank water purchased in large containers or bottles. Demographic and socioeconomic variables were associated with DF. While better SEP appeared to play an important role in DF, a pattern of water intake associated with water purchased in large containers or bottles (which have different connotations to the use of bottled water in industrialized Western countries) did reduce DF risk in these high fluoride content, high altitude communities. © 2012 The Society of The Nippon Dental University.


Hickner J.,Cleveland Clinic | Zafar A.,Indiana University | Zafar A.,The Regenstrief Institute Inc | Kuo G.M.,University of California at San Diego | And 13 more authors.
Annals of Family Medicine | Year: 2010

PURPOSE: In this study, we developed and field tested the Medication Error and Adverse Drug Event Reporting System (MEADERS)-an easy-to-use, Web-based reporting system designed for busy office practices. METHODS: We conducted a 10-week field test of MEADERS in which 220 physicians and office stafffrom 24 practices reported medication errors and adverse drug events they observed during usual clinical care. The main outcomes were (1) use and acceptability of MEADERS measured with a postreporting survey and interviews with office managers and lead physicians, and (2) distributions of characteristics of the medication event reports. RESULTS: A total of 507 anonymous event reports were submitted. The mean reporting time was 4.3 minutes. Of these reports, 357 (70%) included medication errors only, 138 (27%) involved adverse drug events only, and 12 (2.4%) included both. Medication errors were roughly equally divided among ordering medications, implementing prescription orders, errors by patients receiving the medications, and documentation errors. The most frequent contributors to the medication err ors and adverse drug events were communication problems (41%) and knowledge deficits (22%). Eight (1.6%) of the reported events led to hospitalization. Reporting raised staffand physician awareness of the kinds of errors that occur in office medication management; however, 36% agreed or strongly agreed that the event reporting "has increased the fear of repercussion in the practice." Time pressure was the main barrier to reporting. CONCLUSIONS: It is feasible for primary care clinicians and office staffto report medication errors and adverse drug events to a Web-based reporting system. Time pressures and a punitive culture are barriers to event reporting that must be overcome. Further testing of MEADERS as a quality improvement tool is warranted.


Villalobos-Rodelo J.J.,Area de Medicina Preventiva | Villalobos-Rodelo J.J.,Autonomous University of Sinaloa | Medina-Solis C.E.,Autonomous University of the State of Hidalgo | Verdugo-Barraza L.,Area de Medicina Preventiva | And 5 more authors.
Biomedica | Year: 2013

Introduction: Dental caries is one of the most common chronic childhood diseases worldwide. In Mexico it is a public health problem. Objective: To identify variables associated with caries occurrence (non-reversible and reversible lesions) in a sample of Mexican schoolchildren. Material and methods: We performed a cross-sectional study in 640 schoolchildren of 11 and 12 years of age. The dependent variable was the D1+2MFT index, comprising reversible and irreversible carious lesions (dental caries) according to the Pitts D1/D2 classification. Clinical examinations were performed by trained and standardized examiners. Using structured questionnaires we collected socio demographic, socio-economic and health-related oral behaviors. Negative binomial regression was used for the analysis. Results: The D1+2MFT index was 5.68±3.47. The schoolchildren characteristics associated with an increase in the expected average rate of dental caries were: being female (27.1%), having 12 years of age (23.2%), consuming larger amounts of sugar (13.9%), having mediocre (31.3%) and poor/very poor oral hygiene (62.3%). Conversely, when the family owned a car the expected mean D1+2MFT decreased 13.5%. Conclusions: When dental caries occurrence (about 6 decayed teeth) is estimated taking into consideration not only cavities (lesions in need of restorative dental treatment) but also incipient carious lesions, the character of this disease as a common clinical problem and as a public health problem are further emphasized. Results revealed the need to establish preventive and curative strategies in the sample.


del Socorro Herrera M.,National Autonomous University of Nicaragua, León | Medina-Solis C.E.,Autonomous University of the State of Hidalgo | Minaya-Sanchez M.,University of Campeche | Pontigo-Loyola A.P.,Autonomous University of the State of Hidalgo | And 5 more authors.
Medical Science Monitor | Year: 2013

Background: Our study aimed to evaluate the effect of various risk indicators for dental caries on primary teeth of Nicaraguan children (from Leon, Nicaragua) ages 6 to 9, using the negative binomial regression model. Material/Methods: A cross-sectional study was carried out to collect clinical, demographic, socioeconomic, and behavioral data from 794 schoolchildren ages 6 to 9 years, randomly selected from 25 schools in the city of León, Nicaragua. Clinical examinations for dental caries (dmft index) were performed by 2 trained and standardized examiners. Socio-demographic, socioeconomic, and behavioral data were self-reported using questionnaires. Multivariate negative binomial regression (NBR) analysis was used. Results: Mean age was 7.49±1.12 years. Boys accounted for 50.1% of the sample. Mean dmft was 3.54±3.13 and caries prevalence (dmft >0) was 77.6%. In the NBR multivariate model (p<0.05), for each year of age, the expected mean dmft decreased by 7.5%. Brushing teeth at least once a day and having received preventive dental care in the last year before data collection were associated with declines in the expected mean dmft by 19.5% and 69.6%, respectively. Presence of dental plaque increased the expected mean dmft by 395.5%. Conclusions: The proportion of students with caries in this sample was high. We found associations between dental caries in the primary dentition and dental plaque, brushing teeth at least once a day, and having received preventive dental care. To improve oral health, school programs and/or age-appropriate interventions need to be developed based on the specific profile of caries experience and the associated risk indicators. © Med Sci Monit, 2013.


Wilson J.S.,Indiana University – Purdue University Indianapolis | Shepherd D.C.,Indiana University | Shepherd D.C.,The Regenstrief Institute Inc. | Rosenman M.B.,Indiana University | And 3 more authors.
International Journal of Health Geographics | Year: 2010

Background: Residential address is a common element in patient electronic medical records. Guidelines from the U.S. Centers for Disease Control and Prevention specify that residence in a nursing home, skilled nursing facility, or hospice within a year prior to a positive culture date is among the criteria for differentiating healthcare-acquired from community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. Residential addresses may be useful for identifying patients residing in healthcare-associated settings, but methods for categorizing residence type based on electronic medical records have not been widely documented. The aim of this study was to develop a process to assist in differentiating healthcare-associated from community-associated MRSA infections by analyzing patient addresses to determine if residence reported at the time of positive culture was associated with a healthcare facility or other institutional location.Results: We identified 1,232 of the patients (8.24% of the sample) with positive cultures as probable cases of healthcare-associated MRSA based on residential addresses contained in electronic medical records. Combining manual review with linking to institutional address databases improved geocoding rates from 11,870 records (79.37%) to 12,549 records (83.91%). Standardization of patient home address through geocoding increased the number of matches to institutional facilities from 545 (3.64%) to 1,379 (9.22%).Conclusions: Linking patient home address data from electronic medical records to institutional residential databases provides useful information for epidemiologic researchers, infection control practitioners, and clinicians. This information, coupled with other clinical and laboratory data, can be used to inform differentiation of healthcare-acquired from community-acquired infections. The process presented should be extensible with little or no added data costs. © 2010 Wilson et al; licensee BioMed Central Ltd.


Medina-Solis C.E.,Autonomous University of the State of Hidalgo | Pontigo-Loyola A.P.,Autonomous University of the State of Hidalgo | Mendoza-Rodriguez M.,Autonomous University of the State of Hidalgo | Lucas-Rincon S.E.,Autonomous University of the State of Hidalgo | And 4 more authors.
West Indian Medical Journal | Year: 2013

Objective: To determine the Treatment Needs Index (TNI) for dental caries, the restorative Care Index (CI), and to introduce a Tooth Extractions Index (TEI) to estimate past and current treatment needs among Mexican adolescents. Subject and Methods: A descriptive cross-sectional study was carried out on 1538 adolescents aged 12 and 15 years in the state of Hidalgo, Mexico, to collect decayed, missing, filled teeth (DMFT) data to describe TNI, CI and TEI indices. Results: Higher TNI was identified in younger male teenagers who had always lived in the same community, without dental visits in the last year, and who had poorer socio-economic markers. Higher CI was found in older, female subjects who had moved in their lifetimes to a new community in the area, with dental visits in the last year and who had better socio-economic markers. Higher TEI was found in older, female teenagers who had moved in their lifetimes to a new community in the area, without dental visits in the last year, and who had worse socio-economic markers. Conclusions: We observed high rates of treatment needs for dental caries and little experience of restorative treatment. While dental extractions due to advanced caries should ideally be zero, relatively few adolescents had this treatment experience. Despite the fact that the overall background of these adolescents is rather homogeneous, it was still possible to find that treatment needs' indices (past and present needs) appeared to be modified by sociodemographic and socio-economic variables.


Meslin E.M.,Indiana University | Meslin E.M.,Indiana University – Purdue University Indianapolis | Alpert S.A.,Indiana University | Carroll A.E.,Indiana University | And 5 more authors.
International Journal of Medical Informatics | Year: 2013

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a "Points to Consider" (P2C) document, and convened a national expert panel to review and critique the P2C. Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions ("Points") that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. Discussion: The P2C is intended to clarify what is at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. © 2013 The Authors.

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