Showing papers by "James Dziura published in 2015"
TL;DR: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear.
Abstract: RESULTS At week 24, the Aberrant Behavior Checklist–Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, −3.9; 95% CI, −6.2 to −1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire–Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, −0.7; 95% CI, −1.1 to −0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression– Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). CONCLUSIONS AND RELEVANCE For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education.
284 citations
TL;DR: In a multisite, randomized clinical trial, extended-release guanfacine was compared with placebo in children with ASD accompanied by hyperactivity, impulsiveness, and distractibility as discussed by the authors.
Abstract: Objective:Hyperactivity, impulsiveness, and distractibility are common problems in children with autism spectrum disorder (ASD). Extended-release guanfacine is approved for children with attention deficit hyperactivity disorder but not well studied in ASD.Method:In a multisite, randomized clinical trial, extended-release guanfacine was compared with placebo in children with ASD accompanied by hyperactivity, impulsiveness, and distractibility.Results:Sixty-two subjects (boys, N=53; girls, N=9; mean age=8.5 years [SD=2.25]) were randomly assigned to guanfacine (N=30) or placebo (N=32) for 8 weeks. The guanfacine group showed a 43.6% decline in scores on the Aberrant Behavior Checklist-hyperactivity subscale (least squares mean from 34.2 to 19.3) compared with a 13.2% decrease in the placebo group (least squares mean from 34.2 to 29.7; effect size=1.67). The rate of positive response (much improved or very much improved on the Clinical Global Impression-Improvement scale) was 50% (15 of 30) for guanfacine co...
123 citations
TL;DR: The data suggest that protein supplementation above the recommended dietary allowance may preserve fat-free mass without adversely affecting skeletal health or renal function in healthy older adults.
Abstract: Context: It has been assumed that the increase in urine calcium (Ca) that accompanies an increase in dietary protein was due to increased bone resorption. However, studies using stable Ca isotopes have found that dietary protein increases Ca absorption without increasing bone resorption. Objective: The objective of the study was to investigate the impact of a moderately high protein diet on bone mineral density (BMD). Design: This was a randomized, double-blind, placebo-controlled trial of protein supplementation daily for 18 months. Setting: The study was conducted at two institutional research centers. Participants: Two hundred eight older women and men with a body mass index between 19 and 32 kg/m2 and a self-reported protein intake between 0.6 and 1.0 g/kg participated in the study. Intervention: Subjects were asked to incorporate either a 45-g whey protein or isocaloric maltodextrin supplement into their usual diet for 18 months. Main Outcome Measure: BMD by dual-energy x-ray absorptiometry, body com...
67 citations
TL;DR: The effects of glucose and fructose ingestion on ghrelin and PYY in lean and obese adolescents with differing insulin sensitivity in this study were evaluated.
Abstract: Objective
Fructose consumption has risen alongside obesity and diabetes. Gut hormones involved in hunger and satiety (ghrelin and PYY) may respond differently to fructose compared with glucose ingestion. This study evaluated the effects of glucose and fructose ingestion on ghrelin and PYY in lean and obese adolescents with differing insulin sensitivity.
Methods
Adolescents were divided into lean (n = 14), obese insulin sensitive (n = 12) (OIS), and obese insulin resistant (n = 15) (OIR). In a double-blind, cross-over design, subjects drank 75 g of glucose or fructose in random order, serum was obtained every 10 minutes for 60 minutes.
Results
Baseline acyl-ghrelin was highest in lean and lowest in OIR (P = 0.02). After glucose ingestion, acyl-ghrelin decreased similarly in lean and OIS but was lower in OIR (vs. lean, P = 0.03). Suppression differences were more pronounced after fructose (lean vs. OIS, P = 0.008, lean vs. OIR, P < 0.001). OIS became significantly hungrier after fructose (P = 0.015). PYY was not significantly different at baseline, varied minimally after glucose, and rose after fructose.
Conclusions
Compared with lean, OIS adolescents have impaired acyl-ghrelin responses to fructose but not glucose, whereas OIR adolescents have blunted responses to both. Diminished suppression of acyl-ghrelin in childhood obesity, particularly if accompanied by insulin resistance, may promote hunger and overeating.
27 citations
TL;DR: There is a critical mass of ED patients who use new media and older persons are less comfortable texting and using smartphone apps, which has implications for expanding health care beyond the ED visit through the use of cell phones, smartphones, texting, the Internet and health care apps to improve the health of the public.
Abstract: Background: Little is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings The application of this technology has the potential to enhance health care beyond the index visit Objective: The objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health Methods: Face-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012 Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital Results: A total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, P 05) and personal health records ( P <001) Ownership of iPhones compared to Android phones were similar (44% vs 45%, P <05) Race and ethnicity played a significant role in texting and smartphone ownership, with Hispanics reporting the highest rates of 79% and 56%, respectively, followed by black non-Hispanics at 77% and 54%, respectively, and white non-Hispanics at 65% and 42%, respectively ( P <05) Conclusions: There is a critical mass of ED patients who use new media Older persons are less comfortable texting and using smartphone apps Income status has a positive relationship with smartphone ownership and use of smartphone apps Regardless of income, however, texting and ownership of smartphones was highest for Latinos and black non-Latinos These findings have implications for expanding health care beyond the ED visit through the use of cell phones, smartphones, texting, the Internet, and health care apps to improve the health of the public [JMIR Mhealth Uhealth 2015;3(3):e72]
19 citations
TL;DR: Chest pain recidivism is common and costly even in patients without known CAD, and evidence-based guidelines are needed for these patients to minimize returns.
Abstract: Recurrent chest pain is common in patients with and without coronary artery disease. The prevalence and burden of these symptoms on healthcare is unknown.
17 citations
03 Mar 2015-Journal of Environmental Science and Health Part A-toxic\/hazardous Substances & Environmental Engineering
TL;DR: In this article, the authors report on a community environmental health survey conducted in an area of active natural gas drilling, which included the collection of health data on 2452 companion and backyard animals residing in 157 randomly selected households of Washington County, Pennsylvania (USA).
Abstract: Natural gas extraction activities, including the use of horizontal drilling and hydraulic fracturing, may pose potential health risks to both human and animal populations in close proximity to sites of extraction activity. Because animals may have increased exposure to contaminated water and air as well as increased susceptibility to contaminant exposures compared to nearby humans, animal disease events in communities living near natural gas extraction may provide “sentinel” information useful for human health risk assessment. Community health evaluations as well as health impact assessments (HIAs) of natural gas exploration should therefore consider the inclusion of animal health metrics in their assessment process. We report on a community environmental health survey conducted in an area of active natural gas drilling, which included the collection of health data on 2452 companion and backyard animals residing in 157 randomly-selected households of Washington County, Pennsylvania (USA). There were a tot...
12 citations
20 Mar 2015
TL;DR: In this paper, the authors developed a preliminary measure of media consumers' implicit collusion with intimate partner violence (IPV) perpetration reported in newspapers using test-item construction techniques.
Abstract: Despite infusions of federal funding and legislation, intimate partner violence (IPV) persists regardless of preventive efforts. Improved rates of IPV awareness and attitudes have not translated into less violence. Novel research and interventions are necessary to address this gap. This pilot study develops and validates a tool to measure implicit collusion with IPV at the macro societal level in an ecological framework. Using test-item construction techniques, the authors developed a preliminary measure of media consumers' implicit collusion with fatal IPV perpetration reported in newspapers. The present experiment investigates whether the provision of various information influences collusion. The implicit collusion measurement tool was constructed using item analysis principles and techniques. A purposive sample was created using four sites in three states, and included a range of demographic characteristics including income, race, gender, and education. Analysis of covariance procedures and standard scaling techniques including Cronbach's Alpha were used. Test-item construction demonstrated implicit collusion could be reliably measured in testing the effects of IPV news media "frames," "labeling," "extraneous information," and "negative information." When negative information was included about victims of fatal IPV (F(2,67) = 17.8, p Language: en
6 citations
TL;DR: A 2-arm randomized clinical trial of 250 physicians and patients treated by those physicians found intervention physicians were more likely to order tobacco treatment medication, populate the problem list with tobacco use disorder, and make a referral to the state smokers’ quitline.
Abstract: Methods A 2-arm randomized clinical trial of 250 physicians and patients treated by those physicians. The physician is the unit of randomization. A BPA and order set were developed and embedded in the Epic (Madison, WI) EMR used at 2 hospitals. When an adult patient is admitted to a medical service, a BPA fires if the patient is coded in the EMR as a smoker. For physicians randomized to the intervention, the BPA offers to take the physician to an order set to prescribe tobacco treatment medications and refer the patient to the state smoker’s quitline. Additionally, tobacco use disorder” is added to the patient’s problem list, and an email is sent to the patient’s primary care provider (PCP). In the control arm, a BPA silently fires with no additional actions for the physician. Results Since August 2013, the BPA fired for 4187 patients (1887 intervention, 2300 control). Compared to control arm physicians, intervention physicians were more likely to order tobacco treatment medication (24% v. 9%, P = 0.0001, Fisher’s exact test), populate the problem list with tobacco use disorder (46% v. 4%, P < 0.0001), and make a referral to the state smokers’ quitline (19% v. 0%, P < 0.0001). In addition, intervention physicians sent an email to the patient’s PCP 1876 (99%) times.
6 citations
TL;DR: The aim of this study was to establish normative data for IVA at the lateral tricuspid valve annulus (RV IVA) and to establish echocardiographic measure of contractility that is independent of loading conditions.
Abstract: BACKGROUND: Quantitative assessment of right ventricular (RV) function is important for the management of patients with congenital heart disease. Tissue Doppler (TDI)-derived myocardial acceleration during isovolumic contraction (IVA) is an echocardiographic measure of contractility that is independent of loading conditions. The aim of this study was to establish normative data for IVA at the lateral tricuspid valve annulus (RV IVA).METHODS: This is a retrospective study of 340 children who had normal echocardiograms. We analyzed RV IVA in relation to age, body surface area (BSA), gender, heart rate (HR), tricuspid annular plane systolic excursion (TAPSE), and TDI-derived S' (RV S').RESULTS: RV IVA showed a positive correlation with HR (r = 0.58, P 160 bpm. When RV IVA was corrected for HR (RV IVAc), it became independent of HR, age, BSA, and gender. The mean RV IVAc was 2.3 m/sec(1.5) (±2 SD: 1.1-3.6 m/sec(1.5) ). There was a correlation of normalized RV IVAc with normalized TAPSE and RV S'.CONCLUSION: RV IVA, a marker of RV contractility, shows a strong dependence on HR. HR corrected RV IVA (RV IVAc) is independent of age, BSA, gender, and HR. We suggest measuring RV IVAc routinely in patients at risk for RV dysfunction. (Less)
4 citations
TL;DR: Patients with diabetes in the ICU have experienced a disproportionate reduction in mortality that is not explained by glucose control, and potential explanations include improved cardiovascular risk management or advances in therapies for diseases commonly affecting patients with diabetes.
Abstract: BACKGROUND
Hospitalized patients with diabetes have experienced a disproportionate reduction in mortality over the past decade.
OBJECTIVE
To examine whether this differential decrease affected all patients with diabetes, and to identify explanatory factors.
DESIGN
Serial, cross-sectional observational study.
SETTING
Academic medical center.
PATIENTS
All adult, nonobstetric patients with an inpatient discharge between January 1, 2000 and December 31, 2010.
MEASUREMENT
We assessed in-hospital mortality; inpatient glycemic control (percentage of hospital days with glucose below 70, above 299, and between 70 and 179 mg/dL, and standard deviation of glucose measurements), and outpatient glycemic control (hemoglobin A1c).
RESULTS
We analyzed 322,938 admissions, including 76,758 (23.8%) with diabetes. Among 54,645 intensive care unit (ICU) admissions, there was a 7.8% relative reduction in the odds of mortality in each successive year for patients with diabetes, adjusted for age, race, payer, length of stay, discharge diagnosis, comorbidities, and service (odds ratio [OR]: 0.923, 95% confidence interval [CI]: 0.906-0.940). This was significantly greater than the 2.6% yearly reduction for those without diabetes (OR: 0.974, 95% CI: 0.963-0.985; P < 0.001 for interaction). In contrast, the greater decrease in mortality among non-ICU patients with diabetes did not reach significance. Results were similar among medical and surgical patients. Among ICU patients with diabetes, the significant decline in mortality persisted after adjustment for inpatient and outpatient glucose control (OR: 0.953, 95% CI: 0.914-0.994).
CONCLUSIONS
Patients with diabetes in the ICU have experienced a disproportionate reduction in mortality that is not explained by glucose control. Potential explanations include improved cardiovascular risk management or advances in therapies for diseases commonly affecting patients with diabetes. Journal of Hospital Medicine 2015;10:228–235. © 2015 Society of Hospital Medicine
TL;DR: In this issue of HEPATOLOGY, an article by Hung et al. presents another model for assessing HCC risk, aiming to develop a universal tool to stratify a general population for mass HCC screening.