Showing papers by "James Dziura published in 2017"
TL;DR: A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health.
Abstract: A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health
158 citations
TL;DR: This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.
Abstract: Objective: To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders. Methods: Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n = 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 ± 13.9 years (range 9–69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression–Improvement score assessed by masked evaluators. Results: The presence of tic medication significantly moderated response to CBIT vs PST ( p = 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity ( p = 0.005) and positive participant expectancy ( p = 0.01) predicted greater tic improvement. Anxiety disorders ( p = 0.042) and premonitory urge severity ( p = 0.005) predicted lower tic reduction. Conclusions: Presence of co-occurring attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication. ClinicalTrials.gov identifiers: The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively). Classification of evidence: This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.
78 citations
TL;DR: An interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months and demonstrates improvement overall compared to the control group.
Abstract: Grant R01HD062080 from the Eunice Kennedy Shriver National Institute of Child Health and Human
Development.
43 citations
TL;DR: Gender, age, and race/ethnicity as predictors of incident mental health diagnoses among Operations Iraqi Freedom, Enduring Freedom, and New Dawn veterans were evaluated to lead to improved diagnosis and treatment of mental health diseases among veterans and other high-risk groups.
Abstract: Objectives. To evaluate gender, age, and race/ethnicity as predictors of incident mental health diagnoses among Operations Iraqi Freedom, Enduring Freedom, and New Dawn veterans.Methods. We used US Veterans Health Administration (VHA) electronic health records from 2001 to 2014 to examine incidence rates and sociodemographic risk factors for mental health diagnoses among 888 142 veterans.Results. Posttraumatic stress disorder (PTSD) was the most frequently diagnosed mental health condition across gender and age groups. Incidence rates for all mental health diagnoses were highest at ages 18 to 29 years and declined thereafter, with the exceptions of major depressive disorder (MDD) in both genders, and PTSD among women. Risk of incident bipolar disorder and MDD diagnoses were greater among women; risk of incident schizophrenia, and alcohol- and drug-use disorders diagnoses were greater in men. Compared with Whites, risk incident PTSD, MDD, and alcohol-use disorder diagnoses were lower at ages 18 to 29 years...
37 citations
TL;DR: PT was superior to PEP in decreasing disruptive and noncompliant behaviors and IQ and ASD symptom severity did not moderate outcome, suggesting that PT is likely to benefit a wide range of children with ASD and disruptive behavior.
Abstract: We conducted a 6 month, randomized trial of parent training (PT) versus a parent education program (PEP) in 180 young children (158 boys, 22 girls), ages 3–7 years, with autism spectrum disorder (ASD). PT was superior to PEP in decreasing disruptive and noncompliant behaviors. In the current study, we assess moderators of treatment response in this trial. Thirteen clinical and demographic variables were evaluated as potential moderators of three outcome variables: the Aberrant Behavior Checklist-Irritability subscale (ABC-I), Home Situations Questionnaire (HSQ), and Clinical Global Impressions-Improvement Scale (CGI-I). We used an intent-to-treat model and random effects regression. Neither IQ nor ASD severity moderated outcome on the selected outcome measures. Severity of Attention Deficit Hyperactivity Disorder (ADHD) and anxiety moderated outcomes on the ABC-I and HSQ. For instance, there was a 6.6 point difference on the ABC-I between high and low ADHD groups (p = .05) and a 5.3 point difference between high and low Anxiety groups (p = .04). Oppositional defiant disorder symptoms and household income moderated outcomes on the HSQ. None of the baseline variables moderated outcome on the CGI-I. That IQ and ASD symptom severity did not moderate outcome suggests that PT is likely to benefit a wide range of children with ASD and disruptive behavior.
35 citations
TL;DR: Designing and implementing an order set and alert for Tobacco dependence treatment in an EHR is feasible and helps physicians place more orders for tobacco treatment medication, referrals to the state smokers’ quitline, and e-mails to patients’ PCPs.
Abstract: Tobacco dependence treatment for hospitalized smokers results in long-term cessation if treatment continues at least 30 days post-discharge. Health information technology may facilitate ongoing tobacco dependence treatment after hospital discharge. To describe the use and impact of a new decision support tool and order set for inpatient physicians, addressing tobacco dependence treatment for hospitalized smokers, embedded in an electronic health record (EHR). In a cluster-randomized trial, 254 physicians were randomized (1:1) to either receive or not receive the decision support tool and order set, which were embedded in the Epic (Madison, WI) EHR used at 2 hospitals in a single city. When an adult patient was admitted to a medical service, an electronic alert appeared if the patient was coded in the EHR as a smoker. For physicians randomized to the intervention, the alert linked to an order set to prescribe tobacco treatment medications and refer the patient to the state tobacco quitline. Additionally, “tobacco use disorder” was added to the patient’s problem list, and an e-mail was sent to the patient’s primary care provider (PCP). In the control arm, an alert fired with no screen visibility. Generalized estimating equations were used to model the data. Since August 2013, the alert has appeared for 10,939 patients (5391 intervention, 5548 control). Compared to control physicians, intervention physicians were more likely to order tobacco treatment medication (35 vs. 29%, P < 0.0001), populate the problem list with tobacco use disorder (41 vs. 2%, P < 0.0001), and make a referral to the state smokers’ quitline (30 vs. 0%, P < 0.0001). In addition, intervention physicians sent an e-mail to the patient’s PCP 4152 (99%) times. Designing and implementing an order set and alert for tobacco treatment in an EHR is feasible and helps physicians place more orders for tobacco treatment medication, referrals to the state smokers’ quitline, and e-mails to patients’ PCPs. Data on cessation outcomes are pending. Trial registration: www.ClinicalTrials.gov
(NCT01691105).
34 citations
31 citations
TL;DR: An important area of research in childhood obesity is the identification of factors that predict or moderate the responses to obesity intervention programmes, yet few studies have examined the impact of self‐esteem and family functioning on obesity treatment outcomes.
Abstract: BACKGROUND: An important area of research in childhood obesity is the identification of factors that predict or moderate the responses to obesity intervention programmes, yet few studies have exami ...
28 citations
TL;DR: This study aims to identify a clinically efficacious, cost-effective intervention package for the initial treatment of tobacco dependence in ED patients and incorporates qualitative feedback from study participants in evaluating which intervention components will be tested in the future trial.
27 citations
TL;DR: The rationale, aims and study design for the current StartingTreatment for Ethanol inPrimary care Trials (STEP Trials) are described; three parallel randomized controlled effectiveness trials being conducted in five Infectious Disease Clinics.
26 citations
TL;DR: Depression is independently associated with RCP regardless of significant cardiac ischemia on stress testing, and identification and targeted interventions may curtail recidivism with R CP.
TL;DR: Compared with men, women Veterans were more likely to become obese after return from deployment, but less likely to develop any other risk, and for black women, the protective effect of female sex on the combined event (any risk factor), and hypertension was lessened compared with white women.
Abstract: Background:Stressors associated with military service and reintegration may impact psychologic well-being and behaviors that result in increased incidence rates for cardiovascular (CV) risk factors.Objective:Using electronic health record data from the Veterans Health Administration we sought to mea
TL;DR: In an exploratory randomized controlled trial of symptomatic patients with CMD and no coronary artery disease, promising results were seem with ranolazine and CFR improving at 30 days.
TL;DR: The burden of migraines is increasing within the VHA, with a corresponding increase in the delivery of guideline-concordant acute and prophylactic migraine-specific medication.
Abstract: Background and aim Health administrators, policy makers, and educators have attempted to increase guideline adherence of migraine medications while reducing inappropriate use of opioid- and barbiturate-containing medications. We evaluated the burden of migraine and proportion of guideline-concordant care in a large, national health care system over time. Methods We conducted a time-series study using data from the Veterans Health Administration (VHA) electronic health record. Veterans with migraines were identified by ICD-9 code (346.X). Prescriptions and comorbid conditions were evaluated before and after migraine diagnosis. Chi-square tests and logistic regression were performed. Results A total of 57,064 veterans were diagnosed with migraine headache (5.3%), with women significantly more likely diagnosed (11.6% vs. 4.4%, p < 0.0001). The number of veterans diagnosed with migraine has significantly increased over the years. By 2012, triptans were prescribed to 43% of people with migraine, with no difference by gender. However, triptan prescriptions increased from 2004 to 2012 in men, but not women, veterans. Preventive medicines showed a significant increase with the year of migraine diagnosis, after controlling for age, sex, race, and for comorbidities treated with medications used for migraine prevention. Conclusions The burden of migraines is increasing within the VHA, with a corresponding increase in the delivery of guideline-concordant acute and prophylactic migraine-specific medication.
TL;DR: This poster presents a poster presented at the 2016 American Academy of Neurological Surgery Congress exploring the role of epidural localization in the development of central giant cell granuloma and its role in motor neurone disease.
Abstract: ∗Alan L. and Jacqueline B. Stuart Spine Research Center, Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts; ‡Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin; §Department of Orthopedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky; ¶Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut; ||Department of Neurosurgery, University of Virginia, Charlottesville, Virginia; #Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
TL;DR: This study suggests that the BAS-O is a psychometrically valid measure of adherence to the specialized BNI for motivating treatment engagement in patients with opioid use disorders, thus providing a brief (13-item), objective method of evaluating BNI skill performance.
Abstract: Background: No psychometrically validated instrument for evaluating the extent to which interventionists correctly implement brief interventions designed to motivate treatment engagement for opioid use disorders has been reported in the literature. The objective of this study was to develop and examine the psychometric properties of the Brief Negotiation Interview (BNI) Adherence Scale for Opioid Use Disorders (BAS-O). Methods: In the context of a randomized controlled trial evaluating the efficacy of 3 models of emergency department care for opioid use disorders, the authors developed and subsequently examined the psychometric properties of the BAS-O, a 38-item scale that required raters to answer whether or not (“Yes” or “No”) each of the critical actions of the BNI was correctly implemented by the research interventionist. BAS-O items pertained to the BNI's 4 steps: (1) Raise the Subject, (2) Provide Feedback, (3) Enhance Motivation, and (4) Negotiate and Advise. A total of 215 audio-recorded B...
TL;DR: This study highlights the need to understand more fully the rationale behind the continued use of condoms in the context of HIV/AIDS treatment and how these practices have changed over time.