Regenstrief Institute

About: Regenstrief Institute is a nonprofit organization based out in Indianapolis, Indiana, United States. It is known for research contribution in the topics: Health care & Population. The organization has 742 authors who have published 2042 publications receiving 96966 citations.

Active Tuberculosis Is Associated with Worse Clinical Outcomes in HIV-Infected African Patients on Antiretroviral Therapy.

Abstract: Objective: This cohort study utilized data from a large HIV treatment program in western Kenya to describe the impact of active tuberculosis (TB) on clinical outcomes among African patients on antiretroviral therapy (ART). Design: We included all patients initiating ART between March 2004 and November 2007. Clinical (signs and symptoms) radiological (chest radiographs) and laboratory (mycobacterial smears culture and tissue histology) criteria were used to record the diagnosis of TB disease in the programs electronic medical record system. Methods: We assessed the impact of TB disease on mortality loss to follow-up (LTFU) and incident AIDS-defining events (ADEs) through Cox models and CD4 cell and weight response to ART by non-linear mixed models. Results: We studied 21242 patients initiating ART-5186 (24%) with TB; 62% female; median age 37 years. There were proportionately more men in the active TB (46%) than in the non-TB (35%) group. Adjusting for baseline HIV-disease severity TB patients were more likely to die (hazard ratio - HR = 1.32 95% CI 1.18-1.47) or have incident ADEs (HR = 1.31 95% CI: 1.19-1.45). They had lower median CD4 cell counts (77 versus 109) weight (52.5 versus 55.0 kg) and higher ADE risk at baseline (CD4-adjusted odds ratio = 1.55 95% CI: 1.31-1.85). ART adherence was similarly good in both groups. Adjusting for gender and baseline CD4 cell count TB patients experienced virtually identical rise in CD4 counts after ART initiation as those without. However the overall CD4 count at one year was lower among patients with TB (251 versus 269 cells/µl). Conclusions: Clinically detected TB disease is associated with greater mortality and morbidity despite salutary response to ART. Data suggest that identifying HIV patients co-infected with TB earlier in the HIV-disease trajectory may not fully address TB-related morbidity and mortality.

Disparities in chlamydia testing among young women with sexually transmitted infection symptoms.

Abstract: Background: Diagnostic chlamydia testing is recommended for all young women demonstrating sexually transmitted infection (STI) symptoms. Differential testing among symptomatic women may contribute to disparities in chlamydia rates. Our objective was to determine whether providers test young women with STI symptoms for chlamydia differently by age, race/ethnicity, or insurance status, and whether testing patterns differ by documentation of previous STI. Methods: Retrospective cohort analysis using electronic medical records and billing data of women 14 to 25 years old with one or more diagnostic or procedure codes indicative of STI symptoms (N = 61,498 women). Random effects logistic regression analysis was performed to assess the odds of chlamydia testing given a woman presented for a nonpregnancy-related visit with STI symptoms. All analyses controlled for history of STI, setting, and year, and adjusted for within-person correlation. Results: A chlamydia test was performed in 38% of visits with codes indicating STI symptoms. Women aged 19 were less likely to be tested than women aged 18 to 19, with young women aged 14 to 15 having the lowest odds of being tested (Odd Ratio [OR]: 0.52). Providers were more likely to test minority (OR black : 2.87; OR Latina : 2.10) compared with white women. Women were also more likely to be tested if they had public insurance (OR: 2.41) or were self-pay (OR: 2.35) compared with if they had private insurance. Women aged 14 to 15 and 16 to 17 with prior history of STI had increased odds of chlamydia testing (OR: 1.79 and 1.43, respectively) compared with women aged 18 to 19, changing the overall direction of association compared with women with no history of STI. The odds of testing were dramatically reduced for minority and nonprivately insured young women with history of STI, although significant differences persisted. Conclusions: Provider chlamydia testing differs by age, race/ethnicity, and insurance status when a woman presents with STI symptoms and no prior history of STI. This bias may contribute to higher reported rates of chlamydia among younger, minority, and poor women.

Preparing for an aging population and improving chronic disease management.

Abstract: New models of health care delivery are inevitable. There is likely to be increasing emphasis on patient self-monitoring, health care delivery at patient homes, interdisciplinary treatment plans, a greater percentage of medical care delivered by non-physician health professionals, targeted health educational materials, and greater involvement and training of informal caregivers. The Information Technologies (IT) infrastructure of health systems will need to adapt. We have begun sorting out the implications of this future within a County public hospital system: defining the desirable features, relevant technologies, necessary modifications to the network, and additional data elements to be captured. We seek to build an infrastructure that will support new patient-focused technologies designed to more efficiently and effectively support older individuals. We hypothesize utility to further exploring the impact that new health care delivery models will have on health systems' IT infrastructures.

The experiences of family members in the nursing home to hospital transfer decision

Abstract: The objective of this study was to better understand the experiences of family members in the nursing home to hospital transfer decision making process. Semi-structured interviews were conducted with 20 family members who had recently been involved in a nursing home to hospital transfer decision. Family members perceived themselves to play an advocacy role in their resident’s care and interview themes clustered within three over-arching categories: Family perception of the nursing home’s capacity to provide medical care: Resident and family choices; and issues at ‘hand-off’ and the hospital. Multiple sub-themes were also identified. Findings from this study contribute to knowledge surrounding the nursing home transfer decision by illuminating the experiences of family members in the transfer decision process.

Integrative analysis based on survival associated co-expression gene modules for predicting Neuroblastoma patients’ survival time

Abstract: More than 90% of neuroblastoma patients are cured in the low-risk group while only less than 50% for those with high-risk disease can be cured. Since the high-risk patients still have poor outcomes, we need more accurate stratification to establish an individualized precise treatment plan for the patients to improve the long-term survival rate. We focus on extracting features and providing a workflow to improve survival prediction for neuroblastoma patients. With a workflow for gene co-expression network (GCN) mining in microarray and RNA-Seq datasets, we extracted molecular features from each co-expressed module and summarized them into eigengenes. Then we adopted the lasso-regularized Cox proportional hazards model to select the most informative eigengene features regarding association to the risk of metastasis. Nine eigengenes were selected which show strong association with patient survival prognosis. All of the nine corresponding gene modules also have highly enriched biological functions or cytoband locations. Three of them are unique modules to RNA-Seq data, which complement the modules from microarray data in terms of survival prognosis. We then merged all eigengenes from these unique modules and used an integrative method called Similarity Network Fusion to test the prognostic power of these eigengenes for prognosis. The prognostic accuracies are significantly improved as compared to using all eigengenes, and a subgroup of patients with very poor survival rate was identified. We first compared GCNs mined from microarray and RNA-seq data. We discovered that each data modality yields unique GCNs, which are enriched with clear biological functions. Then we do module unique analysis and use lasso-cox model to select survival-associated eigengenes. Integration of unique and survival-associated eigengenes from both data types provides complementary information that leads to more accurate survival prognosis. Reviewed by Susmita Datta, Marco Chierici and Dimitar Vassilev.