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.

Practical clinical tool to monitor dementia symptoms: the HABC-Monitor.

Abstract: Background Dementia care providers need a clinical assessment tool similar to the blood pressure cuff (sphygmomanometer) used by clinicians and patients for managing hypertension. A "blood pressure cuff " for dementia would be an inexpensive, simple, user-friendly, easily standardized, sensitive to change, and widely available multidomain instrument for providers and informal caregivers to measure severity of dementia symptoms. The purpose of this study was to assess the reliability and validity of the Healthy Aging Brain Care Monitor (HABC-Monitor) for measuring and monitoring the severity of dementia symptoms through caregiver reports. Methods The first prototype of the HABC-Monitor was developed in collaboration with the Indianapolis Discovery Network for Dementia, which includes 200 members representing 20 disciplines from 20 local organizations, and an expert panel of 22 experts in dementia care and research. The HABC-Monitor has three patient symptom domains (cognitive, functional, behavioral/psychological) and a caregiver quality of life domain. Patients (n = 171) and their informal caregivers (n = 171) were consecutively approached and consented during, or by phone shortly following, a patient's routine visit to their memory care provider. Results The HABC-Monitor demonstrated good internal consistency (0.73-0.92); construct validity indicated by correlations with the caregiver-reported Neuropsychiatric Inventory (NPI) total score and NPI caregiver distress score; sensitivity to three-month change compared with NPI "reliable change" groups; and known-groups validity, indicated by significant separation of Mini-Mental Status Examination severity groups and clinical diagnostic groups. Although not designed as a screening study, there was evidence for good operating characteristics, according to area under the receiver-operator curve with respect to gold standard clinical diagnoses, relative to Mini-Mental Status Examination or NPI. Conclusion The HABC-Monitor demonstrates good reliability and validity as a clinically practical multidimensional tool for monitoring symptoms of dementia through the informal caregiver.

Anxiety but not Social Stressors Predict 12-Month Depression and Pain Severity

Abstract: Objectives To determine whether baseline anxiety and social stressors as well their early change (first 3 months) predict 12-month depression and pain severity. Methods We analyzed data from the Stepped Care for Affective Disorders and Musculoskeletal Pain study, a randomized clinical trial of a combined medication-behavioral intervention for primary care patients with chronic musculoskeletal pain and depression. Using multivariable linear regression modeling, we examined the independent association of baseline anxiety and social stressors with depression and pain severity at 12 months. In addition, we modeled whether changes in anxiety and social stressors predicted 12-month depression and pain severity. Results Overall, the sample (N=250) was 52.8% women with a mean age of 55.5 years, and a racial distribution of 60.4% white, 36.4% black, and 3.2% other. Depression and pain were moderately severe at baseline (mean SCL-20 depression=1.9 and Brief Pain Inventory pain severity=6.15) and similar across intervention and usual care arms. Baseline anxiety symptoms predicted both depression (t score=2.13, P=0.034) and pain severity (t score=2.75, P=0.007) at 12 months. Also, early change in anxiety predicted 12-month depression (t score=-2.47, P=0.014), but not pain. Neither baseline nor early change in social stressors predicted depression or pain severity. Conclusions Anxiety, but not social stressors predict 12-month depression and pain severity. The presence of comorbid anxiety should be considered in the assessment and treatment of patients with musculoskeletal pain and depression, particularly as a factor that may adversely affect treatment response.

Lower provider volume is associated with higher failure rates for endoscopic retrograde cholangiopancreatography.

Abstract: BACKGROUND Among physicians who perform endoscopic retrograde cholangiopancreatography (ERCP), the relationship between procedure volume and outcome is unknown OBJECTIVE Quantify the ERCP volume-outcome relationship by measuring provider-specific failure rates, hospitalization rates, and other quality measures RESEARCH DESIGN Retrospective cohort SUBJECTS A total of 16,968 ERCPs performed by 130 physicians between 2001 and 2011, identified in the Indiana Network for Patient Care MEASURES Physicians were classified by their average annual Indiana Network for Patient Care volume and stratified into low (<25/y) and high (≥25/y) Outcomes included failed procedures, defined as repeat ERCP, percutaneous transhepatic cholangiography or surgical exploration of the bile duct≤7 days after the index procedure, hospitalization rates, and 30-day mortality RESULTS Among 15,514 index ERCPs, there were 1163 (75%) failures; the failure rate was higher among low (95%) compared with high volume (57%) providers (P<0001) A second ERCP within 7 days (a subgroup of failure rate) occurred more frequently when the original ERCP was performed by a low-volume (41%) versus a high-volume physician (23%, P=0013) Patients were more frequently hospitalized within 24 hours when the ERCP was performed by a low-volume (283%) versus high-volume physician (148%, P=0002) Mortality within 30 days was similar (low=19%, high=19%) Among low-volume physicians and after adjusting, the odds of having a failed procedure decreased 33% (95% confidence interval, 16%-50%, P<0001) with each additional ERCP performed per year CONCLUSIONS Lower provider volume is associated with higher failure rate for ERCP, and greater need for postprocedure hospitalization

Cost-effectiveness of culturing for Chlamydia trachomatis. A study in a clinic for sexually transmitted diseases.

Abstract: We have evaluated the cost-effectiveness of using cell culture to test for chlamydial infections in 9979 patients at a clinic for sexually transmitted diseases. From results of cultures, we have established prevalence data and, using decision-theory analysis, have calculated costs and probabilities of various outcomes. According to their histories and presenting signs and symptoms, patients were classified as at high or low risk for chlamydial infections. Empiric treatment of all patients attending the clinic was the most cost-effective strategy, followed by empiric treatment of high-risk women and culture-based treatment of low-risk women. Obtaining cultures for men at high and low risk was not cost-effective. If universal treatment is not provided, the most cost-effective strategy appears to be empiric therapy in patients at high risk for chlamydial infections and therapy based on diagnostic test results in women at low risk.