Publications
Department of Medicine faculty members published more than 3,000 peer-reviewed articles in 2022.
2018
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2018
2018
2018
2018
OBJECTIVE
Patient and clinician goal alignment, central to effective patient-centered care, has been linked to improved patient experience and outcomes, but has not been explored in rheumatoid arthritis (RA). This study aimed to explore goal conceptualization among RA patients and clinicians.
METHODS
Seven focus groups and one semi-structured interview were conducted with RA patients and clinicians recruited from four rheumatology clinics. An interview guide was developed to explore goal concordance related to RA treatment. Researchers utilized a concurrent deductive-inductive data analysis approach.
RESULTS
19 patients (mean age 55; 74% female; 32% nonwhite; 26% Spanish speakers) and 18 clinicians (44% trainees; 44% female; 28% nonwhite) participated. Across clinician and patient focus groups, two domains were identified: 1) patient knowledge of RA and 2) psychosocial dynamics (stress) in RA treatment. Within the knowledge domain, three themes emerged: 1) RA knowledge for informed choice; 2) RA knowledge to ensure adherence and medication safety; and 3) clinician assumption of patient inability to interpret information. Within the second domain of RA and stress, two themes emerged: 1) patient's illness experience informs treatment context in ways not shared by clinicians; and 2) impact of patient-clinician communication and decision making on goal concordance.
CONCLUSION
Knowledge is a shared goal, but RA patients and clinicians hold divergent attitudes towards this goal. While knowledge is integral to self-management and effective shared decision making, mismatch in attitudes may lead to suboptimal communication. Tools to support patient goal-directed RA care may promote high quality patient-centered care and result in reduced disparities. This article is protected by copyright. All rights reserved.
View on PubMed2018
INTRODUCTION
Incomplete understanding of TB transmission dynamics in high HIV prevalence settings remains an obstacle for prevention. Understanding where transmission occurs could provide a platform for case finding and interrupting transmission.
METHODS
From 2012-2015, we sought to recruit all adults starting TB treatment in a Ugandan community. Participants underwent household (HH) contact investigation, and provided names of social contacts, sites of work, healthcare and socializing, and two sputum samples. Mycobacterium tuberculosis culture-positive specimens underwent 24-loci MIRU-VNTR and spoligotyping. We sought to identify epidemiologic links between genotype-matched cases by analyzing social networks and mapping locations where cases reported spending ≥12 hours over the one-month pre-treatment. Sites of spatial overlap (≤100m) between genotype-matched cases were considered potential transmission sites. We analyzed social networks stratified by genotype clustering status, with cases linked by shared locations, and compared network density by location type between clustered vs. non-clustered cases.
RESULTS
Of 173 adults with TB, 131 (76%) were enrolled, 108 provided sputum, and 84/131 (78%) were MTB culture-positive: 52% (66/131) tested HIV-positive. Of 118 adult HH contacts, 105 (89%) were screened and 3 (2.5%) diagnosed with active TB. Overall, 33 TB cases (39%) belonged to 15 distinct MTB genotype-matched clusters. Within each cluster, no cases shared a HH or reported shared non-HH contacts. In 6/15 (40%) clusters, potential epidemiologic links were identified by spatial overlap at specific locations: 5/6 involved health care settings. Genotype-clustered TB social networks had significantly greater network density based on shared clinics (p<0.001) and decreased density based on shared marketplaces (p<0.001), compared to non-clustered networks.
CONCLUSIONS
In this molecular epidemiologic study, links between MTB genotype-matched cases were only identifiable via shared locations, healthcare locations in particular, rather than named contacts. This suggests most transmission is occurring between casual contacts, and emphasizes the need for improved infection control in healthcare settings in rural Africa.
View on PubMed2018
INTRODUCTION
Electronic cigarettes (e-cigarettes) are often promoted to assist with cigarette smoking cessation. In 2016-2017, the relationship between e-cigarette use and having stopped smoking among ever (current and former) smokers was assessed in the European Union and Great Britain by itself.
METHODS
Cross-sectional logistic regression of the association between being a former smoker and e-cigarette use was applied to the 2014 Eurobarometer survey of 28 European Union countries controlling for demographics.
RESULTS
Among all ever smokers, any regular ever use of nicotine e-cigarettes was associated with lower odds of being a former smoker (unadjusted OR=0.34, 95% CI=0.26, 0.43, AOR=0.43, 95% CI=0.32, 0.58) compared with smokers who had never used e-cigarettes. In unadjusted models, daily use (OR=0.42, 95% CI=0.31, 0.56); occasional use (OR=0.25, 95% CI=0.18, 0.35); and experimentation (OR=0.24, 95% CI=0.19, 0.30) of nicotine e-cigarettes were associated with lower odds of being a former smoker compared with having never used nicotine-containing e-cigarettes. Comparable results were found in adjusted models. Results were similar in Great Britain alone. Among current smokers, daily cigarette consumption was 15.6 cigarettes/day (95% CI=14.5, 16.7) among those who also used e-cigarettes versus 14.4 cigarettes/day (95% CI=13.4, 15.4) for those who did not use them (p<0.05).
CONCLUSIONS
These results suggest that e-cigarettes are associated with inhibiting rather than assisting in smoking cessation. On the population level, the net effect of the entry of e-cigarettes into the European Union (and Great Britain) is associated with depressed smoking cessation of conventional cigarettes.
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