Medical Technology

Advances in drugs, devices, and biological products that change the way health care is delivered. LDI Senior Fellows study the adoption and diffusion of medical technologies and assesses their impact on costs and quality of care.

The Promise Of Direct-To-Consumer COVID-19 Testing: Ethical And Regulatory Issues

Louiza Kalokairinou
Sep. 23, 2020

Louiza Kalokairinou, Patricia J Zettler, Ashwini Nagappan, Moira A KywelukAnna Wexler

Abstract [from journal]

Widespread diagnostic and serological (antibody) testing is one key to mitigating the COVID-19 pandemic. While at first, the majority of COVID-19 diagnostic testing in the USA took place in healthcare settings, quickly a direct-to-consumer (DTC) testing market also emerged. In these DTC provision models, the test is initiated by a consumer and the sample collection occurs at home or in a commercial laboratory. Although the provision of DTC tests has potential benefits—such as...

One Call Makes A Difference: An Evaluation Of The Alzheimer's Association National Helpline On Dementia Caregiver Outcomes

Sep. 23, 2020

Nancy A. Hodgson, Darina V. Petrovsky, Kerry Finegan, Beth A. Kallmyer, Joanne Pike, Sam Fazio

Abstract

Objective: The study evaluated the effects of care consultation delivered through the Alzheimer's Association National Helpline - a free resource in which master's-level clinicians offer confidential support. The study compared the effectiveness of Helpline "Care Consultation" and "Care Consultation Plus" conditions on caller outcomes.

Methods: Four hundred and forty-five non-crisis callers were randomly assigned to the traditional Helpline "Care Consultation" or a "Care Consultation Plus" condition that

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T2 Hepatocellular Carcinoma Exception Policies That Prolong Waiting Time Improve The Use Of Evidence-based Treatment Practices

Therese Bitterman, MD, MSCE
Sep. 21, 2020

Claire Durkin, David E. Kaplan, Therese Bittermann

Abstract [from journal]

Background: A United Network for Organ Sharing policy change in 2015 created a 6-mo delay in the receipt of T2 hepatocellular carcinoma exception points. It was hypothesized that the policy changed locoregional therapy (LRT) practices and explant findings because of longer expected waiting time.

Methods: Patients transplanted with a first T2 hepatocellular carcinoma exception application between January 1, 2010 and December 31, 2014 (prepolicy; N = 6562), and those between August 10, 2015 and

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Healthy Behaviors Are Associated With Positive Outcomes For Cancer Survivors With Ostomies: A Cross-Sectional Study

Sep. 17, 2020

Julia Mo, Cynthia A. Thomson, Virginia Sun, Christopher S. Wendel, Mark C. Hornbrook, Ronald S. Weinstein, Elizabeth Ercolano, Marcia Grant, Zuleyha Cidav, Ruth C. McCorkle, Robert S. Krouse 

Abstract [from journal]

Background: Cancer survivors (CS) with ostomies may face challenges in sustaining physical activity (PA) levels and maintaining healthy diets. This analysis describes lifestyle behaviors and their relationships with health-related quality of life (HRQOL) in CS with ostomies.

Methods: This is a cross-sectional, secondary analysis of a multisite randomized self-management education trial for CS with ostomies. The baseline self-reported measures were queried on aerobic PA and diet using the City

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Novel Risk Prediction Models For Post-Operative Mortality In Patients With Cirrhosis

Sep. 16, 2020

Nadim Mahmud, Zachary Fricker, Rebecca A. Hubbard, George N. Ioannou, James D. Lewis, Tamar H. Taddei, Kenneth D. Rothstein, Marina Serper, David S. Goldberg, David E. Kaplan

Abstract [from journal]

Background & aims: Patients with cirrhosis are at increased risk of post-operative mortality. Currently available tools to predict post-operative risk are suboptimally calibrated and do not account for surgery type. Our objective was to use population-level data to derive and internally validate novel cirrhosis surgical risk models.

Methods: We conducted a retrospective cohort study using data from the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) cohort, which contains

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Wearable Devices To Monitor And Reduce The Risk Of Cardiovascular Disease: Evidence And Opportunities

Sep. 4, 2020

Atsushi Mizuno, Sujatha Changolkar, Mitesh S. Patel

Abstract [from journal]

There is a growing interest in using wearable devices to improve cardiovascular risk factors and care. This review evaluates how wearable devices are used for cardiovascular disease monitoring and risk reduction. Wearables have been evaluated for detecting arrhythmias (e.g., atrial fibrillation) as well as monitoring physical activity, sleep, and blood pressure. Thus far, most interventions for risk reduction have focused on increasing physical activity. Interventions have been more successful if the use of wearable devices is

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Organizational Change or Non-Change?

Sep. 2, 2020

On August 3, 2020, The New York Times ran an article entitled “Is Telemedicine Here to Stay?” The article presented various reasons to answer "yes" to that question, and reasons to answer "no." The question, and its answers, offer a powerful and useful example of organizational change generally, as well as change in health care specifically.

Utilization And Survival Outcomes Of Sequential, Concurrent And Sandwich Therapies For Advanced Stage Endometrial Cancers By Histology

Aug. 13, 2020

Emily M. Ko, Colleen M. Brensinger, Lori Cory, Robert L. Giuntoli 2nd, Ashley F. Haggerty, Nawar A. Latif, Diego Aviles, Lainie Martin, Mark A. Morgan, Lilie L. Lin

Abstract [from journal]

Objective: To determine the impact on overall survival (OS) of different modalities of adjuvant therapy for the treatment of stage III endometrial cancer (EC), by histology.

Methods: Stage 3 endometrioid (EAC), serous (SER), clear cell (CC), and carcinosarcoma (CS) patients who underwent primary surgical staging from 2000 to 2013 were identified in SEER-Medicare. Adjuvant therapy was defined by a 4-arm comparator grouping (none; RT only; CT only; combination RT), as well as by an 8-arm

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Effect Of Operative Time On Complications Following Primary Total Hip Arthroplasty: Analysis Of The NSQIP Database

Neil Sheth, MD
Aug. 12, 2020

Mark Sikov, Matthew Sloan, Neil P. Sheth

Abstract [from journal]

Background: Long operative times in total hip arthroplasty (THA) have been shown to be associated with increased risk of revision as well as perioperative morbidity. This study assesses the effect of extended operative times on complication rates following primary THA using the most recent national data.

Methods: The National Surgical Quality Improvement Program (NSQIP) database (2008-2016) was queried for primary THA. Groups were defined by operative time 1 standard deviation (1 SD) above the

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Evaluating Patient Preferences For Thermal Ablation Versus Non-Thermal, Non-Tumescent Varicose Vein Treatments

Aug. 10, 2020

Peter Pappas, Candace Gunnarsson, Guy David

Abstract [from journal]

Objective: To measure patient preferences for attributes associated with thermal ablation and non-thermal, non-tumescent varicose vein treatments.

Methods: Data were collected from an electronic patient-preference survey taken by 70 adult participants (aged 20 years or older) at 3 Center for Vein Restoration clinics in New Jersey from July 19, 2019, through August 13, 2019. Survey participation was voluntary and anonymous (participation rate of 80.5% [70/87]). Patients were shown 10

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Impact Of COVID-19 Pandemic On STEMI Care: An Expanded Analysis From The United States

Aug. 7, 2020

Santiago Garcia, Larissa Stanberry, Christian Schmidt, Scott Sharkey, Michael Megaly, Mazen S. Albaghdadi, Perwaiz M. Meraj, Ross Garberich, Farouc A. Jaffer, Ada C. Stefanescu Schmidt, Simon R. Dixon, Jeffrey J. Rade, Timothy Smith, Mark Tannenbaum, Jenny Chambers, Frank Aguirre, Paul P. Huang...

Abstract [from journal]

Objective: To evaluate the impact of COVID-19 pandemic migitation measures on of ST-elevation myocardial infarction (STEMI) care.

Background: We previously reported a 38% decline in cardiac catheterization activations during the early phase of the COVID-19 pandemic mitigation measures. This study extends our early observations using a larger sample of STEMI programs representative of different US regions with the inclusion of more contemporary data.

Methods: Data from

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Trends In Use Of Advanced Imaging In Pediatric Emergency Departments, 2009-2018

Margaret Samuels-Kalow, MD, MPhil
Aug. 3, 2020

Jennifer R. Marin,  Jonathan Rodean, Matt Hall, Elizabeth R. Alpern, Paul L. Aronson, Pradip P. Chaudhari, Eyal Cohen, Stephen B. Freedman, Rustin B. Morse, Alon Peltz, Margaret Samuels-Kalow, Samir S. Shah, Harold K. Simon, Mark I. Neuman

Abstract [from journal]

Importance: There is increased awareness of radiation risks from computed tomography (CT) in pediatric patients. In emergency departments (EDs), evidence-based guidelines, improvements in imaging technology, and availability of nonradiating modalities have potentially reduced CT use.

Objective: To evaluate changes over time and hospital variation in advanced imaging use.

Design, setting, and participants: This cross-sectional study assessed 26 082 062 ED visits by

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Efficacy Of An Enhanced Recovery After Surgery (ERAS) Pathway In Elderly Patients Undergoing Spine And Peripheral Nerve Surgery

Jul. 31, 2020

Joseph Ifrach, Rohan Basu, Disha S. Joshi, Tracy M. Flanders, Ali K. Ozturk, Neil R. Malhotra, Rachel Pessoa, Michael J. Kallan, Eileen Maloney, William C. Welch, Zarina S. Ali 

Abstract [from journal]

Objective: Elderly patients are a vulnerable patient population in elective spinal surgery. Older patients have more medical comorbidities and are also more sensitive to opiate medications. Despite this, spine and peripheral nerve surgery is still feasible in these patients, and an Enhanced Recovery After Surgery (ERAS) regimen can further enhance the safety profile.

Methods: This is a before and after cohort study at a single institution on elderly patients who underwent elective spine and

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Thematic Analysis Of The Medical Records Of Patients Evaluated For Kidney Transplant Who Did Not Receive A Kidney

Jul. 25, 2020

Catherine R. Butler, Janelle S. Taylor, Peter P. Reese, Ann M. O’Hare 

Abstract [from journal]

Background: A potential pitfall of policies intended to promote referral for kidney transplant is that greater numbers of patients may be evaluated for transplant without experiencing the intended benefit of receiving a kidney. Little is known about the potential implications of this experience for patients.

Methods: We performed a thematic analysis of clinician documentation in the electronic medical records of all adults at a single medical center with advanced kidney disease who were

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