Suzanne L. Hunt

Equivalent weight loss for weight management programs delivered by phone and clinic.

Face‐to‐face (FTF) weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by FTF clinic or group conference calls (phone).

Physical activity and academic achievement across the curriculum: Results from a 3-year cluster-randomized trial

We compared changes in academic achievement across 3years between children in elementary schools receiving the Academic Achievement and Physical Activity Across the Curriculum intervention (A+PAAC), in which classroom teachers were trained to deliver academic lessons using moderate-to-vigorous physical activity (MVPA) compared to a non-intervention control. Elementary schools in eastern Kansas (n=17) were cluster randomized to A+PAAC (N=9, target ≥100min/week) or control (N=8). Academic achievement (math, reading, spelling) was assessed using the Wechsler Individual Achievement Test-Third Edition (WIAT-III) in a sample of children (A+PAAC=316, Control=268) in grades 2 and 3 at baseline (Fall 2011) and repeated each spring across 3years. On average 55min/week of A+PACC lessons were delivered each week across the intervention. Baseline WIAT-III scores (math, reading, spelling) were significantly higher in students in A+PAAC compared with control schools and improved in both groups across 3years. However, linear mixed modeling, accounting for baseline between group differences in WIAT-III scores, ethnicity, family income, and cardiovascular fitness, found no significant impact of A+PAAC on any of the academic achievement outcomes as determined by non-significant group by time interactions. A+PAAC neither diminished or improved academic achievement across 3-years in elementary school children compared with controls. Our target of 100min/week of active lessons was not achieved; however, students attending A+PAAC schools received an additional 55min/week of MVPA which may be associated with both physical and mental health benefits, without a reduction in time devoted to academic instruction.

A Bayesian comparative effectiveness trial in action: developing a platform for multisite study adaptive randomization

BackgroundIn the last few decades, the number of trials using Bayesian methods has grown rapidly. Publications prior to 1990 included only three clinical trials that used Bayesian methods, but that number quickly jumped to 19 in the 1990s and to 99 from 2000 to 2012. While this literature provides many examples of Bayesian Adaptive Designs (BAD), none of the papers that are available walks the reader through the detailed process of conducting a BAD. This paper fills that gap by describing the BAD process used for one comparative effectiveness trial (Patient Assisted Intervention for Neuropathy: Comparison of Treatment in Real Life Situations) that can be generalized for use by others. A BAD was chosen with efficiency in mind. Response-adaptive randomization allows the potential for substantially smaller sample sizes, and can provide faster conclusions about which treatment or treatments are most effective. An Internet-based electronic data capture tool, which features a randomization module, facilitated data capture across study sites and an in-house computation software program was developed to implement the response-adaptive randomization.ResultsA process for adapting randomization with minimal interruption to study sites was developed. A new randomization table can be generated quickly and can be seamlessly integrated in the data capture tool with minimal interruption to study sites.ConclusionThis manuscript is the first to detail the technical process used to evaluate a multisite comparative effectiveness trial using adaptive randomization. An important opportunity for the application of Bayesian trials is in comparative effectiveness trials. The specific case study presented in this paper can be used as a model for conducting future clinical trials using a combination of statistical software and a web-based application.Trial registrationClinicalTrials.gov Identifier: NCT02260388, registered on 6 October 2014

Correlates of Preincarceration Health Care Use Among Women and Men in Jail

Although women and men in jails bear a burden of health problems, little is known about factors associated with their health care use. We conducted a cross-sectional survey of preincarceration health care use with 596 jail inmates. Descriptive statistics and correlates of participants’ health care use were assessed. A year before incarceration, 54% of participants used an emergency room, 24% were hospitalized, and 39% used primary care. Correlates of health care use included gender, health insurance status, and drug dependence. For participants without mental health problems, use was associated with living in neighborhoods where a higher percentage of residents did not complete high school. Findings suggest individual and community factors that can be targeted by reentry programs to improve health care use after jail.

Augmenting Amyloid PET Interpretations With Quantitative Information Improves Consistency of Early Amyloid Detection

Purpose Establishing reliable methods for interpreting elevated cerebral amyloid-&bgr; plaque on PET scans is increasingly important for radiologists, as availability of PET imaging in clinical practice increases. We examined a 3-step method to detect plaque in cognitively normal older adults, focusing on the additive value of quantitative information during the PET scan interpretation process. Methods Fifty-five 18F-florbetapir PET scans were evaluated by 3 experienced raters. Scans were first visually interpreted as having “elevated” or “nonelevated” plaque burden (“Visual Read”). Images were then processed using a standardized quantitative analysis software (MIMneuro) to generate whole brain and region of interest SUV ratios. This “Quantitative Read” was considered elevated if at least 2 of 6 regions of interest had an SUV ratio of more than 1.1. The final interpretation combined both visual and quantitative data together (“VisQ Read”). Cohen kappa values were assessed as a measure of interpretation agreement. Results Plaque was elevated in 25.5% to 29.1% of the 165 total Visual Reads. Interrater agreement was strong (kappa = 0.73–0.82) and consistent with reported values. Quantitative Reads were elevated in 45.5% of participants. Final VisQ Reads changed from initial Visual Reads in 16 interpretations (9.7%), with most changing from “nonelevated” Visual Reads to “elevated.” These changed interpretations demonstrated lower plaque quantification than those initially read as “elevated” that remained unchanged. Interrater variability improved for VisQ Reads with the addition of quantitative information (kappa = 0.88–0.96). Conclusions Inclusion of quantitative information increases consistency of PET scan interpretations for early detection of cerebral amyloid-&bgr; plaque accumulation.

Learning your ABDs: variation in health care utilization across Kansas Medicaid disability groups.

BACKGROUND State Medicaid programs provide critical health care access for persons with disabilities and older adults. Aged, Blind and Disabled (ABD) programs consist of important disability subgroups that Medicaid programs are not able to readily distinguish. OBJECTIVE/HYPOTHESIS The purpose of this project was to create an algorithm based principally on eligibility and claims data to distinguish disability subgroups and characterize differences in demographic characteristics, disease burden, and health care expenditures. METHODS We created an algorithm to distinguish Kansas Medicaid enrollees as adults with intellectual or developmental delays (IDD), physical disabilities (PD), severe mental illness (SMI), and older age. RESULTS For fiscal year 2009, our algorithm separated 101,464 ABD enrollees into the following disability subgroups: persons with IDD (19.6%), persons with PD (21.0%), older adults (19.7%), persons with SMI (32.8%), and persons not otherwise classified (6.9%). The disease burden present in the IDD, PD, and SMI subgroups was higher than for older adults. Home- and community-based services expenditures were common and highest for persons with IDD and PD. Older adults and persons with SMI had their highest expenditures for long-term care. Mean Medicaid expenditures were consistently higher for adults with IDD followed by adults with PD. CONCLUSIONS There are substantial differences between disability subgroups in the Kansas Medicaid ABD population with respect to demographics, disease burden, and health care expenditures. Through this algorithm, state Medicaid programs have the opportunity to collaborate with the most closely aligned service providers reflecting needed services for each disability subgroup.

Radiologic and Pathologic Features Associated With Upgrade of Atypical Ductal Hyperplasia at Surgical Excision

RATIONALE AND OBJECTIVES To evaluate radiologic and pathologic features associated with upgrade of atypical ductal hyperplasia (ADH) to ductal carcinoma in situ or invasive breast cancer at surgical excision, in order to identify patients who may consider alternatives to excision. MATERIALS AND METHODS This retrospective analysis examined patients who underwent surgical excision of biopsy-proven ADH at our institution. Imaging and pathology from biopsy were reviewed to determine radiologic (lesion size, radiologic abnormality, biopsy type, needle gauge, number of cores, percent of lesion removed) and pathologic features (histologic calcifications, presence of necrosis, micropapillary features, extent of ADH) associated with ADH upgrade. RESULTS One hundred twenty four cases of percutaneous biopsy-proven ADH with subsequent excision were included. The overall upgrade rate was 17.7% (n = 22), with 17 cases to ductal carcinoma in situ and five to invasive cancer. Radiologic features associated with a lower upgrade rate were smaller lesion size (p = 0.032) and larger percent of lesion removed at biopsy (p = 0.047). Larger needle gauge at biopsy (p = 0.070), absence of necrosis (p = 0.051) and focal ADH (<3 foci, p = 0.12) were nearly associated with a lower rate of upgrade and were included for the purpose of multi parameter analyses. CONCLUSION For women with ADH identified on percutaneous biopsy, the risk of upgrade may in part be determined by lesion size, percent of lesion removed at biopsy, presence of necrosis, and extent of ADH. Using a combination of these radiographic and pathologic features to stratify patients with biopsy-proven ADH may help identify women who could be considered for alternative treatment options.