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Journal Articles

Evaluating Child Welfare Policies with Decision-Analytic Simulation Models

Jeremy Goldhaber-Fiebert, Stephanie Bailey Rutledge, Michael S. Hurlburt, Jinjin Zhang, Lonnie R. Snowden, Fred Wulczyn, John Landsverk, Sarah (Sally) M. Horwitz
Administration and Policy in Mental Health , 2011
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Journal Articles

The business case for quality improvement: oral anticoagulation for atrial fibrillation

Adam Rose, Dan Berlowitz, Arlene Ash, Al Ozonoff, Elaine Hylek, Jeremy Goldhaber-Fiebert
Circulation: Cardiovascular Quality and Outcomes , 2011

Background: The potential to save money within a short time frame provides a more compelling "business case" for quality improvement than merely demonstrating cost-effectiveness. Our objective was to demonstrate the potential for cost savings from improved control in patients anticoagulated for atrial fibrillation.

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Journal Articles

Building Academic Health Centers' Capacity to Shape and Respond to CER Policy

Jordan M. VanLare, AB, Patrick H. Conway, MD, MSc, John (Jack) W. Rowe
Academic Medicine , 2011
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Journal Articles

Genetic Conservation in gp36 Transmembrane Sequences of Indian HIV Type 2 Isolates

Jadhav S, Tripathy S, Kulkarni S, Chaturbhuj D, Ghare R, Jay Bhattacharya, Paranjape R
AIDS Research and Human Retroviruses , 2011

Abstract HIV-2 group A is predominant in different parts of the world, especially Africa, Portugal, Spain, France, the United Kingdom, the United States, Korea, and India. Among the Asian countries, India accounts for about 95% of all HIV-2 infections. The prevalence of HIV-2 has been reported from various states of India such as Maharashtra, Goa, Tamil Nadu, West Bengal, and Uttar Pradesh.

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Journal Articles

Systematic Review: Benefits and Harms of In-Hospital Use of Recombinant Factor VIIa for Off-Label Indications

Veronica Yank, C. Vaughan Tuohy, Aaron C Logan, Dena M. Bravata, Kristan Staudenmayer, Robin Eisenhut, Vandana Sundaram, Donal McMahon, Ingram Olkin, Kathryn M. McDonald, Douglas K. Owens, Randall S. Stafford
Annals of Internal Medicine , 2011

Background:Recombinant factor VIIa (rFVIIa), a hemostatic agent approved for hemophilia, is increasingly used for off-label indications.

Purpose:To evaluate the benefits and harms of rFVIIa use for 5 off-label, in-hospital indications: intracranial hemorrhage, cardiac surgery, trauma, liver transplantation, and prostatectomy.

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Journal Articles

Cost-effectiveness of a Modestly Effective HIV Vaccine in the United States

Elisa F Long, Douglas K. Owens
Vaccine , 2011

BACKGROUND: The recent RV144 clinical trial showed that an ALVAC/AIDSVAX prime-boost  HIV vaccine regimen may confer partial immunity in recipients and reduce transmission by 31%. Trial data suggest that efficacy may initially exceed 70% but decline over the following 3.5 years. Estimating the potential health benefits associated with a one-time vaccination campaign, as well as the projected benefits of repeat booster vaccination, may inform future HIV vaccine research and licensing decisions.

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Journal Articles

The use of Omegaven in treating parenteral nutrition-associated liver disease.

KT Park, C Nespor, J Kerner Jr.
J Perinatol , 2011

Parenteral nutrition (PN), containing fat emulsions derived from soybean, has been implicated in the progression of PN-associated liver disease and cholestasis, particularly in infants with short bowel syndrome. Clinical use of Omegaven, a parenteral fish-oil emulsion, has been shown in recent studies to be a promising therapy to reverse liver disease and cholestasis. This review summarizes the rationale, relevant clinical investigations and future direction of Omegaven therapy for PN-dependent infants.

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Journal Articles

Substance use disorders and health care costs among VA nursing home residents

Mark Smith, Lemke SB, Schaefer JA
Medical Care , 2011

Abstract

 

Background: Research on the relationship between substance use disorders (SUDs) and older adults' health care costs is equivocal. A large-scale study comparing health care costs among older adults with and without SUDs has never been conducted.

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Journal Articles

Effect of Treatment Interruption and Intensification of Antiretroviral Therapy on Health-related Quality of Life in Patients with Advanced HIV

Vilija Joyce, Paul G. Barnett, Adam Chow, Ahmed M. Bayoumi, Susan C. Griffin, Huiying Sun, Mark Holodniy, Sheldon T. Brown, Tassos C. Kyriakides, D. William Cameron, Mike Youle, Mark Sculpher, Aslam H. Anis, Douglas K. Owens
Medical Decision Making , 2011

Background. The effect of antiretroviral therapy (ART) interruption or intensification on health-related quality of life (HRQoL) in advanced HIV patients is unknown.

Objective. To assess the impact of temporary treatment interruption and intensification of ART on HRQoL.

Design. A 2 x 2 factorial open label randomized controlled trial.

Setting. Hospitals in the United States, Canada, and the United Kingdom.

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Journal Articles

Effectiveness and Cost Effectiveness of Expanding Harm Reduction Programs and HIV Antiretroviral Therapy in a Mixed HIV epidemic: An Analysis for Ukraine

Sabina S. Alistar, Douglas Owens, Margaret Brandeau
PLoS Med , 2011

Background Injection drug use (IDU) and heterosexual virus transmission both contribute to the growing mixed HIV epidemics in Eastern Europe and Central Asia. In Ukraine—chosen in this study as a representative country—IDU-related risk behaviors cause half of new infections, but few injection drug users (IDUs) receive methadone substitution therapy. Only 10% of eligible individuals receive antiretroviral therapy (ART). The appropriate resource allocation between these programs has not been studied.

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Journal Articles

Results of Antiretroviral Treatment Interruption and Intensification in Advanced Multi-drug Resistant HIV Infection from the OPTIMA trial

Mark Holodniy, Sheldon T. Brown, D. William Cameron, Tassos C. Kyriakides, Brian Angus, Abdel Babiker Abdel Babiker, Joel Singer, Douglas K. Owens, Aslam Anis, Ruth Goodall, Fleur Hudson, Mirek Piaseczny, John Russo, Martin Schechter, Lawrence Deyton, Janet Darbyshire
PLoS ONE , 2011

Background Guidance is needed on best medical management for advanced HIV disease with multidrug resistance (MDR) and limited retreatment options. We assessed two novel antiretroviral (ARV) treatment approaches in this setting.

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Journal Articles

The Behavioural Economics of Exercise Habits

Jeremy Goldhaber-Fiebert, Alan M. Garber
VoxEU , 2011

Obesity – and its related illnesses – endangers the lives of millions across the world. While healthier, more physically active lifestyles can mitigate this, the question remains of how policymakers can get people to switch from being couch potatoes to keen runner beans. This column presents new evidence suggesting that for many even a nudge may suffice.

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Journal Articles

Diagnostic Imaging for Low Back Pain: Advice for High-value Health Care from the American College of Physicians

Roger Chou, Amir Qaseem, Douglas K. Owens, Paul Shekelle
Annals of Internal Medicine , 2011

Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care.

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Journal Articles

High-value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate Benefits, Harms, and Costs of Medical Interventions

Douglas K. Owens, Amir Qaseem, Roger Chou, Paul Shekelle
Annals of Internal Medicine , 2011

Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit.

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Journal Articles

Diabetes Mellitus and Tuberculosis in Countries with High Tuberculosis Burdens: Individual Risks and Social Determinants

Jeremy Goldhaber-Fiebert, Christie Y Jeon, Ted Cohen, Megan B Murray
International Journal of Epidemiology , 2011
Background A growing body of evidence supports the role of type 2 diabetes as an individual-level risk factor for tuberculosis (TB), though evidence from developing countries with the highest TB burdens is lacking. In developing countries, TB is most common among the poor, in whom diabetes may be less common. We assessed the relationship between individual-level risk, social determinants and population health in these settings.
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Journal Articles

Effectiveness and Cost-effectiveness of HIV Antiretroviral Regimens Recommended in the World Health Organization’s Guidelines for Resource-limited Settings

Eran Bendavid, Philip Grant, Annie Talbot, Douglas Owens, Andrew Zolopa
AIDS (Official Journal of the International AIDS Society) , 2011

Objective: The World Health Organization (WHO) recently changed its first-line antiretroviral treatment guidelines in resource-limited settings. The cost-effectiveness of the new guidelines is unknown.

Design: Comparative effectiveness and cost-effectiveness analysis using a model of HIV disease progression and treatment.

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Journal Articles

Rifaximin for Irritable Bowel Syndrome Without Constipation

Nayer Khazeni, Daniella Perlroth
New England Journal of Medicine , 2011

BACKGROUND: Evidence suggests that gut flora may play an important role in the pathophysiology of the irritable bowel syndrome (IBS). We evaluated rifaximin, a minimally absorbed antibiotic, as treatment for IBS.

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