John Cursio | The University of Chicago Medical Center (original) (raw)

Papers by John Cursio

Research paper thumbnail of Incident TTP: Plasmapheresis Therapy-Related Complications Are Common

Blood, 2005

Background: Plasmapheresis is the mainstay of therapy for thrombotic thrombocytopenic purpura (TT... more Background: Plasmapheresis is the mainstay of therapy for thrombotic thrombocytopenic purpura (TTP). Due to the significant mortality associated with TTP if left untreated and the effectiveness of therapy, plasmapheresis may be instituted before the diagnosis is clearly established. Our case-control study of incident TTP allowed us to evaluate the incidence of complications in cases treated at multiple sites across the United States. Methods: The SERF-TTP study is a NHLBI-funded 15-site study to identify 300 cases of incident TTP and 600 age and gender-matched community controls. Each case of incident TTP is identified upon referral for therapeutic plasma exchange (TPE). Exclusion criteria include solid organ or allogeneic stem cell transplant, anti-neoplastic therapy, or metastatic adenocarcinoma. Epidemiologic information, laboratory data, and plasma samples are collected from both patients and controls. In addition, information is collected about volume of TPE, frequency, type of...

Research paper thumbnail of Lifestyle Intervention and Cardiovascular Risk Reduction in the Illinois WISEWOMAN Program

Journal of Women's Health, 2012

Background: The Illinois WISEWOMAN Program (IWP) was designed to address the disproportionate ris... more Background: The Illinois WISEWOMAN Program (IWP) was designed to address the disproportionate risk of cardiovascular disease (CVD) among disadvantaged, low-income women. In total, 1021 women aged 40 to 64 years were recruited from the Illinois Breast and Cervical Cancer Program. The women were randomized to either a minimum intervention (MI) or an enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational materials, and the EI group received a 12-week lifestyle change intervention. Methods: Demographic and clinical data were collected in addition to data on CVD risk, which was measured in terms of nutritional and physical activity behavior, using culturally adapted versions of three valid and reliable questionnaires. IWP data were analyzed for demographic characteristics and clinical and behavioral outcomes at baseline, post-intervention, and follow-up at 1 and 2 years from baseline. This article reports the change in these outcomes up to the 1-year follow-up. Results: Participants in the EI group showed significant improvement on some of the dietary and physical activity outcomes both at post-intervention and 1-year follow-up. Compared with the MI group, the EI group showed more improvement in dietary fat-and fiber-related behaviors and increased physical activity levels. There were improvements in all of the cardiovascular outcomes at post-intervention in both the EI and MI groups; however, these changes were not statistically significant. Conclusion: As an integrated physical activity and nutrition intervention, the IWP has shown its strength in addressing some of the lifestyle behaviors for CVD prevention in this at-risk target population.

Research paper thumbnail of Lifestyle Intervention and Cardiovascular Disease Risk Reduction in Low-Income Hispanic Immigrant Women Participating in the Illinois WISEWOMAN Program

Journal of Community Health, 2014

Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United State... more Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United States. In 2001, the Illinois Department of Public Health received funding from the Centers for Disease Control and Prevention to implement the enhanced WISEWOMAN program (IWP) to address the disproportionate CVD risk among uninsured and underinsured women enrolled in the Illinois Breast and Cervical Cancer Early Detection Program. This paper presents the results of the Spanish-language arm of the IWP. Spanish speaking IWP participants were recruited from two sites, and randomized into either the minimum intervention (MI) or the enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational handouts. The EI group also received an integrated 12-week nutrition and physical activity lifestyle change intervention. Of the 180 Spanish-speaking immigrants in this sample, 90 (50 %) received the EI and 90 (50 %) received the MI. At baseline there were no significant differences between group demographics or clinical values. At post-intervention, the EI group showed improvements in fat intake, fiber intake, moderate intensity physical activity, and total physical activity. At 1 year only the change in fiber intake remained. A significant improvement was also seen in body mass index (BMI) at the 1-year follow-up. The IWP Spanish-language arm was moderately successful in addressing risk factors for CVD in this population. The behavior changes that sustained up to a year were an increase in fiber intake and a decrease in BMI.

Research paper thumbnail of Outcomes of Patients with Accelerated/Blast-Phase Myeloproliferative Neoplasms in the Current Era of Myeloid Therapies

Research paper thumbnail of Sleep Disturbance is Associated with Missing PrEP Doses Among Young Black Sexual Minority Men in The N2 study

Research paper thumbnail of Risk and response adapted de-intensified treatment for HPV-associated oropharyngeal cancer: Optima paradigm expanded experience

Oral Oncology, 2021

Background: Favorable prognosis for Human papillomavirus-associated (HPV+) oropharyngeal cancer (... more Background: Favorable prognosis for Human papillomavirus-associated (HPV+) oropharyngeal cancer (OPC) led to investigation of response-adaptive de-escalation, yet long-term outcomes are unknown. We present expanded experience and follow-up of risk/response adaptive treatment de-intensification in HPV+ OPC.

Research paper thumbnail of Fewer actionable mutations but higher tumor mutational burden characterizes NSCLC in black patients at an urban academic medical center

Oncotarget, 2019

Background: Black patients have been historically underrepresented in studies investigating molec... more Background: Black patients have been historically underrepresented in studies investigating molecular patterns in non-small cell lung cancer (NSCLC). We aimed to investigate differences in actionable mutations among patients at our urban, diverse medical center. Results: 146 patients were included (59 black, 76 white, 7 Asian, 3 Hispanic, 1 mixed). 35 patients had a targetable mutation. Seven black patients (11.8%) had a targetable mutation compared to 28 non-black patients (32.2%, p = 0.005). 15 black patients had PD-L1 expression ≥50% compared to 19 non-black (25.4% vs 21.8%, p = 0.69). Black patients had a higher TMB compared to non-black (15.3 mutations/ Mb compared to 11.5 mutations/Mb, p = 0.001). In a multivariate analysis, TMB was driven by smoking (p < 0.01), without any additive interaction in black patients who smoke (p = 0.8). Conclusion: NSCLC tumors from black patients had a higher TMB and were less likely to carry a targetable mutation. The higher TMB seen was driven by a higher prevalence of smoking among black patients in our study, which may not reflect nationwide trends. Our results serve as a proof of concept that differences in molecular markers exist between black and non-black patients, and that these differences may impact the treatment options available to black patients. Methods: Retrospective chart review of patients with a diagnosis of NSCLC who underwent both PD-L1 testing and massively parallel sequencing (UCM-OncoPlus) was conducted. We examined whether high PD-L1 expression, tumor mutational burden (TMB), and presence of targetable mutations (EGFR, BRAF, ERBB2, RET or ALK translocations, ROS1 rearrangements) occur at different frequencies in tumors from black patients compared to non-black patients.

Research paper thumbnail of Discharge disposition as an independent predictor of readmission among patients hospitalised for community-acquired pneumonia

International journal of clinical practice, 2017

Community-acquired pneumonia (CAP) is the most common non-obstetrical reason for hospital admissi... more Community-acquired pneumonia (CAP) is the most common non-obstetrical reason for hospital admission, the leading infectious cause of death, and a target for public reporting. CAP has thus become a target of quality improvement and pay-for-performance efforts. However, the relationship between discharge disposition and readmission risk has not been investigated. We studied CAP patients admitted to the University of Chicago from 11/2011 to 04/2015. We collected demographic information, comorbidities, laboratory values, vital signs, a modified pneumonia severity index (PSI), length of stay (LOS), clinical instabilities before discharge, discharge disposition and 30-day all-cause readmission. A multivariate logistic regression was performed, specifying readmission as the dependent variable, including as independent variables gender, ethnicity, insurance status, discharge disposition, PSI tertile, the number of clinical instabilities, LOS and comorbidities. Of the 2892 CAP patients ident...

Research paper thumbnail of Improving Pain Relief in Elder Patients (I-PREP): An Emergency Department Education and Quality Intervention

Journal of the American Geriatrics Society, 2016

To assess the effectiveness of a novel combined education and quality improvement (QI) program fo... more To assess the effectiveness of a novel combined education and quality improvement (QI) program for management of pain in older adults in the emergency department (ED). Controlled pre/postintervention examination. An academic urban ED seeing 60,000 adult visits annually. Individuals aged 65 and older experiencing moderate to severe pain. Linked standardized education and continuous QI for multidisciplinary staff in an urban, academic ED from January 2012 to January 2014. Pain intensity, percentage receiving and time to pain assessment and reassessment, percentage receiving and time to delivery of analgesic. The percentage of participants with final pain score of 4 or less (out of 10) increased 47.5% (95% confidence interval (CI) = 41.8-53.2%). Median decrease in pain intensity improved significantly, from 0.0 to 5.0 points (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Median final pain score decreased from 7.0 to 4.0 points (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The percentage of participants with any pain improvement increased 43.7% (95% CI = 37.1-50.3%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Pain reassessments increased significantly (from 51.9% to 82.5%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The percentage receiving analgesics increased significantly (from 64.1% to 84.8%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). After the intervention, participants had 3.1 (95% CI = 2.1-4.4, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) greater odds of receiving analgesics and 4.7 (95% CI = 3.5-6.5, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) greater odds of documented pain reassessment. The I-PREP intervention substantially improved pain management in older adults in the ED with moderate to severe musculoskeletal or abdominal pain. Significant reductions in pain intensity were achieved, the timing of pain assessments and reassessments was improved, and analgesics were delivered faster. Tightly linking education to targeted QI improved pain management of older adults in the ED.

Research paper thumbnail of A Lifestyle Approach to Reducing Cardiovascular Risk Factors in Underserved Women: Design and Methods of the Illinois WISEWOMAN Program

Journal of Women's Health, 2009

Few lifestyle intervention programs address the needs of financially disadvantaged, low literacy ... more Few lifestyle intervention programs address the needs of financially disadvantaged, low literacy populations. The overall goal of the Illinois WISEWOMAN Program (IWP) was to design such a program and test its effectiveness in reducing cardiovascular disease (CVD) risk, specifically physical activity and nutrition factors. The purpose of this paper is to describe the IWP study design and methods, development of the evidence-based curriculum appropriate for a low socioeconomic status (SES) population, and baseline characteristics of IWP participants. The Cooper Institute, in collaboration with the Illinois Department of Public Health and the University of Illinois at Chicago, adapted evidence-based interventions for financially disadvantaged, low literacy populations. The study used a randomized, two-group, experimental design. In total, 1021 women were recruited from the Illinois Breast and Cervical Cancer Program, which serves uninsured and underinsured women, aged 40-64, at or below 200% of poverty. The women were randomized to either a minimum intervention (MI) or an enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational materials. Additionally, the EI group received a 12-week lifestyle intervention. Baseline comparisons show equivalent groups. IWP participants had a higher prevalence of obesity and smoking than similar national samples. IWP addressed many of the cultural and implementation barriers in programs that seek to improve the health of financially disadvantaged, low literacy populations. Because of the high burden of disease, the unique study population, and the sound design, we anticipate that our future results will contribute to the translation literature, which has largely ignored significant health disparities.

Research paper thumbnail of High glucocorticoid receptor expression in the sarcomatous versus carcinomatous elements of Mullerian carcinosarcomas

Gynecologic Oncology Reports

Research paper thumbnail of Rates of Inappropriate Dosing in Older Adults at an Urban, Academic Hospital

American Journal of Medical Quality

Research paper thumbnail of Dose and volume de-escalation for HPV-associated oropharyngeal cancer: Long-term follow-up of the OPTIMA trial

Journal of Clinical Oncology

6575 Background: Human papilloma virus (HPV) associated oropharyngeal cancer is associated with a... more 6575 Background: Human papilloma virus (HPV) associated oropharyngeal cancer is associated with a favorable prognosis, but standard multimodality treatment is associated with substantial treatment related toxicity. A de-escalation treatment paradigm that optimizes oncologic outcomes while reducing toxicity is needed. We sought to further expound on our published OPTIMA data with long-term follow-up and additional pts subsequently treated using the OPTIMA treatment paradigm. Methods: Long-term follow-up of our institutional de-escalation OPTIMA trial (NCT02258659) and retrospective review of additional patients treated subsequently per OPTIMA outline was performed. Pts were classified as low-risk (LR) (≤T3, ≤N2B, ≤10PYH) or high-risk (HR) (T4, ≥N2c, > 10PYH). Pts received induction chemotherapy (IC) of 3 cycles of dose dense carboplatin and nab-paclitaxel (OPTIMA) or paclitaxel (subsequently treated). LR with ≥50% response received low-dose radiotherapy (RT) to 50 Gy. LR with 30-5...

Research paper thumbnail of Knowledge and health beliefs assessment of Sickle cell disease as a prelude to neonatal screening in Ibadan, Nigeria

Journal of Global Health Reports

Back Background ground Nigeria bears the highest burden of sickle cell disease (SCD) in the world... more Back Background ground Nigeria bears the highest burden of sickle cell disease (SCD) in the world. Neonatal screening programmes for SCD in other countries have been associated with remarkable reductions in mortality and morbidity. In Nigeria, there is an ongoing effort to implement a large scale SCD neonatal screening program with long-term follow-up. This study was conducted to assess the adequacy of knowledge and perspectives of the target population with regard to newborn screening for sickle cell disease and also to identify likely barriers and challenges to the successful implementation of the programme.

Research paper thumbnail of Religious Health Fatalism Questionnaire--Muslim Version

Research paper thumbnail of Abstract 3697: High PD-L1 expression and targetable mutations occur independently in NSCLC and are not influenced by smoking or race

Clinical Research (Excluding Clinical Trials)

Research paper thumbnail of Latent trait shared-parameter mixed models for missing ecological momentary assessment data

Research paper thumbnail of Does Nursing Home Compare Reflect Patient Safety In Nursing Homes?

Health Affairs

The past several decades have seen significant policy efforts to improve the quality of care in n... more The past several decades have seen significant policy efforts to improve the quality of care in nursing homes, but the patient safety movement has largely ignored this setting. In this study we compared nursing homes' performance on several composite quality measures from Nursing Home Compare, the most prominent recent example of a national policy aimed at improving the quality of nursing home care, to their performance on measures of patient safety in nursing homes such as pressure sores, infections, falls, and medication errors. Although Nursing Home Compare captures some aspects of patient safety, we found the relationship to be weak and somewhat inconsistent, leaving consumers who care about patient safety with little guidance. We recommend that Nursing Home Compare be refined to provide a clearer picture of patient safety and quality of life, allowing consumers to weight these domains according to their preferences and priorities.

Research paper thumbnail of Adapting a religious health fatalism measure for use in Muslim populations

PLOS ONE

Objective Fatalism has been shown to influence health behaviors and outcomes among different popu... more Objective Fatalism has been shown to influence health behaviors and outcomes among different populations. Our study reports on the adaptation of the Religious Health Fatalism Questionnaire for a Muslim population (RHFQ-M). Design The original RHFQ wording was modified for a Muslim context and cognitively tested in 6 focus groups (FG). Items were revised by Muslim and non-Muslim healthcare researchers based on FG responses regarding the theological "accurateness" of the questions. The revised 9item measure was administered to 58 English-speaking Muslim women (�40 years old) recruited from two mosques in the Chicago area in order to assess psychometric properties. Main outcome measures Cronbach's alpha and exploratory factor analyses were used to assess internal consistency and measure dimensionality, respectively. Statistical correlations with several fatalism and religiosity measures were computed to assess convergent and discriminant validity. Results After testing with an ethnically and racially diverse group of Muslims, the RHFQ-M was found to be reliable (Cronbach's α is 0.79), comprised of two distinct underlying subscales, and is correlated with, but distinct from, other measures of fatalism and Islamic religiosity. Conclusion Our adapted measure, RHFQ-M, appears to accurately assess Islamic dimensions of fatalism and is ready for use in the health literature.

Research paper thumbnail of Adapting a religious health fatalism measure for use in Muslim populations

PLOS ONE

Objective Fatalism has been shown to influence health behaviors and outcomes among different popu... more Objective Fatalism has been shown to influence health behaviors and outcomes among different populations. Our study reports on the adaptation of the Religious Health Fatalism Questionnaire for a Muslim population (RHFQ-M). Design The original RHFQ wording was modified for a Muslim context and cognitively tested in 6 focus groups (FG). Items were revised by Muslim and non-Muslim healthcare researchers based on FG responses regarding the theological "accurateness" of the questions. The revised 9item measure was administered to 58 English-speaking Muslim women (�40 years old) recruited from two mosques in the Chicago area in order to assess psychometric properties. Main outcome measures Cronbach's alpha and exploratory factor analyses were used to assess internal consistency and measure dimensionality, respectively. Statistical correlations with several fatalism and religiosity measures were computed to assess convergent and discriminant validity. Results After testing with an ethnically and racially diverse group of Muslims, the RHFQ-M was found to be reliable (Cronbach's α is 0.79), comprised of two distinct underlying subscales, and is correlated with, but distinct from, other measures of fatalism and Islamic religiosity. Conclusion Our adapted measure, RHFQ-M, appears to accurately assess Islamic dimensions of fatalism and is ready for use in the health literature.

Research paper thumbnail of Incident TTP: Plasmapheresis Therapy-Related Complications Are Common

Blood, 2005

Background: Plasmapheresis is the mainstay of therapy for thrombotic thrombocytopenic purpura (TT... more Background: Plasmapheresis is the mainstay of therapy for thrombotic thrombocytopenic purpura (TTP). Due to the significant mortality associated with TTP if left untreated and the effectiveness of therapy, plasmapheresis may be instituted before the diagnosis is clearly established. Our case-control study of incident TTP allowed us to evaluate the incidence of complications in cases treated at multiple sites across the United States. Methods: The SERF-TTP study is a NHLBI-funded 15-site study to identify 300 cases of incident TTP and 600 age and gender-matched community controls. Each case of incident TTP is identified upon referral for therapeutic plasma exchange (TPE). Exclusion criteria include solid organ or allogeneic stem cell transplant, anti-neoplastic therapy, or metastatic adenocarcinoma. Epidemiologic information, laboratory data, and plasma samples are collected from both patients and controls. In addition, information is collected about volume of TPE, frequency, type of...

Research paper thumbnail of Lifestyle Intervention and Cardiovascular Risk Reduction in the Illinois WISEWOMAN Program

Journal of Women's Health, 2012

Background: The Illinois WISEWOMAN Program (IWP) was designed to address the disproportionate ris... more Background: The Illinois WISEWOMAN Program (IWP) was designed to address the disproportionate risk of cardiovascular disease (CVD) among disadvantaged, low-income women. In total, 1021 women aged 40 to 64 years were recruited from the Illinois Breast and Cervical Cancer Program. The women were randomized to either a minimum intervention (MI) or an enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational materials, and the EI group received a 12-week lifestyle change intervention. Methods: Demographic and clinical data were collected in addition to data on CVD risk, which was measured in terms of nutritional and physical activity behavior, using culturally adapted versions of three valid and reliable questionnaires. IWP data were analyzed for demographic characteristics and clinical and behavioral outcomes at baseline, post-intervention, and follow-up at 1 and 2 years from baseline. This article reports the change in these outcomes up to the 1-year follow-up. Results: Participants in the EI group showed significant improvement on some of the dietary and physical activity outcomes both at post-intervention and 1-year follow-up. Compared with the MI group, the EI group showed more improvement in dietary fat-and fiber-related behaviors and increased physical activity levels. There were improvements in all of the cardiovascular outcomes at post-intervention in both the EI and MI groups; however, these changes were not statistically significant. Conclusion: As an integrated physical activity and nutrition intervention, the IWP has shown its strength in addressing some of the lifestyle behaviors for CVD prevention in this at-risk target population.

Research paper thumbnail of Lifestyle Intervention and Cardiovascular Disease Risk Reduction in Low-Income Hispanic Immigrant Women Participating in the Illinois WISEWOMAN Program

Journal of Community Health, 2014

Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United State... more Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United States. In 2001, the Illinois Department of Public Health received funding from the Centers for Disease Control and Prevention to implement the enhanced WISEWOMAN program (IWP) to address the disproportionate CVD risk among uninsured and underinsured women enrolled in the Illinois Breast and Cervical Cancer Early Detection Program. This paper presents the results of the Spanish-language arm of the IWP. Spanish speaking IWP participants were recruited from two sites, and randomized into either the minimum intervention (MI) or the enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational handouts. The EI group also received an integrated 12-week nutrition and physical activity lifestyle change intervention. Of the 180 Spanish-speaking immigrants in this sample, 90 (50 %) received the EI and 90 (50 %) received the MI. At baseline there were no significant differences between group demographics or clinical values. At post-intervention, the EI group showed improvements in fat intake, fiber intake, moderate intensity physical activity, and total physical activity. At 1 year only the change in fiber intake remained. A significant improvement was also seen in body mass index (BMI) at the 1-year follow-up. The IWP Spanish-language arm was moderately successful in addressing risk factors for CVD in this population. The behavior changes that sustained up to a year were an increase in fiber intake and a decrease in BMI.

Research paper thumbnail of Outcomes of Patients with Accelerated/Blast-Phase Myeloproliferative Neoplasms in the Current Era of Myeloid Therapies

Research paper thumbnail of Sleep Disturbance is Associated with Missing PrEP Doses Among Young Black Sexual Minority Men in The N2 study

Research paper thumbnail of Risk and response adapted de-intensified treatment for HPV-associated oropharyngeal cancer: Optima paradigm expanded experience

Oral Oncology, 2021

Background: Favorable prognosis for Human papillomavirus-associated (HPV+) oropharyngeal cancer (... more Background: Favorable prognosis for Human papillomavirus-associated (HPV+) oropharyngeal cancer (OPC) led to investigation of response-adaptive de-escalation, yet long-term outcomes are unknown. We present expanded experience and follow-up of risk/response adaptive treatment de-intensification in HPV+ OPC.

Research paper thumbnail of Fewer actionable mutations but higher tumor mutational burden characterizes NSCLC in black patients at an urban academic medical center

Oncotarget, 2019

Background: Black patients have been historically underrepresented in studies investigating molec... more Background: Black patients have been historically underrepresented in studies investigating molecular patterns in non-small cell lung cancer (NSCLC). We aimed to investigate differences in actionable mutations among patients at our urban, diverse medical center. Results: 146 patients were included (59 black, 76 white, 7 Asian, 3 Hispanic, 1 mixed). 35 patients had a targetable mutation. Seven black patients (11.8%) had a targetable mutation compared to 28 non-black patients (32.2%, p = 0.005). 15 black patients had PD-L1 expression ≥50% compared to 19 non-black (25.4% vs 21.8%, p = 0.69). Black patients had a higher TMB compared to non-black (15.3 mutations/ Mb compared to 11.5 mutations/Mb, p = 0.001). In a multivariate analysis, TMB was driven by smoking (p < 0.01), without any additive interaction in black patients who smoke (p = 0.8). Conclusion: NSCLC tumors from black patients had a higher TMB and were less likely to carry a targetable mutation. The higher TMB seen was driven by a higher prevalence of smoking among black patients in our study, which may not reflect nationwide trends. Our results serve as a proof of concept that differences in molecular markers exist between black and non-black patients, and that these differences may impact the treatment options available to black patients. Methods: Retrospective chart review of patients with a diagnosis of NSCLC who underwent both PD-L1 testing and massively parallel sequencing (UCM-OncoPlus) was conducted. We examined whether high PD-L1 expression, tumor mutational burden (TMB), and presence of targetable mutations (EGFR, BRAF, ERBB2, RET or ALK translocations, ROS1 rearrangements) occur at different frequencies in tumors from black patients compared to non-black patients.

Research paper thumbnail of Discharge disposition as an independent predictor of readmission among patients hospitalised for community-acquired pneumonia

International journal of clinical practice, 2017

Community-acquired pneumonia (CAP) is the most common non-obstetrical reason for hospital admissi... more Community-acquired pneumonia (CAP) is the most common non-obstetrical reason for hospital admission, the leading infectious cause of death, and a target for public reporting. CAP has thus become a target of quality improvement and pay-for-performance efforts. However, the relationship between discharge disposition and readmission risk has not been investigated. We studied CAP patients admitted to the University of Chicago from 11/2011 to 04/2015. We collected demographic information, comorbidities, laboratory values, vital signs, a modified pneumonia severity index (PSI), length of stay (LOS), clinical instabilities before discharge, discharge disposition and 30-day all-cause readmission. A multivariate logistic regression was performed, specifying readmission as the dependent variable, including as independent variables gender, ethnicity, insurance status, discharge disposition, PSI tertile, the number of clinical instabilities, LOS and comorbidities. Of the 2892 CAP patients ident...

Research paper thumbnail of Improving Pain Relief in Elder Patients (I-PREP): An Emergency Department Education and Quality Intervention

Journal of the American Geriatrics Society, 2016

To assess the effectiveness of a novel combined education and quality improvement (QI) program fo... more To assess the effectiveness of a novel combined education and quality improvement (QI) program for management of pain in older adults in the emergency department (ED). Controlled pre/postintervention examination. An academic urban ED seeing 60,000 adult visits annually. Individuals aged 65 and older experiencing moderate to severe pain. Linked standardized education and continuous QI for multidisciplinary staff in an urban, academic ED from January 2012 to January 2014. Pain intensity, percentage receiving and time to pain assessment and reassessment, percentage receiving and time to delivery of analgesic. The percentage of participants with final pain score of 4 or less (out of 10) increased 47.5% (95% confidence interval (CI) = 41.8-53.2%). Median decrease in pain intensity improved significantly, from 0.0 to 5.0 points (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Median final pain score decreased from 7.0 to 4.0 points (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The percentage of participants with any pain improvement increased 43.7% (95% CI = 37.1-50.3%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Pain reassessments increased significantly (from 51.9% to 82.5%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The percentage receiving analgesics increased significantly (from 64.1% to 84.8%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). After the intervention, participants had 3.1 (95% CI = 2.1-4.4, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) greater odds of receiving analgesics and 4.7 (95% CI = 3.5-6.5, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) greater odds of documented pain reassessment. The I-PREP intervention substantially improved pain management in older adults in the ED with moderate to severe musculoskeletal or abdominal pain. Significant reductions in pain intensity were achieved, the timing of pain assessments and reassessments was improved, and analgesics were delivered faster. Tightly linking education to targeted QI improved pain management of older adults in the ED.

Research paper thumbnail of A Lifestyle Approach to Reducing Cardiovascular Risk Factors in Underserved Women: Design and Methods of the Illinois WISEWOMAN Program

Journal of Women's Health, 2009

Few lifestyle intervention programs address the needs of financially disadvantaged, low literacy ... more Few lifestyle intervention programs address the needs of financially disadvantaged, low literacy populations. The overall goal of the Illinois WISEWOMAN Program (IWP) was to design such a program and test its effectiveness in reducing cardiovascular disease (CVD) risk, specifically physical activity and nutrition factors. The purpose of this paper is to describe the IWP study design and methods, development of the evidence-based curriculum appropriate for a low socioeconomic status (SES) population, and baseline characteristics of IWP participants. The Cooper Institute, in collaboration with the Illinois Department of Public Health and the University of Illinois at Chicago, adapted evidence-based interventions for financially disadvantaged, low literacy populations. The study used a randomized, two-group, experimental design. In total, 1021 women were recruited from the Illinois Breast and Cervical Cancer Program, which serves uninsured and underinsured women, aged 40-64, at or below 200% of poverty. The women were randomized to either a minimum intervention (MI) or an enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational materials. Additionally, the EI group received a 12-week lifestyle intervention. Baseline comparisons show equivalent groups. IWP participants had a higher prevalence of obesity and smoking than similar national samples. IWP addressed many of the cultural and implementation barriers in programs that seek to improve the health of financially disadvantaged, low literacy populations. Because of the high burden of disease, the unique study population, and the sound design, we anticipate that our future results will contribute to the translation literature, which has largely ignored significant health disparities.

Research paper thumbnail of High glucocorticoid receptor expression in the sarcomatous versus carcinomatous elements of Mullerian carcinosarcomas

Gynecologic Oncology Reports

Research paper thumbnail of Rates of Inappropriate Dosing in Older Adults at an Urban, Academic Hospital

American Journal of Medical Quality

Research paper thumbnail of Dose and volume de-escalation for HPV-associated oropharyngeal cancer: Long-term follow-up of the OPTIMA trial

Journal of Clinical Oncology

6575 Background: Human papilloma virus (HPV) associated oropharyngeal cancer is associated with a... more 6575 Background: Human papilloma virus (HPV) associated oropharyngeal cancer is associated with a favorable prognosis, but standard multimodality treatment is associated with substantial treatment related toxicity. A de-escalation treatment paradigm that optimizes oncologic outcomes while reducing toxicity is needed. We sought to further expound on our published OPTIMA data with long-term follow-up and additional pts subsequently treated using the OPTIMA treatment paradigm. Methods: Long-term follow-up of our institutional de-escalation OPTIMA trial (NCT02258659) and retrospective review of additional patients treated subsequently per OPTIMA outline was performed. Pts were classified as low-risk (LR) (≤T3, ≤N2B, ≤10PYH) or high-risk (HR) (T4, ≥N2c, > 10PYH). Pts received induction chemotherapy (IC) of 3 cycles of dose dense carboplatin and nab-paclitaxel (OPTIMA) or paclitaxel (subsequently treated). LR with ≥50% response received low-dose radiotherapy (RT) to 50 Gy. LR with 30-5...

Research paper thumbnail of Knowledge and health beliefs assessment of Sickle cell disease as a prelude to neonatal screening in Ibadan, Nigeria

Journal of Global Health Reports

Back Background ground Nigeria bears the highest burden of sickle cell disease (SCD) in the world... more Back Background ground Nigeria bears the highest burden of sickle cell disease (SCD) in the world. Neonatal screening programmes for SCD in other countries have been associated with remarkable reductions in mortality and morbidity. In Nigeria, there is an ongoing effort to implement a large scale SCD neonatal screening program with long-term follow-up. This study was conducted to assess the adequacy of knowledge and perspectives of the target population with regard to newborn screening for sickle cell disease and also to identify likely barriers and challenges to the successful implementation of the programme.

Research paper thumbnail of Religious Health Fatalism Questionnaire--Muslim Version

Research paper thumbnail of Abstract 3697: High PD-L1 expression and targetable mutations occur independently in NSCLC and are not influenced by smoking or race

Clinical Research (Excluding Clinical Trials)

Research paper thumbnail of Latent trait shared-parameter mixed models for missing ecological momentary assessment data

Research paper thumbnail of Does Nursing Home Compare Reflect Patient Safety In Nursing Homes?

Health Affairs

The past several decades have seen significant policy efforts to improve the quality of care in n... more The past several decades have seen significant policy efforts to improve the quality of care in nursing homes, but the patient safety movement has largely ignored this setting. In this study we compared nursing homes' performance on several composite quality measures from Nursing Home Compare, the most prominent recent example of a national policy aimed at improving the quality of nursing home care, to their performance on measures of patient safety in nursing homes such as pressure sores, infections, falls, and medication errors. Although Nursing Home Compare captures some aspects of patient safety, we found the relationship to be weak and somewhat inconsistent, leaving consumers who care about patient safety with little guidance. We recommend that Nursing Home Compare be refined to provide a clearer picture of patient safety and quality of life, allowing consumers to weight these domains according to their preferences and priorities.

Research paper thumbnail of Adapting a religious health fatalism measure for use in Muslim populations

PLOS ONE

Objective Fatalism has been shown to influence health behaviors and outcomes among different popu... more Objective Fatalism has been shown to influence health behaviors and outcomes among different populations. Our study reports on the adaptation of the Religious Health Fatalism Questionnaire for a Muslim population (RHFQ-M). Design The original RHFQ wording was modified for a Muslim context and cognitively tested in 6 focus groups (FG). Items were revised by Muslim and non-Muslim healthcare researchers based on FG responses regarding the theological "accurateness" of the questions. The revised 9item measure was administered to 58 English-speaking Muslim women (�40 years old) recruited from two mosques in the Chicago area in order to assess psychometric properties. Main outcome measures Cronbach's alpha and exploratory factor analyses were used to assess internal consistency and measure dimensionality, respectively. Statistical correlations with several fatalism and religiosity measures were computed to assess convergent and discriminant validity. Results After testing with an ethnically and racially diverse group of Muslims, the RHFQ-M was found to be reliable (Cronbach's α is 0.79), comprised of two distinct underlying subscales, and is correlated with, but distinct from, other measures of fatalism and Islamic religiosity. Conclusion Our adapted measure, RHFQ-M, appears to accurately assess Islamic dimensions of fatalism and is ready for use in the health literature.

Research paper thumbnail of Adapting a religious health fatalism measure for use in Muslim populations

PLOS ONE

Objective Fatalism has been shown to influence health behaviors and outcomes among different popu... more Objective Fatalism has been shown to influence health behaviors and outcomes among different populations. Our study reports on the adaptation of the Religious Health Fatalism Questionnaire for a Muslim population (RHFQ-M). Design The original RHFQ wording was modified for a Muslim context and cognitively tested in 6 focus groups (FG). Items were revised by Muslim and non-Muslim healthcare researchers based on FG responses regarding the theological "accurateness" of the questions. The revised 9item measure was administered to 58 English-speaking Muslim women (�40 years old) recruited from two mosques in the Chicago area in order to assess psychometric properties. Main outcome measures Cronbach's alpha and exploratory factor analyses were used to assess internal consistency and measure dimensionality, respectively. Statistical correlations with several fatalism and religiosity measures were computed to assess convergent and discriminant validity. Results After testing with an ethnically and racially diverse group of Muslims, the RHFQ-M was found to be reliable (Cronbach's α is 0.79), comprised of two distinct underlying subscales, and is correlated with, but distinct from, other measures of fatalism and Islamic religiosity. Conclusion Our adapted measure, RHFQ-M, appears to accurately assess Islamic dimensions of fatalism and is ready for use in the health literature.