OBJECTIVES:The objective of this study was to analyze factors associated with oral health-related quality of life (OHRQoL) between type 2 diabetes mellitus (T2DM) and nondiabetic US adults.METHODS:The study sample included 2945 participants (aged ≥20) selected from National Health and Nutrition Examination Survey (NHANES) 2003-2004 that represented 130,689,262 million persons in a probability weighted sample. Oral health outcomes were measured by the NHANES version of Oral Health Impact Profile (OHIP) for OHRQoL and summarized as additive scores (OHIP-ADD) and as prevalence of negative impacts (OHIP-SC). Multiple logistic regression models used dichotomous outcome variables OHIP-ADD and OHIP-SC. The cut-off values for poor OHRQoL were heuristically defined as OHIP-ADD ≥6 and as OHIP-SC > 0.RESULTS:Poor OHRQoL was significantly (p < 0.0001) predicted by T2DM (ORSC-controlled  = 1.43, ORSC-uncontrolled  = 1.73), obesity (ORSC  = 1.24), untreated dental caries (ORSC  = 1.79), periodontal disease (ORADD  = 1.07), evaluated unmet denture need (ORSC  = 1.72), low income (ORADD  = 1.22), smoking (ORSC-former-smoker  = 1.04, ORSC-current-smoker  = 1.99), African-American (ORSC  = 1.19), and female (ORSC  = 1.66) in both logistic regression models. In contrast, protective factors significantly (p < 0.0001) associated with poor OHRQoL were private dental insurance (ORSC  = 0.81), college education (ORSC  = 0.85), and annual dental prophylaxis (ORSC  = 0.83), after adjustment for covariates.CONCLUSIONS:This study showed that private insurance coverage and annual prophylaxis are associated with better average OHRQoL among individuals with T2DM. Improved OHRQoL may be associated with glycaemia control, decreased BMI, and smoking cessation. The highest odds for poor OHRQoL were found among US adults with T2DM with uncontrolled HbA1c, untreated dental caries, and current smoking.

OBJECTIVESTo analyze the effects of type 2 diabetes mellitus (T2DM), need for dental care, personal health practices and use of services on oral health-related quality of life (OHRQoL) in US adults.BASIC RESEARCH DESIGNThe sample included 2,945 participants (aged ≥ 20) selected from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 stratified probability sample that represented 124,525,899 individuals in the weighted sample. Two-stage structural equation modelling (SEM) assessed interrelationships between T2DM regressions on factors associated with OHRQoL in a simplified three-factor Andersen Behavioral Model (ABM).RESULTSSEM supported the hypotheses that T2DM directly predicted need (perceived need, evaluated need, general health condition) with a significant path coefficient of 0.49 (β=0.49, p⟨0.05). Need had direct (77%) and indirect (23%) effects on OHRQoL (βdirect=0.30, βindirect=0.09, p⟨ 0.001). Need predicted personal health practices including use of services (reason for dental visit, frequency of dental visits, smoking status) (β=0.46, p⟨0.001). Need, in turn, predicted OHRQoL (β=0.19, p⟨0.001). In the model, 23.8%, 59.7%, and 18.1% of the variance was explained by need, personal health practices including use of services, and OHRQoL, respectively.CONCLUSIONSThe results confirmed T2DM predicted need, which in sequence had direct and indirect effects on OHRQoL.

Setting Nonoptimized medication therapies (NOMTs) are associated with likely avoidable illnesses and mortality affecting millions of people and costing an estimated $528 billion per year in excess health spending in the United States. The coronavirus disease 2019 (COVID-19) pandemic brought into focus barriers limiting the ability of U.S. pharmacists and pharmacies to provide services that can reduce NOMTs and improve U.S. population health. Objectives This National Science Foundation Center for Health Organization Transformation study explored potential strategies that U.S. pharmacists, pharmacies, and their partners could implement to reduce NOMTs while also delivering other forms of value to U.S. populations from 2021 to 2025 (during and after the COVID-19 pandemic). Design A panel of senior leaders representing the U.S. pharmacist and pharmacy sector participated in a 4-round Delphi process to identify unmet needs, barriers, change drivers, and priority strategies for meeting those needs. Data were gathered and analyzed by public health researchers, most of whom are outside the pharmacist and pharmacy sector. Results A comprehensive set of evidence-based strategies with potential to reduce NOMTs, protect and improve population health and well-being, and strengthen the sector were identified. Four transformational strategies were recommended: comprehensive payment and practice transformation, strengthening pharmacy data interoperability infrastructure, development of unifying measurement and management mechanisms, and development of a more robust national research infrastructure. Strengthening health equity was a cross-cutting strategy affecting all areas. Conclusion The results may be of interest to policy makers, pharmacists, pharmacies, physicians, nurses and other clinicians, pharmaceutical firms, plan sponsors, plans, health systems, clinics, aging care, digital technology companies, and others interested in optimizing outcomes from medications and related therapies for U.S. populations.

BACKGROUND:To evaluate the association of statins and co-morbidities with new onset type 2 diabetes mellitus (T2DM) in patients 65 years and older.METHODS:This retrospective study used de-identified administrative healthcare claims and enrolment data from a Medicare Advantage Prescription Drug (MAPD) health plan offered by a large multistate healthcare company. The plan covered >2.4 million individuals, of whom >1.7 million individuals were ≥65 years. Of these, 265 554 individuals had continuous MAPD enrolment January 2008 to December 2015. The unadjusted model assessed demographic, pharmacy and T2DM co-morbidities as covariates. Significant variables (P < .05) in the unadjusted model were then included in the adjusted model. The adjusted model used Cox proportional hazards to evaluate covariate effects. Matched propensity score analysis was used to analyse the association of statins and T2DM onset.RESULTS:The cumulative rate of diagnosed T2DM onset in the study cohort was 4.82% (4314/89 390). Annualised incidence of T2DM diagnosis was 0.82%, 0.88%, 1.04% and 2.09% in 2012, 2013, 2014 and 2015, respectively. T2DM onset was associated with male sex, non-white (African American or Hispanic ethnicity), statin use, hypertension, hyperlipidaemia, heart failure, lower limb ulceration, atherosclerosis, other retinopathy, angina pectoris, poor vision and blindness and absence ischaemic heart disease (IHD). Matched propensity score analysis showed that statin use was significantly associated with T2DM onset (Odds Ratio = 1.26, 95% Confidence Interval: 1.12-1.41, P < .0001) in the adjusted model.CONCLUSIONS:Analyses indicated that statin usage was associated with new onset T2DM after adjusting for covariates.

Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) "remission" in non-bariatric Medicare patients 65 years and older. Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in "remission" if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as "remission"). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM "remission." Results: 4.97% of patients studied met the definition of T2DM "remission" in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM "remission" that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females (p < 0.05). Conclusion: T2DM "remission" in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients.

This study set out to analyze questions about type 2 diabetes mellitus (T2DM) from patients and the public. The aim was to better understand people's information needs by starting with what they do not know, discovered through their own questions, rather than starting with what we know about T2DM and subsequently finding ways to communicate that information to people affected by or at risk of the disease. One hundred and sixty-four questions were collected from 120 patients attending outpatient diabetes clinics and 300 questions from 100 members of the public through the Amazon Mechanical Turk crowdsourcing platform. Twenty-three general and diabetes-specific topics and five phases of disease progression were identified; these were used to manually categorize the questions. Analyses were performed to determine which topics, if any, were significant predictors of a question's being asked by a patient or the public, and similarly for questions from a woman or a man. Further analysis identified the individual topics that were assigned significantly more often to the crowdsourced or clinic questions. These were Causes (CI: [-0.07, -0.03], p < .001), Risk Factors ([-0.08, -0.03], p < .001), Prevention ([-0.06, -0.02], p < .001), Diagnosis ([-0.05, -0.02], p < .001), and Distribution of a Disease in a Population ([-0.05,-0.01], p = .0016) for the crowdsourced questions and Treatment ([0.03, 0.01], p = .0019), Disease Complications ([0.02, 0.07], p < .001), and Psychosocial ([0.05, 0.1], p < .001) for the clinic questions. No highly significant gender-specific topics emerged in our study, but questions about Weight were more likely to come from women and Psychosocial questions from men. There were significantly more crowdsourced questions about the time Prior to any Diagnosis ([(-0.11, -0.04], p = .0013) and significantly more clinic questions about Health Maintenance and Prevention after diagnosis ([0.07. 0.17], p < .001). A descriptive analysis pointed to the value provided by the specificity of questions, their potential to disclose emotions behind questions, and the as-yet unrecognized information needs they can reveal. Large-scale collection of questions from patients across the spectrum of T2DM progression and from the public-a significant percentage of whom are likely to be as yet undiagnosed-is expected to yield further valuable insights.

When patients cannot get answers from health professionals or retain the information given, increasingly they search online for answers, with limited success. Researchers from the United States, Ireland, and the United Kingdom explored this problem for patients with type 2 diabetes mellitus (T2DM). In 2014, patients attending an outpatient clinic (UK) were asked to submit questions about diabetes. Ten questions judged representative of different types of patient concerns were selected by the researchers and submitted to search engines within trusted and vetted websites in the United States, Ireland, and the United Kingdom. Two researchers independently assessed if answers could be found in the three top-ranked documents returned at each website. The 2014 search was repeated in June, 2016, examining the two top-ranked documents returned. One hundred and sixty-four questions were collected from 120 patients during 12 outpatient clinics. Most patients had T2DM (95%). Most questions were about diabetes (N = 155) with the remainder related to clinic operation (N = 9). Of the questions on diabetes, 152 were about T2DM. The 2014 assessment found no adequate answers to the questions in 90 documents (10 questions, 3 websites, 3 top documents). In the 2016 assessment, 1 document out of 60 (10 questions, 3 websites, 2 top documents) provided an adequate answer relating to 1 of the 10 questions. Available online sources of information do not provide answers to questions from patients with diabetes. Our results highlight the urgent need to develop novel ways of providing answers to patient questions about T2DM.

Background: An enabling infrastructure for population-wide health information capture and transfer is beginning to emerge in the U. S. However, the essential infrastructure component that is still missing is effective health information exchange (HIE). Health record banks (HRBs) are one of several possible approaches to achieving HIE. Is the approach viable? If so, what requirements must be satisfied in order for it to succeed?Purpose: The research, conducted in 2007-2008, explored HRB-related interests, concerns, benefits, payment preferences, design requirements, value propositions, and challenges for 12 healthcare stakeholder groups and the consumers they serve in a U. S. metropolitan area of 1.3 million people.Methods: A mixed-methods design was developed in a community action research context. Data were gathered and analyzed through 23 focus groups, 13 web surveys, a consumer phone survey (nonstratified random sample) and follow-up meetings. Recruiting goals for leaders representing targeted groups were achieved using a multi-channel communications strategy. Key themes were identified through data triangulation. Then, requirements, value propositions and challenges were developed through iterative processes of interaction with community members.Results: Results include key themes, design requirements, value propositions, and challenges for 12 stakeholder groups and consumers.Conclusions: The research provides a framework for developing a consumer permission-driven, financially sustainable, community HRB model. However, for such a model to flourish, it will need to be part of a nationwide network of HIEs with compatible HRB approaches able to overcome a number of challenges. (Am J Prev Med 2011;40(5S2):S123-S133) (C) 2011 American Journal of Preventive Medicine

While the information infrastructure to support public health and health research has been dramatically improving, comprehensive, nation-wide, longitudinal, person-centered information has been generally nonexistent. Yet, having such information for large populations is essential to public health and health research. The coupling of internet access, information standards and emerging electronic health records is beginning to provide an enabling infrastructure for population-wide health information capture and transfer. However, the essential infrastructure component that is still missing is effective health information exchange (HIE) that has specific public health and health research-supporting functionality at nation-wide, state-wide and community-wide levels. To better understand the requirements for HIE at a community-wide level, our exploratory research investigated needs and attitudes of over 1200 stakeholders including members of public health, health research and consumer sectors. This paper reports on the study's finding including the functional and infrastructure recommendations of public health and health research stakeholders, and the resultant design attributes for a consumer-centric community HIE which could be linked into a nation-wide HIE network for purposes of improving care, decreasing health related costs and supporting research.

Why am I writing a commentary on the topic of “Informatics or Information Technology for Cancer Research: Which Is It?” The short answer is that I was invited to do so by the Editor-in-Chief becaus...

Significant controversy surrounds the 2012 / 2014 decision announced by the Trustees of the American Board of Radiology (ABR) in October of 2007. According to the ABR, only medical physicists who are graduates of a Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) accredited academic or residency program will be admitted for examination in the years 2012 and 2013. Only graduates of a CAMPEP accredited residency program will be admitted for examination beginning in the year 2014. An essential question facing the radiation oncology physics community is an estimation of supply and demand for medical physicists through the year 2020. To that end, a Demand & Supply dynamic model was created using STELLA software. Inputs into the model include: a) projected new cancer incidence and prevalence 1990-2020; b) AAPM member ages and retirement projections 1990-2020; c) number of ABR physics diplomates 1990-2009; d) number of patients per Qualified Medical Physicist from Abt Reports I (1995), II (2002) and III (2008); e) non-CAMPEP physicists trained 1990-2009 and projected through 2014; f) CAMPEP physicists trained 1993-2008 and projected through 2014; and g) working Qualified Medical Physicists in radiation oncology in the United States (1990-2007). The model indicates that the number of qualified medical physicists working in radiation oncology required to meet demand in 2020 will be 150-175 per year. Because there is some elasticity in the workforce, a portion of the work effort might be assumed by practicing medical physicists. However, the minimum number of new radiation oncology physicists (ROPs) required for the health of the profession is estimated to be 125 per year in 2020. The radiation oncology physics community should plan to build residency programs to support these numbers for the future of the profession.

Lack of capital investment is limiting progress towards NHIN goals. A 10-step strategy for engaging new private-sector investment is presented. The vision involves developing an integrated nationwide network of community health record banks that contain costs and improve quality through robust community-wide process improvement efforts. Purchasers, such as employers, Medicare and Medicaid, jump-start the process, beginning with pilots, by making advance commitments of low per-member per-month fees for 10 percent to 30 percent of each community's population. Additional revenue opportunities are identified, includin value-added services for consumers, pharmaceutical manufacturers and providers. Competing for-profit service providers then are offered exclusive multi-year contracts to build and operate the community health record bank using a revenue share contract. After they're selected, service providers invest capital to build record bank technologies, services and infrastructure. Successful service provider gain opportunities to develop record banks nationwide. To achieve success, the private sector, and federal and state purchasers must work together to support robust community-wide pilots.

There is a crisis in scholarly publishing. The value of the scholarly information is frequently much less than the cost of providing that information. Consequently, libraries are suffering and scholars do not have access to information that they need. However, certain for-profit publishers and scientific societies are benefiting substantially from the current system. The Internet has demonstrated the potential to change this structure. The Budapest, Berlin and Bethesda initiatives show there is significant worldwide interest to replace the current controlled system with one that allows open access of scholarly information to anyone with Internet access. An examination of the scholarly publishing process is offered using a Tetradic Network Technique (TNT) and a Transaction Cost Economic (TCE) analysis as applied to a traditional subscription-based, print medical journal, Medical Physics, and a Web-based, open access medical journal, the Journal of Applied Clinical Medical Physics. The analysis identifies stakeholders and considers transaction and production costs. TCE analysis is performed between each of the following: Libraries, Scholars, Publishers and Societies, for a total of six transaction exchanges for both the traditional and the open access journal. This analysis allows costs to be compared more easily between the two types of journals, and provides the basis for a model online journal pro forma. Results demonstrate that while production costs remain approximately equivalent for the traditional and open access journal, total transaction costs are reduced by a factor of between 5 and 10 for the open access journal. While the cost of producing an eight-page article in a traditional medical journal is approximately US$2500, the cost of publishing the same article in an open access journal is less than US$500. Recommendations are offered that illustrate how an open access online journal may be produced by a university for approximately the cost of several library print journal subscriptions and physical storage of the printed material. Universities may therefore benefit through greater involvement with the scholarly publishing process. There are several considerations and recommendations that one may draw from this investigation. Universities pay for scholarly research, and then pay again to obtain access to published results. University libraries, always a significant cost center, are now in financial crisis. Scientific societies and large publishers gain under the traditional scholarly publication model. The copyright is essential; the one that holds the copyright holds the power in scholarly publishing. Modern open access initiatives state that scholars should retain copyright and publish online. Universities should require promotion and tenure committees to give equal weight to open access publications. Universities should go into the publishing business with scientific societies and control dissemination of scholarly knowledge for the public good.

PURPOSE:The additional equipment and personnel costs of supplying image-guided radiation therapy (IGRT) technology have caused many to question if the marginal gains in patients' health-related quality of life are worth the additional cost. Novel IGRT technologies, including cone-beam computed tomography and helical tomotherapy, provide the opportunity to study cost and effectiveness for patients.MATERIALS AND METHODS:This methodologic study proposes to evaluate the cost and effectiveness of treating conventional radiotherapy versus IGRT patients prospectively among several institutions. The cost of treating patients varies among institutions depending on personnel, equipment, and overhead costs, but the nature and quality of services provided are expected to be consistent.RESULTS:The study will track cost information at a single institution and simultaneously as the median from multiple institutions. Effectiveness measures will include both standard quality-adjusted life-year instruments completed by patients and performance status measures completed by institutional personnel. In addition, disease-specific effectiveness measures will be accommodated in the study. Each participating institution will use the same effectiveness measures to track patients with similar diseases.CONCLUSION:The resulting cost and effectiveness data will be available to investigators at any point during the study, immediately on the completion of a trial, or when statistical acceptability is achieved. These considerations are being incorporated into a high-level information model under development.

Purpose: The additional equipment and personnel costs of supplying Intensity Modulated Radiation Therapy (IMRT) technology have caused many to question if the marginal gains in patient health‐related quality of life are worth the additional cost. A novel IMRT technology, helical tomotherapy, provides the opportunity to study cost and effectiveness for patients. Method and Materials: This methodological study proposes to evaluate the cost and effectiveness of treating conventional radiotherapy versus tomotherapy IMRT patients prospectively, among several institutions. The cost of treating patients varies between institutions, depending on personnel, equipment and overhead costs; however, the nature and quality of services provided are expected to be consistent. Results: The methodology study tracks cost information at a single institution, and simultaneously as the median from multiple institutions. Effectiveness measures include both standard quality adjusted life year instruments completed by patients and performance status measures completed by institutional personnel. In addition, disease specific effectiveness measures are accommodated in the study. Each participating institution uses the same effectiveness measures to track patients with similar disease. Conclusion: The resulting cost and effectiveness data is available to investigators at any point during the study, immediately upon the completion of a trial, or when statistical acceptability is achieved.