Browsing by Author "Morton, Sally C."

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    2017 State of the College of Science
    Morton, Sally C. (Virginia Tech. College of Science, 2017-10-27)
    Slides from the 2017 State of the College of Science address, presented on October 27, 2017, by Dean Sally C. Morton.
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    2018 State of the Virginia Tech College of Science
    Morton, Sally C. (Virginia Tech. College of Science, 2018-10-25)
    College of Science Dean Sally C. Morton presented the 2018 State of the College on Oct. 25 for faculty, staff, alumni, and friends of the college, as well as the university community. This is a photographic slideshow from that presentation.
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    AHRQ series on complex intervention systematic reviews-paper 4: selecting analytic approaches
    Viswanathan, Meera; McPheeters, Melissa L.; Hassan-Murad, M.; Butler, Mary E.; Devin, Emily E. (Beth); Dyson, Michele P.; Guise, Jeanne -Marie; Kahwati, Leila C.; Miles, Jeremy N. V.; Morton, Sally C. (2017-10)
    Background: Systematic reviews of complex interventions can vary widely in purpose, data availability and heterogeneity, and stakeholder expectations. Rationale: This article addresses the uncertainty that systematic reviewers face in selecting methods for reviews of complex interventions. Specifically, it lays out parameters for systematic reviewers to consider when selecting analytic approaches that best answer the questions at hand and suggests analytic techniques that may be appropriate in different circumstances. Discussion: Systematic reviews of complex interventions comprising multiple questions may use multiple analytic approaches. Parameters to consider when choosing analytic methods for complex interventions include nature and timing of the decision (clinical practice guideline, policy, or other); purpose of the review; extent of existing evidence; logistic factors such as the timeline, process, and resources for deciding the scope of the review; and value of information to be obtained from choosing specific systematic review methods. Reviewers may elect to revise their analytic approach based on new or changing considerations during the course of the review but should guard against bias through transparency of reporting. (C) 2017 The Authors. Published by Elsevier Inc.
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    AHRQ series on complex intervention systematic reviews-paper 5: advanced analytic methods
    Pigott, Terri; Noyes, Jane; Umscheid, Craig A.; Myers, Evan; Morton, Sally C.; Fu, Rongwei; Sanders-Schmidler, Gillian D.; Devine, Beth; Murad, M. Hassan; Kelly, Michael P.; Fonnesbeck, Christopher; Kahwati, Leila C.; Beretvas, S. Natasha (2017-10)
    Background and Objective: Advanced analytic methods for synthesizing evidence about complex interventions continue to be developed. In this paper, we emphasize that the specific research question posed in the review should be used as a guide for choosing the appropriate analytic method. Methods: We present advanced analytic approaches that address four common questions that guide reviews of complex interventions: (1) How effective is the intervention? (2) For whom does the intervention work and in what contexts? (3) What happens when the intervention is implemented? and (4) What decisions are possible given the results of the synthesis? Conclusion: The analytic approaches presented in this paper are particularly useful when each primary study differs in components, mechanisms of action, context, implementation, timing, and many other domains. (C) 2017 The Author(s). Published by Elsevier Inc.
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    Are Ayurvedic herbs for diabetes effective?
    Shekelle, Paul G.; Hardy, Mary; Morton, Sally C.; Coulter, Ian; Venuturupalli, Swamy; Favreau, Joya; Hilton, Lara K. (Frontline Medical Communications Inc., 2005-10)
    Objective: To evaluate and synthesize the evidence on the effect of Ayurvedic therapies for diabetes mellitus. Design: Systematic review of trials. Measurements and main results: We found no study that assessed Ayurvedic as a system of care. Botanical therapy was by far the most commonly studied Ayurvedic treatment. Herbs were studied either singly or as formulas. In all, 993 titles in Western computerized databases and 318 titles identified by hand-searching journals in India were examined, yield ing 54 articles reporting the results of 62 studies. The most-studied herbs were G sylvestre, C indica, fenugreek, and Eugenia jambo/ana. A number of herbal formulas were tested, but Ayush- 82 and 0 -400 were most often studied. Thirty-five of the studies included came from the Western literature, 27 from the Indian. Seven were randomized controlled trials (RCTs) and 10 controlled clinical trials (CCTs) or natural experiments. Twenty-two studies went on to further analysis based on a set of criteria. Of these, 10 were RCTs, eCTs, or natural experiments, 12 were case series or cohort studies. There is evidence to suggest that the herbs C indica, holy basil, fenugreek, and G sylvestre, and the herbal formulas Ayush-82 and 0 -400 have a glucose-lowering effect and deserve further study. Evidence of effectiveness of several other herbs is less extensive (C tamala, E jambo/ana, and Momordica charantia). Conclusions: There is heterogeneity in the available literature on Ayurvedic treatment for diabetes. Most studies test herbal therapy. Heterogeneity exists in the herbs and formulas tested (more than 44 different interventions identified) and in the method of their preparation. Despite these limitations, there are sufficient data for several herbs or herbal formulas to warrant further studies.
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    Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis
    Morton, Sally C.; Paige, Neil M.; Miake-Lye, Isomi M.; Booth, Marika; Beroes, Jessica M.; Mardian, Aram S.; Dougherty, Paul; Branson, Richard; Tang, Baron (American Medical Association, 2017-04-11)
    IMPORTANCE Acute low back pain is common and spinal manipulative therapy (SMT) is a treatment option. Randomized clinical trials (RCTs) and meta-analyses have reported different conclusions about the effectiveness of SMT. OBJECTIVE To systematically review studies of the effectiveness and harms of SMT for acute ( 6 weeks) low back pain. DATA SOURCES Search of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature from January 1, 2011, through February 6, 2017, as well as identified systematic reviews and RCTs, for RCTs of adults with low back pain treated in ambulatory settings with SMT compared with sham or alternative treatments, and that measured pain or function outcomes for up to 6 weeks. Observational studies were included to assess harms. DATA EXTRACTION AND SYNTHESIS Data extractionwas done in duplicate. Study qualitywas assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool. This tool has 11 items in the following domains: randomization, concealment, baseline differences, blinding (patient), blinding (care provider [care provider is a specific qualitymetric used by the CBN Risk of Bias tool]), blinding (outcome), co-interventions, compliance, dropouts, timing, and intention to treat. Prior research has shown the CBN Risk of Bias tool identifies studies at an increased risk of bias using a threshold of 5 or 6 as a summary score. The evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. MAIN OUTCOMES AND MEASURES Pain (measured by either the 100-mm visual analog scale, 11-point numeric rating scale, or other numeric pain scale), function (measured by the 24-point Roland Morris Disability Questionnaire or Oswestry Disability Index [range, 0-100]), or any harms measured within 6 weeks. FINDINGS Of 26 eligible RCTs identified, 15 RCTs (1711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain (pooled mean improvement in the 100-mm visual analog pain scale, −9.95 [95%CI, −15.6 to −4.3]). Twelve RCTs (1381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function (pooled mean effect size, −0.39 [95%CI, −0.71 to −0.07]). Heterogeneity was not explained by type of clinician performing SMT, type of manipulation, study quality, or whether SMT was given alone or as part of a package of therapies. No RCT reported any serious adverse event. Minor transient adverse events such as increased pain, muscle stiffness, and headache were reported 50% to 67%of the time in large case series of patients treated with SMT. CONCLUSIONS AND RELEVANCE Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.
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    Delayed Medical Care After Diagnosis in a US National Probability Sample of Persons Infected With Human Immunodeficiency Virus
    Turner, Barbara J.; Cunningham, William E.; Duan, Naihua; Andersen, Ronald M.; Shapiro, Martin F.; Bozzette, Samuel A.; Nakazono, Terry; Morton, Sally C.; Crystal, Steven; St. Clair, Patti; Stein, Michael; Zierler, Sally (AMA, 2000-09-25)
    Objective: To identify health care and patient factors associated with delayed initial medical care for human immunodeficiency virus (HIV) infection. Design: Survey of a national probability sample of persons with HIV in care. Setting: Medical practices in the contiguous United States. Patients: Cohort A (N = 1540) was diagnosed by February 1993 and was in care within 3 years; cohort B (N = 1960) was diagnosed by February 1995 and was in care within 1 year of diagnosis. Main Outcome Measure: More than 3- or 6-month delay. Results: Delay of more than 3 months occurred for 29% of cohort A (median, 1 year) and 17% of cohort B. Having a usual source of care at diagnosis reduced delay, with adjusted odds ratios (ORs) of 0.61 (95% confidence interval [CI], 0.48-0.77) in cohort A and 0.70 (95% CI, 0.50-0.99) in cohort B. Medicaid coverage at diagnosis showed lower adjusted ORs of delay compared with private insurance (cohort A: adjusted OR, 0.52; 95% CI, 0.30-0.92; cohort B: adjusted OR, 0.48; 95% CI, 0.27-0.85). Compared with whites, Latinos had 53% and 95% higher adjusted ORs of delay (P<.05) in cohorts A and B, respectively, and African Americans had a higher adjusted OR in cohort A (1.56; 95% CI, 1.19-2.04). The health care factors showed similar effects on delay of greater than 6 months. Conclusions: Medicaid insurance and a usual source of care were protective against delay after HIV diagnosis. After full adjustment, delay was still greater for Latinos and, to a lesser extent, African Americans compared with whites.
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    Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission A Systematic Review and Meta-analysis
    Morton, Sally C.; Nuckols, Teryl K.; Keeler, Emmett B.; Anderson, Laura J.; Doyle, Brian J.; Pevnick, Joshua; Booth, Marika; Shanman, Roberta; Arifkhanova, Aziza; Shekelle, Paul G. (AMA, 2017-05-30)
    IMPORTANCE Quality improvement (QI) interventions can reduce hospital readmission, but little is known about their economic value. OBJECTIVE To systematically review economic evaluations of QI interventions designed to reduce readmissions. DATA SOURCES Databases searched included PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, andWorldcat (January 2004 to July 2016). STUDY SELECTION Dual reviewers selected English-language studies from high-income countries that evaluated organizational or structural changes to reduce hospital readmission, and that reported program and readmission-related costs. DATA EXTRACTION AND SYNTHESIS Dual reviewers extracted intervention characteristics, study design, clinical effectiveness, study quality, economic perspective, and costs.We calculated the risk difference and net costs to the health system in 2015 US dollars.Weighted least-squares regression analyses tested predictors of the risk difference and net costs. MAIN OUTCOMES AND MEASURES Main outcomes measures included the risk difference in readmission rates and incremental net cost. This systematic review and data analysis is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS Of 5205 articles, 50 unique studies were eligible, including 25 studies in populations limited to heart failure (HF) that included 5768 patients, 21 in general populations that included 10 445 patients, and 4 in unique populations. Fifteen studies lasted up to 30 days while most others lasted 6 to 24 months. Based on regression analyses, readmissions declined by an average of 12.1% among patients with HF (95%CI, 8.3%-15.9%; P < .001; based on 22 studies with complete data) and by 6.3%among general populations (95%CI, 4.0%-8.7%; P < .001; 18 studies). The mean net savings to the health system per patient was $972 among patients with HF (95%CI, −$642 to $2586; P = .23; 24 studies), and the mean net loss was $169 among general populations (95%CI, −$2610 to $2949; P = .90; 21 studies), reflecting nonsignificant differences. Among general populations, interventions that engaged patients and caregivers were associated with greater net savings ($1714 vs −$6568; P = .006). CONCLUSIONS AND RELEVANCE Multicomponent QI interventions can be effective at reducing readmissions relative to the status quo, but net costs vary. Interventions that engage general populations of patients and their caregivers may offer greater value to the health system, but the implications for patients and caregivers are unknown.
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    The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis
    Nuckols, Teryl K.; Smith-Spangler, Crystal; Morton, Sally C.; Asch, Steven M.; Patel, Vaspaan M.; Anderson, Laura J.; Deichsel, Emily L.; Shekelle, Paul G. (BMC, 2014)
    Background: The Health Information Technology for Economic and Clinical Health (HITECH) Act subsidizes implementation by hospitals of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries caused by medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, and effects on medication errors have been variable. The objectives of this analysis were to assess the effectiveness of CPOE at reducing pADEs in hospital-related settings, and examine reasons for heterogeneous effects on medication errors. Methods: Articles were identified using MEDLINE, Cochrane Library, Econlit, web-based databases, and bibliographies of previous systematic reviews (September 2013). Eligible studies compared CPOE with paper-order entry in acute care hospitals, and examined diverse pADEs or medication errors. Studies on children or with limited event-detection methods were excluded. Two investigators extracted data on events and factors potentially associated with effectiveness. We used random effects models to pool data. Results: Sixteen studies addressing medication errors met pooling criteria; six also addressed pADEs. Thirteen studies used pre-post designs. Compared with paper-order entry, CPOE was associated with half as many pADEs (pooled risk ratio (RR) = 0.47, 95% CI 0.31 to 0.71) and medication errors (RR = 0.46, 95% CI 0.35 to 0.60). Regarding reasons for heterogeneous effects on medication errors, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta-regression. Differences between commercial versus homegrown systems, presence and sophistication of clinical decision support, hospital-wide versus limited implementation, and US versus non-US studies were not significant, nor was timing of publication. Higher baseline rates of medication errors predicted greater reductions (P < 0.001). Other context and implementation variables were seldom reported. Conclusions: In hospital-related settings, implementing CPOE is associated with a greater than 50% decline in pADEs, although the studies used weak designs. Decreases in medication errors are similar and robust to variations in important aspects of intervention design and context. This suggests that CPOE implementation, as subsidized under the HITECH Act, may benefit public health. More detailed reporting of the context and process of implementation could shed light on factors associated with greater effectiveness.
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    Effects of Omega-3 Fatty Acids on Cancer Risk
    MacLean, Catherine H.; Newberry, Sydne J.; Mojica, Walter A.; Khanna, Puja; Issa, Amalia M.; Suttorp, Marika J.; Lim, Yee-Wee; Traina, Shana B.; Hilton, Lara K.; Garland, Rena; Morton, Sally C. (AMA, 2006-04)
    Context: Omega-3 fatty acids are purported to reduce the risk of cancer. Studies have reported mixed results. Objective: To synthesize published and unpublished evidence to determine estimates of the effect of omega-3 fatty acids on cancer risk in prospective cohort studies. Data Sources Articles published from 1966 to October 2005 identified through MEDLINE, PREMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CAB Health; unpublished literature sought through letters to experts in the neutraceutical industry. Study Selection: A total of 38 articles with a description of effects of consumption of omega-3 fatty acids on tumor incidence, prospective cohort study design, human study population; and description of effect of omega-3 among groups with different levels of exposure in the cohort were included. Two reviewers independently reviewed articles using structured abstraction forms; disagreements were resolved by consensus. Data Extraction: Two reviewers independently abstracted detailed data about the incidence of cancer, the type of cancer, the number and characteristics of the patients, details on the exposure to omega-3 fatty acids, and the elapsed time between the intervention and outcome measurements. Data about the methodological quality of the study were also abstracted. Data Synthesis: Across 20 cohorts from 7 countries for 11 different types of cancer and using up to 6 different ways to categorize omega-3 fatty acid consumption, 65 estimates of the association between omega-3 fatty acid consumption were reported. Among these, only 8 were statistically significant. The high degree of heterogeneity across these studies precluded pooling of data. For breast cancer 1 significant estimate was for increased risk (incidence risk ratio [IRR], 1.47; 95% confidence interval [CI], 1.10-1.98) and 3 were for decreased risk (RR, 0.68-0.72); 7 other estimates did not show a significant association. For colorectal cancer, there was 1 estimate of decreased risk (RR, 0.49; 95% CI, 0.27-0.89) and 17 estimates without association. For lung cancer one of the significant associations was for increased cancer risk (IRR, 3.0; 95% CI, 1.2-7.3), the other was for decreased risk (RR, 0.32; 95% CI, 0.13-0.76), and 4 other estimates were not significant. For prostate cancer, there was 1 estimate of decreased risk (RR, 0.43; 95% CI, 0.22-0.83) and 1 of increased risk (RR, 1.98; 95% CI, 1.34-2.93) for advanced prostate cancer; 15 other estimates did not show a significant association. The study that assessed skin cancer found an increased risk (RR, 1.13; 95% CI, 1.01-1.27). No significant associations between omega-3 fatty acid consumption and cancer incidence were found for aerodigestive cancer, bladder cancer, lymphoma, ovarian cancer, pancreatic cancer, or stomach cancer. Conclusions: A large body of literature spanning numerous cohorts from many countries and with different demographic characteristics does not provide evidence to suggest a significant association between omega-3 fatty acids and cancer incidence. Dietary supplementation with omega-3 fatty acids is unlikely to prevent cancer.
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    Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance: A Meta-analysis
    Shekelle, Paul G.; Hardy, Mary; Morton, Sally C.; Maglione, Margaret; Mojica, Walter A.; Suttorp, Marika J.; Rhodes, Shannon L.; Jungvig, Lara; Gagné, James (AMA, 2003-03-26)
    CONTEXT: Ephedra and ephedrine sometimes are used for weight loss or enhanced athletic performance, but the efficacy and safety of these compounds are uncertain. OBJECTIVE: To assess the efficacy and safety of ephedra and ephedrine used for weight loss and enhanced athletic performance. DATA SOURCES: We searched 9 databases using the terms ephedra, ephedrine, adverse effect, side effect, efficacy, effective, and toxic. We included unpublished trials and non-English-language documents. Adverse events reported to the US Food and Drug Administration MedWatch program were assessed. STUDY SELECTION: Eligible studies were controlled trials of ephedra or ephedrine used for weight loss or athletic performance and case reports of adverse events associated with such use. Eligible studies for weight loss were human studies with at least 8 weeks of follow-up; and for athletic performance, those having no minimum follow-up. Eligible case reports documented that ephedra or ephedrine was consumed within 24 hours prior to an adverse event or that ephedrine or an associated product was found in blood or urine, and that other potential causes had been excluded. Of the 530 articles screened, 52 controlled trials and 65 case reports were included in the adverse events analysis. Of more than 18 000 other case reports screened, 284 underwent detailed review. DATA EXTRACTION: Two reviewers independently identified trials of efficacy and safety of ephedra and ephedrine on weight loss or athletic performance; disagreements were resolved by consensus. Case reports were reviewed with explicit and implicit methods. DATA SYNTHESIS: No weight loss trials assessed duration of treatment greater than 6 months. Pooled results for trials comparing placebo with ephedrine (n = 5), ephedrine and caffeine (n = 12), ephedra (n = 1), and ephedra and herbs containing caffeine (n = 4) yielded estimates of weight loss (more than placebo) of 0.6 (95% confidence interval, 0.2-1.0), 1.0 (0.7-1.3), 0.8 (0.4-1.2), and 1.0 (0.6-1.3) kg/mo, respectively. Sensitivity analyses did not substantially alter the latter 3 results. No trials of ephedra and athletic performance were found; 7 trials of ephedrine were too heterogeneous to synthesize. Safety data from 50 trials yielded estimates of 2.2- to 3.6-fold increases in odds of psychiatric, autonomic, or gastrointestinal symptoms, and heart palpitations. Data are insufficient to draw conclusions about adverse events occurring at a rate less than 1.0 per thousand. The majority of case reports are insufficiently documented to allow meaningful assessment. CONCLUSIONS: Ephedrine and ephedra promote modest short-term weight loss (approximately 0.9 kg/mo more than placebo) in clinical trials. There are no data regarding long-term weight loss, and evidence to support use of ephedra for athletic performance is insufficient. Use of ephedra or ephedrine and caffeine is associated with increased risk of psychiatric, autonomic, or gastrointestinal symptoms, and heart palpitations.
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    Ephedra
    Morton, Sally C. (Institute of Mathematical Statistics, 2005-08)
    In February 2004, the U.S. Food and Drug Administration (FDA) prohibited the sale of dietary supplements containing ephedrine alkaloids (ephedra), stating that such supplements present an unreasonable risk of illness or injury. The Dietary Supplement Health and Education Act (DSHEA) of 1994 (21 USC §301, 1994) governs dietary supplement regulation in the U.S. DSHEA places the burden of proof for safety on the government rather than on the manufacturer and thus differs significantly from regulations that govern the marketing of drugs. Part of the evidence the FDA used in reaching its decision was a systematic review of the efficacy and safety of ephedra conducted by the Southern California Evidence-Based Practice Center. In addition to a meta-analysis of controlled trial data, the review contained an evaluation of observational case report data, a study design that has limited inferential abilities regarding cause and effect. How did the FDA decide what data were relevant to its decision? How did the FDA argument for the ban differ from a decision based solely on statistical hypothesis testing? This paper will address these questions by describing the systematic review approach, the evidence presented, the interpretation of that evidence by those on both sides of the argument and the process by which the decision was made.
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    Expenditures for the Care of HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy
    Bozzette, Samuel A.; Joyce, Geoffrey; McCaffrey, Daniel F.; Leibowitz, Arleen A.; Morton, Sally C.; Berry, Sandra H.; Rastegar, Afshin; Timberlake, David; Shapiro, Martin F.; Goldman, Dana P. (NEJM Group, 2001-03-15)
    Background: The introduction of expensive but very effective antiviral medications has led to questions about the effects on the total use of resources for the care of patients with human immunodeficiency virus (HIV) infection. We examined expenditures for the care of HIV-infected patients since the introduction of highly active antiretroviral therapy. Methods: We interviewed a random sample of 2864 patients who were representative of all American adults receiving care for HIV infection in early 1996, and followed them for up to 36 months. We estimated the average expenditure per patient per month on the basis of self-reported information about care received. Results: The mean expenditure was $1,792 per patient per month at base line, but it declined to $1,359 for survivors in 1997, since the increases in pharmaceutical expenditures were smaller than the reductions in hospital costs. Use of highly active antiretroviral therapy was independently associated with a reduction in expenditures. After adjustments for the interview date, clinical status, and deaths, the estimated annual expenditure declined from $20,300 per patient in 1996 to $18,300 in 1998. Expenditures among subgroups of patients varied by a factor of as much as three. Pharmaceutical costs were lowest and hospital costs highest among underserved groups, including blacks, women, and patients without private insurance. Conclusions: The total cost of care for adults with HIV infection has declined since the introduction of highly active antiretroviral therapy. Expenditures have increased for medications but have declined for other services. However, there are large variations in expenditures across subgroups of patients. (N Engl J Med 2001;344:817-23.)
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    Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials
    Chang, John T.; Morton, Sally C.; Rubenstein, Laurence Z.; Mojica, Walter A.; Maglione, Margaret; Suttorp, Marika J.; Roth, Elizabeth A.; Shekelle, Paul G. (BMJ Publishing Group Ltd, 2004-03-20)
    Objective: To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group. Design: Systematic review and meta-analyses. Data sources Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews. Data extraction: Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education. Results: 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7). Conclusions: Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.
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    A Model for a Smallpox-Vaccination Policy
    Bozzette, Samuel A.; Boer, Rob; Bhatnagar, Vibha; Brower, Jennifer L.; Keeler, Emmett B.; Morton, Sally C.; Stoto, Michael A. (NEJM Group, 2003-01-30)
    Background: The new reality of biologic terrorism and warfare has ignited a debate about whether to reintroduce smallpox vaccination. Methods: We developed scenarios of smallpox attacks and built a stochastic model of outcomes under various control policies. We conducted a systematic literature review and estimated model parameters on the basis of European and North American outbreaks since World War II. We assessed the trade-offs between vaccine-related harms and benefits. Results: Nations or terrorists possessing a smallpox weapon could feasibly mount attacks that vary with respect to tactical complexity and target size, and patterns of spread can be expected to vary according to whether index patients are hospitalized early. For acceptable results, vaccination of contacts must be accompanied by effective isolation. Vaccination of contacts plus isolation is expected to result in 7 deaths (from vaccine or smallpox) in a scenario involving the release of variola virus from a laboratory, 19 deaths in a human-vector scenario, 300 deaths in a building-attack scenario, 2735 deaths in a scenario involving a low-impact airport attack, and 54,729 deaths in a scenario involving a high-impact airport attack. Immediate vaccination of the public in an attacked region would provide little additional benefit. Prior vaccination of health care workers, who would be disproportionately affected, would save lives in large local or national attacks but would cause 25 deaths nationally. Prior vaccination of health care workers and the public would save lives in a national attack but would cause 482 deaths nationally. The expected net benefits of vaccination depend on the assessed probability of an attack. Prior vaccination of health care workers would be expected to save lives if the probability of a building attack exceeded 0.22 or if the probability of a high-impact airport attack exceeded 0.002. The probability would have to be much higher to make vaccination of the public life-saving. Conclusions: The analysis favors prior vaccination of health care workers unless the likelihood of any attack is very low, but it favors vaccination of the public only if the likelihood of a national attack or of multiple attacks is high.
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    Open Research/Open Data Forum: Transparency, Sharing, and Reproducibility in Scholarship
    Potter, Peter J.; Chen, Daniel; DePauw, Karen P.; Morton, Sally C.; Petters, Jonathan L.; Radcliffe, David H.; Sands, Laura P. (Virginia Tech. University Libraries, 2017-04-10)
    Join our panelists for a discussion on challenges and opportunities related to sharing and using open data in research, including meeting funder and journal guidelines: Daniel Chen (Ph.D. candidate in Genetics, Bioinformatics, and Computational Biology) Karen DePauw (Vice President and Dean for Graduate Education) Sally Morton (Dean, College of Science) Jon Petters (Data Management Consultant, University Libraries) David Radcliffe (English) Laura Sands (Center for Gerontology)
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    Psychiatric Disorders and Drug Use Among Human Immunodeficiency Virus–Infected Adults in the United States
    Bing, Eric G.; Burnam, M. Audrey; Longshore, Douglas; Fleishman, John A.; Sherbourne, Cathy Donald; London, Andrew S.; Turner, Barbara J.; Eggan, Ferd; Beckman, Robin; Vitiello, Benedetto; Morton, Sally C.; Orlando, Maria; Bozzette, Samuel A.; Ortiz-Barron, Lucila; Shapiro, Martin F. (AMA, 2001-08)
    Background: There have been no previous nationally representative estimates of the prevalence of mental disorders and drug use among adults receiving care for human immunodeficiency virus (HIV) disease in the United States. It is also not known which clinical and sociodemographic factors are associated with these disorders. Subjects and Methods: We enrolled a nationally representative probability sample of 2864 adults receiving care for HIV in the United States in 1996. Participants were administered a brief structured psychiatric instrument that screened for psychiatric disorders (major depression, dysthymia, generalized anxiety disorders, and panic attacks) and drug use during the previous 12 months. Sociodemographic and clinical factors associated with screening positive for any psychiatric disorder and drug dependence were examined in multivariate logistic regression analyses. Results: Nearly half of the sample screened positive for a psychiatric disorder, nearly 40% reported using an illicit drug other than marijuana, and more than 12% screened positive for drug dependence during the previous 12 months. Factors independently associated with screening positive for a psychiatric disorder included number of HIV-related symptoms, illicit drug use, drug dependence, heavy alcohol use, and being unemployed or disabled. Factors independently associated with screening positive for drug dependence included having many HIV-related symptoms, being younger, being heterosexual, having frequent heavy alcohol use, and screening positive for a psychiatric disorder. Conclusions: Many people infected with HIV may also have psychiatric and/or drug dependence disorders. Clinicians may need to actively identify those at risk and work with policymakers to ensure the availability of appropriate care for these treatable disorders.
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    Transmission patterns of smallpox: systematic review of natural outbreaks in Europe and North America since World War II
    Bhatnagar, Vibha; Stoto, Michael A.; Morton, Sally C.; Boer, Rob; Bozzette, Samuel A. (BMC, 2006-05-05)
    Background: Because smallpox (variola major) may be used as a biological weapon, we reviewed outbreaks in post-World War II Europe and North America in order to understand smallpox transmission patterns. Methods: A systematic review was used to identify papers from the National Library of Medicine, Embase, Biosis, Cochrane Library, Defense Technical Information Center, WorldCat, and reference lists of included publications. Two authors reviewed selected papers for smallpox outbreaks. Results: 51 relevant outbreaks were identified from 1,389 publications. The median for the effective first generation reproduction rate (initial R) was 2 (range 0–38). The majority outbreaks were small (less than 5 cases) and contained within one generation. Outbreaks with few hospitalized patients had low initial R values (median of 1) and were prolonged if not initially recognized (median of 3 generations); outbreaks with mostly hospitalized patients had higher initial R values (median 12) and were shorter (median of 3 generations). Index cases with an atypical presentation of smallpox were less likely to have been diagnosed with smallpox; outbreaks in which the index case was not correctly diagnosed were larger (median of 27.5 cases) and longer (median of 3 generations) compared to outbreaks in which the index case was correctly diagnosed (median of 3 cases and 1 generation). Conclusion: Patterns of spread during Smallpox outbreaks varied with circumstances, but early detection and implementation of control measures is a most important influence on the magnitude of outbreaks. The majority of outbreaks studied in Europe and North America were controlled within a few generations if detected early.
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    Use of Mental Health and Substance Abuse Treatment Services Among Adults With HIV in the United States
    Burnam, M. Audrey; Bing, Eric G.; Morton, Sally C.; Sherbourne, Cathy Donald; Fleishman, John A.; London, Andrew S.; Vitiello, Benedetto; Stein, Michael; Bozzette, Samuel A.; Shapiro, Martin F. (AMA, 2001-08)
    Background: The need for mental health and substance abuse services is great among those with human immunodeficiency virus (HIV), but little information is available on services used by this population or on individual factors associated with access to care. Methods: Data are from the HIV Cost and Services Utilization Study, a national probability survey of 2864 HIV-infected adults receiving medical care in the United States in 1996. We estimated 6-month use of services for mental health and substance abuse problems and examined socioeconomic, HIV illness, and regional factors associated with use. Results: We estimated that 61.4% of 231 400 adults under care for HIV used mental health or substance abuse services: 1.8% had hospitalizations, 3.4% received residential substance abuse treatment, 26.0% made individual mental health specialty visits, 15.2% had group mental health treatment, 40.3% discussed emotional problems with medical providers, 29.6% took psychotherapeutic medications, 5.6% received outpatient substance abuse treatment, and 12.4% participated in substance abuse self-help groups. Socioeconomic factors commonly associated with poorer access to health services predicted lower likelihood of using mental health outpatient care, but greater likelihood of receiving substance abuse treatment services. Those with less severe HIV illness were less likely to access services. Persons living in the Northeast were more likely to receive services. Conclusions: The magnitude of mental health and substance abuse care provided to those with known HIV infection is substantial, and challenges to providers should be recognized. Inequalities in access to care are evident, but differ among general medical, specialty mental health, and substance abuse treatment sectors.