Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Query Trace: Thaker S[original query] |
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Is it time for a patient-centered quality measure of asthma control
Herman E , Beavers S , Hamlin B , Thaker K . J Allergy Clin Immunol Pract 2019 7 (6) 1771-1777 Quality measures play a prominent role in the US health care system. They are used to monitor and report performance across health plans, providers, and health systems and are a foundational element of value-based payment. Measuring the quality of asthma care has been challenging because of a lack of reliable data to assess clinical processes and track patient-specific outcomes. Existing asthma Healthcare Effectiveness Data and Information Set measures rely on administrative claims-derived data on dispensed medications. These are proxy measures of appropriate prescribing but are not reflective of comprehensive asthma care. The increase in the volume and specificity of longitudinal clinical data in electronic health records, movement toward electronic quality measures, and advances in electronic clinical data systems enable the development of more meaningful measures. A patient-reported measure of asthma control would incorporate key clinical indicators such as a validated age- and culturally appropriate test, and would reflect the combined outcome of medical management, self-management education, reduction of environmental exposures, and appropriate support services. Although there is a current quality measure that includes a test of asthma control (the Optimal Asthma Control Measure), work is needed to address questions about usability, patient literacy, and the influence of setting on self-reported scores. Comprehensive reliability and validity testing of both clinical data and stratification across risk groups will be needed to determine whether a measure based on standardized assessments of asthma control indeed promote improved clinical outcomes. |
Interim estimates of 2016-17 seasonal influenza vaccine effectiveness - United States, February 2017
Flannery B , Chung JR , Thaker SN , Monto AS , Martin ET , Belongia EA , McLean HQ , Gaglani M , Murthy K , Zimmerman RK , Nowalk MP , Jackson ML , Jackson LA , Foust A , Sessions W , Berman L , Spencer S , Fry AM . MMWR Morb Mortal Wkly Rep 2017 66 (6) 167-171 In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months. Each influenza season since 2004-05, CDC has estimated the effectiveness of seasonal influenza vaccine to prevent influenza-associated, medically attended, acute respiratory illness (ARI). This report uses data, as of February 4, 2017, from 3,144 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness Network (U.S. Flu VE Network) during November 28, 2016-February 4, 2017, to estimate an interim adjusted effectiveness of seasonal influenza vaccine for preventing laboratory-confirmed influenza virus infection associated with medically attended ARI. During this period, overall vaccine effectiveness (VE) (adjusted for study site, age group, sex, race/ethnicity, self-rated general health, and days from illness onset to enrollment) against influenza A and influenza B virus infection associated with medically attended ARI was 48% (95% confidence interval [CI] = 37%-57%). Most influenza infections were caused by A (H3N2) viruses. VE was estimated to be 43% (CI = 29%-54%) against illness caused by influenza A (H3N2) virus and 73% (CI = 54%-84%) against influenza B virus. These interim VE estimates indicate that influenza vaccination reduced the risk for outpatient medical visits by almost half. Because influenza activity remains elevated (2), CDC and the Advisory Committee on Immunization Practices recommend that annual influenza vaccination efforts continue as long as influenza viruses are circulating. Vaccination with 2016-17 influenza vaccines will reduce the number of infections with most currently circulating influenza viruses. Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated as soon as possible. |
Enhanced genetic characterization of influenza A(H3N2) viruses and vaccine effectiveness by genetic group, 2014-2015.
Flannery B , Zimmerman RK , Gubareva LV , Garten RJ , Chung JR , Nowalk MP , Jackson ML , Jackson LA , Monto AS , Ohmit SE , Belongia EA , McLean HQ , Gaglani M , Piedra PA , Mishin VP , Chesnokov AP , Spencer S , Thaker SN , Barnes JR , Foust A , Sessions W , Xu X , Katz J , Fry AM . J Infect Dis 2016 214 (7) 1010-9 BACKGROUND: During the 2014-15 US influenza season, expanded genetic characterization of circulating influenza A(H3N2) viruses was used to assess the impact of genetic variability of influenza A(H3N2) viruses on influenza vaccine effectiveness (VE). METHODS: A novel pyrosequencing assay was used to determine genetic group based on hemagglutinin (HA) gene sequences of influenza A(H3N2) viruses from patients enrolled US Flu Vaccine Effectiveness network sites. Vaccine effectiveness was estimated using a test-negative design comparing vaccination among patients infected with influenza A(H3N2) viruses and uninfected patients. RESULTS: Among 9710 enrollees, 1868 (19%) tested positive for influenza A(H3N2); genetic characterization of 1397 viruses showed 1134 (81%) belonged to one HA genetic group (3C.2a) of antigenically drifted H3N2 viruses. Effectiveness of 2014-15 influenza vaccination varied by A(H3N2) genetic group from 1% (95% confidence interval [CI], -14% to 14%) against illness caused by antigenically drifted A(H3N2) group 3C.2a viruses versus 44% (95% CI, 16% to 63%) against illness caused by vaccine-like A(H3N2) group 3C.3b viruses. CONCLUSION: Effectiveness of 2014-15 influenza vaccination varied by genetic group of influenza A(H3N2) virus. Changes in hemagglutinin genes related to antigenic drift were associated with reduced vaccine effectiveness. |
Influenza vaccine effectiveness for fully and partially vaccinated children 6 months to 8 years old during 2011-2012 and 2012-2013: The importance of two priming doses
Thompson MG , Clippard J , Petrie JG , Jackson ML , McLean HQ , Gaglani M , Reis EC , Flannery B , Monto AS , Jackson L , Belongia EA , Murthy K , Zimmerman RK , Thaker S , Fry AM . Pediatr Infect Dis J 2015 35 (3) 299-308 BACKGROUND: Few studies have examined the effectiveness of full vs. partial vaccination with inactivated trivalent influenza vaccines (IIV3) as defined by the U.S. CDC Advisory Committee on Immunization Practices (ACIP). METHODS: Respiratory swabs were collected from outpatients aged 6 months to 8 years with acute cough for ≤7 days in clinics in 5 states during the 2011-2012 and 2012-2013 influenza seasons. Influenza was confirmed by real-time reverse transcription polymerase chain reaction assay. Receipt of current season IIV3 and up to 4 prior vaccinations was documented from medical records and immunization registries. Using a test-negative design, vaccine effectiveness (VE) was estimated adjusting for age, race/ethnicity, medical conditions, study site, and month of enrollment. RESULTS: We did not observe higher VE for children fully vs. partially vaccinated with IIV3, as defined by U.S. ACIP, though our sample of partially vaccinated children was relatively small. However, among children aged 2-8 years in both seasons and against A(H3N2) and B influenza illness separately, VE point estimates were consistently higher for children who had received 2 doses in the same prior season compared to those without (VE range of 58-80% vs. 33-44%, respectively). Across seasons, the odds of A(H3N2) illness despite IIV3 vaccination were 2.4-fold (95% CI = 1.4-4.3) higher among children who had not received 2 doses in the same prior season. We also noted residual protection among unvaccinated children who were vaccinated the previous season (VE range = 36-40% across outcomes). CONCLUSION: Vaccination with IIV3 may provide preventive benefit in subsequent seasons, including possible residual protection if vaccination is missed. Two vaccine doses in the same season may be more effective than alternative priming strategies. |
Illness severity and work productivity loss among working adults with medically-attended acute respiratory illnesses: US Influenza Vaccine Effectiveness Network 2012-2013
Petrie JG , Cheng C , Malosh RE , VanWormer JJ , Flannery B , Zimmerman RK , Gaglani M , Jackson ML , King JP , Nowalk MP , Benoit J , Robertson A , Thaker SN , Monto AS , Ohmit SE . Clin Infect Dis 2015 62 (4) 448-455 BACKGROUND: Influenza causes significant morbidity and mortality with considerable economic costs, including lost work productivity. Influenza vaccines may reduce the economic burden through primary prevention of influenza and reduction in illness severity. METHODS: We examined illness severity and work productivity loss among working adults with medically-attended acute respiratory illnesses, and compared outcomes for patients with and without laboratory-confirmed influenza, and by influenza vaccination status among patients with influenza during the 2012-2013 influenza season. RESULTS: Illnesses laboratory-confirmed as influenza (i.e. Cases) were subjectively assessed as more severe than illnesses not caused by influenza (i.e. Non-Cases) based on multiple measures, including current health status at study enrollment (<7 days from illness onset), and current activity and sleep quality status relative to usual. Influenza Cases reported missing 45% more work hours (20.5 vs. 15.0, P<.001) than Non-Cases, and subjectively assessed their work productivity as impeded to a greater degree (6.0 vs. 5.4, P<.001). Current health status and current activity relative to usual were subjectively assessed as modestly, but significantly, better for vaccinated influenza Cases compared with unvaccinated Cases; however, no significant modifications of sleep quality, missed work hours, or work productivity loss were noted for vaccinated subjects. CONCLUSIONS: Influenza illnesses were more severe and resulted in more missed work hours and productivity loss than illnesses not confirmed as influenza. Modest reductions in illness severity for vaccinated influenza cases were observed. These findings highlight the burden of influenza illnesses and illustrate the importance of laboratory-confirmation of influenza outcomes in evaluations of vaccine effectiveness. |
Early estimates of seasonal influenza vaccine effectiveness - United States, January 2015
Flannery B , Clippard J , Zimmerman RK , Nowalk MP , Jackson ML , Jackson LA , Monto AS , Petrie JG , McLean HQ , Belongia EA , Gaglani M , Berman L , Foust A , Sessions W , Thaker SN , Spencer S , Fry AM . MMWR Morb Mortal Wkly Rep 2015 64 (1) 10-15 In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months. Each season since 2004-05, CDC has estimated the effectiveness of seasonal influenza vaccine in preventing medically attended acute respiratory illness (ARI) associated with laboratory-confirmed influenza. This season, early estimates of influenza vaccine effectiveness are possible because of widespread, early circulation of influenza viruses. By January 3, 2015, 46 states were experiencing widespread flu activity, with predominance of influenza A (H3N2) viruses. This report presents an initial estimate of seasonal influenza vaccine effectiveness at preventing laboratory-confirmed influenza virus infection associated with medically attended ARI based on data from 2,321 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness Network (Flu VE) during November 10, 2014-January 2, 2015. During this period, overall vaccine effectiveness (VE) (adjusted for study site, age, sex, race/ethnicity, self-rated health, and days from illness onset to enrollment) against laboratory-confirmed influenza associated with medically attended ARI was 23% (95% confidence interval [CI] = 8%-36%). Most influenza infections were due to A (H3N2) viruses. This interim VE estimate is relatively low compared with previous seasons when circulating viruses and vaccine viruses were well-matched and likely reflects the fact that more than two-thirds of circulating A (H3N2) viruses are antigenically and genetically different (drifted) from the A (H3N2) vaccine component of 2014-15 Northern Hemisphere seasonal influenza vaccines. These early, low VE estimates underscore the need for ongoing influenza prevention and treatment measures. CDC continues to recommend influenza vaccination because the vaccine can still prevent some infections with the currently circulating A (H3N2) viruses as well as other viruses that might circulate later in the season, including influenza B viruses. Even when VE is reduced, vaccination still prevents some illness and serious influenza-related complications, including thousands of hospitalizations and deaths. Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated, including persons who might already have been ill with influenza this season. |
Influenza vaccine effectiveness in the United States during 2012-13: variable protection by age and virus type
McLean HQ , Thompson MG , Sundaram ME , Kieke BA , Gaglani M , Murthy K , Piedra PA , Zimmerman RK , Nowalk MP , Raviotta JM , Jackson ML , Jackson L , Ohmit SE , Petrie JG , Monto AS , Meece JK , Thaker SN , Clippard JR , Spencer SM , Fry AM , Belongia EA . J Infect Dis 2014 211 (10) 1529-40 BACKGROUND: During the 2012-13 influenza season, there was co-circulation of A/H3N2 and two B lineage viruses in the United States. METHODS: Patients with acute cough illness ≤7 days duration were prospectively enrolled and swabbed at outpatient clinics in five states. Influenza vaccination dates were confirmed by medical records. Vaccine effectiveness (VE) was estimated as [100% x (1-adjusted odds ratio)] for vaccination in cases vs. test-negative controls. RESULTS: Influenza was detected in 2,307 (36%) of 6,452 patients; 1,292 (56%) had A/H3N2, 582 (25%) had B/Yamagata, and 303 (13%) had B/Victoria. VE was 49% (95% CI: 43, 55) overall; 39% (95% CI: 29, 47) against A/H3N2, 66% (95% CI: 58, 73) against B/Yamagata (vaccine lineage), and 51% (95% CI: 36, 63) against B/Victoria. VE against A/H3N2 was highest among persons aged 50-64 years (52%; 95% CI: 33, 65) and 6 months-8 years (51%; 95% CI: 32, 64) and lowest among those ≥65 years (11%; 95% CI: -41, 43). In younger age groups, there was evidence of residual protection from receipt of the 2011-12 vaccine one year earlier. CONCLUSIONS: The 2012-13 vaccines were moderately effective in most age groups. Cross-lineage protection and residual effects from prior vaccination were observed and warrant further investigation. |
Use of influenza antiviral agents by ambulatory care clinicians during the 2012-2013 influenza season
Havers F , Thaker S , Clippard JR , Jackson M , McLean HQ , Gaglani M , Monto AS , Zimmerman RK , Jackson L , Petrie JG , Nowalk MP , Moehling KK , Flannery B , Thompson MG , Fry AM . Clin Infect Dis 2014 59 (6) 774-82 BACKGROUND: Early antiviral treatment (≤2 days since illness onset) of influenza reduces the probability of influenza-associated complications. Early empiric antiviral treatment is recommended for those with suspected influenza at higher risk for influenza complications regardless of their illness severity. We describe antiviral receipt among outpatients with acute respiratory illness (ARI) and antibiotic receipt among patients with influenza. METHODS: We analyzed data from 5 sites in the US Influenza Vaccine Effectiveness Network Study during the 2012-2013 influenza season. Subjects were outpatients aged ≥6 months with ARI defined by cough of ≤7 days' duration; all were tested for influenza by polymerase chain reaction (PCR). Medical history and prescription information were collected by medical and pharmacy records. Four sites collected prescribing data on 3 common antibiotics (amoxicillin-clavulanate, amoxicillin, and azithromycin). RESULTS: Of 6766 enrolled ARI patients, 509 (7.5%) received an antiviral prescription. Overall, 2366 (35%) had PCR-confirmed influenza; 355 (15%) of those received an antiviral prescription. Among 1021 ARI patients at high risk for influenza complications (eg, aged <2 years or ≥65 years or with ≥1 chronic medical condition) presenting to care ≤2 days from symptom onset, 195 (19%) were prescribed an antiviral medication. Among participants with PCR-confirmed influenza and antibiotic data, 540 of 1825 (30%) were prescribed 1 of 3 antibiotics; 297 of 1825 (16%) were prescribed antiviral medications. CONCLUSIONS: Antiviral treatment was prescribed infrequently among outpatients with influenza for whom therapy would be most beneficial; in contrast, antibiotic prescribing was more frequent. Continued efforts to educate clinicians on appropriate antibiotic and antiviral use are essential to improve healthcare quality. |
Interim estimates of 2013-14 seasonal influenza vaccine effectiveness - United States, February 2014
Flannery B , Thaker SN , Clippard J , Monto AS , Ohmit SE , Zimmerman RK , Nowalk MP , Gaglani M , Jackson ML , Jackson LA , Belongia EA , McLean HQ , Berman L , Foust A , Sessions W , Spencer S , Fry AM . MMWR Morb Mortal Wkly Rep 2014 63 (7) 137-42 In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months. Each season since 2004-05, CDC has estimated the effectiveness of seasonal influenza vaccine to prevent influenza-associated, medically attended acute respiratory illness (ARI). This report uses data from 2,319 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness (Flu VE) Network during December 2, 2013-January 23, 2014, to estimate an interim adjusted effectiveness of seasonal influenza vaccine for preventing laboratory-confirmed influenza virus infection associated with medically attended ARI. During this period, overall vaccine effectiveness (VE) (adjusted for study site, age, sex, race/ethnicity, self-rated health, and days from illness onset to enrollment) against influenza A and B virus infection associated with medically attended ARI was 61%. The influenza A (H1N1)pdm09 (pH1N1) virus that emerged to cause a pandemic in 2009 accounted for 98% of influenza viruses detected. VE was estimated to be 62% against pH1N1 virus infections and was similar across age groups. As of February 8, 2014, influenza activity remained elevated in the United States, the proportion of persons seeing their health-care provider for influenza-like illness was lower than in early January but remained above the national baseline, and activity still might be increasing in some parts of the country. CDC and the Advisory Committee on Immunization Practices routinely recommend that annual influenza vaccination efforts continue as long as influenza viruses are circulating. Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated. Antiviral medications are an important second line of defense to treat influenza illness and should be used as recommended among suspected or confirmed influenza patients, regardless of patient vaccination status. Early antiviral treatment is recommended for persons with suspected influenza with severe or progressive illness (e.g., hospitalized persons) and those at high risk for complications from influenza, no matter how severe the illness. |
Influenza vaccine effectiveness in the 2011-2012 season: protection against each circulating virus and the effect of prior vaccination on estimates
Ohmit SE , Thompson MG , Petrie JG , Thaker SN , Jackson ML , Belongia EA , Zimmerman RK , Gaglani M , Lamerato L , Spencer SM , Jackson L , Meece JK , Nowalk MP , Song J , Zervos M , Cheng PY , Rinaldo CR , Clipper L , Shay DK , Piedra P , Monto AS . Clin Infect Dis 2014 58 (3) 319-27 BACKGROUND: Each year, the US Influenza Vaccine Effectiveness Network examines the effectiveness of influenza vaccines in preventing medically attended acute respiratory illnesses caused by influenza. METHODS: Patients with acute respiratory illnesses of ≤7 days' duration were enrolled at ambulatory care facilities in 5 communities. Specimens were collected and tested for influenza by real-time reverse-transcriptase polymerase chain reaction. Receipt of influenza vaccine was defined based on documented evidence of vaccination in medical records or immunization registries. Vaccine effectiveness was estimated in adjusted logistic regression models by comparing the vaccination coverage in those who tested positive for influenza with those who tested negative. RESULTS: The 2011-2012 season was mild and peaked late, with circulation of both type A viruses and both lineages of type B. Overall adjusted vaccine effectiveness was 47% (95% confidence interval [CI], 36-56) in preventing medically attended influenza; vaccine effectiveness was 65% (95% CI, 44-79) against type A (H1N1) pdm09 but only 39% (95% CI, 23-52) against type A (H3N2). Estimates of vaccine effectiveness against both type B lineages were similar (overall, 58%; 95% CI, 35-73). An apparent negative effect of prior year vaccination on current year effectiveness estimates was noted, particularly for A (H3N2) outcomes. CONCLUSIONS: Vaccine effectiveness in the 2011-2012 season was modest overall, with lower effectiveness against the predominant A (H3N2) virus. This may be related to antigenic drift, but past history of vaccination might also play a role. |
Changes in self-rated health and subjective social status over time in a cohort of healthcare personnel
Thompson MG , Gaglani MJ , Naleway A , Thaker S , Ball S . J Health Psychol 2013 19 (9) 1185-96 As part of a prospective cohort study of 1354 female and 347 male healthcare personnel, we examined the stability of subjective social status over ~7 months and the prospective association between subjective social status and self-rated health status. Most (82%) subjective social status ratings were stable (within +/-1 point). Lower baseline subjective social status among healthcare personnel was associated with more subsequent reports of fatigue and headache and worsening global self-rated health status. Healthcare personnel who placed themselves on the bottom half of the subjective social status ladder were four times more likely to experience a decline in global self-rated health status and half as likely to improve to excellent self-rated health status. |
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