Publications by authors named "Siqin Ye"

60 Publications

Anhedonic Depression Is Not Associated With Risk of Recurrent Major Adverse Cardiac Events and All-Cause Mortality in Acute Coronary Syndrome Patients.

Ann Behav Med 2021 Oct 12. Epub 2021 Oct 12.

Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.

Background: Depression after acute coronary syndrome (ACS) is common and increases risks of adverse outcomes, but it remains unclear which depression features are most associated with major adverse cardiac events (MACE) and all-cause mortality (ACM).

Purpose: To examine whether a subtype of depression characterized by anhedonia and major depressive disorder (MDD) predicts 1-year MACE/ACM occurrence in ACS patients compared to no MDD history. We also consider other depression features in the literature as predictors.

Methods: Patients (N = 1,087) presenting to a hospital with ACS completed a self-report measure of current depressive symptoms in-hospital and a diagnostic interview assessing MDD within 1 week post-hospitalization. MACE/ACM events were assessed at 1-, 6-, and 12-month follow-ups. Cox regression models were used to examine the association of the anhedonic depression subtype and MDD without anhedonia with time to MACE/ACM, adjusting for sociodemographic and clinical covariates.

Results: There were 142 MACE/ACM events over the 12-month follow-up. The 1-year MACE/ACM in patients with anhedonic depression, compared to those with no MDD, was somewhat higher in an age-adjusted model (hazard ratio [HR] = 1.63, p = .08), but was not significant after further covariate adjustment (HR = 1.24, p = .47). Of the additional depression features, moderate-to-severe self-reported depressive symptoms significantly predicted the risk of MACE/ACM, even in covariate-adjusted models (HR = 1.72, p = .04), but the continuous measure of self-reported depressive symptoms did not.

Conclusion: The anhedonic depression subtype did not uniquely predict MACE/ACM as hypothesized. Moderate-to-severe levels of total self-reported depressive symptoms, however, may be associated with increased MACE/ACM risk, even after accounting for potential sociodemographic and clinical confounders.
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http://dx.doi.org/10.1093/abm/kaab092DOI Listing
October 2021

The Promise of Remote Patient Monitoring: Lessons Learned During the COVID-19 Surge in New York City.

Am J Med Qual 2021 May-Jun 01;36(3):139-144

Clinical Medicine and Population Health Sciences, Weill Cornell Medical College, Adjunct Professor Columbia University, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY Population Health, NewYork-Presbyterian Healthcare System Inc., New York, NY NewYork-Presbyterian Healthcare System Inc., Digital Health, New York, NY Harvard Medical School, Boston, MA IS & Telehealth, NewYork-Presbyterian Heatlhcare System, Inc., New York, NY Center for Behavioral Cardiovascular Health. Columbia University Irving Medical Center. New York, NY Columbia University Irving Medical Center, New York, NY Weill Cornell Medicine. New York, NY Clinical Emergency Medicine, Weill Cornell Medicine. New York, NY.

The coronavirus pandemic catalyzed a digital health transformation, placing renewed focus on using remote monitoring technologies to care for patients outside of hospitals. At NewYork-Presbyterian, the authors expanded remote monitoring infrastructure and developed a COVID-19 Hypoxia Monitoring program-a critical means through which discharged COVID-19 patients were followed and assessed, enabling the organization to maximize inpatient capacity at a time of acute bed shortage. The pandemic tested existing remote monitoring efforts, revealing numerous operating challenges including device management, centralized escalation protocols, and health equity concerns. The continuation of these programs required addressing these concerns while expanding monitoring efforts in ambulatory and transitions of care settings. Building on these experiences, this article offers insights and strategies for implementing remote monitoring programs at scale and improving the sustainability of these efforts. As virtual care becomes a patient expectation, the authors hope hospitals recognize the promise that remote monitoring holds in reenvisioning health care delivery.
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http://dx.doi.org/10.1097/01.JMQ.0000741968.61211.2bDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091895PMC
May 2021

The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations.

J Am Assoc Nurse Pract 2021 Jan 27. Epub 2021 Jan 27.

Office of Scholarship and Research, Columbia University School of Nursing, New York City, New York Pace University College of Health Professions, New York City, New York Department of Medicine, Columbia University Medical Center, New York City, New York Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York.

Background: New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions.

Purpose: To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries.

Methods: A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition-related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis.

Results: As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p = .007; β = -2.218; 95% confidence interval [CI]: -3.79 to -0.644 and p = .04; β = -2.698; 95% CI: -5.268 to -0.127, respectively).

Implications For Practice: Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries.
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http://dx.doi.org/10.1097/JXX.0000000000000542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363165PMC
January 2021

Hospital Readmissions After Implementation of a Discharge Care Program for Patients with COVID-19 Illness.

J Gen Intern Med 2021 03 14;36(3):722-729. Epub 2021 Jan 14.

Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA.

Background: The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity.

Objective: To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness.

Design: Retrospective case series SETTING: Tertiary care medical center PATIENTS: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home INTERVENTIONS: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge MEASUREMENTS: Fourteen-day emergency department (ED) visits and hospital readmissions RESULTS: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 °F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31-1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52-2.52, p = 0.73).

Limitations: Single-center study; assignment to remote monitoring was not randomized.

Conclusions: During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
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http://dx.doi.org/10.1007/s11606-020-06340-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808120PMC
March 2021

Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study.

Implement Sci 2020 08 8;15(1):63. Epub 2020 Aug 8.

Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA.

Background: The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. We used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis. Informed by geographically diverse provider focus groups (n = 63) exploring barriers to out-of-office testing and key informant interviews (n = 12), a multi-disciplinary team (medicine, psychology, nursing) used rigorous mixed methods to develop, refine, locally adapt, and finalize intervention components. The purpose of this report is to describe the protocol of the Effects of a Multi-faceted intervention on Blood pRessure Actions in the primary Care Environment (EMBRACE) trial, a cluster randomized control trial evaluating whether a theory-informed multi-component strategy increased out-of-office testing for hypertension diagnosis.

Methods/design: The EMBRACE Trial patient sample will include all adults ≥ 18 years of age with a newly elevated office BP (≥ 140/90 mmHg) at a scheduled visit with a primary care provider from a study clinic. All providers with scheduled visits with adult primary care patients at enrolled ACN primary care clinics were included. We determined that the most feasible, effective implementation strategy would include delivering education about out-of-office testing, demonstration/instruction on how to perform out-of-office HBPM and ABPM testing, feedback on completion rates of out-of-office testing, environmental prompts/cues via computerized clinical decision support (CDS) tool, and a culturally tailored, locally accessible ABPM testing service. We are currently comparing the effect of this locally adapted multi-component strategy with usual care on the change in the proportion of eligible patients who complete out-of-office BP testing in a 1:1 cluster randomized trial across 8 socioeconomically diverse clinics.

Conclusions: The EMBRACE trial is the first trial to test an implementation strategy for improving out-of-office testing for hypertension diagnosis. It will elucidate the degree to which targeting provider behavior via education, reminders, and decision support in addition to providing an ABPM testing service will improve referral to and completion of ABPM and HBPMs.

Trial Registration: Clinicaltrials.gov , NCT03480217 , Registered on 29 March 2018.
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http://dx.doi.org/10.1186/s13012-020-01017-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414682PMC
August 2020

Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.

Gen Hosp Psychiatry 2020 Sep - Oct;66:1-8. Epub 2020 Jun 16.

Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.

Objective: The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic.

Methods: This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th-April 24th 2020) at a large medical center in NYC (n = 657).

Results: Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest.

Conclusions: NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences.
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http://dx.doi.org/10.1016/j.genhosppsych.2020.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297159PMC
September 2020

Anxiety Sensitivity and Physical Inactivity in a National Sample of Adults with a History of Myocardial Infarction.

Int J Behav Med 2020 Oct;27(5):520-526

Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.

Background: The psychological factors underlying physical inactivity in vulnerable cardiac adult populations remain understudied. Anxiety sensitivity, a cognitive vulnerability defined as fear of the physical, cognitive, and social consequences of anxiety, may be an important modifiable determinant of physical inactivity. We examined the association of anxiety sensitivity, and each anxiety sensitivity subscale (physical, cognitive, and social concerns), with physical inactivity in adults with a history of myocardial infarction (MI).

Methods: Using cross-sectional data from a nationally representative survey of adults (N = 1417) in the USA who reported a health professional diagnosis of MI, we used weighted logistic regression models to evaluate the association between anxiety sensitivity (overall, and each subscale) and physical inactivity (self-reported exercise 0-1 day/week), with adjustment for age, gender, race, education, number of MIs, and depression.

Results: Overall, 34.3% reported physical inactivity. Anxiety sensitivity was associated with greater odds of physical inactivity (OR = 1.01; 95% CI = 1.00, 1.02; p = .026). Of the subscales, only physical concerns were associated with physical inactivity (OR = 1.02; 95% CI = 1.01, 1.04; p = .008) in the final model. High vs. low fear of shortness of breath was most consistently associated with physical inactivity (OR = 1.49; 95% CI = 1.08, 2.06; p < .021).

Conclusion: Anxiety sensitivity, generally, and fear of the physical sensations of anxiety (i.e., "fear of shortness of breath"), specifically, are important correlates of physical inactivity in adults with a history of MI. Future research should replicate these findings and experimentally test whether cardiac rehabilitation interventions that include an adjunctive component targeting reduction of anxiety sensitivity overall, or specific somatic symptoms, improve physical activity in this population.
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http://dx.doi.org/10.1007/s12529-020-09881-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127064PMC
October 2020

Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants.

Ann Epidemiol 2020 06 7;46:31-40.e2. Epub 2020 May 7.

Columbia University Medical Center, New York, NY; Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY. Electronic address:

Purpose: Depressive symptoms relapse and remit over time, perhaps differentially by race and income. Few studies have examined whether time-varying depressive symptoms (TVDS) differentially predict mortality. We sought to determine whether race (white/black) and income (
Methods: The REGARDS study is a prospective cohort study among community-dwelling U.S. adults aged 45 years or older. Cox proportional hazard models were constructed to separately analyze the association between mortality (all cause, cardiovascular death, noncardiovascular death, and cancer death) and TVDS in race and income stratified models.

Results: Point estimates were similar and statistically significant for white (aHR = 1.24 [95% CI: 1.10, 1.41]), black (aHR = 1.26 [95% CI: 1.11, 1.42]), and low-income participants (aHR = 1.28 [95% CI: 1.16, 1.43]) for the association between TVDS and mortality. High-income participants had a lower hazard (aHR = 1.19 [95% CI: 1.02, 1.38]). Baseline depressive symptoms predicted mortality in blacks only (aHR = 1.17, 95% CI: [1.00, 1.35]).

Conclusions: We found that TVDS significantly increased the immediate hazard of mortality similarly across race and income strata. TVDS may provide more robust evaluations of depression impact compared with the baseline measures, making apparent racial disparities cited in the extant literature a reflection of the imperfection of using baseline measures.
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http://dx.doi.org/10.1016/j.annepidem.2020.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440028PMC
June 2020

Radiopharmacological evaluation of a caspase-3 responsive probe with optimized pharmacokinetics for PET imaging of tumor apoptosis.

Org Biomol Chem 2020 05;18(18):3512-3521

School of Chemical and Material Engineering, Jiangnan University, Wuxi 214122, China.

Early evaluation of the therapy efficiency can promote the development of anti-tumor drugs and optimization of the treatment method. Caspase-3 is a key biomarker for early apoptosis. Detection of caspase-3 activity is essential for quick assessment of the curative effect. We have reported a PET probe that could image drug-induced tumor apoptosis in vivo. However, high liver uptake limits its application. In order to optimize the pharmacokinetics of the previous probe, we introduced a hydrophilic peptide sequence to minimize liver uptake. The structure of the new probe was confirmed by mass spectrometry and nuclear magnetic resonance. This probe was able to cross the cell membrane freely and could be converted into a dimer through the condensation reaction of 2-cyano-6-aminobenzothiazole (CBT) and cysteine in response to intracellular activated caspase-3 and glutathione (GSH). The hydrophobic dimers further self-assembled into nanoparticles, which could enhance the probe aggregation in apoptotic tumor tissues. In vivo experiments showed that the tumor uptake of the new probe was higher than that of the previous probe, while the liver uptake of the new probe was significantly reduced. The new probe might be promising in imaging apoptotic tumors with suitable pharmacokinetics.
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http://dx.doi.org/10.1039/d0ob00690dDOI Listing
May 2020

A New γ-Glutamyltranspeptidase-Based Intracellular Self-Assembly of Fluorine-18 Labeled Probe for Enhancing PET Imaging in Tumors.

Bioconjug Chem 2020 02 17;31(2):174-181. Epub 2020 Jan 17.

NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine , Jiangsu Institute of Nuclear Medicine , Wuxi 214063 , China.

γ-Glutamyltranspeptidase (GGT) is a cell -membrane-associated enzyme which has been recognized as a promising biomarker for the diagnosis of many malignant tumors. Herein, we rationally designed a fluorine-18 labeled small-molecule probe, [F]γ-Glu-Cys(StBu)-PPG(CBT)-AmBF (), by applying a biocompatible CBT-Cys condensation reaction and ingeniously decorating it with a GGT-recognizable substrate, γ-glutamate (γ-Glu), for enhancing PET imaging to detect GGT level of tumors in living nude mice. The probe had exceptional stability at physiological conditions, but could be efficiently cleaved by GGT, followed by a reduction-triggered self-assembly and formation of nanoparticles (NPs) progressively that could be directly observed by transmission electron microscopy (TEM). In cell experiments, showed GGT-targeted uptake contrast of 2.7-fold to that of for the detection of intracellular GGT level. Moreover, the higher uptake in GGT overexpressed HCT116 tumor cells (∼4-fold) compared to GGT-deficient L929 normal cells demonstrated that - was also capable of distinguishing some tumor cells from normal cells. PET imaging revealed enhanced and durable radioactive signal in tumor regions after - coinjecting with , thus allowing real-time detection of endogenous GGT level with high sensitivity and noninvasive effect. We anticipated that our probe could serve as a new tool to investigate GGT-related diseases in the near future.
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http://dx.doi.org/10.1021/acs.bioconjchem.9b00803DOI Listing
February 2020

Instruments to measure shared decision-making in outpatient chronic care: a systematic review and appraisal.

J Clin Epidemiol 2020 05 3;121:15-19. Epub 2020 Jan 3.

Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA.

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http://dx.doi.org/10.1016/j.jclinepi.2020.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220799PMC
May 2020

Developing a toolkit to implement the Statin Choice Conversation Aid at scale: application of a work reduction model.

BMC Health Serv Res 2019 Apr 24;19(1):249. Epub 2019 Apr 24.

Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

Background: Guidelines recommend shared decision making (SDM) for determining whether to use statins to prevent cardiovascular events in at-risk patients. We sought to develop a toolkit to facilitate the cross-organizational spread and scale of a SDM intervention called the Statin Choice Conversation Aid (SCCA) by (i) assessing the work stakeholders must do to implement the tool; and (ii) orienting the resulting toolkit's components to communicate and mitigate this work.

Methods: We conducted multi-level and mixed methods (survey, interview, observation, focus group) characterizations of the contexts of 3 health systems (n = 86, 84, and 26 primary care clinicians) as they pertained to the impending implementation of the SCCA. We merged the data within implementation outcome domains of feasibility, appropriateness, and acceptability. Using Normalization Process Theory, we then characterized and categorized the work stakeholders did to implement the tool. We used clinician surveys and IP address-based tracking to calculate SCCA usage over time and judged how stakeholder effort was allocated to influence outcomes at 6 and 18 months. After assessing the types and impact of the work, we developed a multi-component toolkit.

Results: At baseline, the three contexts differed regarding feasibility, acceptability, and appropriateness of implementation. The work of adopting the tool was allocated across many strategies in complex and interdependent ways to optimize these domains. The two systems that allocated the work strategically had higher uptake (5.2 and 2.9 vs. 1.1 uses per clinician per month at 6 months; 3.8 and 2.1 vs. 0.4 at 18 months, respectively) than the system that did not. The resulting toolkit included context self-assessments intended to guide stakeholders in considering the early work of SCCA implementation; and webinars, EMR integration guides, video demonstrations, and an implementation team manual aimed at supporting this work.

Conclusions: We developed a multi-component toolkit for facilitating the scale-up and spread of a tool to promote SDM across clinical settings. The theory-based approach we employed aimed to distinguish systems primed for adoption and support the work they must do to achieve implementation. Our approach may have value in orienting the development of multi-component toolkits and other strategies aimed at facilitating the efficient scale up of interventions.

Trial Registration: ClinicalTrials.gov NCT02375815 .
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http://dx.doi.org/10.1186/s12913-019-4055-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6480421PMC
April 2019

A protease-responsive fluorescent probe for sensitive imaging of legumain activity in living tumor cells.

Chem Biol Drug Des 2019 08 16;94(2):1494-1503. Epub 2019 May 16.

Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China.

Legumain, a lysosomal cysteine protease, is critical for pathological progression and has been found to play an important role in the occurrence and development of several cancers. However, its biological functions remain few recognized. To further understand the role of legumain activity in tumor progression, a legumain protease-responsive fluorescent probe was developed in the present study. The probe 1 was synthesized by conjugating an aminoluciferin fluorophore with an alanine-alanine-asparagine (AAN) peptide sequence. The successful synthesis of probe 1 was validated by NMR and MS spectra as well as HPLC analysis. The probe 1 was non-toxic and exhibited great stability in the physiological solutions. More importantly, compared with the aminoluciferin fluorophore, the peptide conjugation may dramatically increase the targeting specificity. Probe 1 was able to effectively detect the legumain activity in living HCT116 cells through fluorescence imaging. All these results implied that probe 1 could act as a promising fluorescent probe specialized for the monitoring of legumain activity in living cells.
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http://dx.doi.org/10.1111/cbdd.13530DOI Listing
August 2019

Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial.

ESC Heart Fail 2019 Apr 27;6(2):297-307. Epub 2019 Feb 27.

Columbia University Irving Medical Center, New York, NY, USA.

Aims: There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial.

Methods And Results: We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131).

Conclusions: The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.
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http://dx.doi.org/10.1002/ehf2.12407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437435PMC
April 2019

Development and Psychometric Testing of the Provider Co-Management Index: Measuring Nurse Practitioner-Physician Co-Management.

J Nurs Meas 2018 12;26(3):E127-E141

Columbia University School of Nursing, New York.

Background And Purpose: Provider co-management has emerged in practice to alleviate demands of larger, more complex patient panels, yet no tools exist to measure nurse practitioner (NP)-physician co-management. The purpose of this study is to develop a tool that measures NP-physician co-management.

Methods: Items were generated based on three theoretical dimensions of co-management. Face and content validity were established with six experts. Pilot testing was conducted with a convenience sample of 40 NPs and physicians. We computed mean, standard deviation, skewness, interitem and corrected item-total correlations, and Cronbach's alpha.

Results: Psychometric analysis yielded high subscale reliability: effective communication (α = .811); mutual respect and trust (α = .746); and shared philosophy of care (α = .779).

Conclusions: PCMI demonstrates strong internal reliability consistency. Future research to examine construct validity is recommended.
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http://dx.doi.org/10.1891/1061-3749.26.3.E127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220798PMC
December 2018

Nurse Practitioner-Physician Comanagement of Patients in Primary Care.

Policy Polit Nurs Pract 2018 Aug-Nov;19(3-4):82-90. Epub 2018 Dec 5.

Columbia University School of Nursing, New York, NY, USA.

Current demand for primary care services will soon exceed the primary care provider (PCP) workforce capacity. As patient panel sizes increase, it has become difficult for a single PCP to deliver all recommended care. As a result, provider comanagement of the same patient has emerged in practice. Provider comanagement is defined as two or more PCPs sharing care management responsibilities for the same patient. While physician-physician comanagement of patients has been widely investigated, there is little evidence about nurse practitioner (NP)-physician comanagement. Given the large number of NPs that are practicing in primary care, more evidence is warranted about the PCP perspectives of physicians and NPs comanaging patient care. The purpose of this study was to explore NP-physician comanagement in primary care from the perspectives of PCPs. We conducted in-person qualitative interviews of 26 PCPs, including NPs and physicians, that lasted 25 to 45 minutes, were audio recorded, and then professionally transcribed. Transcripts were deidentified and checked for accuracy prior to a deductive and inductive data analysis. Physicians and NPs reported that comanagement increases adherence to recommended care guidelines, improves quality of care, and increases patient access to care. Effective communication, mutual respect and trust, and a shared philosophy of care are essential attributes of NP-physician comanagement. Physicians and NPs are optimistic about comanagement care delivery and find it a promising approach to improve the quality of care and alleviate primary care delivery strain. Efforts to promote effective NP-physician comanagement should be supported in clinical practice.
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http://dx.doi.org/10.1177/1527154418815024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178928PMC
December 2018

An Informatics Approach to Implement Support for Shared Decision Making for Primary Prevention Statin Therapy.

MDM Policy Pract 2018 Jan-Jun;3(1):2381468318777752. Epub 2018 May 22.

Division of General Internal Medicine Department of Medicine, Columbia University Medical Center, New York, New York.

Shared decision making (SDM) is recommended prior to initiation of statin therapy for primary prevention but is underutilized. We designed an informatics decision-support tool to facilitate use of the Mayo Clinic Statin Choice decision aid at the point-of-care and evaluated its impact. Using an iterative approach, we designed and implemented a single-click decision-support tool embedded within the electronic health records (EHRs) to automate the calculation of 10-year atherosclerotic cardiovascular disease (ASCVD) risk and populate the Statin Choice decision aid. We surveyed primary care providers at two clinics regarding their attitudes about SDM before and after deployment of intervention, as well as their usage of and perceived competence regarding SDM for primary prevention statin therapy. Three-month web traffic to the Statin Choice website was calculated before and after deployment of the intervention. Pre-post surveys were completed by 60 primary care providers (24 [40%] attending physicians and 36 [60%] housestaff physicians). After deployment of the EHR tool, respondents were more aware of the Statin Choice decision aid ( < 0.001), reported being more competent regarding SDM ( = 0.047), and reported using decision aids more often when considering statin initiation ( = 0.043). There was no significant change in attitudes about SDM as measured through the Patient Provider Orientation Scale (pre 4.23 ± 0.40 v. post 4.16 ± 0.38, = 0.11) and the SDM belief scale (pre 21.4 ± 2.1 v. post 21.1 ± 2.0, = 0.35). Web-based usage rates for the Statin Choice decision aid increased from 3.4 to 5.2 per 1,000 outpatient clinic visits ( = 0.002). Implementation of a point-of-care decision-support tool increased the usage of decision aids for primary prevention statin therapy. This effect does not appear to be mediated by any concomitant changes in physician attitude toward SDM.
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http://dx.doi.org/10.1177/2381468318777752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157431PMC
May 2018

Interventions to Increase Depression Treatment Initiation in Primary Care Patients: a Systematic Review.

J Gen Intern Med 2018 11 14;33(11):1978-1989. Epub 2018 Aug 14.

Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.

Introduction: Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear.

Methods: We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation. Two authors independently selected, extracted data, and rated risk of bias from included studies. Eligible studies used a randomized or pre-post design and assessed depression treatment initiation (i.e., ≥ 1 mental health visit or antidepressant fill) among adults, the majority of whom met criteria for depression. Interventions were classified as simple or complex and sub-classified into intervention strategies that were graded for strength of evidence.

Results: Of 9516 articles identified, we included 14 unique studies representing 16 (4 simple and 12 complex) interventions and 8 treatment initiation strategies. We found low to moderate strength of evidence for collaborative/integrated care (3 studies), treatment preference matching (2 studies), and case management (2 studies) strategies. However, there was insufficient evidence to determine the benefit of cultural tailoring (2 studies), motivation (alone, with reminders or with cultural tailoring (5 studies)), education (1 study), and shared decision-making strategies (1 study). Overall, we found moderate strength of evidence for complex interventions (8 of 12 complex interventions demonstrated statistically significant effects on treatment initiation).

Discussion: Collaborative/integrated care, preference treatment matching, and case management strategies had the best evidence for improving depression treatment initiation, but none of the strategies had high strength of evidence. While primary care settings can consider using some of these strategies when referring depressed patients to treatment, our review highlights the need for further rigorous research in this area.
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http://dx.doi.org/10.1007/s11606-018-4554-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206350PMC
November 2018

Heart Failure Severity and Quality of Warfarin Anticoagulation Control (From the WARCEF Trial).

Am J Cardiol 2018 09 4;122(5):821-827. Epub 2018 Jun 4.

Columbia University Irving Medical Center, New York, New York.

Previous studies in patients with atrial fibrillation showed that a history of heart failure (HF) could negatively impact anticoagulation quality, as measured by the average time in therapeutic range (TTR). Whether additional markers of HF severity are associated with TTR has not been investigated thoroughly. We aimed to examine the potential role of HF severity in the quality of warfarin control in patients with HF with reduced ejection fraction. Data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction Trial were used to investigate the association between TTR and HF severity. Multivariable logistic regression models were used to examine the association of markers of HF severity, including New York Heart Association (NYHA) class, Minnesota Living with HF (MLWHF) score, and frequency of HF hospitalization, with TTR ≥70% (high TTR). We included 1,067 participants (high TTR, N = 413; low TTR, N = 654) in the analysis. In unadjusted analysis, patients with a high TTR were older and less likely to have had strokes or receive other antiplatelet agents. Those patients also had lower NYHA class, better MLWHF scores, greater 6-minute walk distance, and lower frequency of HF hospitalizations. Multivariable analysis showed that NYHA class III and/or IV (Odds ratio [OR] 0.68 [95% confidence intervals [CIs] 0.49 to 0.94]), each 10-point increase in MLWHF score (i.e., worse health-related quality of life) (OR 0.92 [0.86 to 0.99]), and higher number of HF hospitalization per year (OR0.45 [0.30 to 0.67]) were associated with decreased likelihood of having high TTR. In HF patients with systolic dysfunction, NYHA class III and/or IV, poor health-related quality of life, and a higher rate of HF hospitalization were independently associated with suboptimal quality of warfarin anticoagulation control. These results affirm the need to assess the new approaches, such as direct oral anticoagulants, to prevent thromboembolism in this patient population.
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http://dx.doi.org/10.1016/j.amjcard.2018.05.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6151139PMC
September 2018

The perspectives of nurse practitioners and physicians on increasing the number of registered nurses in primary care.

Nurs Econ 2018 Jul-Aug;36(4):182-188

Columbia University School of Nursing.

Primary care providers, including physicians and nurse practitioners, described the importance of increased RN staffing in primary care. Adequate RN staffing improves the quality and safety of patient care, alleviates provider workload, and increases care continuity in primary care practices.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172063PMC
June 2021

Commentary: De-implementation Science: A Virtuous Cycle of Ceasing and Desisting Low-Value Care Before Implementing New High Value Care.

Ethn Dis 2017 7;27(4):463-468. Epub 2017 Dec 7.

Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

Implementation science has traditionally focused on increasing the delivery of evidence-based care. The science of systematically stopping low-value and wasteful care is substantially under-recognized, and if successful, may decrease the workload of clinicians. De-implementation science identifies problem areas of low-value and wasteful practice, carries out rigorous scientific examination of the factors that initiate and maintain such behaviors, and then employs evidence-based interventions to cease these practices. In this commentary, we describe how this approach for de-implementation might require a different set of health systems supports, economic and non-economic levers, and behavior change techniques that can lead to a virtuous cycle, ie, a complex chain of events that positively reinforce themselves through a feedback loop of removing low-value care to make room for high quality care.
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http://dx.doi.org/10.18865/ed.27.4.463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720957PMC
December 2019

To Persist or Not to Persist: Learning From Precision Medicine to Optimize Statin Adherence.

Rev Esp Cardiol (Engl Ed) 2018 01 2;71(1):4-5. Epub 2017 Aug 2.

Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, United States. Electronic address:

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http://dx.doi.org/10.1016/j.rec.2017.06.023DOI Listing
January 2018

Reply.

Eur J Heart Fail 2017 04 8;19(4):588. Epub 2017 Feb 8.

Columbia University Medical Center, New York, USA.

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http://dx.doi.org/10.1002/ejhf.783DOI Listing
April 2017

Telemonitoring Adherence to Medications in Heart Failure Patients (TEAM-HF): A Pilot Randomized Clinical Trial.

J Card Fail 2017 Apr 3;23(4):345-349. Epub 2016 Nov 3.

Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York. Electronic address:

Background: Medication nonadherence contributes to hospitalizations in recently discharged patients with heart failure (HF). We aimed to test the feasibility of telemonitoring medication adherence in patients with HF.

Methods And Results: We randomized 40 patients (1:1) hospitalized for HF to 30 days of loop diuretic adherence monitoring with telephonic support or to passive adherence monitoring alone. Eighty-three percent of eligible patients agreed to participate. The median age of patients was 64 years, 25% were female, and 45% were Hispanic. Overall, 67% of patients were nonadherent (percentage of days that the correct number of doses were taken <88%). There were no differences between intervention and passive monitoring group patients, respectively, in adherence (median correct dosing adherence 82% vs 73%; P = .41) or in the proportion readmitted within 30 days (30% vs 20%; P = .72). Eighty-eight percent of patients rated the wireless electronic adherence device as somewhat or very easy to use, and 88% agreed to use it again.

Conclusions: Adherence telemonitoring was acceptable to most patients with HF. Diuretic nonadherence was common even when patients knew they were being monitored. Future studies should assess whether adherence telemonitoring can improve adherence and reduce readmissions among patients with HF.
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http://dx.doi.org/10.1016/j.cardfail.2016.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380538PMC
April 2017

Interventions to improve hospital patient satisfaction with healthcare providers and systems: a systematic review.

BMJ Qual Saf 2017 Jul 3;26(7):596-606. Epub 2016 Aug 3.

Value Institute, New York-Presbyterian Hospital, New York, New York, USA.

Background: Many hospital systems seek to improve patient satisfaction as assessed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. A systematic review of the current experimental evidence could inform these efforts and does not yet exist.

Methods: We conducted a systematic review of the literature by searching electronic databases, including MEDLINE and EMBASE, the six databases of the Cochrane Library and grey literature databases. We included studies involving hospital patients with interventions targeting at least 1 of the 11 HCAHPS domains, and that met our quality filter score on the 27-item Downs and Black coding scale. We calculated post hoc power when appropriate.

Results: A total of 59 studies met inclusion criteria, out of these 44 did not meet the quality filter of 50% (average quality rating 27.8%±10.9%). Of the 15 studies that met the quality filter (average quality rating 67.3%±10.7%), 8 targeted the Communication with Doctors HCAHPS domain, 6 targeted Overall Hospital Rating, 5 targeted Communication with Nurses, 5 targeted Pain Management, 5 targeted Communication about Medicines, 5 targeted Recommend the Hospital, 3 targeted Quietness of the Hospital Environment, 3 targeted Cleanliness of the Hospital Environment and 3 targeted Discharge Information. Significant HCAHPS improvements were reported by eight interventions, but their generalisability may be limited by narrowly focused patient populations, heterogeneity of approach and other methodological concerns.

Conclusions: Although there are a few studies that show some improvement in HCAHPS score through various interventions, we conclude that more rigorous research is needed to identify effective and generalisable interventions to improve patient satisfaction.
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http://dx.doi.org/10.1136/bmjqs-2015-004758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290224PMC
July 2017

CHA DS -VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm.

Eur J Heart Fail 2016 Oct 21;18(10):1261-1266. Epub 2016 Jul 21.

Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.

Aims: The aim of this study was to determine whether the CHA DS -VASc score can predict adverse outcomes such as death, ischaemic stroke, and major haemorrhage, in patients with systolic heart failure in sinus rhythm.

Methods And Results: CHA DS -VASc scores were calculated for 1101 patients randomized to warfarin and 1123 patients randomized to aspirin. Adverse outcomes were defined as death or ischaemic stroke, death alone, ischaemic stroke alone, and major haemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA DS -VASc score was associated with increased hazard of death or ischaemic stroke events [hazard ratio (HR) for the warfarin arm = 1.21, 95% confidence interval (CI) 1.13-1.30, P < 0.001; for aspirin, HR = 1.20, 95% CI 1.11-1.29, P < 0.001]. Similar increased hazards for higher CHA DS -VASc scores were observed for death alone, ischaemic stroke alone, and major haemorrhage. Overall performance of the CHA DS -VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major haemorrhage.

Conclusions: The CHA DS -VASc score predicted adverse outcomes in patients with systolic heart failure in sinus rhythm, with modest prediction accuracy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053869PMC
http://dx.doi.org/10.1002/ejhf.613DOI Listing
October 2016

Distribution of lifespan gain from primary prevention intervention.

Open Heart 2016;3(1):e000343. Epub 2016 Mar 11.

International Centre for Circulatory Health, National Heart and Lung Institute , London , UK.

Objective: When advising patients about possible initiation of primary prevention treatment, clinicians currently do not have information on expected impact on lifespan, nor how much this increment differs between individuals.

Methods: First, UK cardiovascular and non-cardiovascular mortality data were used to calculate the mean lifespan gain from an intervention (such as a statin) that reduces cardiovascular mortality by 30%. Second, a new method was developed to calculate the probability distribution of lifespan gain. Third, we performed a survey in three UK cities on 11 days between May-June 2014 involving 396 participants (mean age 40 years, 55% male) to assess how individuals evaluate potential benefit from primary prevention therapies.

Results: Among numerous identical patients, the lifespan gain, from an intervention that reduces cardiovascular mortality by 30%, is concentrated within an unpredictable minority. For example, men aged 50 years with national average cardiovascular risk have mean lifespan gain of 7 months. However, 93% of these identical individuals gain no lifespan, while the remaining 7% gain a mean of 99 months. Many survey respondents preferred a chance of large lifespan gain to the equivalent life expectancy gain given as certainty. Indeed, 33% preferred a 2% probability of 10 years to fivefold more gain, expressed as certainty of 1 year.

Conclusions: People who gain lifespan from preventative therapy gain far more than the average for their risk stratum, even if perfectly defined. This may be important in patient decision-making. Looking beyond mortality reduction alone from preventative therapy, the benefits are likely to be even larger.
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http://dx.doi.org/10.1136/openhrt-2015-000343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800759PMC
March 2016
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