John B Wong

Maine Medical Center, Portland, Maine, United States

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Publications (97)783.42 Total impact

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    ABSTRACT: The relative efficacy of available treatments of knee osteoarthritis (OA) must be determined for rational treatment algorithms to be formulated. To examine the efficacy of treatments of primary knee OA using a network meta-analysis design, which estimates relative effects of all treatments against each other. MEDLINE, EMBASE, Web of Science, Google Scholar, Cochrane Central Register of Controlled Trials from inception through 15 August 2014, and unpublished data. Randomized trials of adults with knee OA comparing 2 or more of the following: acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, intra-articular (IA) corticosteroids, IA hyaluronic acid, oral placebo, and IA placebo. Two reviewers independently abstracted study data and assessed study quality. Standardized mean differences were calculated for pain, function, and stiffness at 3-month follow-up. Network meta-analysis was performed using a Bayesian random-effects model; 137 studies comprising 33 243 participants were identified. For pain, all interventions significantly outperformed oral placebo, with effect sizes from 0.63 (95% credible interval [CrI], 0.39 to 0.88) for the most efficacious treatment (hyaluronic acid) to 0.18 (CrI, 0.04 to 0.33) for the least efficacious treatment (acetaminophen). For function, all interventions except IA corticosteroids were significantly superior to oral placebo. For stiffness, most of the treatments did not significantly differ from one another. Lack of long-term data, inadequate reporting of safety data, possible publication bias, and few head-to-head comparisons. This method allowed comparison of common treatments of knee OA according to their relative efficacy. Intra-articular treatments were superior to nonsteroidal anti-inflammatory drugs, possibly because of the integrated IA placebo effect. Small but robust differences were observed between active treatments. All treatments except acetaminophen showed clinically significant improvement from baseline pain. This information, along with the safety profiles and relative costs of included treatments, will be helpful for individualized patient care decisions. Agency for Healthcare Research and Quality.
    Annals of internal medicine 01/2015; 162(1):46-54. · 16.10 Impact Factor
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    ABSTRACT: Purpose: The U.S. Agency for Healthcare Research and Quality (AHRQ) solicited the development of guidance for decision and simulation modeling in the context of systematic reviews. Method: We updated and expanded existing systematic reviews of recommendations for the conduct and reporting of decision and simulation modeling with input from a multidisciplinary team of clinical, policy, and decision analysis experts. The results of the systematic review were discussed in-person with a panel of 28 stakeholders including patient representatives, providers of care, purchasers of care, payers, policy makers, and principal investigators. Stakeholders commented on existing recommendations from various sources and identified gaps, limitations and areas for elaboration. We subsequently reviewed the websites of 126 international health technology assessment organizations providing guidance on the conduct and reporting of decision and simulation models. We solicited further input from senior researchers with experience in decision and simulation modeling from AHRQ and its Evidence-based Practice Centers. Result: We developed a list of principles and good practice recommendations for modeling conducted to enhance and contextualize findings of systematic reviews. The guidance applies to structural mathematical models, including declarative, functional, and spatial models. We categorized recommendations by whether they pertain to the model structure, model data, or consistency, and reporting. We provide the rationale for each recommendation, evidence supporting the recommendation, or best judgment where adequate evidence was lacking. Conclusion: We used a systematic approach to develop guidance for decision and simulation modeling in the context of systematic reviews. We are optimistic that this work will contribute to increased use of modeling in systematic reviews.
    The 36th Annual Meeting of the Society for Medical Decision Making; 10/2014
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    ABSTRACT: Knee osteoarthritis (OA) causes pain and long-term disability with annual healthcare costs exceeding $185 billion in the United States. Few medical remedies effectively influence the course of the disease. Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine. We are currently conducting the first comparative effectiveness and cost-effectiveness randomized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA. This article describes the design and conduct of this trial.Methods/design: A single-center, 52-week, comparative effectiveness randomized controlled trial of Tai Chi versus a standardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston, Massachusetts. The study population consists of adults >= 40 years of age with symptomatic and radiographic knee OA (American College of Rheumatology criteria). Participants are randomly allocated to either 12 weeks of Tai Chi (2x/week) or Physical Therapy (2x/week for 6 weeks, followed by 6 weeks of rigorously monitored home exercise). The primary outcome measure is pain (Western Ontario and McMaster Universities WOMAC) subscale at 12 weeks. Secondary outcomes include WOMAC stkiffness and function domain scores, lower extremity strength and power, functional balance, physical performance tests, psychological and psychosocial functioning, durability effects, health related quality of life, and healthcare utilization at 12, 24 and 52 weeks.
    BMC Complementary and Alternative Medicine 09/2014; 14(1):333. · 1.88 Impact Factor
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    ABSTRACT: Seizure frequency represents a commonly assessed epilepsy status, but in the context of the growing trend toward patient-centered care, we examined the adequacy of seizure frequency as a measure of epilepsy status as perceived by the patient.
    Epilepsia 06/2014; · 4.58 Impact Factor
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    ABSTRACT: OBJECTIVES We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. METHODS AND RESULTS We worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs. FINDINGS Reports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports. RECOMMENDATIONS To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.
    Journal of General Internal Medicine 06/2014; · 3.42 Impact Factor
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    ABSTRACT: The potential for academic community partnerships are challenged in places where there is a history of conflict and mistrust. Addressing Disparities in Asian Populations through Translational Research (ADAPT) represents an academic community partnership between researchers and clinicians from Tufts Medical Center and Tufts University and community partners from Boston Chinatown. Based in principles of community-based participatory research and partnership research, this partnership is seeking to build a trusting relationship between Tufts and Boston Chinatown. This case study aims to provides a narrative story of the development and formation of ADAPT as well as discuss challenges to its future viability. Using case study research tools, this study draws upon a variety of data sources including interviews, program evaluation data and documents. Several contextual factors laid the foundation for ADAPT. Weaving these factors together helped to create synergy and led to ADAPT's formation. In its first year, ADAPT has conducted formative research, piloted an educational program for community partners and held stakeholder forums to build a broad base of support. ADAPT recognizes that long term sustainability requires bringing multiple stakeholders to the table even before a funding opportunity is released and attempting to build a diversified funding base.
    Progress in Community Health Partnerships Research Education and Action 01/2014; 8(3):353-63.
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    ABSTRACT: To develop, pilot, and evaluate a curriculum for teaching clinical risk communication skills to medical students. A new experience-based curriculum, "Risk Talk," was developed and piloted over a 1-year period among students at Tufts University School of Medicine. An experimental study of 2nd-year students exposed vs. unexposed to the curriculum was conducted to evaluate the curriculum's efficacy. Primary outcome measures were students' objective (observed) and subjective (self-reported) risk communication competence; the latter was assessed using an Observed Structured Clinical Examination (OSCE) employing new measures. Twenty-eight 2nd-year students completed the curriculum, and exhibited significantly greater (p<.001) objective and subjective risk communication competence than a convenience sample of 24 unexposed students. New observational measures of objective competence in risk communication showed promising evidence of reliability and validity. The curriculum was resource-intensive. The new experience-based clinical risk communication curriculum was efficacious, although resource-intensive. More work is needed to develop the feasibility of curriculum delivery, and to improve the measurement of competence in clinical risk communication. Risk communication is an important advanced communication skill, and the Risk Talk curriculum provides a model educational intervention and new assessment tools to guide future efforts to teach and evaluate this skill.
    Patient Education and Counseling 09/2013; · 2.60 Impact Factor
  • Value in Health 09/2013; 16(6):1108. · 2.89 Impact Factor
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    ABSTRACT: Objective: The objective of this study was to test whether physicians' attitudes regarding the impact of ADHD on healthrelated quality of life (HRQL) explain differences in practices for prescribing psychostimulants in children. Method: In a cross-sectional survey, U.S.-based pediatricians and psychiatrists ("physicians") used the Paper-Standard Gamble-a widely used preference-based assessment of HRQL-to rate four vignettes describing ADHD health states of varying severity. Associations between standard gamble scores and questions about prescribing practices were analyzed using ordinal logistic regression. Results: Surveys were mailed to 291 physicians; 127 (44%) returned complete forms. Lower standard gamble scores were associated with more emphasis on children's ADHD symptoms (p = .03) and less emphasis on parents' concerns about stimulant side effects (p = .03) when prescribing psychostimulants. Conclusion: Differences in physician perceptions of the severity of ADHD symptoms and in their emphasis on parental concerns about side effects may help explain variations in ADHD psychostimulant prescription patterns. (J. of Att. Dis. 2012; XX(X) 1-XX).
    Journal of Attention Disorders 11/2012; · 2.40 Impact Factor
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    ABSTRACT: Abstract Objective: The purpose of this study was to determine psychiatrists' barriers, attitudes, and practices regarding cardiac screening prior to initiating stimulants in children with attention-deficit/hyperactivity disorder. Background: Professional and federal oversight organizations recently have debated the evidence regarding sudden cardiac death (SCD) risk with stimulants, and have published guidelines recommending cardiac screening. It is not known how psychiatrists have responded. Methods: This study was a cross-sectional survey of 1,600 randomly-selected U.S. members of the American Academy of Child and Adolescent Psychiatry. Analyses included descriptive statistics and logistic regression. Results: Response rate was 40%; 96% met eligibility criteria. Barriers to identifying cardiac disorders in general included ability to perform a routine physical examination (74%) and care coordination with primary care providers (35%). Only 27% agreed that SCD risk warranted cardiac assessment. Prior to starting a patient on stimulants, 95% of psychiatrists obtained a routine history. The majority either conducted (9%), or relied on primary care providers to conduct (67%) a physical examination; 26% did not obtain a physical examination. Nineteen percent of psychiatrists ordered an electrocardiogram (ECG), of those, non-mutually exclusive reasons for ordering an ECG included standard practice procedure (62%), clinical findings (27%), medicolegal considerations (25%), and guideline adherence (24%). On multivariate modeling, psychiatrists were less likely to conduct cardiac screening themselves if in private practice (referent: academic medical center), if >50% of their patients had private insurance, or if they believed their ability to perform a physical examination to be a barrier. When modeling cardiac screening performed by any healthcare professional (e.g., psychiatrist, primary care practitioner), screening was less likely if the psychiatrist was practicing in a community mental health center (referent: academic medical center), was male, or if >50% of that psychiatrist's patients had private insurance. Conclusion: Findings suggest the tacit interplay between primary care and psychiatry for the assessment and management of medical risks associated with psychotropic medications should be improved, and solutions prioritized.
    Journal of child and adolescent psychopharmacology 10/2012; 22(5):375-84. · 2.59 Impact Factor
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    ABSTRACT: Trust and confidence are critical to the success of health care models. There are two main methods for achieving this: transparency (people can see how the model is built) and validation (how well it reproduces reality). This report describes recommendations for achieving transparency and validation, developed by a task force appointed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Society for Medical Decision Making (SMDM). Recommendations were developed iteratively by the authors. A nontechnical description should be made available to anyone-including model type and intended applications; funding sources; structure; inputs, outputs, other components that determine function, and their relationships; data sources; validation methods and results; and limitations. Technical documentation, written in sufficient detail to enable a reader with necessary expertise to evaluate the model and potentially reproduce it, should be made available openly or under agreements that protect intellectual property, at the discretion of the modelers. Validation involves face validity (wherein experts evaluate model structure, data sources, assumptions, and results), verification or internal validity (check accuracy of coding), cross validity (comparison of results with other models analyzing same problem), external validity (comparing model results to real-world results), and predictive validity (comparing model results with prospectively observed events). The last two are the strongest form of validation. Each section of this paper contains a number of recommendations that were iterated among the authors, as well as the wider modeling task force jointly set up by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making.
    Medical Decision Making 09/2012; 32(5):733-743. · 2.27 Impact Factor
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    The Journal of thoracic and cardiovascular surgery 07/2012; 144(1):39-71. · 3.41 Impact Factor
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    ABSTRACT: The American College of Cardiology Foundation, in collaboration with the Society for Cardiovascular Angiography and Interventions and key specialty and subspecialty societies, conducted a review of common clinical scenarios where diagnostic catheterization is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of noninvasive imaging appropriate use criteria. The 166 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). Diagnostic catheterization may include several different procedure components. The indications developed focused primarily on 2 aspects of diagnostic catheterization. Many indications focused on the performance of coronary angiography for the detection of coronary artery disease with other procedure components (e.g., hemodynamic measurements, ventriculography) at the discretion of the operator. The majority of the remaining indications focused on hemodynamic measurements to evaluate valvular heart disease, pulmonary hypertension, cardiomyopathy, and other conditions, with the use of coronary angiography at the discretion of the operator. Seventy-five indications were rated as appropriate, 49 were rated as uncertain, and 42 were rated as inappropriate. The appropriate use criteria for diagnostic catheterization have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 06/2012; 80(3):E50-81. · 2.51 Impact Factor
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    Journal of the American College of Cardiology 05/2012; 59(23):2125-43. · 15.34 Impact Factor
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    ABSTRACT: Sudden cardiac death in children is a rare but devastating event. Experts have debated the merits of community-based screening programs using an ECG and targeting 2 potential high-risk groups: school-aged children initiating stimulant medications to treat attention-deficit/hyperactivity disorder and adolescents participating in sports. Simulation models incorporating detailed prevalence, sensitivity and specificity, and treatment algorithms were built to determine the cost-effectiveness of targeted sudden cardiac death screening. Clinical care algorithms were constructed for asymptomatic children initiating stimulants for attention-deficit/hyperactivity disorder (8 years of age) or participating in sports (14 years of age) and presenting with a positive ECG finding suggestive of 1 of the 3 most common pediatric disorders causing sudden cardiac death and identifiable by ECG. Information to develop simulation model assumptions was drawn from the existing literature, Medicaid fees, and expert judgment. Sensitivity analyses examined parameter ranges to identify influential sources of uncertainty. Outcomes included costs and lost life-years caused by condition-related mortality. Our models estimate that screening for all 3 conditions simultaneously would reduce sudden death risk by 3.6 to 7.5 × 10(-5) with projected life expectancy increases of 0.8 to 1.6 days per screened individual. The incremental cost-effectiveness of screening is $91,000 to $204,000 per life-year. Sensitivity analysis showed that assumed disease prevalence, baseline mortality, and the relative risk of mortality resulting from stimulant medication use and sports participation had the greatest impact on estimated cost-effectiveness. Results based on assumptions favoring sudden cardiac death screening indicated that its cost is high relative to its health benefits.
    Circulation 05/2012; 125(21):2621-9. · 14.95 Impact Factor
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    Circulation 04/2012; 125(19):2382-401. · 14.95 Impact Factor
  • Journal of the American College of Cardiology 04/2012; 59(20):1812-32. · 15.34 Impact Factor
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    ABSTRACT: Pediatric sudden cardiac death (SCD) occurs in an estimated 0.8 to 6.2 per 100 000 children annually. Screening for cardiac disorders causing SCD in asymptomatic children has public appeal because of its apparent potential to avert tragedy; however, performance of the electrocardiogram (ECG) as a screening tool is unknown. We estimated (1) phenotypic (ECG- or echocardiogram [ECHO]-based) prevalence of selected pediatric disorders associated with SCD, and (2) sensitivity, specificity, and predictive value of ECG, alone or with ECHO. We systematically reviewed literature on hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), and Wolff-Parkinson-White syndrome, the 3 most common disorders associated with SCD and detectable by ECG. We identified and screened 6954 abstracts, yielding 396 articles, and extracted data from 30. Summary phenotypic prevalences per 100 000 asymptomatic children were 45 (95% confidence interval [CI]: 10-79) for HCM, 7 (95% CI: 0-14) for LQTS, and 136 (95% CI: 55-218) for Wolff-Parkinson-White. The areas under the receiver operating characteristic curves for ECG were 0.91 for detecting HCM and 0.92 for LQTS. The negative predictive value of detecting either HCM or LQTS by using ECG was high; however, the positive predictive value varied by different sensitivity and specificity cut-points and the true prevalence of the conditions. Results provide an evidence base for evaluating pediatric screening for these disorders. ECG, alone or with ECHO, was a sensitive test for mass screening and negative predictive value was high, but positive predictive value and false-positive rates varied.
    PEDIATRICS 03/2012; 129(4):e999-1010. · 5.30 Impact Factor
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    ABSTRACT: To determine pediatricians' attitudes, barriers, and practices regarding cardiac screening before initiating treatment with stimulants for attention-deficit/hyperactivity disorder. A survey of 1600 randomly selected, practicing US pediatricians with American Academy of Pediatrics membership was conducted. Multivariate models were created for 3 screening practices: (1) performing an in-depth cardiac history and physical (H & P) examination, (2) discussing potential stimulant-related cardiac risks, and (3) ordering an electrocardiogram (ECG). Of 817 respondents (51%), 525 (64%) met eligibility criteria. Regarding attitudes, pediatricians agreed that both the risk for sudden cardiac death (SCD) (24%) and legal liability (30%) were sufficiently high to warrant cardiac assessment; 75% agreed that physicians were responsible for informing families about SCD risk. When identifying cardiac disorders, few (18%) recognized performing an in-depth cardiac H & P as a barrier; in contrast, 71% recognized interpreting a pediatric ECG as a barrier. When asked about cardiac screening practices before initiating stimulant treatment for a recent patient, 93% completed a routine H & P, 48% completed an in-depth cardiac H & P, and 15% ordered an ECG. Almost half (46%) reported discussing stimulant-related cardiac risks. Multivariate modeling indicated that ≥1 of these screening practices were associated with physicians' attitudes about SCD risk, legal liability, their responsibility to inform about risk, their ability to perform an in-depth cardiac H & P, and family concerns about risk. Variable pediatrician attitudes and cardiac screening practices reflect the limited evidence base and conflicting guidelines regarding cardiac screening. Barriers to identifying cardiac disorders influence practice.
    PEDIATRICS 02/2012; 129(2):222-30. · 5.30 Impact Factor
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    ABSTRACT: Purpose: Highly publicized sudden cardiac deaths (SCD) in asymptomatic children and young adults have stimulated public interest in pre-athletics and school-based screening for asymptomatic cardiac disorders to avert these tragedies. However, the performance and trade-offs of the electrocardiogram (ECG) as a screening tool for the most common of these cardiac conditions is less understood. Method: We systematically reviewed published literature on hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), and Wolff-Parkinson-White syndrome (WPW), the three most common disorders associated with SCD and detectable by ECG. Using this information, we estimated (1) phenotypic prevalence, (2) sensitivity and specificity of ECG in detecting these disorders, (3) and predictive values using the illustrative point where sensitivity and specificity were equally weighted and the illustrative point where specificity was maximized. Result: We identified and screened 6,954 abstracts, yielding 396 articles, and extracted data from 30. Summary prevalence estimates per 100,000 asymptomatic children were low at 45 (95% CI: 10, 79) for HCM; 7 (95% CI: 0, 14) for LQTS; and 136 (95% CI: 55, 218) for WPW. The areas under the receiver operating characteristic (ROC) curves for ECG were 0.91 for detecting HCM and 0.92 for LQTS. When sensitivity and specificity were weighted equally, the positive predictive value (PPV) of detecting either HCM or LQTS using ECG was less than 1%, there were many false positives per case detected (399 for HCM and 2,323 for LQTS), and the false negative rate was 15% for HCM and LQTS. However, when specificity was maximized, the PPV increased to 2% for HCM and 1% for LQTS, the false positives per case detected declined (57 for HCM and 135 for LQTS), as did the false negative rate (<1% for HCM and LQTS). Regardless of sensitivity and specificity cut-point, the negative predictive value (NPV) was near 100% and the false reassurance rate was low (<45 per 100,000 screened) for HCM and LQTS. Conclusion: Because HCM, LQTS, and WPW have very low prevalence rates, population screening with ECG would yield substantial false positives. Guidelines regarding ECG screening will need to balance trade-offs between identification and treatment of affected individuals against the additional costs and risks associated with post-screening cardiac evaluations to rule out these disorders as well as potential overdiagnosis and overtreatment of asymptomatic individuals.
    The 33rd Annual Meeting of the Society for Medical Decision Making; 10/2011

Publication Stats

5k Citations
783.42 Total Impact Points

Institutions

  • 2013
    • Maine Medical Center
      Portland, Maine, United States
  • 1988–2013
    • Tufts University
      • • Department of Medicine
      • • Institute for Clinical Research and Health Policy Studies
      Georgia, United States
  • 2012
    • Archimedes, Inc.
      San Francisco, California, United States
  • 2011–2012
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
    • Boston University
      • Renal Section
      Boston, MA, United States
  • 2002–2010
    • Tufts Medical Center
      • • Institute for Clinical Research and Health Policy Studies
      • • Division of Nephrology
      • • Department of Medicine
      Boston, MA, United States
    • University of Zurich
      • Klinik für Gastroenterologie und Hepatologie
      Zürich, ZH, Switzerland
  • 2009
    • Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik
      Solbad Hall in Tirol, Tyrol, Austria
    • Columbia University
      • Department of Neurology
      New York City, NY, United States
  • 2007
    • Duke University
      Durham, North Carolina, United States
  • 2005
    • University Hospital Medical Information Network
      Edo, Tōkyō, Japan
  • 2004
    • Brigham and Women's Hospital
      • Department of Medicine
      Boston, MA, United States
    • University of Illinois at Chicago
      • Department of Medical Education (Chicago)
      Chicago, IL, United States
  • 2001
    • New England Baptist Hospital
      Boston, Massachusetts, United States