Timothy J Wilt

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (276)1716.35 Total impact

  • J Dik F Habbema, Timothy J Wilt, Ruth Etzioni
    Annals of internal medicine 04/2015; 162(7):530-531. DOI:10.7326/L15-5075-2 · 16.10 Impact Factor
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    ABSTRACT: Evaluate the effect of outpatient antimicrobial stewardship programs on prescribing, patient, microbial outcomes, and costs. Systematic review Search of MEDLINE (2000 through November 2013), Cochrane Library, and reference lists of relevant studies. We included English language studies with patient populations relevant to the United States (eg, infectious conditions, prescription services) evaluating stewardship programs in outpatient settings and reporting outcomes of interest. Data regarding study characteristics and outcomes were extracted and organized by intervention type. We identified 50 studies eligible for inclusion, with most (29 of 50; 58%) reporting on respiratory tract infections, followed by multiple/unspecified infections (17 of 50; 34%). We found medium-strength evidence that stewardship programs incorporating communication skills training and laboratory testing are associated with reductions in antimicrobial use, and low-strength evidence that other stewardship interventions are associated with improved prescribing. Patient-centered outcomes, which were infrequently reported, were not adversely affected. Medication costs were generally lower with stewardship interventions, but overall program costs were rarely reported. No studies reported microbial outcomes, and data regarding outpatient settings other than primary care clinics are limited. Low- to moderate-strength evidence suggests that antimicrobial stewardship programs in outpatient settings improve antimicrobial prescribing without adversely effecting patient outcomes. Effectiveness depends on program type. Most studies were not designed to measure patient or resistance outcomes. Data regarding sustainability and scalability of interventions are limited. Infect Control Hosp Epidemiol 2014;00(0):1-11.
    Infection Control and Hospital Epidemiology 02/2015; 36(2):142-52. DOI:10.1017/ice.2014.41 · 3.94 Impact Factor
  • Hanna E Bloomfield, Andrew Olson, Timothy J Wilt
    Annals of internal medicine 12/2014; 161(12):924-5. DOI:10.7326/L14-5034-2 · 16.10 Impact Factor
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    ABSTRACT: Clinical practice guidelines should be based on the best scientific evidence derived from systematic reviews of primary research. However, these studies often do not provide evidence needed by guideline development groups to evaluate the tradeoffs between benefits and harms. In this article, the authors identify 4 areas where models can bridge the gaps between published evidence and the information needed for guideline development applying new or updated information on disease risk, diagnostic test properties, and treatment efficacy; exploring a more complete array of alternative intervention strategies; assessing benefits and harms over a lifetime horizon; and projecting outcomes for the conditions for which the guideline is intended. The use of modeling as an approach to bridge these gaps (provided that the models are high-quality and adequately validated) is considered. Colorectal and breast cancer screening are used as examples to show the utility of models for these purposes. The authors propose that a modeling study is most useful when strong primary evidence is available to inform the model but critical gaps remain between the evidence and the questions that the guideline group must address. In these cases, model results have a place alongside the findings of systematic reviews to inform health care practice and policy.
    Annals of internal medicine 12/2014; 161(11):812-8. DOI:10.7326/M14-0845 · 16.10 Impact Factor
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    ABSTRACT: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the comparative effectiveness and safety of preventive dietary and pharmacologic management of recurrent nephrolithiasis in adults.
    Annals of internal medicine 11/2014; 161(9):659-67. DOI:10.7326/M13-2908 · 16.10 Impact Factor
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    ABSTRACT: Purpose: To inform the VA Office of Health Promotion and Disease Prevention we conducted a systematic review to examine the effects of cancer screening shared decision making (SDM) interventions. Method: We searched MEDLINE, CINAHL, PsycINFO, and relevant journals from 1995 through 2013 for randomized controlled trials (RCTs) of cancer screening SDM interventions in adults in clinical settings. We extracted key study population and intervention characteristics and the effect of SDM on three outcomes of interest. Outcomes of interest drawn from the Ottawa Decision Support Framework included: (1) Decision Quality (informed, values-based, patient involvement), (2) Decision Action (screening preference/intention, screening behavior), and (3) Decision Impact (decisional conflict, health services use, decision satisfaction). Result: We identified twenty-two eligible RCTs evaluating SDM interventions for: breast (k=2), colorectal (k=3), and prostate (k=17) cancer screening. More than half of all SDM interventions included a values clarification exercise (k=15), but few used a theoretical framework (k=7). SDM intervention effects on outcomes varied. For Decision Quality, knowledge was assessed in the majority of studies (n=19), and in all cases SDM increased knowledge. Studies measured values and patient involvement less often (k=5 and k=11, respectively) and found no consistent effect. Eleven studies assessed Decision Action with no consistent SDM effect of SDM. Screening intention was evaluated for breast (k=2) and prostate cancer (k=9). Three studies assessed screening preference, all colorectal cancer. Screening behavior was assessed in 16 studies, ranging from 2 weeks to 1 year. SDM enhanced Decision Impact as measured by a consistent decrease in decisional conflict (k=12). However, SDM had no consistent effect on health services use (k=6) or decision satisfaction (k=2), though outcomes were infrequently reported. Conclusion: SDM interventions for cancer screening consistently increase patient knowledge and often decrease decisional conflict. However, there have been varying intervention effects on Decision Action or Decision Impact. Research is needed to guide future SDM intervention development to enhance the effect on decision action and impact.
    The 36th Annual Meeting of the Society for Medical Decision Making; 10/2014
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    ABSTRACT: Prostate cancer is a common malignancy in men and the worldwide burden of this disease is rising. Lifestyle modifications such as smoking cessation, exercise, and weight control offer opportunities to reduce the risk of developing prostate cancer. Early detection of prostate cancer by prostate-specific antigen (PSA) screening is controversial, but changes in the PSA threshold, frequency of screening, and the use of other biomarkers have the potential to minimise the overdiagnosis associated with PSA screening. Several new biomarkers for individuals with raised PSA concentrations or those diagnosed with prostate cancer are likely to identify individuals who can be spared aggressive treatment. Several pharmacological agents such as 5α-reductase inhibitors and aspirin could prevent development of prostate cancer. In this Review, we discuss the present evidence and research questions regarding prevention, early detection of prostate cancer, and management of men either at high risk of prostate cancer or diagnosed with low-grade prostate cancer.
    The Lancet Oncology 10/2014; 15(11):e484-e492. DOI:10.1016/S1470-2045(14)70211-6 · 24.73 Impact Factor
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    ABSTRACT: Objective. Evaluate the evidence for effects of inpatient antimicrobial stewardship programs (ASPs) on patient, prescribing, and microbial outcomes. Design. Systematic review. Methods. Search of MEDLINE (2000 through November 2013), Cochrane Library, and reference lists of relevant studies. We included English language studies with patient populations relevant to the United States (ie, infectious conditions and prescriptions required for antimicrobials) that evaluated ASP interventions and reported outcomes of interest. Study characteristics and outcomes data were extracted and reviewed by investigators and trained research personnel. Results. Few intervention types (eg, audit and feedback, guideline implementation, and decision support) substantially impacted patient outcomes, including mortality, length of stay, readmission, or incidence of Clostridium difficile infection. However, most interventions were not powered adequately to demonstrate impacts on patient outcomes. Most interventions were associated with improved prescribing patterns as measured by decreased antimicrobial use or increased appropriate use. Where reported, ASPs were generally associated with improvements in microbial outcomes, including institutional resistance patterns or resistance in the study population. Few data were provided on harms, sustainability, or key intervention components. Studies were typically of short duration, low in methodological quality, and varied in study design, populations enrolled, hospital setting, ASP intent, intervention composition and implementation, comparison group, and outcomes assessed. Conclusions. Numerous studies suggest that ASPs can improve prescribing and microbial outcomes. Strength of evidence was low, and most studies were not designed adequately to detect improvements in mortality or other patient outcomes, but obvious adverse effects on patient outcomes were not reported.
    Infection Control and Hospital Epidemiology 10/2014; 35(10):1209-1228. DOI:10.1086/678057 · 3.94 Impact Factor
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    ABSTRACT: The American College of Physicians recently published a guideline on screening for CKD that recommends against screening for CKD in asymptomatic adults without risk factors. The generally accepted criteria for population-based screening for disease state that screening should improve important clinical outcomes while limiting harms for those individuals screened. However, CKD screening does not meet these criteria. There is currently no evidence evaluating or demonstrating benefits for providing early treatment for patients identified via screening who do not have risk factors. On the other hand, harms are associated with the screening and include false-positive results, unnecessary testing and treatment, and disease labeling.
    Clinical Journal of the American Society of Nephrology 09/2014; 9(11). DOI:10.2215/CJN.02940314 · 5.25 Impact Factor
  • John M Hollingsworth, Timothy J Wilt
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    ABSTRACT: Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (TURP) was the mainstay of treatment. However, several efficacious drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α adrenoceptor antagonists can significantly ameliorate lower urinary tract symptoms. Moreover, 5α reductase inhibitors, alone or combined with an α adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of urinary retention and the need for surgical intervention. Newer medical regimens including the use of antimuscarinic agents or phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of TURP. A variety of laser procedures have also been introduced, whose improved hemostatic properties abrogate many of the complications associated with traditional surgery.
    BMJ Clinical Research 08/2014; 349:g4474. DOI:10.1136/bmj.g4474 · 14.09 Impact Factor
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    ABSTRACT: The Agency for Healthcare Research and Quality (AHRQ) has funded systematic reviews of comparative effectiveness research in 17 areas over the last 10 years as part of a federal mandate. These reviews provide a reliable and unbiased source of comprehensive information about the effectiveness and risks of treatment alternatives for patients and clinicians. This article describes comparative effectiveness research, provides an overview of how physicians can use it in clinical practice, and references important contributions made by the Minnesota Evidence-based Practice Center.
    Minnesota medicine 08/2014; 97(8):49-51.
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    ABSTRACT: Background: Pelvic examination is often included in well-woman visits even when cervical cancer screening is not required. Purpose: To evaluate the diagnostic accuracy, benefits, and harms of pelvic examination in asymptomatic, nonpregnant, average-risk adult women. Cervical cancer screening was not included. Data Sources: MEDLINE and Cochrane databases through January 2014 and reference lists from identified studies. Study Selection: 52 English-language studies, 32 of which included primary data. Data Extraction: Data were extracted on study and sample characteristics, interventions, and outcomes. Quality of the diagnostic accuracy studies was evaluated using a published instrument, and quality of the survey studies was evaluated with metrics assessing population representativeness, instrument development, and response rates. Data Synthesis: The positive predictive value of pelvic examination for detecting ovarian cancer was less than 4% in the 2 studies that reported this metric. No studies that investigated the morbidity or mortality benefits of screening pelvic examination for any condition were identified. The percentage of women reporting pelvic examination-related pain or discomfort ranged from 11% to 60% (median, 35%; 8 studies [n = 4576]). Corresponding figures for fear, embarrassment, or anxiety ranged from 10% to 80% (median, 34%; 7 studies [n = 10 702]). Limitation: Only English-language publications were included; the evidence on diagnostic accuracy, morbidity, and mortality was scant; and the studies reporting harms were generally low quality. Conclusion: No data supporting the use of pelvic examination in asymptomatic, average-risk women were found. Low-quality data suggest that pelvic examinations may cause pain, discomfort, fear, anxiety, or embarrassment in about 30% of women.
    Annals of internal medicine 07/2014; 161(1):46-53. DOI:10.7326/M13-2881 · 16.10 Impact Factor
  • Amir Qaseem, Timothy Wilt, Thomas D Denberg
    Annals of internal medicine 07/2014; 161(1):83-84. DOI:10.7326/L14-5013-5 · 16.10 Impact Factor
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    ABSTRACT: Behavioral change is critical for improving health outcomes in patients with chronic obstructive pulmonary disease. An educational approach alone is insufficient; changes in behavior, especially the acquisition of self-care skills, are also required. There is mounting evidence that embedding collaborative self-management (CSM) within existing health care systems provides an effective model to meet these needs. CSM should be integrated with pulmonary rehabilitation programs, one of the main goals of which is to induce long-term changes in behavior. More research is needed to evaluate the effectiveness of assimilating CSM into primary care, patient-centered medical homes, and palliative care teams.
    Clinics in Chest Medicine 06/2014; 35(2):337-351. DOI:10.1016/j.ccm.2014.02.004 · 2.17 Impact Factor
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    ABSTRACT: Family and caregiver interventions typically aim to develop family members' coping and caregiving skills and to reduce caregiver burden. We conducted a systematic review of published randomized controlled trials (RCTs) evaluating whether family-involved interventions improve patient outcomes among adults with cancer. RCTs enrolling patients with cancer were identified by searching MEDLINE, PsycInfo and other sources through December 2012. Studies were limited to subjects over 18 years of age, published in English language, and conducted in the United States. Patient outcomes included global quality of life; physical, general psychological and social functioning; depression/anxiety; symptom control and management; health care utilization; and relationship adjustment. We identified 27 unique trials, of which 18 compared a family intervention to usual care or wait list (i.e., usual care with promise of intervention at completion of study period) and 13 compared one family intervention to another individual or family intervention (active control). Compared to usual care, overall strength of evidence for family interventions was low. The available data indicated that overall, family-involved interventions did not consistently improve outcomes of interest. Similarly, with low or insufficient evidence, family-involved interventions were not superior to active controls at improving cancer patient outcomes. Overall, there was low or insufficient evidence that family and caregiver interventions were superior to usual or active care. Variability in study populations and interventions made pooling of data problematic and generalizing findings from any single study difficult. Most of the included trials were of poor or fair quality.
    Journal of General Internal Medicine 05/2014; 29(9). DOI:10.1007/s11606-014-2873-2 · 3.42 Impact Factor
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    ABSTRACT: Tissue-preserving focal therapies, such as brachytherapy, cryotherapy, high-intensity focused ultrasound and photodynamic therapy, aim to target individual cancer lesions rather than the whole prostate. These treatments have emerged as potential interventions for localized prostate cancer to reduce treatment-related adverse-effects associated with whole-gland treatments, such as radical prostatectomy and radiotherapy. In this article, the Prostate Cancer RCT Consensus Group propose that a novel cohort-embedded randomized controlled trial (RCT) would provide a means to study men with clinically significant localized disease, which we defined on the basis of PSA level (≤15 ng/ml or ≤20 ng/ml), Gleason grade (Gleason pattern ≤4 + 4 or ≤4 + 3) and stage (≤cT2cN0M0). This RCT should recruit men who stand to benefit from treatment, with the control arm being whole-gland surgery or radiotherapy. Composite outcomes measuring rates of local and systemic salvage therapies at 3-5 years might best constitute the basis of the primary outcome on which to change practice.
    Nature Reviews Clinical Oncology 04/2014; 11(8). DOI:10.1038/nrclinonc.2014.44 · 15.70 Impact Factor
  • Timothy J Wilt, Philipp Dahm
    BMJ (online) 04/2014; 348:g2559. DOI:10.1136/bmj.g2559 · 16.38 Impact Factor
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    ABSTRACT: Die „prostatotropen Phytotherapeutika“ werden heiß diskutiert, seit der Arbeitskreis benigne Prostatahyperplasie die diesbezüglichen Leitlinien auf dem Deutschen Urologenkongreß 1998 vorstellte. Vor diesem Hintergrund erscheint die strukturierte Übersicht, die am 11.11.98 in JAMA publiziert wurde, bedeutsam. Es handelt sich um die bis dato umfangreichste Literaturrecherche aller wissenschaftlichen Studien, die sich mit der Wirkung von Extrakten der Früchte von Serenoa repens (botanisch Sabal serrulata) befassen. Insgesamt wurden 11 Sabal serrulata-Mono- und —Kombinationspräparate metaanalysiert. Die Extraktionsverfahren und die Liste der 11 zugelassenen Sabal serrulata-Monopräparate wurden kürzlich besprochen und darauf hingewiesen, daß der mit hyperkritischem Kohlendioxid gewonnene Extrakt (in Talso) einen hohen Phytosterolgehalt aufweist (Bracher: Urologe A 36:10, 1997). Die Wirkmechanismen solcher Extrakte schließen antiöstrogene, antiandrogene und antiphlogistische Effekte ein.
    Der Urologe B 04/2014; 39(2):131-132. DOI:10.1007/s001310050285
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    CancerSpectrum Knowledge Environment 03/2014; 106(3). DOI:10.1093/jnci/dju010 · 15.16 Impact Factor
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    ABSTRACT: Nonhealing ulcers affect patient quality of life and impose a substantial financial burden on the health care system. To systematically evaluate benefits and harms of advanced wound care therapies for nonhealing diabetic, venous, and arterial ulcers. MEDLINE (1995 to June 2013), the Cochrane Library, and reference lists. English-language randomized trials reporting ulcer healing or time to complete healing in adults with nonhealing ulcers treated with advanced therapies. Study characteristics, outcomes, adverse events, study quality, and strength of evidence were extracted by trained researchers and confirmed by the principal investigator. For diabetic ulcers, 35 trials (9 therapies) met eligibility criteria. There was moderate-strength evidence for improved healing with a biological skin equivalent (relative risk [RR], 1.58 [95% CI, 1.20 to 2.08]) and negative pressure wound therapy (RR, 1.49 [CI, 1.11 to 2.01]) compared with standard care and low-strength evidence for platelet-derived growth factors and silver cream compared with standard care. For venous ulcers, 20 trials (9 therapies) met eligibility criteria. There was moderate-strength evidence for improved healing with keratinocyte therapy (RR, 1.57 [CI, 1.16 to 2.11]) compared with standard care and low-strength evidence for biological dressing and a biological skin equivalent compared with standard care. One small trial of arterial ulcers reported improved healing with a biological skin equivalent compared with standard care. Overall, strength of evidence was low for ulcer healing and low or insufficient for time to complete healing. Only studies of products approved by the U.S. Food and Drug Administration were reviewed. Studies were predominantly of fair or poor quality. Few trials compared 2 advanced therapies. Compared with standard care, some advanced wound care therapies may improve the proportion of ulcers healed and reduce time to healing, although evidence is limited. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative.
    Annals of internal medicine 10/2013; 159(8):532-542. DOI:10.7326/0003-4819-159-8-201310150-00006 · 16.10 Impact Factor

Publication Stats

10k Citations
1,716.35 Total Impact Points

Institutions

  • 2007–2014
    • University of Minnesota Duluth
      • Medical School
      Duluth, Minnesota, United States
    • Universidade Federal de São Paulo
      • School of Medicine
      San Paulo, São Paulo, Brazil
  • 1990–2012
    • Minneapolis Veterans Affairs Hospital
      • Department of Veterans Affairs
      Minneapolis, Minnesota, United States
  • 2011
    • University of Aberdeen
      • Academic Urology Unit
      Aberdeen, SCT, United Kingdom
  • 2008–2011
    • University of Minnesota Twin Cities
      • • School of Public Health
      • • Division of Health Policy and Management
      Minneapolis, Minnesota, United States
    • Terumo BCT
      Denver, Colorado, United States
  • 2006–2011
    • Monash University (Australia)
      • School of Public Health and Preventive Medicine
      Melbourne, Victoria, Australia
    • San Francisco VA Medical Center
      San Francisco, California, United States
    • University of Virginia
      Charlottesville, Virginia, United States
    • The University of Hong Kong
      Hong Kong, Hong Kong
  • 2009
    • University of Ottawa
      • Department of Pediatrics
      Ottawa, Ontario, Canada
  • 2002–2009
    • Spokane VA Medical Center
      Spokane, Washington, United States
  • 2006–2007
    • University of Washington Seattle
      Seattle, Washington, United States
  • 2000–2007
    • Velindre NHS Trust
      Cardiff, Wales, United Kingdom
    • Blue Cross and Blue Shield Association, Technology Evaluation Center (TEC)
      Chicago, Illinois, United States
  • 2005
    • Sichuan University
      • Department of Urology
      Hua-yang, Sichuan, China
    • Hennepin County Medical Center
      Minneapolis, Minnesota, United States
  • 2000–2005
    • BC Cancer Agency
      Vancouver, British Columbia, Canada
  • 2000–2001
    • Massachusetts General Hospital
      • Hospital Medicine Unit
      Boston, MA, United States
  • 1996
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1995
    • University of Wisconsin, Madison
      • Department of Surgery
      Madison, MS, United States