MBA

Are you MBA?

Claim your profile

Publications (30)57.02 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Previous surveys of men who have sex with men (MSM) in Africa have not adequately profiled HIV status and risk factors by sex work status. MSM in Nairobi, Kenya, were recruited using respondent-driven sampling (RDS), completed a behavioral interview, and were tested for HIV and STIs. Overlapping recruitment among 273 male sex workers and 290 other MSM was common. Sex workers were more likely to report receptive anal sex with multiple partners (65.7% versus 18.0%, P<0.001) and unprotected receptive anal intercourse (40.0% versus 22.8%, P=0.005). Male sex workers were also more likely to be HIV infected (26.3% versus 12.2%, P=0.007).
    JAIDS Journal of Acquired Immune Deficiency Syndromes 09/2014; · 4.65 Impact Factor
  • Western Association of Gynecologic Oncology (WAGO) Meeting, Truckee, CA.; 06/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: • Memory preservation with conformal avoidance of the hippocampus during whole-brain radiotherapy for patients with brain metastases: Preliminary results of RTOG 0933. Presented in plenary session of SNO 2013.
    4th Quadrennial Meeting of the World Federation of Neuro-Oncology & the 18th Annual Scientific Meeting of Society of NeuroOncology, San Francisco, CA; 11/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: • Memory preservation with conformal avoidance of the hippocampus during whole-brain radiotherapy for patients with brain metastases: Preliminary results of RTOG 0933
    15th world Conference on Lung Cancer, Sydney,Australia; 10/2013
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: Importance Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. Objectives To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. Design We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. Results US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. Conclusions and Relevance From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. The United States spends the most per capita on health care across all countries,1- 2 lacks universal health coverage, and lags behind other high-income countries for life expectancy3 and many other health outcome measures.4 High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups.5- 6 Although overall life expectancy has slowly risen, the increase has been slower than for many other high-income countries.3 In addition, in some US counties, life expectancy has decreased in the past 2 decades, particularly for women.7- 8 Decades of health policy and legislative initiatives have been directed at these challenges; a recent example is the Patient Protection and Affordable Care Act, which is intended to address issues of access, efficiency, and quality of care and to bring greater emphasis to population health outcomes.9 There have also been calls for initiatives to address determinants of poor health outside the health sector including enhanced tobacco control initiatives,10- 12 the food supply,13- 15 physical environment,16- 17 and socioeconomic inequalities.18 With increasing focus on population health outcomes that can be achieved through better public health, multisectoral action, and medical care, it is critical to determine which diseases, injuries, and risk factors are related to the greatest losses of health and how these risk factors and health outcomes are changing over time. The Global Burden of Disease (GBD) framework19 provides a coherent set of concepts, definitions, and methods to do this. The GBD uses multiple metrics to quantify the relationship of diseases, injuries, and risk factors with health outcomes, each providing different perspectives. Burden of disease studies using earlier variants of this approach have been published for the United States for 199620- 22 and for Los Angeles County, California.23 In addition, 12 major risk factors have also been compared for 2005.24 In this report, we use the GBD Study 2010 to identify the leading diseases, injuries, and risk factors associated with the burden of disease in the United States, to determine how these health burdens have changed over the last 2 decades, and to compare the United States with other Organisation for Economic Co-operation and Development (OECD) countries.
    JAMA The Journal of the American Medical Association 07/2013; · 29.98 Impact Factor
  • Source
    Neurology 05/2013; · 8.30 Impact Factor
  • Journal of the American College of Cardiology 01/2013; 61. · 14.09 Impact Factor
  • Revista Neurociências 12/2012; 13(4).
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Wide-spread adoption of electronic medical records (EMRs) containing rich amounts of longitudinal clinical data and the formation of EMR-linked biobanks represent an opportunity to rapidly expand sample sizes and efficiently phenotype subjects for genomic studies. The Electronic Medical Records & Genomics (eMERGE) Network consists of five leading institutions involved in EMR phenotyping with linked DNA biobanks. The goal of eMERGE is to conduct genome-wide association studies (GWAS) in approximately 19,000 individuals using EMR-derived phenotypes and biorepository-derived genome-wide genotypes. These institutions include Group Health Research Institute, Marshfield Clinic, Mayo Clinic, Northwestern University and Vanderbilt University. Each site has used electronic algorithms to identify both site-specific phenotypes and network-wide phenotypes (applied at all five sites) for genomic analysis. The panel will present data from site-specific and network-wide studies illustrating the strengths and limitations of EMRs for genomic studies. Panelists will discuss and compare approaches to developing phenotypic electronic algorithms, challenges in implementing algorithms at each site, and approaches to validation of the algorithms and genomic results. Panelists will also present results from initial studies into performing phenome-wide analyses for genetic associations. Finally, the panel will present lessons learned from these efforts.
    04/2010;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The association of Helicobacter Pylori with gastritis, peptic ulcer diseases and gastric cancer is established now days. Frequency of these diseases is very high in developing countries including Pakistan. PATIENTS AND METHODS: This was a descriptive study expanded over twelve months during which frequency of H. Pylori was noted in 50 patients suffering from dyspepsia manifestation suspecting case of acid peptic disease. The patients were collected from surgical and medical in/out patients department of civil hospital Karachi. RESULTS: Out of 50 (n=50) patients, 30 (60 %) were male and 20 (40 %) were female with a male: female ratio of 3:2. Age range was 20-50 years with a mean of + / -SD of 37.74 ± 7.31. All patients were of low and middle socio-economic class living in congested overcrowded areas. All patients reported with epigastric pain while 43 (86%) patients were having heartburn. Upper gastrointestinal endoscopy revealed 16 % gastric ulcer, 25 % duodenal ulcer, 40 % gastritis, 6 % Oesophagitis and 12 % normal results. Frequency of H. Pylori as per upper gastrointestinal endoscopy and ELISA Test result was 78 % . CONCLUSION: H. Pylori plays a definite role in causing acid peptic disease. The patient presented with symptoms of peptic ulcer and therefore majority showed positive, endoscopy and ELISA test result. Various epidemiological factors like gender variations, increasing age and lower socioeconomic status were also positively associated.
    MEDICAL CHANNEL PAKISTAN. 04/2010; 16(( 2 )):237 - 239.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Nonadherence to asthma medications is associated with increased emergency department visits and hospitalizations. If adherence is to be improved, first-fill adherence is the first goal to meet after the physician and patient have decided to begin treatment. Little is known about first-fill adherence with asthma medications and the factors for no-fill. Objective: The goal of the study was to examine the proportion of patients who fill a new prescription for an asthma medication and analyze characteristics associated with this first-fill. Methods: This retrospective cohort study linked electronic health records with pharmacy claims. The cohort was comprised of 2023 patients aged 18 years or older who sought care from the Geisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed an asthma medication for the first time between 2002 and 2006. The primary outcome of interest was first-time prescription filled by the patient within 30 days of the prescription order date. Covariates examined included factors related to the patient (ie, age, sex, and ethnicity), comorbidities and utilization (ie, Charlson comorbidity index, number of office visits, number of additional medications), asthma treatment (ie, delivery route, pharmacologic class), and pharmacy copay amount. A logistic-regression model was used to determine covariates associated with first-fill. Results: The overall first-fill rate for new asthma medications was 78%. First-fill rate was lower for patients with a copay above the mean of $12 (odds ratio = 0.76; 95% confidence interval, 0.58-0.99) and higher for patients prescribed oral plus inhaled medications (versus inhaled only, odds ratio = 3.91; 95% confidence interval, 2.15-7.11). Conclusions: Several factors associated with failing to fill an initial prescription for asthma can be addressed through simple interventions: screening for difficulties a patient may have in filling prescriptions, avoiding nonformulary medications, and recognizing the barrier that high copays present. In addition, for employers and policymakers, decreasing copay may improve adherence and, therefore, asthma control. [AHDB. 2009;2(4):174-180.
    American Health and Drug Benefits. 01/2009; 2:174-180.
  • Nash, MD, MBA, David
    [Show abstract] [Hide abstract]
    ABSTRACT: The first 2 issues of Prescriptions for Excellence in Health Care addressed quality improvement in general terms ("Doing Things Right and Doing the Right Things - Quality and Safety in Health Care," Fall 2007) and from the hospital's perspective ("Hospitals Take Ownership for Quality Improvement and Patient Safety," Winter 2007). In this issue, we feature innovative strategies for improving quality of care in 4 different clinical settings.
    Prescriptions for Excellence in Health Care Newsletter Supplement. 01/2008;
  • Casey, MD, MPH, MBA, FACP, Donald E
    [Show abstract] [Hide abstract]
    ABSTRACT: Randomized clinical trials and observational studies have demonstrated the positive effects of multidisciplinary teams on heart failure (HF) readmissions. Many believe that such teams require the presence of an advanced practice nurse specializing in HF. Catholic Healthcare Partners (CHP) demonstrated that the deployment of Heart Failure Advocates (HFA), non-advanced practice nurses specially trained to promote guideline-based care, can result in significant reductions in both HF hospitalizations and associated costs.
    Prescriptions for Excellence in Health Care Newsletter Supplement. 01/2008;
  • Nash, MD, MBA, David B
    [Show abstract] [Hide abstract]
    ABSTRACT: Welcome to the premiere issue of Prescriptions for Excellence in Health Care, a series of supplements to our Health Policy Newsletter devoted to the quality improvement agenda. Change - in regulations, technology, and quality measurement, to name a few - is accelerating exponentially. Amid this constant change, it is challenging for health care professionals to remain current on the programs and initiatives being implemented. To help address this issue, the Department of Health Policy has partnered with Eli Lilly and Company to provide you with essential information from the quality improvement and patient safety arenas.
    Prescriptions for Excellence in Health Care Newsletter Supplement. 01/2007;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Pediatric cardiac surgery (PCS) is an ideal model to study the coordinated efforts of team members in a complex organizational structure. We explored the impact of human factors on intraoperative events and outcomes in Pediatric Cardiac Surgery. �Methods: Prospective observations of PCS procedures were conducted by two researchers from the patient pick-up for surgery to the patient hand-off in the intensive care unit. Complexity scores were calculated using the AristotleR scoring system and outcomes were coded as: 1) uncomplicated hospital stay, 2) mild morbidity, 3) major morbidity, 4) death. Process of care was divided into seven epochs: 1) pre-op/transport to OR, 2) pre-surgery/anesthesia induction, 3) surgery/pre-bypass, 4) surgery/bypass/repair, 5) surgery/post-bypass, 6) transport to ICU, 7) handoff. Events were extracted and coded into compensated or uncompensated major and minor events. Based on NIH definitions, adverse events were defined as unintended incidents in care that may result in adverse outcomes or may require additional care efforts to prevent adverse outcome. Depending on the outcome, they were described as compensated (no adverse outcome) or uncompensated. Linear regression and analysis of variance (AOV) were used to analyze relationships between epochs, complexity, number of events and outcome. Variables such as age, weight, decompensation, pre-op intubation, complexity, surgery duration, pre-surgery/anesthesia induction duration, number of minor events/case, and cardiopulmonary bypass were tested in a forward stepwise logistic regression as predictors of cases with 1 or more major events.��Results: In the 13-month study period, 102 (29%) of 345 cases were observed. The study group median age was 119 days (range 1-5758), and the median complexity was 12.1 (range 5-24.5). The overall study mortality was 4.8% (N=4), with no intraoperative mortality. An average of 1.2 (range 0-6) major events occurred per case. The most common type of major event was cardiovascular (N=15, 16%), while most events occurred during the surgery/post-bypass epoch (N=41, 45%). Cognitive compensation was the most common defense mechanism (N=38, 41%) for major events. An average of 15.3 minor events (range 2-35) occurred per case. The most common type of minor event was communication and coordination failure (N=315, 26%). Minor events occurred most frequently during the surgery/bypass epoch (N=385, 31%). Surgery duration (mean=201 min; SD=91 min) correlated with case complexity. AOV showed significantly higher case complexity, longer surgery duration and higher number of major events/case with death outcomes compared to other outcome groups (p<0.01). Using a logistic regression model we found that complexity OR=1.29 (1.05-1.57, p=0.0131) and surgery duration OR=1.01 (1.00-1.02, p=0.0475) were both significant predictors of major events. ��Conclusions: We demonstrated that the number of major events that occur during PCS increases with case complexity and impacts outcome. Cognitive and system compensation, rather than primary prevention, were the prevalent team practices. Team training and systems management should be improved. In addition, greater emphasis should be placed on preventive measures.
    American Heart Association Annual meeting; 12/2006
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Given the dramatic increase in type 2 diabetes in the United States, the development of effective strategies to prevent and control this potentially devastating illness is more important than ever. In the Southwest, diabetes is a far too common and rapidly growing problem among Mexican Americans living near the U.S.-Mexico border. A project designed to address this problem enabled faculty from the University of Arizona to work with community health centers to evaluate and improve diabetes care in border communities. Context This project was a component of the Border Health Strategic Initiative (Border Health ¡SI!) and Racial and Ethnic Approaches to Community Health 2010 (REACH 2010), both funded by the Centers for Disease Control and Prevention. University of Arizona faculty worked in partnership with five community health centers funded by the Health Resources and Services Administration. The goal of the faculty was to assist the community health centers with 1) development of measures of diabetes care based on national clinical practice guidelines, 2) identification of gaps in care based on those measures, and 3) implementation of strategies for closing those gaps. Methods All five centers prioritized their top four or five indicators of diabetes care (e.g., annual dilated eye examination). Different community health centers selected different indicators. Baseline medical record audits were performed using the chosen indicators. Individual results were shared confidentially with providers; overall center results were shared and discussed with providers and staff. Consequences Each clinic chose its own strategies for closing gaps in care. At one-year follow-up, there was evidence of improvement for the majority of indicators in all community health centers. However, some gaps remained. Of the three community health centers having a second-year evaluation, two maintained or increased the improvements made, but one lost ground. Interpretation Our experience with these five border clinics was that translating guidelines into practice is easier said than done. Factors that favored success included an onsite champion, staff buy-in, a willingness to see systems change, and the availability of additional resources, particularly for chart reviews.
    Preventing Chronic Disease. 01/2005;
  • Nash, MD, MBA, David B
    [Show abstract] [Hide abstract]
    ABSTRACT: David B. Nash is the Founding Dean of the Jefferson School of Population Health on the campus of Thomas Jefferson University in Philadelphia, PA. Dr. Nash is also the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy, an endowed professorship that is one of a handful of such chairs in the nation. His new appointment as the Founding Dean culminates a nearly twenty-year tenure at Jefferson.Dr. Nash, a board certified Internist, founded the original Office of Health Policy in 1990. Thirteen years later, the Office evolved into one of the first Departments of Health Policy in an American medical college. In 2008, the Board of Thomas Jefferson University approved the creation of the new Jefferson School of Population Health. The new school represents the first time a health-sciences university has placed four Masters Programs under one roof, namely a Masters in Public Health, Health Policy, Healthcare Quality and Safety and Chronic Care Management. The goal of this innovative school is to produce a new type of healthcare leader for the future. Dr. Nash is internationally recognized for his work in outcomes management, medical staff development and quality-of-care improvement; his publications have appeared in more than 100 articles in major journals. He has edited seventeen books, including A Systems Approach to Disease Management, Connecting with the New Healthcare Consumer, The Quality Solution, Practicing Medicine in the 21st Century and, most recently, Governance for Health Care Providers: The Call to Leadership.In 1995, he was awarded the Latiolais Prize by the Academy of Managed Care Pharmacy for his leadership in disease management and pharmacoeconomics. He also received the Philadelphia Business Journal Healthcare Heroes Award in October 1997 and was named an honorary distinguished fellow of the American College of Physician Executives in 1998. Finally, in 2006, he received the Elliot Stone Award for leadership in public accountability for health data from NAHDO.Repeatedly named by Modern Healthcare to the top 100 most powerful persons in healthcare, his national activities include membership on the Board of Directors of the DMAA: The Care Continuum Alliance, Chair of a National Quality Forum Technical Advisory Panel and membership in the American College of Surgeons Health Policy Institute - three key national groups focusing on quality measurement and improvement. He continues as one of the principal faculty members for quality of care issues of the American College of Physician Executives in Tampa, FL and is the developer of the ACPE Capstone Course on Quality. He serves on the Board of the West Virginia Medical Institute (WVMI), the Medicare QIO for Pennsylvania. He recently ended his tenure as a member of the Board of Trustees of Catholic Healthcare Partners in Cincinnati, Ohio – one of the nation’s largest integrated delivery systems – and he chairs the Board Committee on Quality and Safety. Most recently, he was appointed to the Board of Main Line Health, a four hospital system in suburban Philadelphia, PA. Finally, he chairs the Highmark Blue Cross Board Quality Committee in Pittsburgh, PA.Dr. Nash is a consultant to organizations in both the public and private sectors, including the Technical Advisory Group of the Pennsylvania Health Care Cost Containment Council (a group he has chaired for the last decade) and numerous corporations within the pharmaceutical industry. He is on the board of directors and advisory board of multiple healthcare companies. From 1984 to 1989, he was Deputy Editor, Annals of Internal Medicine, at the American College of Physicians. Currently, he is Editor-in-Chief of four major national journals including P&T, Population Health Management, Biotechnology Healthcare and the American Journal of Medical Quality. Through his writings, public appearances and his online presence (Nash on Health Policy blog), his message reaches more than 100,000 persons every month.Dr. Nash received his BA in economics (Phi Beta Kappa) from Vassar College, Poughkeepsie, NY; his MD from the University of Rochester School of Medicine and Dentistry; and his MBA in Health Administration (with honors) from the Wharton School at the University of Pennsylvania. While at Penn, he was a Robert Wood Johnson Foundation Clinical Scholar and Medical Director of a nine physician faculty group practice in general internal medicine.
    Policy Forum-Regulation of Follow-on Biologics: Ensuring Quality and Patient Safety (National Press Club, Holeman Lounge, 529 14th Street, NW. Washington, DC).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nationwide, the American Recovery and Reinvestment Act of 2009 includes over $32 billion for health care. This panel will discuss the impact of stimulus funding at the national level on health information technology, comparative effectiveness research, prevention and wellness, and health workforce programs.
    The Future of Health Care in PA; Developing Leaders in Health Care Quality and Safety.
  • Source
    Health Policy Newsletter.