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Zeliadt, Steven B.

Works: 8 works in 8 publications in 1 language and 14 library holdings
Genres: Academic theses 
Roles: Thesis advisor, Author
Publication Timeline
Publications about Steven B Zeliadt
Publications by Steven B Zeliadt
Most widely held works by Steven B Zeliadt
Interventions to prevent the acquisition of resistant Gram-negative bacteria in critically ill patients : a systematic review and meta-analysis by Ahmed Zaky( file )
1 edition published in 2012 in English and held by 3 libraries worldwide
Background: The rising incidence of multidrug-resistant Gram negative bacterial infections acquired in intensive care units has prompted a variety of patient-level infection control efforts. However, there is yet no consensus on which measures are effective. Design: Meta-analysis of studies to assess the efficacy of interventions in the prevention of colonization and infection with resistant Gram-negative bacteria in intensive care units. Methods: PubMed, Cochrane, Embase and World of Science databases were searched. Interventional comparative studies were systematically analyzed. Results: Comprehensive review of interventions with measureable outcomes resulted in 6 studies from a total of 631potential studies meeting all inclusion criteria. 5 randomized and 1 observational interventional trial evaluating 6 patient- level interventions were quantitatively analyzed. 2 randomized studies lacked data on infection. Compared to control settings, the use of probiotics and selective digestive decontamination were associated with a significant reduction of colonization with multidrug-resistant Gram negative bacteria (OR 0.39; 95%CI 0.16-0.95 and OR 0.54; 95%CI 0.38-0.77, respectively). No significant reduction in infection was observed by any patient-level intervention (pooled OR 1.24, 95% CI 0.94-1.64). Selective digestive decontamination was significantly associated with a reduction in intensive care unit mortality (OR 0.71; 95%CI 0.53-0.94). Conclusions: Several interventions appear to be promising in reducing colonization but despite lower colonization rates associated with these efforts they did not translate to a reduction in hospital-acquired infections. Colonization may not be the only predecessor of infection in intensive care units. The use of probiotics and selective decontamination of the digestive tract should be studied in large randomized controlled trials
Has there been an increase in the discussion of advantages and disadvantages for PSA screening of prostate cancer from 2000 to 2010? by Crystal Kimmie( file )
1 edition published in 2012 in English and held by 3 libraries worldwide
Purpose: Historically, men have received PSA tests in primary care without comprehensive discussions with their providers about the harms and benefits associated with cancer screening. We explore whether primary care providers have altered their discussion with their patients to discuss PSA screening in more detail following availability of evidence from two large screening trials about the potential harms of screening relative to its small absolute benefit. Methods: Data among men over age 40 from the cancer supplement to the nationally representative National Health Interview Survey was analyzed for 3,596 men in 2000, and 4,702 men in 2010, representing 25.5 million and 43.6 million Americans, respectively. Results: The age-standardized proportion of men reporting their provider engaged them in a discussion of PSA testing declined to 31.0% in 2010 from 38.0% in 2000 (p<0.001). More men reported receiving a PSA test in the past five years than reported having a discussion with their provider in both study periods, with the rate of testing declining to 44.4% in 2010 from 57.7% in 2000 (p<0.001). Testing rates and the frequency of discussions were highest among men over age 80, with 70.2% in 2010 reporting being tested in the past 5 years, and 49.5% indicating their doctor had discussed testing. Men in 2010 reported that 39.5% felt their provider recommended testing, 27.5% felt their providers discussed the advantage of PSA testing, while 14.1% indicated their providers discussed the disadvantages of testing. Conclusion: Despite an increased emphasis to more fully inform men about the harms and benefits of PSA testing, the frequency of these discussions in primary care has declined. When discussions do occur, providers are much more likely to highlight the advantages of testing. PSA testing is declining; however, testing remains highest among older men for whom some guidelines recommend against testing
User-centered design of quality of life reports for clinical prostate cancer care by Jason Patrick Izard( file )
1 edition published in 2013 in English and held by 1 library worldwide
Primary treatment of localized prostate cancer can result in bothersome urinary, sexual, and bowel symptoms. Yet clinical application of health-related quality of life (HRQOL) questionnaires is rare. We employed user-centered design to develop graphical dashboards of prostate cancer patients' questionnaire responses that would facilitate clinical integration of HRQOL measurement. We interviewed 50 prostate cancer patients and 50 providers, assessed literacy with validated instruments (Rapid Estimate of Adult Literacy in Medicine short form, Subjective Numeracy Scale, Graphical Literacy Scale), and presented participants with prototype dashboards that display prostate cancer-specific HRQOL with elements derived from patient focus groups. We assessed dashboard comprehension and preferences in table, bar, line, and pictograph formats with patient scores contextualized with HRQOL scores of similar patients. Health literacy (mean score 6.8/7) and numeracy (mean score 4.5/6) of patient participants was high. Patients favored bar charts (mean rank 1.8, p=0.12 vs line graphs, p<0.01 vs tables and pictographs); providers demonstrated similar preference for table, bar, and line formats (ranked 1st by 30%, 34%, and 34% of providers, respectively). Providers expressed unsolicited concerns over presentation of comparison group scores (n=19, 38%) and impact on clinic efficiency (n=16, 32%). Based on prostate cancer patient and provider preferences, we developed the design concept of a dynamic HRQOL dashboard that permits a base patient-centered report in bar chart format that can be toggled to other formats and include error bars that frame comparison group scores. Inclusion of lower literacy patients may yield different preferences
A study of prostate cancer control strategies in the U.S. by Steven B Zeliadt( Archival Material )
1 edition published in 2004 in English and held by 1 library worldwide
How family history and race influence prostate cancer screening by Benjamin Sener Dunlap( file )
1 edition published in 2015 in English and held by 1 library worldwide
Background: Most major U.S. medical organizations recommend that screening for prostate cancer using the prostate-specific antigen (PSA) test should be based on individual patient preferences. Men with risk factors for prostate cancer diagnosis and mortality may have different preferences for screening than men without any risk factors. Methods: We used nationally-representative survey data from the 2005 and 2010 National Health Interview Survey to assess PSA-screening patterns by age, family history of prostate cancer and race among men in the United States over 40 years old using bivariate and multivariable logistic regression. Results: Men with any family history of prostate cancer were more likely to be screened using the PSA test in the last two years at any age (OR=2.2, 95% CI 1.8-2.6), and men with a father and brother diagnosed were more likely to be screened than men with only a father diagnosed, after adjustment (p=0.019). Younger (40-54 year old) African-American or black men had a higher odds of being screened than White, non-Hispanic men of the same age, after adjustment (OR=1.5, 95% CI=1.2-1.9), but this same adjusted comparison within other age groups indicated no significant difference in screening rates by race (age 55-69 years old: OR=1.0, 95% CI=0.8-1.3; age 70 years or more: OR=-0.9, 95% CI=0.7-1.3). Conclusion: There is considerable heterogeneity in PSA-screening practices. A family history of prostate cancer, and to a limited degree black or African-American race, both contribute to increased odds of undergoing screening. Understanding how to discuss risk factors with men to ensure individual patient preferences are appropriately integrated into screening decisions should be a priority for providers
Predictors of imaging surveillance for surgically treated, early-stage lung cancer by Leah M Backhus( file )
1 edition published in 2014 in English and held by 1 library worldwide
Current guidelines recommend routine imaging surveillance for non-small cell lung cancer (NSCLC) patients following treatment. Little is known about surveillance patterns for surgically resected, early-stage lung cancer patients in the community-at-large. We sought to characterize surveillance patterns in a national cohort. We conducted a retrospective study using Surveillance, Epidemiology, and End-Results (SEER)-Medicare database (1995-2010). Patients with stage I/II NSCLC treated with surgical resection were included. Our primary outcome was receipt of imaging between 4 and 8 months following surgery. Covariates included demographics and comorbidities. Chest radiography (CXR) was the most frequent initial modality (60%) followed by chest computerized tomography (CT) (25%). Positron emission tomography (PET) was least frequent as initial imaging modality (3%). A total of 13% of patients received no imaging within the initial surveillance period. Adherence to National Comprehensive Cancer Network (NCCN) guidelines for imaging by overall prevalence was 47% for receipt of CT, however rates of CT imaging increased over time from 28% to 61% (p<0.01). Reduced rates of CT imaging were associated with stage I disease and surgery as the sole treatment modality. Imaging following definitive surgery for NSCLC predominantly utilizes CXR rather than CT. Most of this imaging is likely for surveillance and in that context, CXR has inferior detection rates for recurrence and detection of new cancers. Adherence to guideline recommended CT surveillance following surgery is poor, but the reason multifactorial. Efforts to improve adherence to imaging surveillance must be coupled with greater evidence demonstrating improved long-term outcomes
Using data from the iSanté national electronic medical record system to strengthen Haiti's HIV antiretroviral therapy program by Nancy H Puttkammer( file )
1 edition published in 2014 in English and held by 1 library worldwide
The scale-up of electronic medical records (EMR) in low resource settings offers opportunities to improve patient care and health outcomes through improved information to guide decision-making at individual patient, facility, and national levels. In this dissertation, we explored use of data relevant for quality improvement in Haiti's national HIV care and treatment program, at each of these three levels of decision-making. Our first analysis was relevant to improved clinical decision making for individual patients. We developed a simple prediction model for risk of therapeutic failure among patients on HIV antiretroviral therapy (ART), using pharmacy-based adherence data and other patient characteristics. This model strongly differentiated patients at high, medium and low risk and could be help providers identify which patients to target with intensive adherence support services. We concluded that targeting patients according to their predicted risk could help providers to reach the greatest number of patients with high need in the context of constrained resources. Our second analysis examined attrition from the ART program in two large departmental hospitals in Haiti and identified patient demographic, clinical, temporal, and health service-related factors associated with ART attrition. This analysis was relevant to improved management of services at the facility level. We found that at 12 months after ART initiation 26.6% of ART patients were no longer retained in care (95% CI: 24.6-28.7%). Location of patient residence in communes distant from the health care facility was strongly associated with attrition, as was briefer duration of enrollment within HIV care and treatment prior to ART initiation, having a non-standard ART regimen, and having no counseling sessions prior to ART initiation. We concluded that quality improvement interventions which address these risk factors merit further testing within the two facilities. Our third analysis examined the performance of 95 facilities using the iSanté EMR system with respect to a series of 14 priority data quality indicators. In this analysis, we examined consistency of performance across the indicators, as well as site and system use characteristics associated with strong vs. weak data quality. This analysis offers insight on where and how efforts to strengthen data quality should focus, and on which system "ingredients" may be necessary to produce strong data quality. Together our analyses demonstrate the value of using data from the iSanté EMR system to identify improvements in individual patient follow-up, organization of services, quality of information, and allocation of system-wide resources. There are tremendous on-going pressures to expand access to HIV care and treatment, to assure quality of services, and to optimize efficiency in Haiti and other low-resource settings. Our analyses of iSantéa EMR data represent three examples of data use which address these pressures. Building upon the momentum of the present analyses by translating the findings into on-ground program improvements, and by exploring other data uses which answer timely health services research questions is of great importance
Differences in the rate of advanced stage breast cancer between regular screeners and non-regular screeners over age 50 in the community by Steven B Zeliadt( Archival Material )
1 edition published in 2000 in English and held by 1 library worldwide
English (8)
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