Comparative effectiveness research includes cohort studies and registries of interventions. When investigators design such studies, how important is it to follow patients from the day they initiated treatment with the study interventions? Our article considers this question and related issues to start a dialogue on the value of the incident user design in comparative effectiveness research. By incident user design, we mean a study that sets the cohort's inception date according to patients' new use of an intervention. In contrast, most epidemiologic studies enroll patients who were currently or recently using an intervention when follow-up began. We take the incident user design as a reasonable default strategy because it reduces biases that can impact non-randomized studies, especially when investigators use healthcare databases. We review case studies where investigators have explored the consequences of designing a cohort study by restricting to incident users, but most of the discussion has been informed by expert opinion, not by systematic evidence.

The incentives in the American Recovery and Reinvestment Act to expand the "meaningful use" of electronic health record systems have many health care professionals searching for information about the cost and staff resources that such systems require. We report the cost of implementing an electronic health record system in twenty-six primary care practices in a physician network in north Texas, taking into account hardware and software costs, as well as the time and effort invested in implementation. For an average five-physician practice, implementation cost an estimated $162,000, with $85,500 in maintenance expenses during the first year. We also estimate that the HealthTexas network implementation team and the practice implementation team needed 611 hours, on average, to prepare for and implement the electronic health record system, and that "end users"-physicians, other clinical staff, and nonclinical staff-needed 134 hours per physician, on average, to prepare for use of the record system in clinical encounters. 1 Potential adopters of this technology need information about the financial and other resources required to implement and maintain the systems.We quantified the costs of implementing one system-GE Healthcare's Centricity Electronic Medical Record 2 -at HealthTexas Provider Network, a large physician network in north Texas that provides fee-for-service ambulatory care. Financial costs included those pertaining to purchases of hardware and of software licenses. We also considered the maintenance costs for software licenses, hosting, and technical support for the first year following implementation.We considered nonfinancial costs to be related to the time spent by many parties to bring the system online and into full use. These parties included three groups of people.First was the HealthTexas network implementation team, which consisted of the manager for training and work flow, the senior vice president for disease management and quality, the vice presidents for informatics and for electronic health records and information technology (IT), a project manager, a process improvement consultant, and staff who conducted the workflow analyses and electronic health record training for physicians and clinic staff. This team planned and led the implementation of the system throughout the network.Second were the individual practice implementation teams, which prepared for the practice's implementation through planning, workflow reengineering, and training, and which consisted of "physician champions" chosen to spearhead the implementation at the particular practice, clinical staff "superusers," and office managers. Third were the end users-the physicians, other clinical staff, and nonclinical staff. End users had to be trained to use the electronic health record and had to prepare for its use in clinical encounters-for example, by loading information from patients' paper records.We interviewed key leaders of HealthTexas's electronic health record implementation: the vice presidents for informatics an...

This study assessed muscle recruitment patterns and stroke kinematics during ergometer and on-water rowing to validate the accuracy of rowing ergometry. Male rowers (n = 10; age 21 ± 2 years, height 1.90 ± 0.05 m and body mass 83.3 ± 4.8 kg) performed 3 × 3 min exercise bouts, at heart and stroke rates equivalent to 75, 85 and 95% VO2peak, on both dynamic and stationary rowing ergometers, and on water. During exercise, synchronised data for surface electromyography (EMG) and 2D kinematics were recorded. Overall muscle activity was quantified by the integration of rmsEMG and averaged for each 10% interval of the stroke cycle. Muscle activity significantly increased in rectus femoris (RF) and vastus medialis (VM) (P <0.01), as exercise intensity increased. Comparing EMG data across conditions revealed significantly (P <0.05) greater RF and VM activity during on-water rowing at discrete 10% intervals of stroke cycle. In addition, the drive/recovery ratio was significantly lower during dynamic ergometry compared to on-water (40 ± 1 vs. 44 ± 1% at 95%, P <0.01). Results suggest that significant differences exist while comparing recruitment and kinematic patterns between on-water and ergometer rowing. These differences may be due to altered acceleration and deceleration of moving masses on-ergometer not perfectly simulating the on-water scenario.

Given the increasing prevalence of diabetes in USA and documented disparities in diabetes care and outcomes for minorities, particularly Hispanic patients, new models of care such as the DEP are needed to expand access to and improve the delivery of diabetes care and help patients achieve improved outcomes.