Scholars@Duke
Sudha Rani Raman

Sudha Rani Raman

Assistant Professor in Population Health Sciences
Population Health Sciences
sudha.raman@duke.edu
Duke Box 104023, Durham, NC 27710
215 Morris Street, Suite 210, Durham, NC 27701

Selected Publications

Genomic classifiers and prognosis of localized prostate cancer: a systematic review.

Journal Article Prostate Cancer Prostatic Dis · March 2025 BACKGROUND: Refinement of the risk classification for localized prostate cancer is warranted to aid in clinical decision making. A systematic analysis was undertaken to evaluate the prognostic ability of three genomic classifiers, Decipher, GPS, and Prolar ... Full text Link to item Cite

Impact of Genomic Classifiers on Risk Stratification and Treatment Intensity in Patients With Localized Prostate Cancer : A Systematic Review.

Journal Article Ann Intern Med · February 2025 BACKGROUND: Tissue-based genomic classifiers (GCs) have been developed to improve prostate cancer (PCa) risk assessment and treatment recommendations. PURPOSE: To summarize the impact of the Decipher, Oncotype DX Genomic Prostate Score (GPS), and Prolaris ... Full text Link to item Cite

Analyzing missingness patterns in real-world data using the SMDI toolkit: application to a linked EHR-claims pharmacoepidemiology study.

Journal Article BMC Med Res Methodol · October 19, 2024 BACKGROUND: Missing data in confounding variables present a frequent challenge in generating evidence using real-world data, including electronic health records (EHR). Our objective was to apply a recently published toolkit for characterizing missing data ... Full text Link to item Cite

Vaccine patterns among older adults with Guillain-Barré syndrome and matched comparators, 2006-2019.

Journal Article J Am Geriatr Soc · October 2024 BACKGROUND: Some vaccines have a small risk of triggering Guillain-Barré syndrome (GBS), an autoimmune disorder where nerve damage leads to paralysis. There is a CDC precaution for patients whose GBS was associated with an influenza or tetanus toxoid-conta ... Full text Link to item Cite

Evidence for the Use of Opioid Medication for Pediatric Acute Pain in the Outpatient Setting: Technical Report.

Journal Article Pediatrics · September 30, 2024 This technical report summarizes the results of a systematic review designed to support the American Academy of Pediatrics' "Clinical Practice Guideline: Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings." PubM ... Full text Link to item Cite

Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline.

Journal Article Pediatrics · September 30, 2024 This is the first clinical practice guideline (CPG) from the American Academy of Pediatrics outlining evidence-based approaches to safely prescribing opioids for acute pain in outpatient settings. The central goal is to aid clinicians in understanding when ... Full text Link to item Cite

Variations in antibiotic prescribing among children enrolled in North Carolina Medicaid, 2013-2019.

Journal Article The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · June 2024 PurposeThe majority of pediatric antibiotic prescribing occurs in the outpatient setting and inappropriate use contributes to antimicrobial resistance. There are regional variations in outpatient antibiotic use with the highest rates occurring in ... Full text Cite

smdi: an R package to perform structural missing data investigations on partially observed confounders in real-world evidence studies.

Journal Article JAMIA Open · April 2024 OBJECTIVES: Partially observed confounder data pose a major challenge in statistical analyses aimed to inform causal inference using electronic health records (EHRs). While analytic approaches such as imputation are available, assumptions on underlying mis ... Full text Link to item Cite

Overview of global real-world data sources for pediatric pharmacoepidemiologic research.

Journal Article Pharmacoepidemiol Drug Saf · January 2024 PURPOSE: Given limited information available on real-world data (RWD) sources with pediatric populations, this study describes features of globally available RWD sources for pediatric pharmacoepidemiologic research. METHODS: An online questionnaire about p ... Full text Link to item Cite

Underimmunization of very low birth weight infants at discharge from the neonatal intensive care unit.

Journal Article J Perinatol · January 2024 OBJECTIVE: To quantify immunization status among premature infants discharged from neonatal intensive care units (NICUs), and identify risk factors for underimmunization. STUDY DESIGN: We performed a cohort study of infants <33 weeks gestation discharged h ... Full text Link to item Cite

A Principled Approach to Characterize and Analyze Partially Observed Confounder Data from Electronic Health Records.

Journal Article Clin Epidemiol · 2024 OBJECTIVE: Partially observed confounder data pose challenges to the statistical analysis of electronic health records (EHR) and systematic assessments of potentially underlying missingness mechanisms are lacking. We aimed to provide a principled approach ... Full text Link to item Cite

Health Care Team Interventions to Reduce Distress Behaviors in Older Adults: A Systematic Review.

Journal Article Clin Gerontol · 2024 OBJECTIVES: This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings. METHODS: We searched interventions addressing heal ... Full text Link to item Cite

Vaccine patterns among patients diagnosed with Guillain-Barré Syndrome and matched counterparts in a Medicare supplemental population, 2000-2020.

Journal Article Vaccine · September 7, 2023 Some vaccines have a small risk of Guillain-Barré Syndrome (GBS), a rare autoimmune disorder characterized by paralysis if untreated. The CDC's Advisory Committee on Immunization Practices (ACIP) guidelines do not consider GBS a precaution for future vacci ... Full text Link to item Cite

Optimizing data integration in trials that use EHR data: lessons learned from a multi-center randomized clinical trial.

Journal Article Trials · September 1, 2023 BACKGROUND: Despite great promise, trials that ascertain patient clinical data from electronic health records (EHR), referred to here as "EHR-sourced" trials, are limited by uncertainty about how existing trial sites and infrastructure can be best used to ... Full text Link to item Cite

Geographic Trends in Pediatric Psychotropic Medication Dispensing Before and After the Start of the COVID-19 Pandemic.

Journal Article Psychiatr Serv · August 1, 2023 OBJECTIVE: This study examined trends and geographic variability in dispensing of prescription psychotropic medications to U.S. youths before and after the start of the COVID-19 pandemic. METHODS: Using national data on prescription medication dispensing, ... Full text Link to item Cite

Higher Temperatures in Socially Vulnerable US Communities Increasingly Limit Safe Use of Electric Fans for Cooling.

Journal Article Geohealth · August 2023 As the globe warms, people will increasingly need affordable, safe methods to stay cool and minimize the worst health impacts of heat exposure. One of the cheapest cooling methods is electric fans. Recent research has recommended ambient air temperature th ... Full text Link to item Cite

Non-overdose acute care hospitalizations for opioid use disorder among commercially-insured adults: a retrospective cohort study.

Journal Article Addict Sci Clin Pract · July 11, 2023 BACKGROUND: Acute care inpatient admissions outside of psychiatric facilities have been increasingly identified as a critical touchpoint for opioid use disorder (OUD) treatment. We sought to describe non-opioid overdose hospitalizations with documented OUD ... Full text Link to item Cite

Impact of state legislation and institutional protocols on opioid prescribing practices following pediatric tonsillectomy.

Journal Article Laryngoscope Investig Otolaryngol · June 2023 OBJECTIVES: Tonsillectomy is a common pediatric surgery, and pain is an important consideration in recovery. Due to the opioid epidemic, individual states, medical societies, and institutions have all taken steps to limit postoperative opioids, yet few stu ... Full text Link to item Cite

Preoperative dysphagia risk in community-dwelling adults aged ≥50 years: Prevalence and risk factors.

Journal Article Nutr Clin Pract · February 2023 BACKGROUND: Preoperative dysphagia screening is rare. The purpose of this study was to assess the prevalence and potential risk factors of preoperative dysphagia risk in adults preparing for surgery. METHODS: The Eating Assessment Tool (EAT-10), Patient-Ge ... Full text Open Access Link to item Cite

Fitness of real-world data for clinical trial data collection: Results and lessons from a HARMONY Outcomes ancillary study.

Journal Article Clin Trials · December 2022 BACKGROUND: Despite the extensive use of real-world data for retrospective, observational clinical research, our understanding of how real-world data might increase the efficiency of data collection in patient-level randomized clinical trials is largely un ... Full text Link to item Cite

Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics.

Journal Article Matern Child Health J · December 2022 OBJECTIVE: To compare differences in healthcare utilization and costs for Medicaid-insured children with medical complexity (CMC) by race/ethnicity and rurality. METHODS: Retrospective cohort of North Carolina (NC) Medicaid claims for children 3-20 years o ... Full text Link to item Cite

Postpartum Medicaid enrollment and churn in North Carolina.

Journal Article Am J Obstet Gynecol MFM · July 2022 Full text Link to item Cite

Implementation of a comprehensive hospitalist-led initiative to improve care for patients with opioid use disorder.

Journal Article J Hosp Med · June 2022 BACKGROUND: As opioid-related hospitalizations rise, hospitals must be prepared to evaluate and treat patients with opioid use disorder (OUD). We implemented a hospitalist-led program, Project Caring for patients with Opioid Misuse through Evidence-based T ... Full text Link to item Cite

Evaluating fitness-for-use of electronic health records in pragmatic clinical trials: reported practices and recommendations.

Journal Article J Am Med Inform Assoc · April 13, 2022 OBJECTIVE: To empirically explore how pragmatic clinical trials (PCTs) that used real-world data (RWD) assessed study-specific fitness-for-use. METHODS: We conducted interviews and surveys with PCT teams who used electronic health record (EHR) data to asce ... Full text Link to item Cite

Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018.

Journal Article JAMA Health Forum · December 2021 IMPORTANCE: Brief disruptions in insurance coverage among eligible participants are associated with poorer health outcomes for children. OBJECTIVE: To describe factors associated with coverage disruptions among children enrolled in North Carolina Medicaid ... Full text Link to item Cite

The use of electronic health records for recruitment in clinical trials: a mixed methods analysis of the Harmony Outcomes Electronic Health Record Ancillary Study.

Journal Article Trials · July 19, 2021 BACKGROUND: The electronic health record (EHR) contains a wealth of clinical data that may be used to streamline the identification of potential clinical trial participants. However, there is little empirical information on site-level facilitators of and b ... Full text Link to item Cite

Abstract P112: Impact Of Look Back Period Length On Associations When Using Electronic Health Record Data For Epidemiologic Research

Conference Circulation · May 25, 2021 Introduction: Studies using electronic health record (EHR) data often have a limited number of years available for analysis. There is a trade off between the look back period length used to define bas ... Full text Cite

Real-World Data for Planning Eligibility Criteria and Enhancing Recruitment: Recommendations from the Clinical Trials Transformation Initiative.

Journal Article Ther Innov Regul Sci · May 2021 The growing availability of real-world data (RWD) creates opportunities for new evidence generation and improved efficiency across the research enterprise. To varying degrees, sponsors now regularly use RWD to make data-driven decisions about trial feasibi ... Full text Link to item Cite

Association between Dysphagia and Surgical Outcomes across the Continuum of Frailty.

Journal Article J Nutr Gerontol Geriatr · 2021 This study examined the relationship between dysphagia and adverse outcomes across frailty conditions among surgical patients ≥50 years of age. A retrospective cohort analysis of surgical hospitalizations in the Healthcare Cost and Utilization Project's Na ... Full text Open Access Link to item Cite

Approaches to mitigate bias in the design and analysis of pRCTs

Chapter · January 1, 2021 Unlike traditional randomized clinical trials (RCTs), pragmatic randomized trials (pRCTs) enroll a broader population of patients typically encountered in routine clinical practice, generating results that can usually be better generalized to routine clini ... Full text Cite

Correction to: The 2020 blast in the Port of Beirut: can the Lebanese health system "build back better"?

Journal Article BMC Health Serv Res · December 3, 2020 An amendment to this paper has been published and can be accessed via the original article. ... Full text Link to item Cite

BMC health services research title: the 2020 blast in the port of Beirut: can the Lebanese health system "build back better"?

Journal Article BMC Health Serv Res · November 12, 2020 The August 2020 explosion in Lebanon resulted in casualties, injuries, and a great number of internally displaced persons. The blast occurred during an economically and politically complex time in the country. Given multiple and competing post-explosion re ... Full text Link to item Cite

Association Between Dysphagia and Inpatient Outcomes Across Frailty Level Among Patients ≥ 50 Years of Age.

Journal Article Dysphagia · October 2020 Frail patients may have heightened risk of dysphagia, a potentially modifiable health factor. Our aim is to examine whether the relationship between dysphagia and adverse health outcomes differs by frailty conditions among inpatients ≥ 50 years of age. Med ... Full text Link to item Cite

Children And The Opioid Epidemic: Age-Stratified Exposures And Harms.

Journal Article Health Aff (Millwood) · October 2020 Using North Carolina Medicaid 2016-18 claims data, we found that approximately one in ten adolescents (10.8 percent) filled at least one opioid prescription per year. Dentists, advanced practice providers, and surgeons were common prescribers of opioids to ... Full text Link to item Cite

Long-term opioid therapy definitions and predictors: A systematic review.

Journal Article Pharmacoepidemiol Drug Saf · March 2020 PURPOSE: This review sought to (a) describe definitions of long-term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short-term opioid use to LTOT for opioid-naïve individuals. METHODS: We conduct ... Full text Link to item Cite

Considerations for using distributed research networks to conduct aspects of randomized trials.

Journal Article Contemp Clin Trials Commun · March 2020 Stakeholders in the clinical research enterprise are aligned around the need to make clinical research in general, and randomized controlled trials in particular, more meaningful and efficient. To that end, we have built distributed research networks (DRNs ... Full text Link to item Cite

Data linkage in pharmacoepidemiology: A call for rigorous evaluation and reporting.

Journal Article Pharmacoepidemiol Drug Saf · January 2020 PURPOSE: The purpose of this paper is to provide guidance on the evaluation of data linkage quality through the development of a checklist for reporting key elements of the linkage process. METHODS: Responding to a call for manuscripts from the Internation ... Full text Link to item Cite

Linking electronic health data in pharmacoepidemiology: Appropriateness and feasibility.

Journal Article Pharmacoepidemiol Drug Saf · January 2020 PURPOSE: To provide guidance on data linkage appropriateness and feasibility to plan purposeful and sustainable new linkages that advance pharmacoepidemiology and healthcare research. Planning a new data linkage requires careful evaluation to weigh the res ... Full text Link to item Cite

Characteristics of New Opioid Use Among Medicare Beneficiaries: Identifying High-Risk Patterns.

Journal Article J Manag Care Spec Pharm · September 2019 BACKGROUND: Opioid prescription patterns, including long-term use, multiple prescribers, and high opioid doses, increase the risk for adverse outcomes; however, previous research in older adult populations has primarily described opioid dose patterns using ... Full text Link to item Cite

Trends in attention-deficit hyperactivity disorder medication use: a retrospective observational study using population-based databases.

Journal Article Lancet Psychiatry · October 2018 BACKGROUND: The use of medications to treat attention deficit hyperactivity disorder (ADHD) has increased, but the prevalence of ADHD medication use across different world regions is not known. Our objective was to determine regional and national prevalenc ... Full text Link to item Cite

Leveraging electronic health records for clinical research.

Journal Article Am Heart J · August 2018 Electronic health records (EHRs) can be a major tool in the quest to decrease costs and timelines of clinical trial research, generate better evidence for clinical decision making, and advance health care. Over the past decade, EHRs have increasingly offer ... Full text Link to item Cite

Linking a Total Ankle Arthroplasty Registry to Medicare Inpatient Claims without Unique Identifiers.

Journal Article J Bone Joint Surg Am · June 20, 2018 BACKGROUND: Linking clinical registries to administrative claims data enables researchers to capitalize on the specific strengths of each data source with respect to the depth, breadth, and completeness of information. The objectives of this study were to ... Full text Link to item Cite

Anogenital Findings in 3569 Pediatric Examinations for Sexual Abuse/Assault.

Journal Article J Pediatr Adolesc Gynecol · April 2018 STUDY OBJECTIVE: Accurate interpretation of anogenital examination findings in the context of suspected child and adolescent sexual abuse/assault is essential, because misinterpretation has significant child protection and criminal justice implications. A ... Full text Link to item Cite

The 2015 Nepal Earthquake(s): Lessons Learned From the Disability and Rehabilitation Sector's Preparation for, and Response to, Natural Disasters.

Journal Article Phys Ther · November 2016 The frequency of natural disasters appears to be mounting at an alarming rate, and the degree to which people are surviving such traumatic events also is increasing. Postdisaster survival often triggers increases in population and individual disability-rel ... Full text Link to item Cite

Rehabilitation following natural disasters: Three important lessons from the 2015 earthquake in Nepal

Journal Article Physiotherapy Practice and Research · June 4, 2016 On April 25, 2015, a 7.8 magnitude earthquake occurred in Nepal; then on the afternoon of May 12, 2015, the small Himalayan nation experienced a second 7.3 magnitude earthquake. As of the writing of this commentary, the estimate of casualties has surpassed ... Full text Cite

Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants.

Journal Article JAMA Pediatr · August 2015 IMPORTANCE: Immunization of extremely low-birth-weight (ELBW) infants in the neonatal intensive care unit (NICU) is associated with adverse events, including fever and apnea or bradycardia, in the immediate postimmunization period. These adverse events pre ... Full text Link to item Cite

An observational study of pharmacological treatment in primary care of children with ADHD in the United kingdom.

Journal Article Psychiatr Serv · June 2015 OBJECTIVE: The study described initial pharmacological treatment of children in the United Kingdom diagnosed as having ADHD and assessed predictors of medication persistence. METHODS: U.K. children ages 3-16 diagnosed as having ADHD between 1994 and 2006 w ... Full text Link to item Cite

Safety of milrinone use in neonatal intensive care units.

Journal Article Early Hum Dev · January 2015 BACKGROUND: Milrinone use in the neonatal intensive care unit has increased over the last 10 years despite a paucity of published safety data in infants. We sought to determine the safety of milrinone therapy among infants in the neonatal intensive care un ... Full text Link to item Cite

Exploring the factors that influence the perceptions of disability: a qualitative study of mothers of children with disabilities at a community-based rehabilitation centre in Sri Lanka.

Journal Article WHO South East Asia J Public Health · 2015 BACKGROUND: The prevalence of disability is growing worldwide; however, perceptions regarding disability are not well understood. The aim of this study was to explore factors that influence the perception of disability among mothers of children with disabi ... Full text Link to item Cite

Seat-belt use still low in Kuwait: self-reported driving behaviours among adult drivers.

Journal Article Int J Inj Contr Saf Promot · 2014 Kuwait mandated seat-belt use by drivers in 1976 and by front seat passengers in 1994. The study objectives were to identify and estimate current factors associated with seat-belt use and levels of potentially unsafe driving behaviours in Kuwait. In 2010, ... Full text Link to item Cite

Stimulant treatment and injury among children with attention deficit hyperactivity disorder: an application of the self-controlled case series study design.

Journal Article Inj Prev · June 2013 OBJECTIVE: The aim of the present work was to assess the short-term effects of stimulant medication use on risk of injury among children diagnosed as having attention deficit hyperactivity disorder (ADHD). METHODS: The study group for this self-controlled ... Full text Link to item Cite

Keeping our children safe in motor vehicles: knowledge, attitudes and practice among parents in Kuwait regarding child car safety.

Journal Article Int J Inj Contr Saf Promot · 2013 Child safety restraints can reduce risk of death and decrease injury severity from road traffic crashes; however, knowledge about restraints and their use in Kuwait is limited. A cross-sectional, self-administered survey about child car safety was used amo ... Full text Link to item Cite

Prevalence and risk factors associated with self-reported carpal tunnel syndrome (CTS) among office workers in Kuwait.

Journal Article BMC Res Notes · June 13, 2012 BACKGROUND: The prevalence of carpal tunnel syndrome (CTS) is not well understood in many Arabian Peninsula countries. The objective of this study was to investigate the prevalence and factors associated with self-reported CTS in Kuwait. FINDINGS: A cross- ... Full text Link to item Cite

Accessing timely rehabilitation services for a global aging society? Exploring the realities within Canada's universal health care system.

Journal Article Curr Aging Sci · July 2010 The proportion of older persons is increasing in developed and developing countries: this aging trend can be viewed as a two-edged sword. On the one hand, it represents remarkable successes regarding advances in health care; and on the other hand, it repre ... Full text Link to item Cite

Exploring the meaning of childhood disability: perceptions of disability among mothers of children with disabilities (CWD) in Kuwait.

Journal Article World Health Popul · 2010 The purpose of this exploratory research was to examine perceptions of mothers with children with disabilities (CWD) in Kuwait in order to understand the meaning of disability from their perspective and to explore the extent to which such perceptions influ ... Full text Link to item Cite

Emotional health of Canadian and Finnish students with disabilities or chronic conditions.

Journal Article Int J Rehabil Res · June 2009 The purpose of this study was to investigate the dimensions of emotional health in two population-based groups (Finland and Canada) of adolescents (ages 13 and 15 years) who self-identify as having a disability or chronic condition, as conceptualized by th ... Full text Link to item Cite

Community-acquired MRSA infections in North Carolina children: prevalence, antibiotic sensitivities, and risk factors.

Journal Article N C Med J · 2009 BACKGROUND: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children has increased dramatically over the past decade. CA-MRSA infections are often resistant to standard outpatient antibiotics and pres ... Link to item Cite

Associations between adolescent risk behaviors and injury: the modifying role of disability.

Journal Article J Sch Health · January 2009 BACKGROUND: Adolescents with disabilities are at risk for poor health outcomes including injury. The objective of this study was to examine if disability status modifies the association between risk behavior and injury among adolescents. METHODS: The cross ... Full text Link to item Cite

Prevalence and risk factors associated with low back pain among health care providers in a Kuwait hospital.

Journal Article Spine (Phila Pa 1976) · March 1, 2008 STUDY DESIGN: A cross-sectional survey among health professionals working in a Kuwait hospital. OBJECTIVE: To investigate the prevalence and factors associated with low back pain (LBP). SUMMARY OF BACKGROUND DATA: The literature suggests that health profes ... Full text Link to item Cite

Millennium Development Goals (MDGs): a global policy paradox.

Journal Article Healthc Q · 2008 Health status is connected with factors such as the environment, trade, economic growth and national security. Due to these close associations, health has emerged as a mediating factor inherent to a nation's prospect for human development. ... Link to item Cite

Injury among 1107 Canadian students with self-identified disabilities.

Journal Article Disabil Rehabil · November 30, 2007 PURPOSE: Students with disabilities are at risk for poor health outcomes; however, the causes and consequences of injury in this group are not well understood. The epidemiologies of injuries among students with and without disabilities were profiled and co ... Full text Link to item Cite