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The Palliative Care Research Cooperative Group (PCRC) formed to lead, catalyze, and empower a community of scientists to build an evidence base to ensure high-quality care and optimal well-being for persons with serious illness and their caregivers. The PCRC grew to 630 members representing 220 distinct sites. The PCRC awarded 44 pilot grant awards (total investment $1.4 million), resulting in $15.8 million in extramural grant funding, supported monthly webinars, an annual mentorship selective, "Clinical Trials Intensives," research consultation, and grant review. Among the 169 Clinical Trials Intensive participants, 74 subsequently achieved extramural grant award funding with direct costs of over $139 million. The PCRC supported the submission of extramural research applications and fostered community through annual meetings, special interest groups, newsletters, and its website. The PCRC filled an important void in serious illness science and set the stage for the next era of advancing serious illness research. [ABSTRACT FROM AUTHOR]

Engaging patients-defined broadly as individuals with lived experience of a given condition, family members, caregivers, and the organisations that represent them-as partners in research is a priority for policymakers, funders, and the public. Nonetheless, formal efforts to engage patients are absent from most studies, and models to support meaningful patient engagement in clinical anaesthesia research have not been previously described. Here, we review our experience in developing and implementing a multifaceted patient engagement strategy within the Regional Versus General Anesthesia for Promoting Independence After Hip Fracture (REGAIN) surgery trial, an ongoing randomised trial comparing spinal vs general anaesthesia for hip fracture surgery in 1600 older adults across 45 hospitals in the USA and Canada. This strategy engaged patients and their representatives at both the level of overall trial oversight and at the level of individual recruiting sites. Activities spanned a continuum ranging from events designed to elicit patients' input on key decisions to longitudinal collaborations that empowered patients to actively participate in decision-making related to trial design and management. Engagement activities were highly acceptable to participants and led to concrete changes in the design and conduct of the REGAIN trial. The REGAIN experience offers a model for future efforts to engage patients as partners in clinical anaesthesia research, and highlights potential opportunities for investigators to increase the relevance of anaesthesia studies by incorporating patient voices and perspectives into the research process. [ABSTRACT FROM AUTHOR]

Objective: To characterize the nature and degree of hospitals' efforts to collaborate with skilled nursing facilities (SNFs) and associated patient outcomes.Data Sources/study Setting: Qualitative data were collected through 138 interviews with staff in 16 hospitals and 25 SNFs in eight markets across the United States in 2015. Quantitative data include Medicare claims data for the 290,603 patients discharged from those 16 hospitals between 2008 and 2015.Study Design/data Collection: Semi-structured interviews with hospital and SNF staff were coded and used to classify hospitals' collaboration efforts with SNFs into high versus low collaboration hospitals, and risk-adjusted, claims-based hospital readmission rates from SNF were compared.Principal Findings: Hospital collaboration efforts were defined as establishing SNF partners, transition management initiatives, and hospital staff visits to SNFs. High collaboration hospitals were more likely to send patients to SNFs (as opposed to home, home with home health, or other PAC settings), sent a higher share of patients to high quality SNFs, and had fewer hospital readmissions from SNF sooner than did low collaboration hospitals.Conclusions: Although collaboration with SNF requires significant administrative and clinical time investment, it is associated with positive patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To characterize the motivations of stakeholders from diverse sectors who engaged in cross-sector collaboration with an academic medical center.Data Source: Primary qualitative data (2014-2015) were collected from 22 organizations involved in a cross-sector diabetes intervention on the South Side of Chicago.Study Design: In-depth, semistructured interviews; participants included leaders from all stakeholder organization types (e.g., businesses, community development, faith-based) involved in the intervention.Data Collection Methods: Data were transcribed verbatim from audio and video recordings. Analysis was conducted using the constant comparison method, derived from grounded theory.Principal Findings: All stakeholders described collaboration as an opportunity to promote community health in vulnerable populations. Among diverse motivations across organization types, stakeholders described collaboration as an opportunity for: financial support, brand enhancement, access to specialized skills or knowledge, professional networking, and health care system involvement in community-based efforts. Based on our findings, we propose a framework for implementing a working knowledge of stakeholder motivations to facilitate effective cross-sector collaboration.Conclusions: We identified several factors that motivated collaboration across diverse sectors with health care systems to promote health in a high-poverty, urban setting. Understanding these motivations will be foundational to optimizing meaningful cross-sector collaboration and improving diabetes outcomes in the nation's most vulnerable communities. [ABSTRACT FROM AUTHOR]

Publicly insured children needing referral to mental health (MH) services often do not access or receive services. The objective of this study was to identify gaps in communication and coordination between primary care providers (PCPs) and MH providers during the MH referral and care process for publicly insured children. Thirteen semi-structured interviews were conducted with 10 PCPs and staff from a federally qualified health center (FQHC) and 6 MH providers and staff from two local MH clinics. Interview participants identified multiple gaps in communication throughout the care process and different phases as priorities for improvement. PCPs described primary care-MH communication challenges during early phases, while MH providers described coordination challenges in transferring patients back to primary care for ongoing mental health management. Strategies are needed to improve primary care-specialty MH communication and coordination throughout all phases of the referral and care process, particularly at initial referral and transfer back to primary care. [ABSTRACT FROM AUTHOR]

Objective: To understand how health care providers and social services providers coordinate their work in communities that achieve relatively low health care utilization and costs for older adults.Study Setting: Sixteen Hospital Service Areas (HSAs) in the United States.Study Design: We conducted a qualitative study of HSAs with performance in the top or bottom quartiles nationally across three key outcomes: ambulatory care sensitive hospitalizations, all-cause risk-standardized readmission rates, and average reimbursements per Medicare beneficiary. We selected 10 higher performing HSAs and six lower performing HSAs for inclusion in the study.Data Collection: To understand patterns of collaboration in each community, we conducted site visits and in-depth interviews with a total of 245 representatives of health care organizations, social service agencies, and local government bodies.Principal Findings: Organizations in higher performing communities regularly worked together to identify challenges faced by older adults in their areas and responded through collective action-in some cases, through relatively unstructured coalitions, and in other cases, through more hierarchical configurations. Further, hospitals in higher performing communities routinely matched patients with needed social services.Conclusions: The collaborative approaches used by higher performing communities, if spread, may be able to improve outcomes elsewhere. [ABSTRACT FROM AUTHOR]

For the past two decades, the National Cancer Institute (NCI) has supported the involvement of patient advocates in both internal advisory activities and funded research projects to provide a patient perspective. Implementation of the inclusion of patient advocates has varied considerably, with inconsistent involvement of patient advocates in key phases of research such as concept development. Despite this, there is agreement that patient advocates have improved the patient focus of many cancer research studies. This commentary describes our experience designing and pilot testing a new framework for patient engagement at SWOG, one of the largest cancer clinical trial network groups in the United States and one of the four adult groups in the NCI's National Clinical Trials Network (NCTN). Our goal is to provide a roadmap for other clinical trial groups that are interested in bringing the patient voice more directly into clinical trial conception and development. We developed a structured process to engage patient advocates more effectively in the development of cancer clinical trials and piloted the process in four SWOG research committees, including implementation of a new Patient Advocate Executive Review Form that systematically captures patient advocates' input at the concept stage. Based on the positive feedback to our approach, we are now developing training and evaluation metrics to support meaningful and consistent patient engagement across the SWOG clinical trial life cycle. Ultimately, the benefits of more patient-centered cancer trials will be measured in the usefulness, relevance, and speed of study results to patients, caregivers, and clinicians. [ABSTRACT FROM AUTHOR]

Objective: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program.Data Sources/study Setting: Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs.Study Design: Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance.Data Collection Methods: A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed.Principal Findings: Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators.Conclusions: Shorter interventions can improve ACO performance-use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician-hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance. [ABSTRACT FROM AUTHOR]

Objectives: To summarize the development process of a national database that was designed to facilitate communication and collaboration, improve care, and create a framework for aggregate data sharing in cochlear implant (CI) research.Methods: A group of nationally represented, multidisciplinary CI providers cooperated to define a standard set of data elements to incorporate into a database built by them in association with a group of computer scientists and software designers. CI centers across the USA, then, joined the non-profit Auditory Implant Initiative to use the database for their own clinical purposes and to help contribute to the national de-identified dataset for research and analytics.Results: Approximately 12 months after the full release of the database, clinical information on 373 patients has been entered from 17 different CI centers representing 61 hearing professionals. A blend of six academic, seven private, and four non-profit CI centers participated in this phase of the data sharing network.Discussion: The adoption of a single, standardized database by 17 centers throughout the USA has begun a framework for data sharing in CI research. Future steps include (1) expanding adoption, (2) scaling the database to include more patients, (3) streamlining the legal hurdles required for adoption, and (4) integrating the database with other software platforms (e.g. electronic health records, processors).Conclusion: A standardized clinical outcomes database that is utilized by a growing network of CI centers can help strengthen research through aggregate data sharing. [ABSTRACT FROM AUTHOR]

Objective: To assess medical and psychosocial screening and evaluation received by gestational carriers and compare those using agencies to those not using agencies.Design: Cross-sectional questionnaire.Setting: Not applicable.Patient(s): A total of 204 women who completed a survey on their experiences as gestational carriers in the United States.Intervention(s): None.Main Outcome Measure(s): Self-reported screening received before gestational carrier pregnancies.Result(s): Overall, 97.1% of gestational carriers had a complete medical evaluation and 94.6% had an evaluation or counseling by a mental health professional. Most participants indicated that they had been informed of at least some medical risks (92.6%) and psychological considerations (89.7%). Participants most often recalled being informed of the risks of multiple pregnancy (89.2%) and medical procedures and medications (87.2%), but least often recalled being informed about the risks of impact on their own employment (46.6%) and to their own children (61.3%). There were no differences in outcome measures between those using an agency and those who did not.Conclusion(s): Self-reported screening and evaluation was high, but still not 100% on all measures. Further education of providers regarding guidelines for the screening and evaluation of gestational carriers may be needed. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life.Methods: A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression.Results: At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm.Conclusions: The integration of screening and symptom management into cancer care is recommended. [ABSTRACT FROM AUTHOR]

Virtual Reality (VR) can reduce time and costs, and lead to increases in quality, in the development of a product. Given the pressure on car companies to reduce time-to-market and to continually improve quality, the automotive industry has championed the use of VR across a number of applications, including design, manufacturing, and training. This paper describes interviews with 11 engineers and employees of allied disciplines from an automotive manufacturer about their current physical and virtual properties and processes. The results guided a review of research findings and scientific advances from the academic literature, which formed the basis of recommendations for future developments of VR technologies and applications. These include: develop a greater range of virtual contexts; use multi-sensory simulation; address perceived differences between virtual and real cars; improve motion capture capabilities; implement networked 3D technology; and use VR for market research. [ABSTRACT FROM AUTHOR]

This study's purpose was to identify distinct publishing trajectories among 442 participants in three prominent mentored health services research career development programs (Veterans Affairs, National Institutes of Health, and Agency for Healthcare Research & Quality) in the 10 years after award receipt and to examine awardee characteristics associated with different trajectories. Curricula vitae (CVs) of researchers receiving awards between 1991 and 2010 were coded for publications, grants, and awardee characteristics. We found that awardees published at constant or increasing rates despite flat or decreasing rates of first-author publications. Senior-author publications rose concurrently with rates of overall publications. Higher overall publication trajectories were associated with receiving more grants, more citations as measured by the h-index, and more authors per article. Lower trajectory groups were older and had a greater proportion of female awardees. Career development awards supported researchers who generally published successfully, but trajectories varied across individual researchers. Researchers' collaborative efforts produced an increasing number of articles, whereas first author articles were written at a more consistent rate. Career development awards in health services research supported the careers of researchers who published at a high rate; future research should further examine reasons for variation in publishing among early career researchers. [ABSTRACT FROM AUTHOR]

Background: Both antenatal and postpartum depression have adverse, lasting effects on maternal and child well-being. Socioeconomically disadvantaged women are at increased risk for perinatal depression and have experienced difficulty accessing evidence-based depression care. The authors evaluated whether "MOMCare,"a culturally relevant, collaborative care intervention, providing a choice of brief interpersonal psychotherapy and/or antidepressants, is associated with improved quality of care and depressive outcomes compared to intensive public health Maternity Support Services (MSS-Plus).Methods: A randomized multisite controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System. From January 2010 to July 2012, pregnant women were recruited who met criteria for probable major depression and/or dysthymia, English-speaking, had telephone access, and ≥18 years old. The primary outcome was depression severity at 3-, 6-, 12-, 18-month postbaseline assessments; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care.Results: All participants were on Medicaid and 27 years old on average; 58% were non-White; 71% were unmarried; and 65% had probable PTSD. From before birth to 18 months postbaseline, MOMCare (n = 83) compared to MSS-Plus participants (n = 85) attained significantly lower levels of depression severity (Wald's χ(2) = 6.09, df = 1, P = .01) and PTSD severity (Wald's χ(2) = 4.61, df = 1, P = .04), higher rates of depression remission (Wald's χ(2) = 3.67, df = 1, P = .05), and had a greater likelihood of receiving ≥4 mental health visits (Wald's χ(2) = 58.23, df = 1, P < .0001) and of adhering to antidepressants in the prior month (Wald's χ(2) = 10.00, df = 1, P < .01).Conclusion: Compared to MSS-Plus, MOMCare showed significant improvement in quality of care, depression severity, and remission rates from before birth to 18 months postbaseline for socioeconomically disadvantaged women. Findings suggest that evidence-based perinatal depression care can be integrated into the services of a county public health system in the United States.Clinical Trial Registration: ClinicalTrials.govNCT01045655. [ABSTRACT FROM AUTHOR]

The widespread adoption of science-based prevention requires local infrastructures for prevention service delivery. Communities That Care (CTC) is a tested prevention service delivery system that enables a local coalition of community stakeholders to use a science-based approach to prevention and improve the behavioral health of young people. This paper uses data from the Community Youth Development Study (CYDS), a community-randomized trial of CTC, to examine the extent to which better internal team functioning of CTC coalitions increases the community-wide adoption of science-based prevention within 12 communities, relative to 12 matched comparison communities. Specifically, this paper examines the potential of both a direct relationship between coalition functioning and the community-wide adoption of science-based prevention and a direct relationship between functioning and the coalition capacities that ultimately enable the adoption of science-based prevention. Findings indicate no evidence of a direct relationship between four dimensions of coalition functioning and the community-wide adoption of a science-based approach to prevention, but suggest a relationship between coalition functioning and coalition capacities (building new member skills and establishing external linkages with existing community organizations) that enable science-based prevention. [ABSTRACT FROM AUTHOR]

Objective: To describe the impact on community pharmacy service development of a faculty-student-pharmacist collaborative program offered by five U.S. colleges.Setting: Colleges of pharmacy and community pharmacies in Arizona, Illinois, Ohio, Utah, and West Virginia.Practice Description: Partner for Promotion (PFP) is an elective, longitudinal advanced pharmacy practice experience (APPE) focused on enhancement of community pharmacy management skills, specifically the development and implementation of direct patient care services. This faculty-student-pharmacist collaborative model has been implemented in five U.S. colleges of pharmacy beyond the originating institution.Evaluation: Data on pharmacy demographics and the impact of PFP on service creation and longevity at these partnering schools were reported via annual online surveys completed by faculty directors at each partnering college of pharmacy.Results: Over a 3-year period, 19 pharmacy teams across five states worked to create a total of 15 direct patient care services, 12 of which were still being offered to patients at the time of data collection (80% longevity). The PFP program guided 38 students through the process of developing and implementing a sustainable service at a community pharmacy. All participating faculty from partnering colleges of pharmacy (100%) indicated that PFP model materials were "very useful" (4-point Likert scale; 1, not useful, to 4, very useful), and all five colleges plan to continue offering the program moving forward.Conclusion: The PFP model of training and service development can have a positive impact on the pharmacy profession, serve as an avenue for training students in the development of clinical services, and be a catalyst for establishing the growth of community pharmacy as a patient-centered, service-oriented partner in the health care system. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) and its comorbidities are endemic among injured trauma survivors. Previous collaborative care trials targeting PTSD after injury have been effective, but they have required intensive clinical resources. The present pragmatic clinical trial randomized acutely injured trauma survivors who screened positive on an automated electronic medical record PTSD assessment to collaborative care intervention (n = 60) and usual care control (n = 61) conditions. The stepped measurement-based intervention included care management, psychopharmacology, and psychotherapy elements. Embedded within the intervention were a series of information technology (IT) components. PTSD symptoms were assessed with the PTSD Checklist at baseline prerandomization and again, 1-, 3-, and 6-months postinjury. IT utilization was also assessed. The technology-assisted intervention required a median of 2.25 hours (interquartile range = 1.57 hours) per patient. The intervention was associated with modest symptom reductions, but beyond the margin of statistical significance in the unadjusted model: F(2, 204) = 2.95, p = .055. The covariate adjusted regression was significant: F(2, 204) = 3.06, p = .049. The PTSD intervention effect was greatest at the 3-month (Cohen's effect size d = 0.35, F(1, 204) = 4.11, p = .044) and 6-month (d = 0.38, F(1, 204) = 4.10, p = .044) time points. IT-enhanced collaborative care was associated with modest PTSD symptom reductions and reduced delivery times; the intervention model could potentially facilitate efficient PTSD treatment after injury. [ABSTRACT FROM AUTHOR]

Many institutions collect reports in databases to make important lessons-learned available to their members. The Uniformed Services University of the Health Sciences collaborated with the Peacekeeping and Stability Operations Institute to conduct a descriptive and qualitative analysis of global health engagements (GHEs) contained in the Stability Operations Lessons Learned and Information Management System (SOLLIMS). This study used a summative qualitative content analysis approach involving six steps: (1) a comprehensive search; (2) two-stage reading and screening process to identify first-hand, health-related records; (3) qualitative and quantitative data analysis using MAXQDA, a software program; (4) a word cloud to illustrate word frequencies and interrelationships; (5) coding of individual themes and validation of the coding scheme; and (6) identification of relationships in the data and overarching lessons-learned. The individual codes with the most number of text segments coded included: planning, personnel, interorganizational coordination, communication/information sharing, and resources/supplies. When compared to the Department of Defense's (DoD's) evolving GHE principles and capabilities, the SOLLIMS coding scheme appeared to align well with the list of GHE capabilities developed by the Department of Defense Global Health Working Group. The results of this study will inform practitioners of global health and encourage additional qualitative analysis of other lessons-learned databases. [ABSTRACT FROM AUTHOR]

Background: Critical Care Air Transport Teams (CCATTs) are a critical component of the United States Air Force evacuation paradigm. This study was conducted to assess the incidence of task saturation in simulated CCATT missions and to determine if there are predictable performance domains.Methods: Sixteen CCATTs were studied over a 6-month period. Performance was scored using a tool assessing eight domains of performance. Teams were also assessed during critical events to determine the presence or absence of task saturation and its impact on patient care.Results: Sixteen simulated missions were reviewed and 45 crisis events identified. Task saturation was present in 22/45 (49%) of crisis events. Scoring demonstrated that task saturation was associated with poor performance in teamwork (odds ratio [OR] = 1.96), communication (OR = 2.08), and mutual performance monitoring (OR = 1.9), but not maintenance of guidelines, task management, procedural skill, and equipment management. We analyzed the effect of task saturation on adverse patient outcomes during crisis events. Adverse outcomes occurred more often when teams were task saturated as compared to non-task-saturated teams (91% vs. 23%; RR 4.1, p < 0.0001).Conclusions: Task saturation is observed in simulated CCATT missions. Nontechnical skills correlate with task saturation. Task saturation is associated with worsening physiologic derangements in simulated patients. [ABSTRACT FROM AUTHOR]

Background: We aimed to make individual patient data from the International Stroke Trial (IST), one of the largest randomised trials ever conducted in acute stroke, available for public use, to facilitate the planning of future trials and to permit additional secondary analyses.Methods: For each randomised patient, we have extracted data on the variables assessed at randomisation, at the early outcome point (14-days after randomisation or prior discharge) and at 6-months and provide them as an analysable database.Results: The IST dataset includes data on 19 435 patients with acute stroke, with 99% complete follow-up. Over 26.4% patients were aged over 80 years at study entry. Background stroke care was limited and none of the patients received thrombolytic therapy.Conclusions: The IST dataset provides a source of primary data which could be used for planning further trials, for sample size calculations and for novel secondary analyses. Given the age distribution and nature of the background treatment given, the data may be of value in planning trials in older patients and in resource-poor settings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between self-reported endometriosis and the putative functional promoter +331C/T single nucleotide polymorphism and the PROGINS allele.Design: Control subjects from ovarian cancer case-control studies participating in the international Ovarian Cancer Association Consortium. The majority of controls are drawn from population-based studies.Setting: An international ovarian cancer consortium including studies from Australia, Europe, and the United States.Patient(s): Five thousand eight hundred twelve white female controls, of whom 348 had endometriosis, from eight ovarian cancer case-control studies.Intervention(s): None.Main Outcome Measure(s): Genotypes for the +331C/T single nucleotide polymorphism and PROGINS allele and a history of endometriosis.Result(s): The occurrence of endometriosis was reduced in women carrying one or more copies of the +331 T allele (odds ratio=0.65; 95% confidence interval: 0.43-0.98), whereas there was no association between the PROGINS allele and endometriosis (odds ratio=0.94, 95% confidence interval 0.76-1.16).Conclusion(s): Additional studies of the +331C/T variant are warranted given the current finding and the equivocal results of previous studies. The +331 T allele has been shown to result in a reduced progesterone (P) receptor A to P receptor B ratio, and if the observed association with endometriosis is confirmed it would suggest that this ratio is important for this disease. [ABSTRACT FROM AUTHOR]

The author reflects on how the quality of hospital language services has been improved and measured. In relation to this, a program called Speaking Together: National Language Services Network has been launched by the Robert Wood Johnson Foundation. This is designed to improve the quality and availability of language services at hospitals in the U.S.

Objectives: Our objectives were to analyze the possibility of an exchange of an entire clinical study between two different and independent study software solutions. The question addressed was whether a software-independent transfer of study metadata can be performed without programming efforts and with software routinely used for clinical research.Methods: Study metadata was transferred with ODM standard (CDISC). Study software systems employed were MACRO (InferMed) and XTrial (XClinical). For the Proof of Concept, a test study was created with MACRO and exported as ODM. For modification and validation of the ODM export file XML-Spy (Altova) and ODM-Checker (XML4Pharma) were used.Results: Through exchange of a complete clinical study between two different study software solutions, a Proof of Concept of the technical feasibility of a system-independent metadata exchange was conducted successfully. The interchange of study metadata between two different systems at different centers was performed with minimal expenditure. A small number of mistakes had to be corrected in order to generate a syntactically correct ODM file and a "vendor extension" had to be inserted. After these modifications, XTrial exhibited the study, including all data fields, correctly. However, the optical appearance of both CRFs (case report forms) was different.Conclusions: ODM can be used as an exchange format for clinical studies between different study software. Thus, new forms of cooperation through exchange of metadata seem possible, for example the joint creation of electronic study protocols or CRFs at different research centers. Although the ODM standard represents a clinical study completely, it contains no information about the representation of data fields in CRFs. [ABSTRACT FROM AUTHOR]

Objectives: To determine the degree of collaboration in a limited number of pharmacist-physician professional relationships and identify variables important in establishing collaboration between pharmacists and physicians.Design: A multicase design, using a personal interview and a mailed survey.Setting: Iowa.Participants: Pharmacists in 10 community pharmacies and physicians with whom they collaborated.Intervention: Two researchers independently judged the stage of collaboration for each case and the level of effect each influence variable had on the development of pharmacist-physician collaboration.Main Outcome Measures: Using the Collaborative Working Relationship Model, nine indicators of collaboration were assessed. In addition, influence variables were studied, which included individual, context, and exchange characteristics believed to affect the development of collaborative working relationships between pharmacists and physicians.Results: A Perrealt-Leigh reliability index of 0.89 was calculated as an estimate of interrater reliability of the judgments of nine indicators of collaboration. Four pharmacies were rated as having achieved early-stage collaboration, while six pharmacies were at late-stage collaboration. A high level of joint care activities, care communication, and increased accessibility to the physician and to patient information characterized late-stage collaboration. Six variables, labeled as discriminating, helped distinguish between early-stage collaboration and late-stage collaboration: the development of bidirectional communication, caring for mutual patients, the ability to identify a win-win opportunity, adding value to the medical practice, physician convenience, and movement toward balanced dependence between the pharmacist and physician.Conclusion: The development of collaboration between pharmacists and physicians is influenced by characteristics of exchanges occurring between them. Continued study of collaborative working relationships between physicians and pharmacists can assist health care practitioners in developing a team-based approach to patient care, improving the ability of pharmacists and physicians to work together to coordinate patient care. [ABSTRACT FROM AUTHOR]

Describes a process by which a collaboration was formed between public and private sectors in the United States on the issue of tobacco use. Retreat held among private and public representatives to identify risk factors for tobacco use and facilitate collaborations among various disciplines; Identification of barriers to collaboration; Design of research projects on adolescent tobacco use.

In the United States (US), chronic disease risk factors are highly prevalent among Asian immigrant communities, who also exhibit low health screening rates. Perceived neighborhood social cohesion (NSC) has been associated with preventive healthcare use in the general US population, although it remains unexplored among Asian Americans (AAs). The aim of this study is to evaluate the association between NSC and preventive screening for hypertension, high cholesterol, diabetes, and depression among East, South and Southeast Asian American (EAA, SAA, SEAA) communities in New York City (NYC) using cross-sectional, locally collected data from 2013 to 2016. NSC was assessed using a 4-question scale to create an additive score between 4 and 16 and was analyzed both as a continuous and categorial variable (High, Medium, and Low tertiles). Recent screening was defined as a check-up within the last year for each of the included health conditions. A one-unit increase in NSC score was associated with increased odds of recent screening for high cholesterol in EAAs (AOR = 1.09, 95%CI:1.00-1.20); for high cholesterol, diabetes, and depression in SAAs (AOR = 1.08, 95%CI:1.00-1.20; AOR = 1.07, 95%CI:1.00-1.15; AOR = 1.15, 95%CI:1.06-1.25); and with high cholesterol among SEAAs (AOR = 1.12, 95%CI:1.00-1.25). Overall, NSC was an important facilitator for preventive screening behaviors for specific conditions in different groups, though was consistently associated with screening for high cholesterol in our sample. Enhancing NSC through family and community-based programming may be one strategy to encourage screening for preventive behaviors, though more research is needed to elucidate a precise mechanism. [ABSTRACT FROM AUTHOR]

Purpose: We wanted to obtain the viewpoints of a community advisory board in training junior minority faculty members and graduate students for community-based participatory research (CBPR) on mental health in primary care.Methods: During training institutes, members of a community advisory board presented plenary sessions on research collaboration with communities. The program director edited the transcribed recordings of the presentations for style but not for content. Advisory board members collaborated in revising the transcripts and summarizing themes.Results: Board members expressed several key themes. Research must take into account traditional healing practices and prior exploitative research. Historical trauma impedes collaborations, which require conflict resolution and departure from traditional definitions of normalcy. Researchers should include communities in formulating research agendas and should take findings back to the communities for critical appraisal and practical applications. Collaborations should address policy issues including interpreter services, Medicaid managed care, and parity in insurance coverage for physical and mental health problems.Conclusions: Community advisory board members present key concerns that otherwise would not enter into the researchers' training curriculum. Such an advisory board can make important contributions to programs that seek to improve CBPR in mental health and primary care. [ABSTRACT FROM AUTHOR]

Surgeon scientists are a vanishing group, a reason for which may be an initially frustrating experience in the laboratory. This essay proposes a specific plan to improve the first time researcher’s bench research experience. [Copyright &y& Elsevier]

Almost two decades after Doll and Peto (1981) provided evidence that one third of cancer deaths are related to diet, it remains unclear which dietary components may be key in cancer prevention. Although the complexity of the diet can become overwhelming, the National Cancer Institute (NCI) of the National Institutes of Health (NIH) has remained steadfast in its commitment to defining the roles that diet and nutrition have in the development of cancer and has provided increased research and training support to assist in unraveling this interrelationship. Evidence for this sustained commitment is highlighted by a fourfold increase in NCI expenditures for nutrition research and training from 1983 to 1998; this substantial increase reflects a trend that is occurring in some universities and the private sector. More than one third of the nutrition-related NCI research is funded by the Division of Cancer Prevention. Supported investigations cover the gamut from basic mechanisms of action of dietary constituents, methodology development, human metabolic studies, clinical trials of dietary modification and the chemopreventive potential of individual nutrients to population-based studies. [ABSTRACT FROM AUTHOR]

Background: Tic disorders, including Tourette syndrome, are complex, multisymptom diseases, yet the impact of these disorders on affected children, families, and communities is not well understood.Methods: To improve the understanding of the impacts of Tourette syndrome, two research groups conducted independent cross-sectional studies using qualitative and quantitative measures. They focused on similar themes, but distinct scientific objectives, and the sites collaborated to align methods of independent research proposals with the aim of increasing the analyzable sample size.Results: Site 1 (University of Rochester) was a Pediatric Neurology referral center. Site 2 (University of South Florida) was a Child Psychiatry referral center. A total of 205 children with tic disorders were enrolled from both studies. The University of Rochester also enrolled 100 control children in order to clearly isolate impacts of Tourette syndrome distinct from those occurring in the general population. The majority of children with tic disorders (n = 191, 93.1%) had Tourette syndrome, the primary population targeted for these studies. Children with Tourette syndrome were similar across sites in terms of tic severity and the occurrence of comorbid conditions. The occurrence of psychiatric comorbidities in the control group was comparable with that in the general pediatric population of the United States, making this a well-justified comparison group.Conclusions: Through collaboration, two sites conducting independent research developed convergent research methods to enable pooling of data, and by extension increased power, for future analyses. This method of collaboration is a novel model for future epidemiological research of tic disorders. [ABSTRACT FROM AUTHOR]