Search

In this study, we examined rates of insomnia and co-occurring unhealthy alcohol use in a national sample of women Veterans age 50 years and older. We further explored associations between sociodemographic measures, insomnia-related clinical characteristics, and unhealthy alcohol use, and analyzed whether women with insomnia were more likely to report unhealthy alcohol use. Study aims were evaluated using national Veterans Health Administration (VA) electronic health records data from VA's Corporate Data Warehouse. Data were extracted for women Veterans ≥50 years old with ≥1 VA primary care visit in each study year (2018: 3/11/18–3/10/19; 2020: 3/11/20–3/10/21; 2022: 3/11/22–3/10/23). Cases of insomnia were identified via diagnostic codes and prescription medications for insomnia. Unhealthy alcohol use was identified via Alcohol Use Disorders Identification Test-Consumption screening scores indicating unhealthy alcohol use. Annual sample sizes ranged from 240,420–302,047. Over the study timeframe, insomnia rates (diagnosis or medication) among women ≥50 years old ranged from 18.11–19.29%; co-occurring insomnia and unhealthy alcohol use rates ranged from 2.02–2.52%. Insomnia and unhealthy alcohol use rates were highest among women aged 50–59 years old. Depression and physical health comorbidities were consistently associated with insomnia; associations by race and ethnicity were less consistent. Compared to women without insomnia, women Veterans with either concurrent or unremitting insomnia were more likely to endorse unhealthy alcohol use. Findings signal a potential need for assessment and preventative efforts aimed at addressing insomnia and unhealthy alcohol use among women Veterans. [ABSTRACT FROM AUTHOR]

Objective: Describe the epidemiology of cluster headache (CH) using Veterans Health Administration (VHA) Electronic Health Record (EHR) data. Background: Epidemiologic studies of CH at the population level are difficult because it has a prevalence of ~0.1%. Hospital system‐wide studies are an attractive alternative as they have large numbers of patients and broader populations than headache or neurology clinic‐based studies. The VHA is an ideal hospital‐based system in which to study CH because it is nationwide, predominantly male, has a strong focus on mood disorders and suicidality, and has accessible individual medical records. Here, we report the first headache study based on an ongoing longitudinal cohort of patients with CH using VHA EHR data. Methods: The VHA EHR data were accessed from Fiscal Year 2008 to 2019. Patients with CH consisted of all patients with at least one outpatient visit containing a CH diagnosis code from the International Classification of Diseases (ICD)‐9 or ‐10. We extracted data on demographic features, incidence, and prevalence, as well as pain and psychiatric comorbidities. Results: Of the 1,524,960 distinct patients who presented for headache treatment in the VHA between Fiscal Year 2008–2019, 24,131 had at least one visit with a CH diagnosis. The 1‐year period prevalence of a CH diagnosis in the VHA ranges from 0.08% to 0.10% for women and 0.10% to 0.18% for men. A larger proportion of women versus men received a diagnosis of unspecified CH (59.6% [1412/2368] vs. 53.6% [11,663/21,763], p < 0.001). Most patients with CH had both comorbid headache and non‐headache pain diagnoses. Headache not‐otherwise‐specified was the most common comorbid headache disorder at 70.0% (16,885/24,131) and was more common in women (76.1%, 1801/2368) compared to men (69.3%, 15,084/21,763). Other common comorbidities included migraine, depression, tobacco use, and obstructive sleep apnea. Rates of suicidal ideation or attempt were almost 50% higher in women (5‐year proportion 9.4%, 222/2368) with CH compared to men (6.6%, 1433/21,763). Conclusions: To our knowledge this is the largest hospital system study of CH to date and reinforces several previous studies. Pain, mental health, and sleep disorders comorbidities are particularly prevalent in this group and were often more common in women compared to men with CH. Future work should examine gender and race stratified prevalence estimates within the VHA and other healthcare systems. Plain Language Summary: This study describes the epidemiology of cluster headache among all Veterans Health Administration (VHA) enrollees using electronic medical record data from the VHA. We found that during any given 1‐year period, between 0.08–0.10% of women and 0.10–0.18% of men in the VHA were treated for cluster headache. Many of these patients also had co‐occurring disorders including other headache disorders and depression, so more research is needed to find the best ways to treat these patients. [ABSTRACT FROM AUTHOR]

Objective Most pragmatic trials follow the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) criteria. The criteria specify unobtrusive measurement of participants' protocol adherence and practitioners' intervention fidelity but suggest no special monitoring strategies to assure trial integrity. We present experience with adherence/fidelity monitoring in the Pain Management Collaboratory (PMC) and provide recommendations for their monitoring in pragmatic trials to preserve inferences of treatment comparisons. Methods In November 2021, we surveyed 10 of 11 originally funded PMC pragmatic trials to determine the extent to which adherence and fidelity data were being monitored. Results Of the 10 PMC trials, 8 track adherence/fidelity. The electronic health record is the most frequent source for monitoring adherence (7/10) and fidelity (5/10). Most adherence data are used to monitor participant engagement with the trial intervention (4/10) and are reviewed by study teams (8/10) and often with a data and safety monitoring board (DSMB) (5/10). Half of the trials (5/10) reported using fidelity data for feedback/training; such data are not shared with a DSMB (0/10). Only 2 of 10 trials reported having prespecified guidance or rules around adherence/fidelity (eg, stopping rules or thresholds for corrective action, such as retraining). Conclusions As a best practice for pragmatic trials, we recommend early and regular adherence/fidelity monitoring to determine whether intervention delivery is as intended. We propose a 2-stage process with thresholds for intervening and triggers for conducting a formal futility analysis if adherence and fidelity are not maintained. The level of monitoring should be unobtrusive for both participants and those delivering the intervention; resulting data should be reviewed by an independent DSMB. [ABSTRACT FROM AUTHOR]

Objective This manuscript describes the uptake of the AIM-Back Pain Navigator Pathway (PNP) designed to encourage use of non-pharmacologic care options within the Veterans Health Administration (VHA). Design This manuscript describes the implementation of a telehealth intervention from one arm of a multisite, embedded, cluster-randomized pragmatic trial comparing the effectiveness of two novel clinical care pathways that provide access to non-pharmacologic care for Veterans with low back pain (LBP). Setting Ten VHA clinics Subjects 19 pain navigators, >200 primary care physicians, and over 1000 Veterans were involved in the PNP implementation Methods Data were generated within the VHA electronic health record (EHR) for the ongoing AIM-Back trial to describe PNP implementation for system-level findings in terms of number of visits, and type of care received Results Over a 3-year period, 9 of 10 clinics implemented the PNP within the context of the AIM-Back trial. The most frequent care recommended in the PNP included physical therapy, chiropractic, acupuncture, and yoga/tai chi. During follow-up at six-weeks, ∼50% of Veterans elected to receive a different care choice than what was initially prescribed. Notable variation across clinics was documented for PNP based on time to initiation of care and follow-up rates. Conclusions Implementation of the telehealth delivered PNP provides a nuanced understanding of the introduction of novel care programs within diverse clinical settings. These findings are most applicable to care programs that are delivered remotely and involve facilitation of existing care options. [ABSTRACT FROM AUTHOR]

The goal of this study was to describe the cohort of women prescribed PrEP at the Veterans Health Administration. We used a cross-sectional study of electronic health record data. We used descriptive statistics and calculated estimated average percent change by year of prescription. A total of 417 women were prescribed PrEP over the study period. The most substantial change over time in PrEP prescribing occurred among women aged 18–24, in Other race group, and in the Western US. Though PrEP prescribing increased since its approval, more research is needed to identify barriers and expand PrEP access for women Veterans. [ABSTRACT FROM AUTHOR]

Background: Decreasing suicide mortality has become an overarching goal for societies worldwide. Suicide registers and other monitoring systems are a valuable source of information that can be used for addressing the suicide phenomenon and evaluating preventative interventions. Aims: This scoping review provides an overview of literature published in the last decade that has focussed on the operations (functioning) and characteristics of suicide registers and other suicide monitoring systems. Methods: Four electronic databases were searched in 2020 for identifying published material from January 2010 to October 2020. The searches were updated in October 2023 to include material from 2020 to date. Grey literature through Google searches and mental health commissions websites and the reference lists of selected documents were also searched. Results: Twenty-five articles were included in this review. Nearly half the articles were from the United States, followed by Australia. Nine countries were identified as having used suicide registers or suicide-specific monitoring systems to inform suicide prevention. Monitoring mechanisms varied across the countries examined. No article provided evidence that definitively linked suicide registers or other monitoring systems for suicide with the prevention of suicide or reduction in suicide rates. However, a variety of benefits of suicide monitoring for preventative and public health interventions were identified. Conclusions: The number of nations with surveillance systems for suicide prevention is low. Further, there is a lack of consistency in the systematic collection, analysis and interpretation of suicide-related information across the countries examined. Efforts to establish high-quality suicide surveillance systems that can be accessed in a timely and easy manner are needed to inform tailored strategies for suicide prevention. [ABSTRACT FROM AUTHOR]

Objectives. To assess multilevel factors associated with variation in COVID-19 vaccination rates in a US network of community health centers. Methods. Using multilevel logistic regression with electronic health record data from ADVANCE (Accelerating Data Value Across a National Community Health Center Network; January 1, 2022–December 31, 2022), we assessed associations between health care delivery site–level (n = 1219) and patient-level (n = 1 864 007) characteristics and COVID-19 primary vaccine series uptake. Results. A total of 1 337 440 patients completed the COVID-19 primary vaccine series. Health care delivery site characteristics were significantly associated with lower series completion rates, including being located in non-Medicaid expansion states and isolated or rural communities and serving fewer patients. Patient characteristics associated with significantly lower likelihood of completing the vaccine series included being Black/African American or American Indian/Alaska Native (vs White), younger age, lower income, being uninsured or publicly insured (vs using private insurance), and having fewer visits. Conclusions. Both health care delivery site– and patient-level factors were significantly associated with lower COVID-19 vaccine uptake. Community health centers have been a critical resource for vaccination during the pandemic. (Am J Public Health. 2024;114(11):1242–1251. https://doi.org/10.2105/AJPH.2024.307773) [ABSTRACT FROM AUTHOR]

Background: Two-drug regimens (2DRs) have been introduced in recent years to potentially reduce antiretroviral therapy (ART) toxicities and drug-drug interactions while demonstrating comparable efficacy to three-drug regimens (3DRs) for people with HIV (PWH). The objective of this study was to compare the real-world effectiveness and durability of a single-tablet 2DR of dolutegravir/lamivudine (DTG/3TC) with that of commonly prescribed 3DRs in ART-experienced, virologically suppressed PWH during the first 24 months of DTG/3TC availability in the United States. Methods: Virologically suppressed (viral load [VL] < 200 copies/mL) adult PWH initiating DTG/3TC 2DR, bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), or a DTG-based 3DR between 01MAY2019 and 31OCT2020 were identified in the OPERA® cohort and followed through 30APR2021. Univariate Poisson regression (incidence rates) and marginal structural Cox proportional hazards models with inverse probability of treatment weights (hazard ratios) were used to quantify relationships between regimen type and confirmed virologic failure (2 consecutive VLs ≥ 200 copies/mL) or regimen discontinuation. Reasons for discontinuation were examined. Results: A total of 8,037 ART-experienced, virologically suppressed PWH met the inclusion criteria and switched to DTG/3TC (n = 1,450), BIC/FTC/TAF (n = 5,691), or a DTG-based 3DR (n = 896). Incidence rates of confirmed virologic failure were low for all groups, at 0.66 (DTG/3TC), 0.84 (BIC/FTC/TAF), and 1.78 (DTG 3DR) per 100 person-years (py). Compared to DTG/3TC, only the DTG 3DRs were associated with a statistically significant increased hazard of confirmed virologic failure (hazard ratio: 5.21, 95% confidence interval: 1.85, 14.67). Discontinuation rates per 100 py were highest in the DTG 3DR group (24.90), followed by the DTG/3TC group (17.69) and the BIC/FTC/TAF group (8.30). Regardless of regimen, discontinuations were infrequently attributed to effectiveness (VL ≥ 200 copies/mL; 4%) or tolerability (adverse diagnoses, side effects, or lab abnormalities; 6%). Conclusions: Among virologically suppressed PWH initiating a new regimen, few individuals experienced virologic failure in real-world clinical care. While rates of regimen discontinuation were high, most discontinuations could not be attributed to a lack of virologic control or poor tolerability. These findings suggest that DTG/3TC is an effective option for ART-experienced, virologically suppressed PWH. [ABSTRACT FROM AUTHOR]

Background Data on the true prevalence of respiratory syncytial virus (RSV) among medically attended acute respiratory illnesses (MAARI) has been limited by the lack of regular clinical testing of mild to moderate illnesses. Here we present a prospective evaluation of the epidemiology of RSV-associated MAARI across age groups and multimorbidity status over 3 seasons, which is informative in light of the recommendations for shared decision making for vaccination in older adults. Methods Ambulatory patients ≥6 months of age meeting a common MAARI case definition were prospectively enrolled in the Michigan Ford Influenza Vaccine Effectiveness (MFIVE) study, a subsite of the US Influenza Vaccine Effectiveness Network. All participants were tested by nasal-throat swab for RSV and influenza, including subtype, independently from clinician-directed testing. Participant illness characteristics and calculated multimorbidity-weighted index (MWI) were collected by in-person survey and electronic medical record review. Results Over 3 surveillance seasons (fall 2017 to spring 2020), 9.9% (n = 441) of 4442 participants had RSV detected. RSV-associated MAARI was more prevalent than influenza for participants 6 months to 4 years of age. Adults with RSV-MAARI had higher median MWI scores overall compared to influenza-MAARI and controls with neither virus (1.62, 0.40, and 0.64, respectively). Conclusions RSV is a significant, underrecognized cause of MAARI in both children and adults presenting for ambulatory care. Multimorbidity is an important contributor to RSV-associated MAARI in outpatient adults, providing information to support shared clinical decision making for vaccination. [ABSTRACT FROM AUTHOR]

In recent decades, the use of assisted reproductive technology (ART) has increased rapidly. To assess the relationship between ART and autism diagnosis, we linked California birth records from 2000 through 2016 with contemporaneous records from the National ART Surveillance System (NASS) and autism caseload records from California's Department of Developmental Services from 2000 through November 2019. All 95 149 birth records that were successfully linked to a NASS record, indicating an ART birth, were matched 1:1 using propensity scores to non-ART births. We calculated the hazard risk ratio for autism diagnosis and the proportions of the relationship between ART conception and autism diagnosis mediated by multiple birth pregnancy and related birth complications. The hazard risk ratio for autism diagnosis following ART compared with non-ART conception is 1.26 (95% CI, 1.17-1.35). Multiple birth, preterm birth, and cesarean delivery jointly mediate 77.9% of the relationship between ART conception and autism diagnosis. Thus, increased use of single embryo transfer in the United States to reduce multiple births and related birth complications may be a strategy to address the risk of autism diagnosis among ART-conceived children. [ABSTRACT FROM AUTHOR]

Little is known about spiritual care in small hospitals and critical access hospitals (CAHs), essential sources of health care in rural areas of the US. Using interview-administered surveys with spiritual care providers, we examined spiritual care services in 19 facilities, including seven small hospitals, nine CAHs, and three freestanding emergency departments, in one religiously-owned healthcare system. We identified four groups of facilities based on intensity/frequency of chaplain availability. A central finding was the variation in spiritual care services provided in these diverse facilities. Of the 16 hospitals in the sample, 11 of them (69%) offered spiritual care from professional chaplains at least three days per week. Support for staff was an important priority in all the facilities. Needs identified include virtual training and support for the spiritual care providers in these settings. Future research should replicate this study in a representative sample of hospitals that serve the rural US population. [ABSTRACT FROM AUTHOR]

Background and aims: Opioid use disorder (OUD) and opioid dependence lead to significant morbidity and mortality, yet treatment retention, crucial for the effectiveness of medications like buprenorphine‐naloxone, remains unpredictable. Our objective was to determine the predictability of 6‐month retention in buprenorphine‐naloxone treatment using electronic health record (EHR) data from diverse clinical settings and to identify key predictors. Design: This retrospective observational study developed and validated machine learning‐based clinical risk prediction models using EHR data. Setting and cases: Data were sourced from Stanford University's healthcare system and Holmusk's NeuroBlu database, reflecting a wide range of healthcare settings. The study analyzed 1800 Stanford and 7957 NeuroBlu treatment encounters from 2008 to 2023 and from 2003 to 2023, respectively. Measurements Predict continuous prescription of buprenorphine‐naloxone for at least 6 months, without a gap of more than 30 days. The performance of machine learning prediction models was assessed by area under receiver operating characteristic (ROC‐AUC) analysis as well as precision, recall and calibration. To further validate our approach's clinical applicability, we conducted two secondary analyses: a time‐to‐event analysis on a single site to estimate the duration of buprenorphine‐naloxone treatment continuity evaluated by the C‐index and a comparative evaluation against predictions made by three human clinical experts. Findings Attrition rates at 6 months were 58% (NeuroBlu) and 61% (Stanford). Prediction models trained and internally validated on NeuroBlu data achieved ROC‐AUCs up to 75.8 (95% confidence interval [CI] = 73.6–78.0). Addiction medicine specialists' predictions show a ROC‐AUC of 67.8 (95% CI = 50.4–85.2). Time‐to‐event analysis on Stanford data indicated a median treatment retention time of 65 days, with random survival forest model achieving an average C‐index of 65.9. The top predictor of treatment retention identified included the diagnosis of opioid dependence. Conclusions: US patients with opioid use disorder or opioid dependence treated with buprenorphine‐naloxone prescriptions appear to have a high (∼60%) treatment attrition by 6 months. Machine learning models trained on diverse electronic health record datasets appear to be able to predict treatment continuity with accuracy comparable to that of clinical experts. [ABSTRACT FROM AUTHOR]

In light of the Minamata Convention on Mercury and efforts to phase down dental amalgam use, tracking dental amalgam proportions across US Food and Drug Administration (FDA)–identified at-risk populations is of interest to optimize material selection aligned with patient needs. A retrospective observational study of Epic's Cosmos electronic health records data set was conducted to calculate the rates of dental amalgam restorations from 2017 through 2023 and stratified using the social vulnerability index (quartile 4 indicates the highest social vulnerability and quartile 1 indicates the lowest) and payer type (Medicare, Medicaid, self-pay, miscellaneous or other). The authors included the following FDA-identified at-risk populations: pregnant people, children younger than 6 years, people with preexisting neurologic conditions, and people with impaired kidney function (n = 1,897,976). The overall rate of dental amalgam restoration placements in the general population declined from 21.8% in 2017 to 4.1% in 2023. Dental amalgam restoration trends, according to social vulnerability index quartile and payer type, decreased consistently across all 4 evaluated populations. Of all the social vulnerability index quartiles, quartile 4, representing the most socially vulnerable group, had the smallest decrease in dental amalgam placement rates among the FDA-identified populations examined. The study results showed a decreasing trend in dental amalgam restorations from 2017 through 2023 among FDA-identified populations, consistent with the Minamata Convention on Mercury directive for a phasedown in dental amalgam use. Notwithstanding improvements, lingering disparities persist among the most vulnerable population. Even within the groups identified as most vulnerable to harm, more targeted interventions and strategies are required to improve treatment among the most socially vulnerable. [ABSTRACT FROM AUTHOR]

Background: Health care providers have a critical opportunity to mitigate the public health problem of suicide. Virtual patient simulations (VPS) allow providers to learn and practice evidence-based suicide prevention practices in a realistic and risk-free environment. The purpose of this study was to test whether receiving VPS training increases the likelihood that providers will engage in effective suicide safer care practices. Methods: Behavioral health and non-behavioral health providers (N = 19) at a Federally Qualified Health Center who work with patients at risk for suicide received the VPS training on risk assessment, safety planning, and motivation to engage in treatment. Providers' electronic health records were compared 6 months pre- and post-VPS training on their engagement in suicide safer care practices of screening, assessment, safety planning, and adding suicide ideation to the problem list. Results: Most behavioral health providers were already engaging in evidence-based suicide prevention care prior to the VPS training. Findings demonstrated the VPS training may impact the likelihood that non-behavioral health providers engage in suicide safer care practices. Conclusion: VPS training in evidence-based suicide prevention practices can optimize and elevate all health care providers' skills in suicide care regardless of role and responsibility, demonstrating the potential to directly impact patient outcomes. [ABSTRACT FROM AUTHOR]

Many individuals with serious mental illness are at high risk for hospitalization or death due to inadequate treatment of medical conditions or unhealthy behaviors. The authors describe demographic and clinical characteristics associated with increased risk in this population. Electronic data were obtained for individuals in treatment at a large Veterans' healthcare system who were at high risk according to a validated model. A random sample of these individuals was assessed in person. Multivariable regressions estimated the effect of numerous demographic, health, and clinical characteristics on risk. Emergency visits and hospitalizations were common. Greater risk was associated with being male, not married, and having more diagnoses. While risk varied by race, this effect was no longer significant after controlling for other factors. Health-related quality of life worsened with increasing risk. Routine data identify a large population of high-risk individuals who may benefit from outreach to provide healthcare services. [ABSTRACT FROM AUTHOR]

Background: Only 5–10% of emergency medical services (EMS) patients are children, and most pediatric encounters are low-acuity. EMS chart review has been used to identify adverse safety events (ASEs) in high-acuity and high-risk pediatric encounters. The objective of this work was to evaluate the frequency, type, and potential harm of ASEs in varied acuity pediatric EMS encounters. Methods: This cross-sectional study evaluated pediatric (ages 0–18 years) prehospital records from 15 EMS agencies among three states (Colorado, Connecticut, and Rhode Island) between November 2019 and October 2021. Research associates used a previously validated tool to analyze electronic EMS and hospital records. Adverse safety events were recorded in six care categories, grouped into four levels for analysis: assessment/diagnosis/clinical decision-making, procedures, medication administration (including O2), and fluid administration, and defined across five types of ASEs: Unintended injuries or consequences, Near misses, Suboptimal actions, Errors, and Management complications (UNSEMs). Type and frequency of ASEs in each category were rated in three harm severities: Harm Unlikely, Mild/Temporary, or Permanent/Severe. Three physicians verified ASEs determined by research associates. Frequency of ASEs and harm likelihood are reported. Results: Records for 508 EMS patients were reviewed, with 63 (12.4%) transported using lights and sirens. At least one clinical intervention beyond assessment/diagnosis/clinical decision-making was documented for 183 (36.1%, 95% CI: 31.8, 40.4) patients. A total of 162 ASEs were identified for 112 patients (22.1%, 95% CI: 18.5, 25.7). Suboptimal actions were the most frequent UNSEM (n = 66, 40.7%; 95% CI: 33.1, 48.3). For ASEs, (n = 162), the most frequent associations were with procedures 39.5% (95% CI: 32.0, 47.0) or assessment/diagnosis/clinical decision making, 32.1%, (95% CI: 24.9, 39.3). Among care categories, fluid administration was associated with significantly more UNSEMs (58.1%, 95% CI:53.8, 62.4). Most ASEs were determined to be 'Harm Unlikely' 62.4% (95% CI: 54.4, 70.4), with assessment/diagnosis/clinical decision making having significantly fewer ASEs with documented harm (22.4%, 95% CI: 10.7, 34.1) compared to other care categories. Conclusion: Over 20% of pediatric EMS encounters had an identified ASE, and most were unlikely to cause harm. Most frequent ASEs were likely to be associated with procedures and assessment/diagnosis/clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: The use of electronic intake forms within the electronic health record (EHR) is an emerging method for routinely collecting patient-reported outcomes (PRO). However, few studies have evaluated experiences/perspectives toward electronic forms among outpatients receiving care within Integrative Health and Medicine (IHM) clinics. The study purpose was to understand patients' perspectives of electronic intake and PRO forms in the outpatient IHM setting. Methods: Electronic intake (e.g., treatment expectations, medical history, chief complaints, prior experience with integrative modalities) and PRO forms (i.e., Patient Reported Outcome Measurement Information System [PROMIS]-29, Perceived Stress Scale 4, Oswestry Disability Index) were designed in collaboration with clinic leadership and the Information Technology team. Semi-structured interviews were used to gather perspectives of the functionality and acceptability of the forms among outpatients receiving care at the IHM center. Interviews were coded to describe themes regarding perceptions and suggestions for improvement. Results: Qualitative interviews were completed with 10 participants (median age 51 years, 70% female, 30% Black/African American). Participants considered electronic intake and PRO forms as relevant to their health concerns, valuable for conveying important health information to providers, and easy to navigate. Suggested changes to the intake form included adding relevant open-ended questions, save and print functions, and examples and definitions to prompt responses. Conclusion: Participants felt the electronic format was a feasible and acceptable method of collecting patient information and PROs. Future goals are to implement the revised forms in a common EHR to patients receiving care at multiple IHM clinics across the United States. [ABSTRACT FROM AUTHOR]

Personal and family history of suicidal thoughts and behaviors (PSH and FSH, respectively) are significant risk factors associated with suicides. Research is limited in automatic identification of such data from clinical notes in Electronic Health Records. This study developed deep learning (DL) tools utilizing transformer models (Bio_ClinicalBERT and GatorTron) to detect PSH and FSH in clinical notes derived from three academic medical centers, and compared their performance with a rule-based natural language processing tool. For detecting PSH, the rule-based approach obtained an F1-score of 0.75 ± 0.07, while the Bio_ClinicalBERT and GatorTron DL tools scored 0.83 ± 0.09 and 0.84 ± 0.07, respectively. For detecting FSH, the rule-based approach achieved an F1-score of 0.69 ± 0.11, compared to 0.89 ± 0.10 for Bio_ClinicalBERT and 0.92 ± 0.07 for GatorTron. Across sites, the DL tools identified more than 80% of patients at elevated risk for suicide who remain undiagnosed and untreated. [ABSTRACT FROM AUTHOR]

Background: Research on Qi Gong (QG) supports promising health benefits. Both interest and use of QG in U.S. adults has increased over the past decade. Shared Medical Appointments (SMAs) are a novel, cost-effective, and time efficient health care delivery approach associated with patient and clinician satisfaction. Objectives: A telehealth delivered QG SMA was pilot tested among a diverse demographic population within an integrative medicine practice at an academic medical center to assess feasibility and acceptability. Methods: This was a feasibility/acceptability pilot study conducted at a large New York City academic medical center's Integrative Health and Wellness center from January to July 2023. A QG instructor-acupuncturist and an integrative medicine physician-acupuncturist co-led 3 separate series (5 Element QG, Eight-Section Brocade, and Joint-Mobilizing/Sinew Strengthening exercises) of weekly 30-45-minute sessions of QG SMA on a weekday afternoon via telemedicine. The first session included an overview of QG and Traditional Chinese Medicine (TCM) research while follow-up sessions included a check-in, didactic demonstration followed by QG practice, and a debrief to answer questions. Video links were provided for home practice. Surveys assessing satisfaction were sent pre/post series. Results: 18 sessions of QG SMA were offered over a 6-month period. A total of 40 unique participants from diverse demographics (gender, race/ethnicity, primary residence) attended, for a total of 197 virtual visits. A total of 20 participants enrolled in Series 1 (8 weeks), 23 enrolled in Series 2 (7 weeks), and 16 enrolled in Series 3 (3cweeks). For each session, group attendance ranged from 8-16 with an average of 11 participants. Attendance was high with participants attending an average of 72% of the sessions. Participants attended 88% of the first 8-week series, 54% of the second 7-week series, and 60% of the third series. Participant interest persisted over time with 35% of the 40 participants attending more than 1 series, and 12.5% attending all 3 series. Participants' diagnoses and health symptoms included pain (62.5%), cancer (45%) anxiety/depression (40%), cardiovascular disease (CVD) or metabolic conditions (32.5%), gastrointestinal (GI) symptoms/diagnoses (27.5%), stress (22.5%), osteopenia/osteoporosis (17.5%), and insomnia (17.5%). Pre-series [n = 27] participants endorsed symptoms including sleep disturbances, fatigue, pain, stress, weakness, GI symptoms, psychological symptoms, hot flashes, and brain fog. Post-program survey results [n = 11] suggested QG program addressed common symptoms including fatigue, insomnia, anxiety, stress, pain, weakness, and gastrointestinal symptoms. Participants reported incorporating QG, breathing techniques, and meditation into their daily routine. All participants reported their goals were met and that they would recommend the program to others. Regarding delivery preferences, 73% preferred telehealth, 27% hybrid, and none preferred in-person. Participants appreciated the format, new skills, community, and instructors. Conclusion: While the Virtual QG SMA series provided to diverse demographic population with mixed diagnoses is feasible, acceptable, and shows promising positive impact in this pilot, caution in interpreting the data is advised due to the low response rate of the post-program survey. Robust studies with longer follow-ups are recommended. [ABSTRACT FROM AUTHOR]

Introduction: Adrenoleukodystrophy (ALD) patients exhibit three primary clinical phenotypes: primary adrenal insufficiency, adrenomyeloneuropathy, and cerebral demyelination due to the accumulation of saturated very long-chain fatty acids in the adrenal cortex and central nervous system white matter and axons. We investigated the diagnosis of adrenal insufficiency (AI) and the use of mineralocorticoid treatment in male ALD patients. Methods: A retrospective chart review of electronic medical records was conducted for all ALD patients at a single institution between January 1, 2011, and December 6, 2021. Results: Among the 437 ALD patients, 82% were male and 18% were female. Of the male ALD patients, 60% (213 out of 358) had a diagnosis of AI, and 39% (84 out of 213) of those with AI were prescribed mineralocorticoid replacement therapy. Conclusion: AI is highly prevalent among ALD patients, with approximately 40% of those with a diagnosis of AI undergoing mineralocorticoid replacement therapy. Further research is warranted to delineate the characteristics of patients predisposed to developing mineralocorticoid deficiency within the context of ALD and AI. [ABSTRACT FROM AUTHOR]

Older age is linked with poorer self-care in the chronic kidney disease (CKD) setting. Informal health supporters (family members and friends) are critical sources of self-care support, but much remains unclear about the characteristics and implications of received support among this patient population. We examined how received self-care support (amount and type) related to positive (CKD management self-efficacy) and negative (depressive symptoms) psychosocial health correlates of self-care in 536 adults aged 65 years and older with non-dialysis-dependent CKD. Participants who received a greater amount of support reported less CKD management self-efficacy and more depressive symptoms. We did not observe associations between self-care support type and psychosocial health. Further research is needed to clarify our findings, especially studies that investigate causality and contextual influences. [ABSTRACT FROM AUTHOR]

Introduction: Patients with long bone fractures often present to the emergency department (ED) with severe pain and are typically treated with opioid and non-opioid analgesics. Historical data reveals racial disparities in analgesic administration, with White patients more likely to receive analgesics. With the diversifying US population, health equity is increasingly crucial. In this study we aimed to evaluate the early administration of opioid and non-opioid analgesia among Black and White patients with long bone and femur fractures in EDs over different time frames using a substantial database. Methods: We retrospectively extracted Information from 57 US healthcare organizations within the TriNetX database, encompassing 95 million patients. The ED records from 2003–2023 were subjected to propensity score matching for age and gender. We focused on four cohorts: two comprising Black and White patients diagnosed with long bone fractures, and another two with Black and White patients diagnosed solely with femur fractures. We examined analgesic administration rates over 20 years (2003–2023) at five-year intervals (2003–2008; 2008–2013; 2013–2018; 2018–2023), and further analyzed the rates for the most recent two-year period (2021–2023). Results: Disparities in analgesic administration significantly diminished over the study period. For patients with long bone fractures (1,095,052), the opioid administration gap narrowed from 6.3% to 1.1%, while non-opioid administration disparities reduced from 4.4% to 0.3%. Similar trends were noted for femur fractures (265,181). By 2021–2023, no significant differences in analgesic administration were observed between racial groups. Conclusion: Over the past 20 years, the gap in early administration of opioid and non-opioid analgesics for Black and White patients presenting with long bone fractures or femur fractures has been disappearing. [ABSTRACT FROM AUTHOR]

The article discusses research which examined how nursing practices may have impacted central line-associated bloodstream infection (CLABSI) rates among intensive care unit (ICU) patients with COVID-19 during the first few months of the pandemic. Cited are the relationship between ICU COVID-19 patients with those with and without CLABSI, in terms of adherence, ICU incident reporting data on infusion and infusion medication errors and near misses, and study implications for nurse leaders.

There are >390 000 children in foster care (ie, in the custody of a county or state children's services agency and placed with temporary caregivers, including licensed foster caregivers, approved kinship caregivers, or in congregate or independent living situations with staff serving as caregivers) in the United States. Children in foster care face many health challenges compared with the general population, including increased rates of substance use and substance use disorders. Standardized screening, through Screening, Brief Intervention, and Referral to Treatment (SBIRT), is an evidence-based approach that assesses current substance use and provides the appropriate level of treatment. For standardized screening to be effective, substance use disclosure is critical. Adolescents report preferring self-administered (paper, digital) substance use screeners and response patterns suggest adolescents disclose substance use reliably. Electronic health record advances have made tablet-based screening efficient and cost-effective. However, before accepting tablet-based standardized substance use screening as a standard of care among youth in foster care, it is important to describe the validity of standardized substance use screening in a foster care clinic and factors associated with patterns of responding. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer screening rates are very low despite a level B recommendation from the United States Preventive Services Task Force since 2013 and clear evidence that lung cancer screening reduces mortality. The Center for Medicare and Medicaid Services requires shared decision-making (SDM) for lung cancer screening reimbursement. The objective of this study was to determine the effect of an SDM intervention on lung cancer screening in primary care. Methods: The study design was a single-arm clinical trial design. The intervention included phone contact outside of a primary care visit and the use of the Decision Counseling Program ®, an online interactive decision aid focused on determining the factors which influence patients to screen or not screen, prioritizing those factors, and determining a decision preference score. The primary outcome was the completion of low-dose computed tomography scan (LDCT) 1 year after the SDM session compared in participants versus nonparticipants. Results: From six practices, there were 1359 potentially eligible patients in electronic medical record data, and 336 were reached to assess eligibility criteria. A total of 80 patients consented to be in the study, 64 completed a decision counseling session and 16 did not complete a session. Among the 64 people who agreed to have decision counseling, 45% had LDCT, higher than typically seen in routine clinical practice. Although not a comparable group, among the 16 people who declined decision counseling, none had LDCT. Conclusions: Decision counseling is a promising intervention that might support SDM in the context of improving uptake of lung cancer screening in primary care. However, further, larger studies are needed. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) refer to social and economic factors that influence a patient's health status. The purpose of this study was to investigate the impact of SDOH on preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores and postoperative resource utilization following primary shoulder arthroplasty (SA). This retrospective chart review evaluated data from all patients who underwent primary SA (including anatomic, reverse, and hemiarthroplasty) at a single health system between May 2020 and May 2022. Patients without at least 6-month postoperative PROMIS questionnaires and those undergoing revision surgeries were excluded. The electronic medical record was used to identify SDOH for each patient, and PROMIS scores for Upper Extremity (PROMIS-UE), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed electronically at respective preoperative and postoperative visits. Univariate analysis using independent 2-group t -tests and Chi-squared tests were used to analyze the mean difference between patient groups based on SDOH. Multivariate linear regressions were performed with all predictors used in the univariate model using the least squares method. The study included 248 patients who underwent SA, with a mean age of 67.9 years. Caucasian patients were over-represented in the highest quartile of median household income (MHI) compared to Black patients (35.1% vs. 17.2%) who were over-represented in the lowest MHI quartile (37.9% vs. 8.3%). At 6-month postoperative, black patients had significantly lower UE (33.8 ± 6.2 vs. 38.1 ± 9.0; P =.03) and greater PI scores (59.1 ± 6.1 vs. 55.6 ± 8.6; P =.145) compared to Caucasian patients. Similarly, at 6-month follow-up, the lowest MHI quartile had lower UE (33.8 ± 7.7 vs. 39.6 ± 8.8; P =.01) and higher PI scores (58.7 ± 6.5 vs. 54.3 ± 8.2; P <.01) compared to the highest MHI quartile, and females demonstrated lower UE (36.3 ± 7.9 vs. 38.6 ± 9.8; P =.04) and higher D scores (46.2 ± 9.1 vs. 42.0 ± 8.6; P =.046) compared to males. Government/public insurance demonstrated lower UE (36.8 ± 8.0 vs. 39.8 ± 10.4; P =.03) and higher D scores (45.9 ± 9.2 vs. 40.6 ± 7.6; P =.03) compared to private insurance. At 12-month follow-up, females demonstrated lower UE scores compared to males (36.0 ± 10.2 vs. 40.1 ± 11.3; P =.03). Black patients harbored lower UE, PI, and D scores compared to Caucasian patients, although not statistically significant. Several socioeconomic factors such as race, gender, and insurance status are associated with differential outcomes after SA. Patients who are Black, female, current smokers, and from the lowest income quartile are associated with inferior PROMIS function, pain, and depression outcomes following SA. [ABSTRACT FROM AUTHOR]

PURPOSE: Routine collection of sexual orientation (SO) and gender identity (GI; collectively SOGI) in cancer clinics advances cancer care equity. METHODS: In 2022, NCI Community Oncology Research Program (NCORP) practice groups were asked about routine collection of SOGI data in the electronic health record. The proportions of practice groups reporting collection of SO and/or GI data were calculated, and practice group characteristics were assessed for associations. RESULTS: Of 271 practice groups nationwide, 42% (n = 112) collect SO data, 58% (n = 157) collect GI data, and 35% (n = 96) collect both. In multivariate analyses, SO data collection was associated with practice groups having minority outreach staff (odds ratio [OR], 2.07 [95% CI, 1.12 to 3.81]; P =.02); GI data collection was associated with practice groups located in the Northeastern United States (OR, 2.08 [95% CI, 0.73 to 5.91]; P =.045), and those with a higher proportion of new patients who were White (OR, 1.02 [95% CI, 1.01 to 1.04]; P <.001). Practice groups in the South were least likely to collect SOGI data (OR, 0.49 [95% CI, 0.26 to 0.94]; P =.004). There were no statistically significant differences in SO and/or GI collection on the basis of the practice group's proportion of Medicaid/Medicare patients, number of new patients with cancer per year, or practice ownership. CONCLUSION: Slightly over one third of NCORP practice groups report routinely collecting SOGI data. There are regional differences in data collection, underscoring the need to craft targeted, region-specific interventions focused on boosting the capture and recording of SOGI data in an affirming manner. [ABSTRACT FROM AUTHOR]

Objective The Food and Drug Administration approved the MRI-compatible wireless SCOUT localization system in April 2022. The purpose of this study was to evaluate feasibility of SCOUT localization under MRI guidance. We present our initial experience adopting MRI-guided SCOUT localization and compare it to MRI-guided wire localization. Methods Electronic medical records and imaging were retrospectively reviewed for all patients who underwent MRI-guided SCOUT or wire localization at our institution between October 2022 and July 2023. Statistical analysis was performed using 2-sample proportion and Wilcoxon rank-sum tests. Results There were 14 MRI-guided SCOUT and 23 MRI-guided wire localization cases during the study period. All SCOUTs were placed without complication and were considered to be in adequate proximity to the target. There was no significant difference in complication rate (P = .25) or days lapsed from MRI-detected abnormality to surgery (P = .82) between SCOUT and wire cases. SCOUT was placed at time of biopsy for 71% (10/14) of cases. 57% (8/14) of SCOUT cases were used for breast conservation surgery (BCS) compared to 100% (23/23) of wire cases (P <.01), with all 6 SCOUTs not used for BCS placed at time of biopsy. Conclusion MRI-guided SCOUT localization is feasible and offers an alternative to MRI-guided wire localization, with no SCOUT complications reported. SCOUT placement at time of biopsy obviates the need for an additional procedure, but predicting appropriateness is challenging, with 60% (6/10) of SCOUTs placed at time of MRI-guided biopsy not used for subsequent localization surgery. [ABSTRACT FROM AUTHOR]

Introduction: Niraparib first-line maintenance (1LM) therapy has demonstrated clinical benefit for patients with ovarian cancer (OC) in clinical trial and real-world settings, but data on factors associated with real-world patient outcomes remain limited. This analysis identified patient characteristics associated with time to next treatment (TTNT), a proxy for real-world progression-free survival, in patients with OC treated with 1LM niraparib monotherapy. Methods: This retrospective observational study used a USA nationwide electronic health record-derived deidentified database and included adult patients diagnosed with OC who initiated 1LM niraparib monotherapy after first-line platinum-based chemotherapy. Patients were followed until the earliest occurrence of last clinical activity, death, or end of study period. TTNT was measured from 1LM niraparib initiation to the start of second-line treatment or death. Cox proportional hazards models assessed univariable and multivariable associations between baseline characteristics and TTNT. Results: Of 7872 patients diagnosed with OC, 526 met the eligibility criteria and were included in this analysis. Median (IQR) duration of follow-up was 14.1 (7.4–23.6) months. In univariable analyses, age, BRCA/homologous recombination deficiency (HRD) status, socioeconomic status, stage at initial diagnosis, cytoreductive surgery type, and residual disease status were significantly associated with observed TTNT and were introduced into the multivariable model with other clinically relevant variables. In the multivariable analysis, BRCA/HRD status, cytoreductive surgery type, and residual disease status were significantly associated with observed TTNT after covariate adjustment. Conversely, age, Eastern Cooperative Oncology Group performance status, disease stage, niraparib starting dose status, and first-line bevacizumab use were not associated with observed TTNT. Conclusion: This real-world, retrospective, observational analysis offers valuable insights on prognostic factors associated with TTNT in patients with OC treated with 1LM niraparib monotherapy after first-line platinum-based chemotherapy. Future studies are needed to examine how additional patient characteristics associated with clinical outcomes may guide treatment decisions and improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Two‐thirds of pregnancy‐related deaths occur from 1 day to 1 year after birth, and medical complications frequently occur after birth. Postpartum health concerns are often urgent, requiring timely medical care, which may contribute to a reliance on acute care. One approach to improving postpartum health is to investigate birthing parents' accounts of acute care use in the months after birth, which is what we did in this study. Methods: This mixed‐methods study included questionnaire responses, semi‐structured interviews, and chart review of 18 English‐speaking individuals who used acute care in the 90 days after birth in the southeastern United States. Interviews were conducted remotely, recorded, and professionally transcribed. Qualitative data were inductively coded to iteratively develop categories and themes with respect to contributors and barriers to postpartum acute care use. Results: Birthing parents engaged in complex decision‐making processes to decide where and when to seek postpartum acute care in response to their urgent health concerns. Many described fear and uncertainty about their postpartum health. Most participants contacted a healthcare practitioner before using acute care, followed their guidance, and were treated or otherwise reassured at the acute care visit. Discussion: These findings suggest multilevel opportunities for strengthening healthcare systems, including better‐preparing individuals for the postpartum period and structuring care to accommodate birthing parents and include their support systems. The insights from this study can inform multilevel strategies for strengthening healthcare so that birthing parents are safe and well postpartum. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between maternal cervical cancer (CC) screening status and child human papillomavirus (HPV) vaccination uptake. To understand if child sex or social deprivation index (SDI) modify this association. Methods: We used a national cohort of children linked to at least one parent using electronic health record (EHR) data from a network of community health centers across the United States. We used SDI scores and child sex as moderating variables. We performed the analysis (1) for the whole sample (with SDI and child sex added as covariates), (2) stratified by SDI quartile (with child sex added as a covariate), and (3) stratified by SDI quartile and child sex, to examine whether associations vary by SDI quartile and by child sex. Results: N = 52,919 linked mother–child pairs. Mother's receipt of CC screening was positively associated with the linked child's odds of receiving HPV vaccination [adjusted odds ratio (AOR) 1.39, 95% confidence interval (CI) 1.32, 1.47]. Neither sex or SDI modified this association. There were no significant differences in odds of HPV vaccination in children between SDI quartiles or between male and female children. Conclusions for Practice: An effective way to improve rates of HPV vaccination among children and adolescents may be to target attention towards increasing CC screening rates among mothers. Further, focusing resources and efforts on CC screenings and care of both mothers and their children may be more worthwhile than isolated efforts targeting HPV vaccination for children and adolescents. Significance: What is already known on this subject?: Human papillomavirus (HPV) vaccination reduces risk of cervical cancer. HPV vaccination rates are lower among children than other vaccination rates. Mothers' healthcare visits are associated with their child's healthcare visits. What does this study add?: Children of mothers up-to-date on cervical cancer screening have higher odds of HPV vaccination than children of mothers who have not received recommended cervical cancer screenings. These findings suggest that interventions that focus on cervical cancer screenings and care of both mothers and their children may help to increase HPV rates among children. Multigenerational approaches to cervical cancer prevention may be an important part of the elimination of this cancer. [ABSTRACT FROM AUTHOR]

Security breaches of the U.S. healthcare system's electronic health records (EHRs) present a critical challenge in healthcare. Current literature indicates that healthcare professionals' poor cybersecurity behaviors are the leading cause of data breaches in the U.S. healthcare system. Using technology threat avoidance theory, this non-experimental quantitative correlational study aimed to determine to what extent U.S. healthcare professionals' perceived susceptibility, perceived severity, safeguard effectiveness, safeguard cost, self-efficacy, and threat perceptions of EHRs security breaches influenced their threat avoidance motivations and threat avoidance behaviors while using EHRs. The research findings indicated that perceived severity and perceived susceptibility significantly correlate with a user's threat perception. The cost of safeguarding measures and the user's self-efficacy were predictors of healthcare professionals' threat avoidance motivation. Perceived threat and safeguarding effectiveness were not proven to affect avoidance motivation significantly. Avoidance motivation strongly predicted healthcare professionals' EHRs security breach threat avoidance behavior. [ABSTRACT FROM AUTHOR]

Purpose Results of the 2023 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. Methods Pharmacy directors at 1,497 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online using Qualtrics. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA's hospital database. Results The response rate was 21.6%. Inpatient pharmacists independently prescribe medications in 26.7% of hospitals. Advanced analytics are used in 5.7% of hospitals. Basic analytics are used in 87.3% of hospitals. Pharmacists work in ambulatory or primary care clinics in 54.2% of hospitals operating outpatient clinics. Most hospitals (86.1%) use automated dispensing cabinets as the primary method of maintenance dose distribution. Machine-readable coding is used in 73.6% of hospitals to verify doses during dispensing in the pharmacy. Autoverification functionality in the electronic health record system is used in 73.4% of hospitals. Most hospitals report some integration of pharmacy services to optimize patient care transitions (60.0%), while 24.9% report no integration. Traditional technician activities still predominate, but more advanced roles are emerging. Technologies to assist sterile product preparation are used in 62.8% of hospitals. Conclusion Drug distribution continues to trend toward decentralized models with medications available closer to patients. Technologies are enabling this transition to occur without a significant negative impact on patient safety. The pharmacy workforce is stable, and more advanced responsibilities are being assigned to pharmacy technicians, enabling pharmacists to increase their clinical role. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to report clinical outcomes of patients with vaginal melanoma (VaM) or vulvar melanoma (VuM) who were treated with immune checkpoint inhibitors (ICI) and discuss the development of immune‐related adverse events (irAE). Materials and Methods. This is a retrospective case series of patients diagnosed with VaM or VuM between July 2011 and September 2022 at the University of Virginia, Emily Couric Clinical Cancer Center. Patient demographics, disease characteristics, treatment outcomes, and adverse events were abstracted. The primary outcome was incidence of irAE. Results. Eight patients were included in this study, four with VaM and four with VuM. Most (n = 6) had local or regional disease at first presentation, and 25% (n = 2) presented with distant metastasis. All patients received a CTLA‐4 inhibitor and 75% (n = 6) received PD‐1 inhibitor alone or in combination with a CTLA‐4 inhibitor. Most (75%, n = 6) patients experienced irAE. Of those who had irAE, 83% (n = 5) required therapy interruption or discontinuation. Most (66%, n = 4) underwent ICI rechallenge of which 75% (n = 3) experienced subsequent irAE. Of all patients in the series, 75% of patients (n = 6) had partial or complete response to ICI. Conclusion. This series is the first to detail incidence of irAEs and ICI rechallenges in vulvovaginal melanoma. Our findings indicate that while ICIs are effective, their use is associated with significant irAE development. Rechallenge of ICI after irAE is feasible but associated with risk of recurrent/new irAE. Further studies are needed to better quantify this risk. [ABSTRACT FROM AUTHOR]

Background: Opt2Move is a theory-guided moderate and vigorous physical activity (MVPA) promotion trial that uses multiphase optimization strategy (MOST) methodology to evaluate the individual and combined effects of four intervention components in a full factorial experiment among young adult cancer survivors (YACS; N = 304). All participants will receive the core mHealth MVPA intervention, which includes a Fitbit and standard self-monitoring Opt2Move smartphone application. YACS will be randomized to one of 16 conditions to receive between zero and four additional components each with two levels (yes v. no): E-Coach, buddy, general mindfulness, and MVPA-specific mindfulness. Objective: The primary aim is to determine the individual and combined effects of the components on MVPA post-intervention (12-weeks) and at 24-week follow-up. The secondary aim is to examine how changes in MVPA are associated with patient-reported outcomes, light-intensity activity, sedentary time, and sleep duration and quality. Potential mediators and moderators of component effects will also be examined. Results: Results will support the selection of a package of intervention components optimized to maximize MVPA to be tested in a randomized controlled trial. Conclusion: Opt2Move represents the first systematic effort to use MOST to design an optimized, scalable mHealth MVPA intervention for YACS and will lead to an improved understanding of how to effectively change YACS' MVPA and ultimately, improve health and disease outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Superior vena cava (SVC) syndrome is a constellation of symptoms that results from partial or complete SVC obstruction. Endovascular SVC stenting is an effective treatment for SVC syndrome with rapid clinical efficacy and low risk of complications. In this study, we assess the technical and clinical outcomes of a cohort of patients with SVC syndrome treated with the AbreTM self-expanding venous stent (Medtronic, Inc, Minneapolis, MN, USA). Methods: An institutional database was used to retrospectively identify patients with SVC syndrome treated with AbreTM venous self-expanding stent placement between 2021-2023. Patient demographic data, technical outcomes, treatment effectiveness, and adverse events were obtained from the electronic medical record. Nineteen patients (mean age 58.6) were included in the study. Thirteen interventions were performed for malignant compression of the SVC, 5 for central venous catheter-related SVC stenosis, and 1 for HD fistula-related SVC stenosis refractory to angioplasty. Results: Primary patency was achieved in 93% of patients (17/19). Two patients (7%) required re-intervention with thrombolysis and angioplasty within 30 days post-stenting. Mean duration of clinical and imaging follow-up were 228.7 ± 52.7 and 258.7 ± 62.1 days, respectively. All patients with clinical follow-up experienced significant improvement in clinical symptoms post-intervention. No stent related complications were identified post-intervention. Conclusions: Treatment of SVC syndrome with the AbreTM self-expanding venous stent has high rates of technical and clinical success. No complications related to stent placement were identified in this study. [ABSTRACT FROM AUTHOR]

Summary: Background: Anti‐obesity medications (AOMs) are promising lifestyle modification (LSM) adjuncts for obesity treatment, and phentermine is commonly prescribed in paediatric weight management clinics. Determining 'real‐world' AOM effectiveness and characteristics predicting response is important. Objectives: We sought to describe phentermine plus LSM effectiveness and identify baseline characteristics predicting response. Methods: This was a retrospective cohort study among youth seen in a US academic‐based weight management clinic from 2012 to 2020. Baseline characteristics (e.g., body mass index (BMI), liver transaminases, eating‐related behaviours) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, %BMI change, weight) were determined through electronic health records and intake surveys. Results: Among 91 youth prescribed phentermine plus LSM over 8 years (mean %BMIp95 150%), %BMIp95 was statistically significantly reduced at 1.5, 3, 6 and 12 months (peak reduction 10.9 percentage points at 6 months; p < 0.001). Considering multiple comparisons, the presence of baseline elevated alanine aminotransferase was associated with statistically significant smaller 1.5‐month %BMIp95 reductions (p = 0.001) and higher food responsiveness with smaller 3‐ (p = 0.001) and 6‐month (p < 0.001) reductions. Conclusions: Phentermine plus LSM reduced %BMIp95 among youth in a weight management clinic, and baseline characteristics may help determine those more or less likely to respond. Prospective studies are needed to further characterize effectiveness and confirm response predictors. [ABSTRACT FROM AUTHOR]

Background: The United States faces a growing challenge with over 6.5 million people living with dementia (PLwD). PLwD and their caregivers struggle with cognitive, functional, behavioral, and psychosocial issues. As dementia care shifts to home settings, caregivers receive inadequate support but bear increasing responsibilities, leading to higher healthcare costs. In response, the Centers for Medicare & Medicaid Services (CMS) introduced the Guiding an Improving Dementia Experience (GUIDE) Model. The study explores the real‐world implementation of the Cedars‐Sinai C.A.R.E.S. Program, a pragmatic dementia care model, detailing its recruitment process and initial outcomes. Methods: The Cedars‐Sinai C.A.R.E.S. Program was integrated into the Epic electronic health record system and focused on proactive patient identification, engagement, interdisciplinary collaboration, care transitions, and ongoing care management. Eligible patients with a dementia diagnosis were identified through electronic health record and invited to join the program. Nurse practitioners with specialized training in dementia care performed comprehensive assessments using the CEDARS‐6 tool, leading to personalized care plans developed in consultation with primary care providers. Patients benefited from a multidisciplinary team and support from care navigators. Results: Of the 781 eligible patients identified, 431 were enrolled in the C.A.R.E.S. Program. Enrollees were racially diverse, with lower caregiver strain and patient behavioral and psychological symptoms of dementia (BPSD) severity compared to other programs dementia care programs. Healthcare utilization, including hospitalizations, emergency department (ED) admissions, and urgent care visits showed a downward trend over time. Completion of advanced directives and Physician Order of Life‐Sustaining Treatment (POLST) increased after enrollment. Conclusion: The Cedars‐Sinai C.A.R.E.S. Program offers a promising approach to dementia care. Its real‐world implementation demonstrates the feasibility of enrolling a diverse population and achieving positive outcomes for PLwD and their caregivers, supporting the goals of national dementia care initiatives. [ABSTRACT FROM AUTHOR]

Background: High-quality sleep is important for optimal patient recovery. Sleep deprivation during hospitalization may lead to poor patient outcomes. Objective: To examine whether implementation of a sleep promotion bundle in the intensive care unit affects rates of delirium and agitation, restraint use, and length of stay. Methods: An evidence-based sleep promotion bundle was developed and implemented in 2 intensive care units in a 1025-bed level I trauma teaching hospital. Deidentified data from the electronic health record were obtained for patients hospitalized before and during the intervention. Data included scores on the Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation-Sedation Scale, and Glasgow Coma Scale; restraint use; and hospital and intensive care unit length of stay. Results: A total of 137 patients during the preintervention period and 149 patients during the intervention period were hospitalized in the intensive care units and met inclusion criteria. A 9-percentage-point decrease in the incidence of delirium from before to during the intervention was found, although it was not statistically significant (P =.07). Significant reductions were found in both intensive care unit (P =.04) and hospital (P =.03) length of stay. A significant decrease was found in Richmond Agitation-Sedation Scale high scores for patients requiring mechanical ventilation (P =.03). No significant differences were found in Richmond Agitation-Sedation Scale low scores, Glasgow Coma Scale scores, or restraint use. Conclusions: Critical care nurses are in an optimal position to implement evidence-based sleep promotion measures. Further research on sleep promotion bundles is needed. [ABSTRACT FROM AUTHOR]

Even though a well-functioning primary care system is widely acknowledged as critical to population health, the number of primary care physicians (PCPs) practicing in the United States has steadily declined, and PCPs are in short supply. The reasons are multiple and include inadequate income relative to other specialties, excessive administrative demands on PCPs and the lack of respect given to primary care specialties during medical school and residency. Advanced practice nurses can augment the services of primary care physicians but cannot substitute for them. To change this situation, we need action on several fronts. Medical schools should give preference to students who are more likely to enter the primary care specialties. The income gap between primary care and other specialties should be narrowed. The administrative load placed on PCPs, including cumbersome electronic medical records, must be lessened. Insurers, including Medicare and Medicaid, must provide the resources to allow primary care physicians to act as leaders of multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Aim: This study examines the intricate language and communication patterns of nurse‐to‐nurse handoffs across three units with varying patient acuity levels and nurse–patient ratios, seeking to identify linguistic factors that may affect the quality of information transfer and patient outcomes. Design: A mixed‐methods cross‐sectional design. Methods: This study used the Nurse‐to‐Nurse Transition of Care Communication Model to explore the content and meaning of language in nursing handoffs within a large academic medical centre. Data were collected on three units through digital audio recordings of 20 handoffs between June and September 2022, which were transcribed and analysed using the Linguistic Inquiry Word Count programme. Trustworthiness was established by adhering to COREQ and STROBE guidelines for qualitative and quantitative research, respectively. Results: Analysis revealed a preference for casual, narrative language across all units, with ICU nurses demonstrating a higher confidence and leadership in communication. Cognitive processes such as insight and causation were found to be underrepresented, indicating a potential area for miscommunication. Communication motives driven by affiliation were more pronounced in ICU settings, suggesting a strong collaborative nature. No significant differences were observed among the units post multiple testing adjustments. Speech dysfluencies were most pronounced in ICU handoffs, reflecting possible stress and cognitive overload. Conclusion: The study highlights the need for improved communication strategies such as interventions to enhance language clarity and incorporating technological tools into handoff processes to mitigate potential miscommunications and errors. The findings advance nursing science by highlighting the critical role of nuanced language in varied‐acuity hospital settings and the necessity for structured nurse education in handoff communication and standardized handoff procedures. Implications for the profession and patient care: This study underscores the critical role of language in nurse‐to‐nurse handoffs. It calls for enhanced communication strategies, technology integration and training to reduce medical errors, improving patient outcomes in high‐acuity hospital settings. Patient or Public Contribution: Nurses only. [ABSTRACT FROM AUTHOR]

Out of all the racial groups in the United States, people who identify as American Indian and Alaska Native (AI/AN) have disproportionately worse health as a result of living in poverty. The preponderance of research connects poor health with a socioeconomic perspective, which might create prejudice against AI/AN. As already known, AI/AN's high rates of obesity, diabetes, and stroke in comparison with that of other ethnic groups are mainly derived from their impoverished economic conditions that have forced them to consume the food distributed by the U.S. government. When minority health is discussed generally, the ethnic density perspective explains a minority population's positive health despite low socioeconomic status. This perspective helps researchers and practitioners understand the connections of psychological and social factors with physical health and demonstrates positive health effects on minority groups. Despite the high correlation between ethnic density and health having been validated, little to no research has explored AI/AN's health from this perspective. Using 13,064 electronic health records, this research tests the relationship between AI/AN density and health outcomes. This article introduces an innovative analytical strategy (i.e. a data mining technique), which is ideal for discovering frequently appearing health outcomes in a group. The finding reveals positive relationships between health outcomes and AI/AN density. [ABSTRACT FROM AUTHOR]

Sepsis is a leading cause of pediatric mortality and timely antibiotic administration has been shown to improve outcomes. In this retrospective review of a single center sepsis dataset, we identified younger age and female sex as more likely to have delays in antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: There is limited epidemiologic evidence on keloids using real‐world data, especially in the United States (US) across race and ethnicity. Methods: We conducted a retrospective cohort study using Cerner Real‐World Data, between 2015 and 2021, to describe the demographic and clinical characteristics of US adults with keloids. Keloids were identified using a combination of ICD‐10 and (Systemized Nomenclature of Medicine‐Clinical Terms [SNOMED] codes). Demographics (including race and ethnicity), clinical characteristics, treatment patterns, and healthcare utilization were compared across keloid and non‐keloid populations. Results: Among 5,457 keloid patients identified in the study, the majority were female (61.8%) with a mean age of 34.2 years and of non‐Hispanic Black, Hispanic, and Asian descent (P < 0.001). Relative to non‐keloid cohorts, patients with keloids had significantly higher rates of integumentary, cardiorespiratory, general, auditory, and ocular surgeries and burns (all P < 0.05). Patients with keloids were also more likely to have comorbidities like obesity, hypertension, hyperlipidemia, and diabetes (P < 0.05) when compared to those with no keloids. A large proportion of keloids were untreated; among those treated, the most common keloid treatments were medication therapy (51.5%) and surgical excision (10.6%). Non‐Hispanic Black and Hispanic keloid patients were significantly more likely to receive medication therapy and surgical excision (P < 0.001) compared to keloid patients of other races or ethnicities. Conclusions: This study provided real‐world insights into the keloid population in the US. Our findings emphasize the high burden of keloids and its substantial impact on ethnic minorities. Given high keloid recurrence rates and limited standardized treatments for keloids, further research into keloids is crucial to the development of keloid‐specific therapeutic options. [ABSTRACT FROM AUTHOR]

Background/Aims: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, 103.4 million cases and 1.1 million deaths have occurred nationally as of November 2023. Despite the benefit of mitigating measures, the pandemic's effect on participant safety is rarely documented. Methods: This study assessed noncompliance occurring from July 2019 to August 2021 that were stratified by the date of noncompliance (before or after restrictions). Events were described by size, site, noncompliance type, primary category, subcategory, and cause. In addition, noncompliance associated with COVID-19 was analyzed to determine characteristics. Results: In total, 323 noncompliance events occurred across 21,146 participants at risk in 35 protocols. The overall rate of noncompliance increased from 0.008 events per participant to 0.022 events per participant after the COVID-19 restrictions (p < 0.001). For onsite protocols, the median within protocol change in rates was 0.001 (interquartile range = 0.141) after the onset of COVID-19 restrictions (p = 0.54). For large-sized protocols (n ≥ 100), the median within protocol change in rates was also 0.001 (interquartile range = 0.017) after COVID-19 restrictions (p = 0.15). For events related to COVID-19 restrictions, 160/162 (99%) were minor deviations, 161/162 (99%) were procedural noncompliance, and 124/162 (77%) were an incomplete study visit. Conclusion: These noncompliance events have implications for clinical trial methodology because nonadherence to trial design can lead to participant safety concerns and loss of trial data validity. Protocols should be written to better facilitate the capture of all safety and efficacy data. This recommendation should be considered when changes occur to the protocol environment that are outside of the study team's control. [ABSTRACT FROM AUTHOR]

Documentation of patient care is essential for both out-of-hospital and in-hospital clinical management. Secondarily, documentation is key for monitoring and improving quality; however, in some EMS systems initial care is often provided by non-transporting agencies whose personnel may not routinely complete patient care reports. Limited data exist describing effective methods for increasing complete patient care documentation among non-transporting agencies. The aim of this quality improvement project was to increase electronic health record (EHR) documentation compliance in a large urban fire-based non-transporting EMS agency. The improvement project began in May 2020. Our primary outcome was the proportion of completed EHR records for EMS responses. Primary drivers were determined from informal interviews with front-line firefighters. Interventions were implemented following a Plan-Do-Study-Act (PDSA) approach first at a single station, then battalion, and ultimately at the entire department. Interventions included performance reports, modifications of chart requirements, localized directive requiring EHR completion for all EMS runs, directive to officers that EHRs are required, documentation training, and a department-wide directive. We used statistical process control charts (p-chart) to identify special cause variation following interventions. The baseline of EHR completion for the entire fire department was 5% (373/7423 records) for the month of January 2020. Front-line interviews with 58 firefighters revealed drivers including lack of accountability and unfamiliarity with the software. After implementing a station performance report at one fire station, the station's EHR rate climbed from 0.9% (3/337 records) to 26.7% (179/671) after 9 weeks. This test was expanded to a battalion of six stations with similar results. After multiple PDSA cycles focused on agency policy and training, overall department wide EHR compliance per month improved to 89% (4,816/5,439 records) for the month of February 2021 and sustained in following months. Within this large urban fire department, EHR documentation compliance improved significantly through a series of tests of change. Informal interviews with front-line personnel were instrumental in determining primary drivers to develop change ideas. Performance reports, training and facilitation of the reporting process, and department-wide directives led to acceptance and improvement with EHR compliance. [ABSTRACT FROM AUTHOR]

Research has established relationships between social determinants of health (SDOH) and mental health, with mixed findings on which ethnoracial groups are most vulnerable to deleterious outcomes. The current study examines ethnoracial differences in SDOH and their associations with acute mental health symptoms among patients hospitalized after emergency care. Using data collected in a multi-site study of 1,318 diverse adults admitted to inpatient units, we performed analyses using linear regression models. Findings show that Multiracial/Indigenous and Black adults had significantly higher discrimination and financial stress scores. However, compared with White adults, the positive association between extreme discrimination and acute mental health symptoms was diminished among Latinx (B=–2.3; p=.02) and Black individuals (B=–1.6; p=.05) as was the positive association between financial insecurity and acute mental health symptoms for Black adults (B=–2.3; p=.04). This study provides evidence of differential experiences of SDOH and mental health challenges that may warrant tailored interventions. [ABSTRACT FROM AUTHOR]

Background: Approximately 20–50% of adolescent and young adult-aged childhood cancer survivors (AYA-CCS) experience sexual dysfunction (SD), although this healthcare need is widely underrecognized. Previous research from both AYA-CCS patients and their providers report that SD needs are unaddressed despite patient desires for SD discussions to be incorporated as part of their care. Patients and providers agree that standardized use of a patient-reported outcome measure may facilitate SD discussions; an SD screening approach was developed with patient and provider input. This study will measure the effectiveness of a standardized SD screening intervention and assess implementation outcomes and multilevel barriers and facilitators to guide future research. Methods: This multi-site, mixed methods, type 1 effectiveness-implementation hybrid trial will be evaluated using a pre-post design (NCT05524610). The trial will enroll 86 AYA-CCS (ages 15–39) from two cancer centers in the United States. The SD intervention consists of core fundamental functions with a "menu" of intervention options to allow for flexibility in delivery and tailoring in variable contexts. Effectiveness of the intervention on facilitating SD communication will be measured through patient surveys and clinical data; multivariable logistic regression will be used for the binary outcome of self-reported SD screening, controlling for patient-level predictors. Implementation outcomes will be assessed using mixed methods (electronic health record abstraction, patient and provider surveys, and provider interviews. Quantitative and qualitative findings will be merged using a joint display to understand factors affecting intervention success. Implications: Identification and treatment of SD in AYA-CCS is an important and challenging quality of life concern. The type 1 hybrid design will facilitate rapid translation from research to practice by testing the effects of the intervention while simultaneously identifying multilevel barriers and facilitators to real-world implementation. This approach will inform future testing and dissemination of the SD screening intervention. [ABSTRACT FROM AUTHOR]

Introduction: Equity-oriented efforts to mitigate and prevent COVID-related disparities are hindered due to methodological limitations of the categorization of racial and ethnic groups, including Arabs and Middle Eastern and North African (MENA) communities, which remain invisible in national data collection efforts. This study highlights the disparities in COVID-related outcomes in Toronto, Canada and supports ongoing calls to collect public health data among MENA communities in the United States. Methods: Data on racial/ethnic identity and hospitalizations were collected by the Toronto Public Health (TPH) of the Ontario Ministry of Public Health Case between May 20, 2020, and September 30, 2021 from people with a confirmed or probable case of COVID-19. Results: The reported COVID-19 infection rate for Arab, Middle Eastern, West Asians (i.e., categories used to self-identify as MENA in Canada) relative to Whites in Toronto was 3.51. The age-standardized hospitalization rate ratio between Arab, Middle Eastern, West Asians and Whites was 4.59. Discussion: Data from Toronto highlight that Arab, Middle Eastern, and West Asians have higher rates of COVID-19 infections and hospitalizations than their White counterparts. Comparable studies are currently not possible in the United States due to lack of data that can disaggregate MENA individuals. This study underscores the critical need to collect data among MENA communities in the United States to advance our field's goal of promoting and advancing equity. [ABSTRACT FROM AUTHOR]

Introduction: Left bundle branch area (LBBA) pacing (LBBAP) has been proposed as an alternative therapy option in patients indicated for cardiac pacing to treat bradycardia or heart failure. The aim of the study was to evaluate the safety and effectiveness of LBBAP in patients implanted with a Tendril 2088 stylet‐driven lead. Methods: The international retrospective data collection registry included 11 sites from 5 countries globally. Patients with attempted implants of the Tendril lead in the LBBA were followed for at least 6 months post the implant attempt. The primary safety and efficacy endpoints were freedom from LBBAP lead‐related serious adverse events and the composite of LBBA capture threshold of ≤2.0 V and R‐wave amplitudes ≥5 mV (or ≥value at implant), respectively. Results: Of 221 patients with attempted implants of the Tendril 2088 lead in the LBBA, 91.4% (202/221) had successful implants for LBBAP. Regardless of the LBBAP implant success, all patients were followed for at least 6 months (8.7 ± 7.3 months). Baseline characteristics: 44% female, 84% ≥65 years old, 34% coronary artery disease, and 86% of primary indications for pacemaker implant. Both primary safety and effectiveness endpoints were met (freedom from LBBAP lead‐related serious adverse device effects of 99.5% and electrical performance composite success rate of 93%). The capture thresholds in LBBAP at implant and 6 months were 0.8 ± 0.3 V@0.4 ± 0.1 ms and 0.8 ± 0.3 V@0.4 ± 0.1 ms. The rate of patients with capture threshold rise ≥1 V was 1.5% through 6 months. The R‐wave amplitudes in LBBAP at implant and 6 months were 9.3 ± 3.2 mV and 10.6 ± 3.0 mV. Conclusions: This large multicenter study demonstrates that the stylet‐driven Tendril™ STS 2088 lead is safe and effective for LBBAP with high success and low complication rates. [ABSTRACT FROM AUTHOR]