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Electronic health record (EHR) tools such as documentation shortcuts and ordering templates are designed to enhance both the efficiency and quality of care delivery. Use of such tools vary widely in primary care. Understanding patterns of use as a means to identify priority areas for improvement are lacking. Objective: This study is designed to identify and understand patterns of EHR efficiency use among primary care clinicians as a means to inform training support needs. Study Design: Retrospective observational study. Setting or Dataset: 340 Community Health Centers (CHCs) across 48 US states from the OCHIN Network. Population Studied: The OCHIN's network and 2033 primary care clinicians engaged in patient care at least 2 days a week during DEC 2019-FEB 2020. Methods: Six EHR efficiency indicators were drawn from the Epic EHR Signal efficiency indicators which are automatically generated monthly for clinicians. Indicators include: use of quick actions, preference lists, level of service and diagnosis speed buttons and chart search functions and notes written with smart tools. A weighted score of these indicators represented overall EHR proficiency with a possible range of 0- 10 with higher scores suggesting higher efficiency. Latent profile analysis (LPA) was used to identify clusters of clinicians defined by distinct patterns of efficiency indicators. Results: The median EHR proficiency score was 4 and ranged from 0 to 9.5. The 9 cluster LPA solution the best overall fit. Clusters represented different patterns with notable strengths and deficiencies in EHR use efficiency. Cluster 2 was large (n=518) and characterized by being low on all indicators except for chart search. In contrast, cluster 9 was very small (n=12) and characterized by high scores for 4/6 indicators and low on quick actions. Conclusions: Substantial variation in EHR use efficiency among primary care clinicians was observed and can be represented by nine different patterns of indicators. These patterns show strengths and deficiencies in EHR use efficiency and could guide a tailored training approach to improve EHR efficiency., Presenters Jeremy Erroba, Miguel Marino, PhD, Rachel Gold, PhD, MPH, Rachel Springer, MS, Jennifer DeVoe, MD, DrPH, FAAFP, DPhil, Susan Flocke, PhD, David Boston, MD, [...]

Treatment with caffeine and 2,3-butanedione monoxime (BDM) markedly protects adult rabbit ventricular myocytes from ATP depletion injury and enhances their long-term survival. BDM prevents contracture, and inhibits both Ca2+ -induced force development and rigor due to ATP depletion. Caffeine prevents the oscillatory release of Ca2+ from sarcoplasmic reticulum. The resting membrane potential normalizes after 24 hrs of metabolic inhibition. However, myocyte functioning shows characteristics of stunning with depression in myocyte contractility and impairment in relaxation.

Context: Atherosclerotic cardiovascular disease (ASCVD) disproportionally affects racial and ethnic minority populations. HMG-CoA reductase inhibitors (statins) have long been first-line pharmacotherapy for ASCVD prevention. Measures recommended to guide statin indication changed in 2013 guidelines aimed at improving ASCVD prevention and reducing ASCVD disparities. It is unknown whether risk screening for initiating statins for primary prevention of ASCVD differs across race and ethnicity. Objective: Examine racial/ethnic/language differences in electronic health record (EHR) prevalence of ASCVD screening measures used for statin consideration. Specifically, compare Asian, Latino, non-Hispanic Black, and non-Hispanic White adults further distinguished by language preference. Design: Retrospective cohort study. Setting: ADVANCE (Advancing Data Value Across a National Community Health Center) network-a PCORNet data network-635 community health centers (CHCs) in 24 US states with a shared EHR platform. Population: Adults 50+ years with =1 primary care encounter in the network 2009-2013, and/or 2014-2018. Outcome measures: Prevalence of period-specific guideline concordant screening measures for statin consideration in 2009-2013: low-density lipoprotein (LDL) and 2014-2018: pooled cohort equation (PCE) components of age, sex, race, systolic blood pressure, total cholesterol, high-density lipoprotein, smoking status. For patients seen in both periods, we assessed change in period-specific measure prevalence. Outcomes were analyzed using GEE logistic regression to measure the association between race/ethnicity/language and measurement prevalence. Results: Adjusting for sociodemographic and clinical factors, compared to English-preferring non-Hispanic White patients, all other groups were more likely to have LDL documented (2009-2013, N=195,061) and all PCE components documented (2014-2018, N=344,504). Among those seen in both periods (N=128,621), all groups had lower odds of having PCE components vs. LDL documented in the measures' respective period; English-preferring non-Hispanic Black adults experienced a greater decline in measure documentation across the two periods compared to English-preferring non-Hispanic White adults (odds ratio 0.81; 95% confidence interval 0.72-0.91). Conclusions: CHCs may mitigate racial/ethnic/language disparities in the collection of screening measures for ASCVD prevention, which did not improve after the 2013 guideline change. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Understanding how the COVID-19 pandemic affected cardiovascular disease (CVD) risk monitoring in primary care may inform new approaches for addressing modifiable CVD risks. This study examined how pandemic-driven changes in primary care delivery affected CVD risk management processes. STUDY DESIGN: This retrospective study used electronic health record data from patients at 70 primary care community clinics with scheduled appointments from September 1, 2018, to September 30, 2021. METHODS: Analyses examined associations between appointment type and select care process measures: appointment completion rates, time to appointment, and up-to-date documentation for blood pressure (BP) and hemoglobin A1c (HbA1c). RESULTS: Of 1,179,542 eligible scheduled primary care appointments, completion rates were higher for virtual care (VC) vs in-person appointments (10.7 percentage points [PP]; 95% CI, 10.5-11.0; P < .001). Time to appointment was shorter for VC vs in-person appointments (--3.9 days; 95% CI, --4.1 to --3.7; P < .001). BP documentation was higher for appointments completed pre-- vs post pandemic onset (16.2 PP; 95% CI, 16.0-16.5; P < .001) and for appointments completed in person vs VC (54.9 PP; 95% CI, 54.6-55.2; P < .001). HbA1c documentation was higher for completed appointments after pandemic onset vs before (5.9 PP; 95% CI, 5.1-6.7; P < .001) and for completed VC appointments vs in-person appointments (3.9 PP; 95% CI, 3.0-4.7; P < .001). CONCLUSIONS: After pandemic onset, appointment completion rates were higher, time to appointment was shorter, HbA1c documentation increased, and BP documentation decreased. Future research should explore the advantages of using VC for CVD risk management while continuing to monitor for unintended consequences. [ABSTRACT FROM AUTHOR]

Context: Racial and ethnic minorities in the United States have higher mortality/morbidity from cardiovascular disease (CVD) compared to non-Hispanic whites, and some evidence has suggested that poor risk factor control, including appropriate prescribing of statins for lipid disorders and CVD risk reduction, contributes to these disparities. It is uncertain if the 2013 American Heart Association (AHA)/American College of Cardiology (ACC) guideline change for statin prescription affected this disparity. Objective: To compare the prevalence of patients with guideline indications for statin prescribing, and to compare prescribing prevalence before and after this major guideline change between racial and ethnic groups, by preferred language. Study Design: Retrospective, cohort study. Setting/Dataset: A national network of community health centers (CHCs) linked by a common electronic health record dataset. Population studied: Patients were age 50-73, and had =1 primary care visit in 2009-2013 and/or 2014-2018. Outcomes: By period, 1) proportion with period-specific indications for statin initiation 2) proportion with a statin prescription if indicated. Results: In the 2009-2013 period (N=109,330), non-English preferring White (OR=1.41, 95% CI 1.15-1.72), Black (OR=1.25, 95% CI 1.10-1.41), and Latino patients (OR=1.09, 95% CI 1.02-1.16) had higher odds of meeting guideline indications for statins than Non-Hispanic White English preferring patients, and of those meeting indications, all except Black non-English patients had higher odds of statin prescription. In the 2014-2018 period (N=319,094), all groups except Latino English-preferred and White Non-English preferred patients had higher odds of meeting the new guideline indications for statin prescription. Of those meeting indications in this period, Latino English speakers had similar odds of statin prescription as non-Hispanic whites; English preferring Black patients had lower odds (OR=0.95, 95% CI 0.91-0.99). Conclusions: CHCs provide CVD screening and statin prescriptions for thousands of racial, ethnic, and language minorities, even more so than some non-Hispanic white English speakers. However, disparities appeared for English preferring Latino and Black patients after the 2013 ACC/AHA guideline change. The evaluation of major clinical guideline changes should account for their impact on racial and ethnic disparities. [ABSTRACT FROM AUTHOR]

Four derivatives of the laminate acceptor ligand dipyrido-[3,2-a:2′,3′-c]phenazine (dppz) and their corresponding ruthenium complexes, [Ru(phen)2(dppzX2)]2+, were prepared and characterized by NMR spectroscopy, ESI-MS, and elemental analysis. The new ligands, generically denoted dppzX2, were symmetrically disubstituted on the distal benzene ring to give 10,13-dibromodppz (dppz- p-Br), 11,12-dibromodppz (dppz- o-Br), 10,13-dicyanodppz (dppz- p-CN), 11,12-dicyanodppz (dppz- o-CN). Solvated ground state MO calculations of the ruthenium complexes reveal that these electron-withdrawing substituents not only lower the LUMO of the dppz ligand (dppz(CN)2

The ruthenium complexes [Ru(phen)2(ptpba)]2+ (Rua) and [Ru(phen)2(ptpbß)]2+ (Ruß), where phen =1,10-phenanthroline ; ptpba = pyrido[2',3':5,6]pyrazino[2,3-f][1,10]phenanthroline; ptpbß = pyrido[3',4':5,6]pyrazino[2,3-f][1,10]phenanthroline, are shown as electrocatalysts and photocatalysts for CO2 reduction to formate, formaldehyde, and methanol. Photochemical activity of both complexes is lost in water but is retained in 1 M H2O in DMF. Controlled current electrolysis of a solution of Ruß in CO2 saturated DMF:H2O (1 M) yields predominantly methanol over a 6 h period at -0.60 V versus Ag/AgCl, with traces of formaldehyde. After this time, the potential jumped to -1.15 V producing both methanol and CO as products. Irradiation of Ruß in a solution of DMF:H2O (1 M) containing 0.2 M TEA (as the sacrificial reductant) yields methanol, formaldehyde, and formate. Identifications of all of the relevant redox and protonated states of the respective complexes were obtained by a combination of voltammetry and differential reflectance measurements. Spectroelectrochemistry was particularly useful to probe the photochemical and electrochemical reduction mechanisms of both complexes as well as the complexes speciation in the absence and presence of CO2. [ABSTRACT FROM AUTHOR]