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Foley KL, Dressler EV, Weaver KE, Sutfin EL, Miller DP, Bellinger C, Kittel C, Stone RJ, Petty WJ, Land SR, Spangler JG, Lesser GJ, Chiles C. The Optimizing Lung Screening Trial (WF-20817CD): Multicenter Randomized Effectiveness Implementation Trial to Increase Tobacco Use Cessation for Individuals Undergoing Lung Screening. Chest 2023; 164:531-543. [PMID: 36931460 PMCID: PMC10410244 DOI: 10.1016/j.chest.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND One-half of all people who undergo lung cancer screening (LCS) currently use tobacco. However, few published studies have explored how to implement effective tobacco use treatment optimally during the LCS encounter. RESEARCH QUESTION Was the Optimizing Lung Screening intervention (OaSiS) effective at reducing tobacco use among patients undergoing LCS in community-based radiology facilities? STUDY DESIGN AND METHODS The OaSiS study (National Cancer Institute [NCI] Protocol No.: WF-20817CD) is an effectiveness-implementation hybrid type II cluster randomized trial of radiology facilities conducted in partnership with the Wake Forest National Cancer Institute Community Oncology Research Program research base. We randomly assigned 26 radiology facilities in 20 states to the intervention or usual care group. Staff at intervention facilities implemented a variety of strategies targeting the clinic and care team. Eligible patient participants were aged 55 to 77 years undergoing LCS and currently using tobacco. Of 1,094 who completed a baseline survey (523 intervention group, 471 control group) immediately before the LCS appointment, 956 completed the 6-month follow-up (86% retention rate). Fifty-four percent of those who reported not using tobacco at 6 months completed biochemical verification via mailed cotinine assay. Generalized estimating equation marginal models were used in an intention-to-treat analysis to predict 7-day tobacco use abstinence. RESULTS The average self-reported abstinence among participants varied considerably across facilities (0%-27%). Despite a significant increase in average cessation rate over time (0% at baseline to approximately 13% at 6 months; P < .0001), tobacco use did not differ by trial group at 14 days (OR, 0.96; 95% CI, 0.46-1.99; P = .90), 3 months (OR, 1.17; 95% CI, 0.69-1.99; P = .56), or 6 months (OR, 0.97; 95% CI, 0.65-1.43; P = .87). INTERPRETATION The OaSiS trial participants showed a significant reduction in tobacco use over time, but no difference by trial arm was found. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03291587; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Kristie L Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - David P Miller
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christina Bellinger
- Department of Pulmonology and Critical Care, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Rebecca J Stone
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - W Jeffrey Petty
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Stephanie R Land
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Glenn J Lesser
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Caroline Chiles
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
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Snavely AC, Foley K, Dharod A, Dignan M, Brower H, Wright E, Miller DP. Effectiveness and implementation of mPATH™-CRC: a mobile health system for colorectal cancer screening. Trials 2023; 24:274. [PMID: 37060023 PMCID: PMC10103028 DOI: 10.1186/s13063-023-07273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Screening for colorectal cancer (CRC) is widely recommended but underused, even though CRC is the third most diagnosed cancer and the second leading cause of cancer death in the USA. The mPATH™ program is an iPad-based application designed to identify patients due for CRC screening, educate them on the commonly used screening tests, and help them select their best option, with the goal of increasing CRC screening rates. METHODS The mPATH™ program consists of questions asked of all adult patients at check-in (mPATH™-CheckIn), as well as a module specific for patients due for CRC screening (mPATH™-CRC). In this study, the mPATH™ program is evaluated through a Type III hybrid implementation-effectiveness design. Specifically, the study consists of three parts: (1) a cluster-randomized controlled trial of primary care clinics comparing a "high touch" evidence-based implementation strategy with a "low touch" implementation strategy; (2) a nested pragmatic study evaluating the effectiveness of mPATH-CRC™ on completion of CRC screening; and (3) a mixed-methods study evaluating factors that facilitate or impede the maintenance of interventions like mPATH-CRC™. The primary objective is to compare the proportion of patients aged 50-74 who are eligible for CRC screening who complete mPATH™-CRC in the 6th month following implementation between the "high touch" and "low touch" implementation strategies. Effectiveness of mPATH™-CRC is evaluated by comparing the proportion who complete CRC screening within 16 weeks of their visit to the clinic between a pre-implementation cohort (8 months before implementation) and a post-implementation cohort (8 months after implementation). DISCUSSION This study will provide data on both the implementation of the mPATH™ program and its effectiveness in improving screening rates for CRC. In addition, this work has the potential to have an even broader impact by identifying strategies to support the sustained use of other similar technology-based primary care interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03843957. Registered on 18 February 2019.
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Affiliation(s)
- Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Kristie Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ajay Dharod
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Holly Brower
- Wake Forest University School of Business, Winston-Salem, NC, USA
| | - Elena Wright
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - David P Miller
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Eberth JM, Zgodic A, Pelland SC, Wang SY, Miller DP. Outcomes of Shared Decision-Making for Low-Dose Screening for Lung Cancer in an Academic Medical Center. J Cancer Educ 2023; 38:522-537. [PMID: 35488967 DOI: 10.1007/s13187-022-02148-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 05/20/2023]
Abstract
Shared decision-making (SDM) helps patients weigh risks and benefits of screening approaches. Little is known about SDM visits between patients and healthcare providers in the context of lung cancer screening. This study explored the extent that patients were informed by their provider of the benefits and harms of lung cancer screening and expressed certainty about their screening choice. We conducted a survey with 75 patients from an academic medical center in the Southeastern U.S. Survey items included knowledge of benefits and harms of screening, patients' value elicitation during SDM visits, and decisional certainty. Patient and provider characteristics were collected through electronic medical records or self-report. Descriptive statistics, Kruskal-Wallis tests, and Pearson correlations between screening knowledge, value elicitation, and decisional conflict were calculated. The sample was predominately non-Hispanic White (73.3%) with no more than high school education (53.4%) and referred by their primary care provider for screening (78.7%). Patients reported that providers almost always discussed benefits of screening (81.3%), but infrequently discussed potential harms (44.0%). On average, patients had low knowledge about screening (score = 3.71 out of 8) and benefits/harms. Decisional conflict was low (score = - 3.12) and weakly related to knowledge (R= - 0.25) or value elicitation (R= - 0.27). Black patients experienced higher decisional conflict than White patients (score = - 2.21 vs - 3.44). Despite knowledge scores being generally low, study patients experienced low decisional conflict regarding their decision to undergo lung cancer screening. Additional work is needed to optimize the quality and consistency of information presented to patients considering screening.
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene St., Columbia, SC, 29208, USA.
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA.
| | - Anja Zgodic
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene St., Columbia, SC, 29208, USA
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | | | | | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Mavragani A, Sandberg JC, Miller DP, Wells BJ. Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study. JMIR Form Res 2023; 7:e41011. [PMID: 36649056 PMCID: PMC9890353 DOI: 10.2196/41011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A1c (HbA1c) screening has not yet been studied. It is imperative to gauge perceptions of "cold texts" to ensure that information and language are optimized to promote engagement with text messages that affect follow-through with health behaviors. OBJECTIVE This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA1c screening and walk them through the steps required to perform the behavior based solely on an automated text exchange. METHODS In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages. RESULTS Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA1c screening. Plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity, were important to participants' understanding of and receptiveness to messages. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step of the process. Participants needed further clarification to understand the steps involved in following through with HbA1c screening and receiving results. CONCLUSIONS Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA1c in direct-to-patient alerts that use cold texting. Using plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. A patient's relationship with their provider and the financial costs associated with texts and screening may affect receptiveness and engagement in this process.
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Affiliation(s)
| | - Joanne C Sandberg
- Department of Family & Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - David P Miller
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Brian J Wells
- Department of Biostatistics and Data Science, Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States.,Department of Family & Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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Mavragani A, Duncan PW, Thakur E, Puccinelli-Ortega N, Salsman JM, Russell G, Pasche BC, Wentworth S, Miller DP, Wagner LI, Topaloglu U. Adaptation of a Personalized Electronic Care Planning Tool for Cancer Follow-up Care: Formative Study. JMIR Form Res 2023; 7:e41354. [PMID: 36626203 PMCID: PMC9893883 DOI: 10.2196/41354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Most patients diagnosed with colorectal cancer will survive for at least 5 years; thus, engaging patients to optimize their health will likely improve outcomes. Clinical guidelines recommend patients receive a comprehensive care plan (CP) when transitioning from active treatment to survivorship, which includes support for ongoing symptoms and recommended healthy behaviors. Yet, cancer care providers find this guideline difficult to implement. Future directions for survivorship care planning include enhancing information technology support for developing personalized CPs, using CPs to facilitate self-management, and assessing CPs in clinical settings. OBJECTIVE We aimed to develop an electronic tool for colorectal cancer follow-up care (CFC) planning. METHODS Incorporating inputs from health care professionals and patient stakeholders is fundamental to the successful integration of any tool into the clinical workflow. Thus, we followed the Integrate, Design, Assess, and Share (IDEAS) framework to adapt an existing application for stroke care planning (COMPASS-CP) to meet the needs of colorectal cancer survivors (COMPASS-CP CFC). Constructs from the Consolidated Framework for Implementation Research (CFIR) guided our approach. We completed this work in 3 phases: (1) gathering qualitative feedback from stakeholders about the follow-up CP generation design and workflow; (2) adapting algorithms and resource data sources needed to generate a follow-up CP; and (3) optimizing the usability of the adapted prototype of COMPASS-CP CFC. We also quantitatively measured usability (target average score ≥70; range 0-100), acceptability, appropriateness, and feasibility. RESULTS In the first phase, health care professionals (n=7), and patients and caregivers (n=7) provided qualitative feedback on COMPASS-CP CFC that informed design elements such as selection, interpretation, and clinical usefulness of patient-reported measures. In phase 2, we built a minimal viable product of COMPASS-CP CFC. This tool generated CPs based on the needs identified by patient-completed measures (including validated patient-reported outcomes) and electronic health record data, which were then matched with resources by zip code and preference to support patients' self-management. Elements of the CFIR assessed revealed that most health care professionals believed the tool would serve patients' needs and had advantages. In phase 3, the average System Usability Scale score was above our target score for health care professionals (n=5; mean 71.0, SD 15.2) and patients (n=5; mean 95.5, SD 2.1). Participants also reported high levels of acceptability, appropriateness, and feasibility. Additional CFIR-informed feedback, such as desired format for training, will inform future studies. CONCLUSIONS The data collected in this study support the initial usability of COMPASS-CP CFC and will inform the next steps for implementation in clinical care. COMPASS-CP CFC has the potential to streamline the implementation of personalized CFC planning to enable systematic access to resources that will support self-management. Future research is needed to test the impact of COMPASS-CP CFC on patient health outcomes.
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Affiliation(s)
| | - Pamela W Duncan
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | | | | | - John M Salsman
- Wake Forest University School of Medicine, Winston-Salem, NC, United States.,Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Greg Russell
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Boris C Pasche
- Wake Forest University School of Medicine, Winston-Salem, NC, United States.,Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Stacy Wentworth
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - David P Miller
- Wake Forest University School of Medicine, Winston-Salem, NC, United States.,Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, United States.,Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Umit Topaloglu
- Wake Forest University School of Medicine, Winston-Salem, NC, United States.,Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
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Palakshappa D, Denizard-Thompson N, Puccinelli-Ortega N, Brooks A, Damman A, Miller DP. The experiences of community organizations partnering with a medical school to improve students' understanding of the social determinants of health: A qualitative study. Med Teach 2022; 44:1260-1267. [PMID: 35382676 PMCID: PMC10029361 DOI: 10.1080/0142159x.2022.2056007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE There has been increasing interest among national organizations for medical schools to provide students experiential training in the social determinants of health (SDH) through community partnerships. Despite this interest, there is limited data about how these experiential activities can be designed most effectively, and community organizations' views of partnering with medical schools on these curricula is unknown. The authors' objective was to determine community organizations' and clinical clerkship directors' perceptions of the benefits and challenges of utilizing academic-community partnerships to improve medical students' understanding of the SDH. METHODS The authors conducted a qualitative study consisting of open-ended, semi-structured interviews (between 2018 and 2021). All community organizations and clinical clerkship directors who partnered with a health equity curriculum were eligible to participate. Semi-structured interviews elicited participants' perceptions of the academic-community partnership; experience with the curriculum and the students; and recommendations for improving the curriculum. All interviews were audio recorded and transcribed. The authors used a directed content analysis approach to code the interviews inductively and identified emerging themes through an iterative process. RESULTS Of the fifteen participants interviewed, ten were from community organizations and five from clinical clerkships. Three primary themes emerged: (1) community organizations felt educating students about the SDH aligned with the organization's mission and they benefited from consistent access to volunteers; (2) students benefited through greater exposure to the SDH; (3) participants suggested standardizing students' experiences, ensuring the students and organizations are clear about the goals and expectations, and working with organizations that have experience with or the capacity for a large volume of volunteers as ways to improve the experiential activity. CONCLUSION This study found that community organizations were very willing to partner with a medical school to provide students experiential learning about the SDH, and this partnership was beneficial for both the students and the organizations.
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Affiliation(s)
- Deepak Palakshappa
- Departments of Internal Medicine, Pediatrics, and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Amber Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda Damman
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David P Miller
- Department of Internal Medicine and Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Califf RM, Wong C, Doraiswamy PM, Hong DS, Miller DP, Mega JL. Importance of Social Determinants in Screening for Depression. J Gen Intern Med 2022; 37:2736-2743. [PMID: 34405346 PMCID: PMC9411454 DOI: 10.1007/s11606-021-06957-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 01/07/2023]
Abstract
IMPORTANCE The most common screening tool for depression is the Patient Health Questionnaire-9 (PHQ-9). Despite extensive research on the clinical and behavioral implications of the PHQ-9, data are limited on the relationship between PHQ-9 scores and social determinants of health and disease. OBJECTIVE To assess the relationship between the PHQ-9 at intake and other measurements intended to assess social determinants of health. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analyses of 2502 participants from the Baseline Health Study (BHS), a prospective cohort of adults selected to represent major demographic groups in the US; participants underwent deep phenotyping on demographic, socioeconomic, clinical, laboratory, functional, and imaging findings. INTERVENTIONS None. MAIN OUTCOMES AND MEASURES Cross-sectional measures of clinical and socioeconomic status (SES). RESULTS In addition to a host of clinical and biological factors, higher PHQ-9 scores were associated with female sex, younger participants, people of color, and Hispanic ethnicity. Multiple measures of low SES, including less education, being unmarried, not currently working, and lack of insurance, were also associated with higher PHQ-9 scores across the entire spectrum of PHQ-9 scores. A summative score of SES, which was the 6th most predictive factor, was associated with higher PHQ-9 score after adjusting for 150 clinical, lab testing, and symptomatic characteristics. CONCLUSIONS AND RELEVANCE Our findings underscore that depression should be considered a comorbidity when social determinants of health are addressed, and both elements should be considered when designing appropriate interventions.
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Affiliation(s)
| | | | - P Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences and the Duke Institute for Brain Sciences, Duke University School of Medicine, Durham, NC, USA
| | - David S Hong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Wyss R, Schneeweiss S, Lin KJ, Miller DP, Kalilani L, Franklin JM. Synthetic Negative Controls: Using Simulation to Screen Large-scale Propensity Score Analyses. Epidemiology 2022; 33:541-550. [PMID: 35439779 PMCID: PMC9156547 DOI: 10.1097/ede.0000000000001482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The propensity score has become a standard tool to control for large numbers of variables in healthcare database studies. However, little has been written on the challenge of comparing large-scale propensity score analyses that use different methods for confounder selection and adjustment. In these settings, balance diagnostics are useful but do not inform researchers on which variables balance should be assessed or quantify the impact of residual covariate imbalance on bias. Here, we propose a framework to supplement balance diagnostics when comparing large-scale propensity score analyses. Instead of focusing on results from any single analysis, we suggest conducting and reporting results for many analytic choices and using both balance diagnostics and synthetically generated control studies to screen analyses that show signals of bias caused by measured confounding. To generate synthetic datasets, the framework does not require simulating the outcome-generating process. In healthcare database studies, outcome events are often rare, making it difficult to identify and model all predictors of the outcome to simulate a confounding structure closely resembling the given study. Therefore, the framework uses a model for treatment assignment to divide the comparator population into pseudo-treatment groups where covariate differences resemble those in the study cohort. The partially simulated datasets have a confounding structure approximating the study population under the null (synthetic negative control studies). The framework is used to screen analyses that likely violate partial exchangeability due to lack of control for measured confounding. We illustrate the framework using simulations and an empirical example.
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Affiliation(s)
- Richard Wyss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Jessica M Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Bellinger C, Foley KL, Dressler EV, Kittel C, Miller DP, Weaver KE, Sutfin EL, Petty WJ, Spangler J, Stone R, Anderson DM, Kehn H, Steenstra C, Panikkar R, Chiles C. Organizational Characteristics and Smoking Cessation Support in Community-Based Lung Cancer Screening Programs. J Am Coll Radiol 2022; 19:529-533. [PMID: 35247325 PMCID: PMC8983582 DOI: 10.1016/j.jacr.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Christina Bellinger
- Department of Pulmonology and Critical Care, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Kristie Long Foley
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David P Miller
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Jeffrey Petty
- Department of Thoracic Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rebecca Stone
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Heather Kehn
- Metro Minnesota Community Oncology Research Consortium
| | | | - Rajiv Panikkar
- Geisinger Cancer Institute National Cancer Institute Community Oncology Research Program
| | | | - Caroline Chiles
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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10
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Miller DP, Foley KL, Bundy R, Dharod A, Wright E, Dignan M, Snavely AC. Universal Screening in Primary Care Practices by Self-administered Tablet vs Nursing Staff. JAMA Netw Open 2022; 5:e221480. [PMID: 35258581 PMCID: PMC8905387 DOI: 10.1001/jamanetworkopen.2022.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This nonrandomized controlled trial investigates whether self-administered screening via an in-office tablet app was associated with improved detection of patients at risk for depression, injurious falls, or intimate partner violence compared with screening performed by clinicians.
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Affiliation(s)
- David P. Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristie L. Foley
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Richa Bundy
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elena Wright
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington
| | - Anna C. Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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11
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Puccinelli-Ortega N, Cromo M, Foley KL, Dignan MB, Dharod A, Snavely AC, Miller DP. Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative Study. Appl Clin Inform 2022; 13:1-9. [PMID: 34986491 PMCID: PMC8731240 DOI: 10.1055/s-0041-1740481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our team developed an innovative iPad-based application (aka "app") to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid. OBJECTIVE The aim of the study is to explore how informed decision aids can be implemented successfully in primary care clinics, including the facilitators and barriers to implementation; strategies for minimizing barriers; adequacy of draft training materials; and any additional support or training desired by clinics. DESIGN This work deals with a multicenter qualitative study in rural and urban settings. PARTICIPANTS A total of 48 individuals participated including primary care practice managers, clinicians, nurses, and front desk staff. APPROACH Focus groups and semi-structured interviews, with data analysis were guided by thematic analysis. KEY RESULTS Salient emergent themes were time, workflow, patient age, literacy, and electronic health record (EHR) integration. Saving time was important to most participants. Patient flow was a concern for all clinic staff, and they expressed that any slowdown due to patients using the iPad module or perceived additional work to clinic staff would make staff less motivated to use the program. Participants voiced concern about older patients being unwilling or unable to utilize the iPad and patients with low literacy ability being able to read or comprehend the information. CONCLUSION Integrating new IDM apps into the current clinic workflow with minimal disruptions would increase the probability of long-term adoption and ultimate sustainability. NIH TRIAL REGISTRY NUMBER R01CA218416-A1.
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Affiliation(s)
- Nicole Puccinelli-Ortega
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States,Address for correspondence Nicole Puccinelli-Ortega, MS Department of Internal Medicine, Medical Center BoulevardWinston-Salem, NC 27157-1063United States
| | - Mark Cromo
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Kristie L. Foley
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - Mark B. Dignan
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - Anna C. Snavely
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - David P. Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
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Califf RM, Wong C, Doraiswamy PM, Hong DS, Miller DP, Mega JL. Biological and clinical correlates of the patient health questionnaire-9: exploratory cross-sectional analyses of the baseline health study. BMJ Open 2022; 12:e054741. [PMID: 34983769 PMCID: PMC8728408 DOI: 10.1136/bmjopen-2021-054741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We assessed the relationship between the Patient Health Questionnaire-9 (PHQ-9) at intake and other measurements intended to assess biological factors, markers of disease and health status. DESIGN, SETTING AND PARTICIPANTS We performed a cross-sectional analysis of 2365 participants from the Baseline Health Study, a prospective cohort of adults selected to represent major demographic groups in the USA. Participants underwent deep phenotyping on demographic, clinical, laboratory, functional and imaging findings. IMPORTANCE Despite extensive research on the clinical implications of the PHQ-9, data are limited on the relationship between PHQ-9 scores and other measures of health and disease; we sought to better understand this relationship. INTERVENTIONS None. MAIN OUTCOMES AND MEASURES Cross-sectional measures of medical illnesses, gait, balance strength, activities of daily living, imaging and laboratory tests. RESULTS Compared with lower PHQ-9 scores, higher scores were associated with female sex (46.9%-66.7%), younger participants (53.6-42.4 years) and compromised physical status (higher resting heart rates (65 vs 75 bpm), larger body mass index (26.5-30 kg/m2), greater waist circumference (91-96.5 cm)) and chronic conditions, including gastro-oesophageal reflux disease (13.2%-24.7%) and asthma (9.5%-20.4%) (p<0.0001). Increasing PHQ-9 score was associated with a higher frequency of comorbidities (migraines (6%-20.4%)) and active symptoms (leg cramps (6.4%-24.7%), mood change (1.2%-47.3%), lack of energy (1.2%-57%)) (p<0.0001). After adjustment for relevant demographic, socioeconomic, behavioural and medical characteristics, we found that memory change, tension, shortness of breath and indicators of musculoskeletal symptoms (backache and neck pain) are related to higher PHQ-9 scores (p<0.0001). CONCLUSIONS Our study highlights how: (1) even subthreshold depressive symptoms (measured by PHQ-9) may be indicative of several individual- and population-level concerns that demand more attention; and (2) depression should be considered a comorbidity in common disease. TRIAL REGISTRATION NUMBER NCT03154346.
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Affiliation(s)
- Robert M Califf
- Verily Life Sciences LLC, South San Francisco, California, USA
| | - Celeste Wong
- Verily Life Sciences LLC, South San Francisco, California, USA
| | - P Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Institute for Brain Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - David S Hong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - David P Miller
- Verily Life Sciences LLC, South San Francisco, California, USA
| | - Jessica L Mega
- Verily Life Sciences LLC, South San Francisco, California, USA
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13
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Palakshappa D, Ip EH, Berkowitz SA, Bertoni AG, Foley KL, Miller DP, Vitolins MZ, Rosenthal GE. Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk. J Am Heart Assoc 2021; 10:e021901. [PMID: 34743567 PMCID: PMC8751929 DOI: 10.1161/jaha.121.021901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
Background Food insecurity (FI) has been associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk; however, the pathways by which FI leads to worse cardiovascular health are unknown. We tested the hypothesis that FI is associated with ASCVD risk through nutritional/anthropometric (eg, worse diet quality and increased weight), psychological/mental health (eg, increased depressive symptoms and risk of substance abuse), and access to care pathways. Methods and Results We conducted a cross-sectional study of adults (aged 40-79 years) using the 2007 to 2016 National Health and Nutrition Examination Survey. Our primary exposure was household FI, and our outcome was 10-year ASCVD risk categorized as low (<5%), borderline (≥5% -<7.5%), intermediate (≥7.5%-<20%), and high risk (≥20%). We used structural equation modeling to evaluate the pathways and multiple mediation analysis to determine direct and indirect effects. Of the 12 429 participants, 2231 (18.0%) reported living in a food-insecure household; 5326 (42.9%) had a low ASCVD risk score, 1402 (11.3%) borderline, 3606 (29.0%) intermediate, and 2095 (16.9%) had a high-risk score. In structural models, we found significant path coefficients between FI and the nutrition/anthropometric (β, 0.130; SE, 0.027; P<0.001), psychological/mental health (β, 0.612; SE, 0.043; P<0.001), and access to care (β, 0.110; SE, 0.036; P=0.002) pathways. We did not find a significant direct effect of FI on ASCVD risk, and the nutrition, psychological, and access to care pathways accounted for 31.6%, 43.9%, and 15.8% of the association, respectively. Conclusions We found that the association between FI and ASCVD risk category was mediated through the nutrition/anthropometric, psychological/mental health, and access to care pathways. Interventions that address all 3 pathways may be needed to mitigate the negative impact of FI on cardiovascular disease.
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Affiliation(s)
- Deepak Palakshappa
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
- Department of PediatricsWake Forest School of MedicineWinston‐SalemNC
| | - Edward H. Ip
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - Seth A. Berkowitz
- Division of General Medicine and Clinical EpidemiologyDepartment of MedicineUniversity of North Carolina at Chapel Hill School of MedicineChapel HillNC
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillNC
| | - Alain G. Bertoni
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - Kristie L. Foley
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - David P. Miller
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - Mara Z. Vitolins
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - Gary E. Rosenthal
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
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14
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Stinson JA, Boopathy AV, Cieslewicz BM, Zhang Y, Hartman NW, Miller DP, Dirckx M, Hurst BL, Tarbet EB, Kluge JA, Kosuda KM. Enhancing influenza vaccine immunogenicity and efficacy through infection mimicry using silk microneedles. Vaccine 2021; 39:5410-5421. [PMID: 34391593 DOI: 10.1016/j.vaccine.2021.07.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/04/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Traditional bolus vaccine administration leads to rapid clearance of vaccine from lymphoid tissue. However, there is increasing evidence suggesting that the kinetics of antigen delivery can impact immune responses to vaccines, particularly when tailored to mimic natural infections. Here, we present the specific enhancements sustained release immunization confers to seasonal influenza vaccine, including the magnitude, durability, and breadth of humoral responses. To achieve sustained vaccine delivery kinetics, we have developed a microneedle array patch (MIMIX), with silk fibroin-formulated vaccine tips designed to embed in the dermis after a short application to the skin and release antigen over 1-2 weeks, mimicking the time course of a natural influenza infection. In a preclinical murine model, a single influenza vaccine administration via MIMIX led to faster seroconversion, response-equivalence to prime-boost bolus immunization, higher HAI titers against drifted influenza strains, and improved protective efficacy upon lethal influenza challenge when compared with intramuscular injection. These results highlight infection mimicry, achieved through sustained release silk microneedles, as a powerful approach to improve existing seasonal influenza vaccines, while also suggesting the broader potential of this platform technology to enable more efficacious next-generation vaccines and vaccine combinations.
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Affiliation(s)
- Jordan A Stinson
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Archana V Boopathy
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Brian M Cieslewicz
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Yichen Zhang
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Nickolas W Hartman
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - David P Miller
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Matthew Dirckx
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Brett L Hurst
- Institute for Antiviral Research, Department of Animal, Dairy, and Veterinary Sciences, Utah State University, 5600 Old Main Hill, Logan, UT 84322, USA
| | - E Bart Tarbet
- Institute for Antiviral Research, Department of Animal, Dairy, and Veterinary Sciences, Utah State University, 5600 Old Main Hill, Logan, UT 84322, USA
| | - Jonathan A Kluge
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Kathryn M Kosuda
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA.
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15
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Nickels S, Edwards MD, Poole SF, Winter D, Gronsbell J, Rozenkrants B, Miller DP, Fleck M, McLean A, Peterson B, Chen Y, Hwang A, Rust-Smith D, Brant A, Campbell A, Chen C, Walter C, Arean PA, Hsin H, Myers LJ, Marks WJ, Mega JL, Schlosser DA, Conrad AJ, Califf RM, Fromer M. Toward a Mobile Platform for Real-world Digital Measurement of Depression: User-Centered Design, Data Quality, and Behavioral and Clinical Modeling. JMIR Ment Health 2021; 8:e27589. [PMID: 34383685 PMCID: PMC8386379 DOI: 10.2196/27589] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although effective mental health treatments exist, the ability to match individuals to optimal treatments is poor, and timely assessment of response is difficult. One reason for these challenges is the lack of objective measurement of psychiatric symptoms. Sensors and active tasks recorded by smartphones provide a low-burden, low-cost, and scalable way to capture real-world data from patients that could augment clinical decision-making and move the field of mental health closer to measurement-based care. OBJECTIVE This study tests the feasibility of a fully remote study on individuals with self-reported depression using an Android-based smartphone app to collect subjective and objective measures associated with depression severity. The goals of this pilot study are to develop an engaging user interface for high task adherence through user-centered design; test the quality of collected data from passive sensors; start building clinically relevant behavioral measures (features) from passive sensors and active inputs; and preliminarily explore connections between these features and depression severity. METHODS A total of 600 participants were asked to download the study app to join this fully remote, observational 12-week study. The app passively collected 20 sensor data streams (eg, ambient audio level, location, and inertial measurement units), and participants were asked to complete daily survey tasks, weekly voice diaries, and the clinically validated Patient Health Questionnaire (PHQ-9) self-survey. Pairwise correlations between derived behavioral features (eg, weekly minutes spent at home) and PHQ-9 were computed. Using these behavioral features, we also constructed an elastic net penalized multivariate logistic regression model predicting depressed versus nondepressed PHQ-9 scores (ie, dichotomized PHQ-9). RESULTS A total of 415 individuals logged into the app. Over the course of the 12-week study, these participants completed 83.35% (4151/4980) of the PHQ-9s. Applying data sufficiency rules for minimally necessary daily and weekly data resulted in 3779 participant-weeks of data across 384 participants. Using a subset of 34 behavioral features, we found that 11 features showed a significant (P<.001 Benjamini-Hochberg adjusted) Spearman correlation with weekly PHQ-9, including voice diary-derived word sentiment and ambient audio levels. Restricting the data to those cases in which all 34 behavioral features were present, we had available 1013 participant-weeks from 186 participants. The logistic regression model predicting depression status resulted in a 10-fold cross-validated mean area under the curve of 0.656 (SD 0.079). CONCLUSIONS This study finds a strong proof of concept for the use of a smartphone-based assessment of depression outcomes. Behavioral features derived from passive sensors and active tasks show promising correlations with a validated clinical measure of depression (PHQ-9). Future work is needed to increase scale that may permit the construction of more complex (eg, nonlinear) predictive models and better handle data missingness.
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Affiliation(s)
| | | | - Sarah F Poole
- Verily Life Sciences, South San Francisco, CA, United States
| | - Dale Winter
- Verily Life Sciences, South San Francisco, CA, United States
| | | | | | - David P Miller
- Verily Life Sciences, South San Francisco, CA, United States
| | - Mathias Fleck
- Verily Life Sciences, South San Francisco, CA, United States
| | - Alan McLean
- Verily Life Sciences, South San Francisco, CA, United States
| | - Bret Peterson
- Verily Life Sciences, South San Francisco, CA, United States
| | - Yuanwei Chen
- Verily Life Sciences, South San Francisco, CA, United States
| | - Alan Hwang
- Verily Life Sciences, South San Francisco, CA, United States
| | | | - Arthur Brant
- Verily Life Sciences, South San Francisco, CA, United States
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Chen Chen
- Verily Life Sciences, South San Francisco, CA, United States
| | - Collin Walter
- Verily Life Sciences, South San Francisco, CA, United States
| | - Patricia A Arean
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Honor Hsin
- Verily Life Sciences, South San Francisco, CA, United States
| | - Lance J Myers
- Verily Life Sciences, South San Francisco, CA, United States
| | - William J Marks
- Verily Life Sciences, South San Francisco, CA, United States
| | - Jessica L Mega
- Verily Life Sciences, South San Francisco, CA, United States
| | | | - Andrew J Conrad
- Verily Life Sciences, South San Francisco, CA, United States
| | - Robert M Califf
- Verily Life Sciences, South San Francisco, CA, United States
| | - Menachem Fromer
- Verily Life Sciences, South San Francisco, CA, United States
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16
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Denizard-Thompson N, Palakshappa D, Vallevand A, Kundu D, Brooks A, DiGiacobbe G, Griffith D, Joyner J, Snavely AC, Miller DP. Association of a Health Equity Curriculum With Medical Students' Knowledge of Social Determinants of Health and Confidence in Working With Underserved Populations. JAMA Netw Open 2021; 4:e210297. [PMID: 33646312 PMCID: PMC7921901 DOI: 10.1001/jamanetworkopen.2021.0297] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE National organizations recommend that medical schools train students in the social determinants of health. OBJECTIVE To develop and evaluate a longitudinal health equity curriculum that was integrated into third-year clinical clerkships and provided experiential learning in partnership with community organizations. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study was conducted from June 2017 to October 2020 to evaluate the association of the curriculum with medical students' self-reported knowledge of social determinants of health and confidence working with underserved populations. Students from 1 large medical school in the southeastern US were included. Students in the class of 2019 and class of 2020 were surveyed at baseline (before the start of their third year), end of the third year, and graduation. The class of 2018 (No curriculum) was surveyed at graduation to serve as a control. Data analysis was conducted from June to September 2020. EXPOSURES The curriculum began with a health equity simulation followed by a series of modules. The class of 2019 participated in the simulation and piloted the initial 3 modules (pilot), and the class of 2020 participated in the simulation and the full 9 modules (full). MAIN OUTCOMES AND MEASURES A linear mixed-effects model was used to evaluate the change in the self-reported knowledge and confidence scores over time (potential scores ranged from 0 to 32, with higher scores indicating higher self-reported knowledge and confidence working with underserved populations). In secondary analyses, a Kruskal-Wallis test was conducted to compare graduation scores between the no, pilot, and full curriculum classes. RESULTS A total of 314 students (160 women [51.0%], 205 [65.3%] non-Hispanic White participants) completed at least 1 survey, including 125 students in the pilot, 121 in the full, and 68 in the no curriculum classes. One hundred forty-one students (44.9%) were interested in primary care. Total self-reported knowledge and confidence scores increased between baseline and end of clerkship (15.4 vs 23.7, P = .001) and baseline and graduation (15.4 vs 23.7, P = .001) for the pilot and full curriculum classes. Total scores at graduation were higher for the pilot curriculum (median, 24.0; interquartile range [IQR], 21.0-27.0; P = .001) and full curriculum classes (median, 23.0; IQR, 20.0-26.0; P = .01) compared with the no curriculum class (median, 20.5; IQR, 16.25-24.0). CONCLUSIONS AND RELEVANCE In this cohort study of medical students, a dedicated health equity curriculum was associated with a significant improvement in students' self-reported knowledge of social determinants of health and confidence working with underserved populations.
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Affiliation(s)
- Nancy Denizard-Thompson
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Andrea Vallevand
- Medical Education, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Debanjali Kundu
- Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amber Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gia DiGiacobbe
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - JaNae Joyner
- Medical Education, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C. Snavely
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David P. Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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17
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Weaver KE, Sutfin EL, Dressler E, Bellinger C, Miller DP, Chiles C, Petty WJ, Lesser G, Foley KL. Abstract PO-009: Rural/urban and race differences in factors related to cessation readiness among cigarette smokers presenting for lung cancer screening in community settings. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Many patients presenting for lung cancer screening are current smokers; screening may be a teachable moment for cessation. The objective of the current analysis is to compare cessation readiness among lung screening patients by rural/urban residence and race/ethnicity to identify populations who may benefit from tailored support. Methods: We enrolled 1,095 current smokers presenting for low dose CT lung cancer screening at 24 NCI Community Oncology Research Program (NCORP) imaging clinics as part of the OaSiS trial (WF 20817CD). Prior to screening, we collected data regarding perceived risk and worry about lung cancer, perceived impact of cessation on lung cancer risk, cessation readiness, and quitting self-efficacy (both 1-10 Likert type scales). We classified participants as rural vs urban using the zip-code-based definitions of the Federal Office of Rural Health Policy. We summarized group differences using chi-square analyses. Results: Participants were 50.2% female; average age 64 years (range 55-79); 81.9% non-Hispanic White (NHW), 13.3% non-Hispanic Black (NHB), 2.6% Hispanic, 2.2% American Indian; 20.2% rural residence). The median cigarettes smoked per day was 20 and the median pack years smoked was 44. NHW participants were less likely than other groups to report being “extremely” worried about lung cancer [15.5% vs NHB (31.4%), Hispanic (35.7%), and American Indian (25%), p<.0001]. When queried about their perceived risk of developing lung cancer, NHB (21.8%), Hispanic (14.3%), and American Indian (12.5%) participants were also more likely to report that they didn’t know, compared to NHW participants (9.7%, p <.0001). NHB participants were more likely to believe that quitting smoking would “very much” reduce their risk of lung cancer (52.1%), compared to NHW (36.3%), Hispanic (35.7%), and American Indian (37.5%) participants (p<.001). NHWs reported lower cessation readiness compared to NHB, Hispanic, and American Indian participants (p<.001). NHB and Hispanic participants also reported high quitting self-efficacy compared to NHW and American Indian participants (p<.0001). With regard to rural/urban differences, compared to urban residents, rural residents reported lower or unknown perceived impact of cessation on lung cancer risk (9.5 vs 6.8% no impact & 13.2 vs 6.9% unknown, p<.01). There were no other differences in cessation readiness factors by rural-urban residence. Conclusions: To advance health equity, it is important to understand cessation readiness, among patients presenting to community-based imaging clinics for lung cancer screening. Evidence-based cessation treatment for racial/ethnic minorities within these settings may be enhanced by tailoring for higher cessation readiness. Rural and racial/ethnic minority patients may benefit from enhanced education regarding lung cancer risk and the impact of cessation. This work was supported by the National Cancer Institute (R01CA207158 & UG1CA189824).
Citation Format: Kathryn E. Weaver, Erin L. Sutfin, Emily Dressler, Christina Bellinger, David P. Miller, Caroline Chiles, W. J. Petty, Glenn Lesser, Kristie L. Foley. Rural/urban and race differences in factors related to cessation readiness among cigarette smokers presenting for lung cancer screening in community settings [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-009.
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Affiliation(s)
| | | | | | | | | | | | - W. J. Petty
- Wake Forest School of Medicine, Winston-Salem, NC
| | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC
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Polonsky WH, Layne JE, Parkin CG, Kusiak CM, Barleen NA, Miller DP, Zisser H, Dixon RF. Impact of Participation in a Virtual Diabetes Clinic on Diabetes-Related Distress in Individuals With Type 2 Diabetes. Clin Diabetes 2020; 38:357-362. [PMID: 33132505 PMCID: PMC7566922 DOI: 10.2337/cd19-0105] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Onduo Virtual Diabetes Clinic is a telehealth program for people with type 2 diabetes that combines mobile app technology, remote personalized lifestyle coaching, connected blood glucose meters, real-time continuous glucose monitoring (rtCGM) devices, and clinical support from board-certified endocrinologists. This analysis evaluated change in diabetes distress among 228 program participants who reported moderate distress (score 2.0-2.9) or high distress (score ≥3.0) on the 17-item Diabetes Distress Scale (DDS17) at enrollment. Participants reported significant reductions in overall distress from 3.0 ± 0.8 at baseline to 2.5 ± 0.9 (P <0.001) at an average of 6 months of follow-up. Significant reductions in all DDS17 subscale scores were observed; most notable were reductions in the regimen-related and emotional distress subscales (-0.9 and -0.4, respectively; both P <0.001). Significantly greater reductions in overall distress (P = 0.012) and regimen-related distress (P <0.001) were reported by participants who were prescribed and used intermittent rtCGM (n = 77) versus nonusers (n = 151). Although the generalizability of these findings may be limited by the study's small sample size and potential for self-selection bias, these results do suggest that telemedicine programs such as the Onduo VDC could be a valuable tool for addressing the problem of diabetes-related distress.
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Affiliation(s)
- William H. Polonsky
- Behavioral Diabetes Institute, San Diego, CA
- University of California, San Diego, San Diego, CA
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Palakshappa D, Benefield AJ, Furgurson KF, Harley MG, Bundy R, Moses A, Taxter AJ, Bensinger AS, Cao X, Denizard-Thompson N, Rosenthal GE, Miller DP. Feasibility of Mobile Technology to Identify and Address Patients' Unmet Social Needs in a Primary Care Clinic. Popul Health Manag 2020; 24:385-392. [PMID: 32924796 DOI: 10.1089/pop.2020.0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Mobile health tools may overcome barriers to social needs screening; however, there are limited data on the feasibility of using these tools in clinical settings. The objective was to determine the feasibility of using a mobile health system to screen for patients' social needs. In one large primary care clinic, the authors tested a tablet-based system that screens patients for social needs, transmits results to the electronic health record, and alerts providers. All adult patients presenting for a nonurgent visit were eligible. The authors evaluated the feasibility of the system and conducted follow-up surveys to determine acceptability and if patients accessed resources through the process. All providers were surveyed. Of the 252 patients approached, 219 (86.9%) completed the screen. Forty-three (19.6%) required assistance with the tablet, and 150 (68.5%) screened positive for at least 1 unmet need (food, housing, or transportation). Of the 150, 103 (68.7%) completed a follow-up survey. The majority agreed that people would learn to use the tablet quickly. Forty-eight patients (46.6%) reported contacting at least 1 community organization through the process. Of the 27 providers, 23 (85.2%) completed a survey and >70% agreed the system would result in patients having better access to resources. It was feasible to use a tablet-based system to screen for social needs. Clinics considering using mobile tools will need to determine how to screen patients who may need assistance with the tool and how to connect patients to resources through the system based on the burden of unmet needs.
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Affiliation(s)
- Deepak Palakshappa
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew J Benefield
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katherine F Furgurson
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael G Harley
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Richa Bundy
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam Moses
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alysha J Taxter
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew S Bensinger
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Xiangkun Cao
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nancy Denizard-Thompson
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gary E Rosenthal
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David P Miller
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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20
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Dixon RF, Zisser H, Layne JE, Barleen NA, Miller DP, Moloney DP, Majithia AR, Gabbay RA, Riff J. A Virtual Type 2 Diabetes Clinic Using Continuous Glucose Monitoring and Endocrinology Visits. J Diabetes Sci Technol 2020; 14:908-911. [PMID: 31762302 PMCID: PMC7477772 DOI: 10.1177/1932296819888662] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The Onduo Virtual Diabetes Clinic (VDC) telehealth technology/care model for adults with type 2 diabetes (T2D) combines connected devices, remote lifestyle coaching, and clinical support with a mobile App. Key differentiating program features are the availability of live video consultations with board-certified endocrinologists for medication management and real-time continuous glucose monitor use for higher-risk participants. Preliminary data (n = 740) suggest that participation was associated with a significant improvement in HbA1c with up to 6 months follow-up in those not meeting treatment targets. HbA1c decreased by 2.3% ± 1.9%, 0.7% ± 1.0%, and 0.2% ± 0.8% across baseline categories of >9.0%, 8.0%-9.0% and 7.0% to <8.0%, respectively (all P < .001). These findings suggest that the VDC has potential to support individuals with T2D and their clinicians in diabetes management between office visits.
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Affiliation(s)
| | | | - Jennifer E. Layne
- Onduo LLC, Newton, MA, USA
- Jennifer E. Layne, PhD, Onduo LLC, 55 Chapel
Street, Newton, MA 02458, USA.
| | | | | | | | - Amit R. Majithia
- School of Medicine, University of
California San Diego, La Jolla, CA, USA
| | - Robert A. Gabbay
- Joslin Diabetes Center, Harvard Medical
School, One Joslin Place, Boston, MA, USA
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21
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Majithia AR, Kusiak CM, Armento Lee A, Colangelo FR, Romanelli RJ, Robertson S, Miller DP, Erani DM, Layne JE, Dixon RF, Zisser H. Glycemic Outcomes in Adults With Type 2 Diabetes Participating in a Continuous Glucose Monitor-Driven Virtual Diabetes Clinic: Prospective Trial. J Med Internet Res 2020; 22:e21778. [PMID: 32856597 PMCID: PMC7486672 DOI: 10.2196/21778] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The Onduo virtual diabetes clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote personalized lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices for intermittent use. OBJECTIVE This prospective single-arm study evaluated glycemic outcomes associated with participation in the Onduo VDC for 4 months. METHODS Adults aged ≥18 years with T2D and a baseline glycated hemoglobin (HbA1c) of ≥8% to ≤12% were enrolled from 2 primary care centers from February 2019 to October 2019. Participants were asked to engage at ≥1 time per week with their care team and to participate in a telemedicine consultation with a clinic endocrinologist for diabetes medication review. Participants were asked to use a RT-CGM device and wear six 10-day sensors (total 60 days of sensor wear) intermittently over the course of 4 months. The primary outcome was change in HbA1c at 4 months from baseline. Other endpoints included change in weight and in RT-CGM glycemic metrics, including percent time <70, 70-180, 181-250, and >250 mg/dL. Changes in blood pressure and serum lipids at 4 months were also evaluated. RESULTS Participants (n=55) were 57.3 (SD 11.6) years of age, body mass index 33.7 (SD 7.2), and 40% (22/55) female. HbA1c decreased significantly by 1.6% (SD 1%; P<.001). When stratified by baseline HbA1c of 8.0% to 9.0% (n=36) and >9.0% (n=19), HbA1c decreased by 1.2% (SD 0.6%; P<.001) and 2.4% (SD 1.3%; P<.001), respectively. Continuous glucose monitoring-measured (n=43) percent time in range (TIR) 70-180 mg/dL increased by 10.2% (SD 20.5%; P=.002), from 65.4% (SD 23.2%) to 75.5% (SD 22.7%), which was equivalent to a mean increase of 2.4 hours TIR per day. Percent time 181-250 mg/dL and >250 mg/dL decreased by 7.2% (SD 15.4; P=.005) and 3.0% (SD 9.4; P=.01), respectively. There was no change in percent time <70 mg/dL. Mean weight decreased by 9.0 lb (SD 10.4; P<.001). Significant improvements were also observed in systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglycerides (P=.04 to P=<.001). CONCLUSIONS Participants in the Onduo VDC experienced significant improvement in HbA1c, increased TIR, decreased time in hyperglycemia, and no increase in hypoglycemia at 4 months. Improvements in other metabolic health parameters including weight and blood pressure were also observed. In conclusion, the Onduo VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialty care and advanced diabetes technology including RT-CGM. TRIAL REGISTRATION ClinicalTrials.gov NCT03865381; https://clinicaltrials.gov/ct2/show/NCT03865381.
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Affiliation(s)
- Amit R Majithia
- Department of Medicine and Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Coco M Kusiak
- Verily Life Sciences, South San Francisco, CA, United States
| | - Amy Armento Lee
- Verily Life Sciences, South San Francisco, CA, United States
| | | | | | - Scott Robertson
- Verily Life Sciences, South San Francisco, CA, United States
| | - David P Miller
- Verily Life Sciences, South San Francisco, CA, United States
| | | | | | | | - Howard Zisser
- Verily Life Sciences, South San Francisco, CA, United States
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22
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Denizard-Thompson NM, Miller DP, Snavely AC, Spangler JG, Case LD, Weaver KE. Effect of a Digital Health Intervention on Decreasing Barriers and Increasing Facilitators for Colorectal Cancer Screening in Vulnerable Patients. Cancer Epidemiol Biomarkers Prev 2020; 29:1564-1569. [PMID: 32381556 PMCID: PMC7416430 DOI: 10.1158/1055-9965.epi-19-1199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/09/2019] [Accepted: 05/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Colorectal cancer is the second leading cause of cancer-related death in the United States, in part, because one third of Americans fail to get screened. In a prior randomized controlled trial, we found that an iPad patient decision aid called Mobile Patient Technology for Health-CRC (mPATH-CRC) doubled the proportion of patients who completed colorectal cancer screening. METHODS All data for the current analysis were collected as part of a randomized controlled trial to determine the impact of mPATH-CRC on receipt of colorectal cancer screening within 24 weeks. Participants were enrolled from six community-based primary care practices between June 2014 and May 2016 and randomized to either usual care or mPATH-CRC. Six potential mediators of the intervention effect on screening were considered. The Iacobucci method was used to assess the significance of the mediation. RESULTS A total of 408 patients had complete data for all potential mediators. Overall, the potential mediators accounted for approximately three fourths (76.3%) of the effect of the program on screening completion. Perceived benefits, self-efficacy, ability to state a screening decision, and patient-provider discussion were statistically significant mediators. Patient-provider discussion accounted for the largest proportion of the effect of mPATH-CRC (70.7%). CONCLUSIONS mPATH-CRC increased completion of colorectal cancer screening by affecting patient-level and system-level mediators. However, the most powerful mediator was the occurrence of a patient-provider discussion about screening. Digital interventions like mPATH-CRC are an important adjunct to the patient-provider encounter. IMPACT Understanding the factors that mediated mPATH-CRC's success is paramount to developing other effective interventions.
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Affiliation(s)
| | - David P Miller
- Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - L Doug Case
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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23
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Zgodic A, Zahnd WE, Miller DP, Studts JL, Eberth JM. Predictors of Lung Cancer Screening Utilization in a Population-Based Survey. J Am Coll Radiol 2020; 17:1591-1601. [PMID: 32681828 DOI: 10.1016/j.jacr.2020.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Annual low-dose CT (LDCT) screening in high-risk individuals has been recommended to detect lung cancer earlier and reduce mortality. The objective of this study was to identify demographic, financial, and health care factors associated with screening uptake in a population-based survey. METHODS Data from the Lung Cancer Screening Module and core modules of the 2017 Behavioral Risk Factor Surveillance System, a population-based survey administered via cell phone and landline, were analyzed to examine demographic, health, and financial factors associated with screening uptake among the 10 states that administered the screening module. Weighted frequencies and confidence intervals (CIs) were produced, and weighted Wald χ2 tests were used to compare differences in screening utilization by patient characteristics. A multivariate logistic mixed-effects model was constructed, in which participant clustering by state was accounted for with a random intercept. RESULTS The uninsured were less likely to undergo LDCT screening (odds ratio [OR], 0.28; 95% CI, 0.12-0.65). LDCT screening uptake was higher for participants with chronic respiratory conditions (OR, 4.14; 95% CI, 2.33-7.35); those who were divorced, separated, widowed, or refused to answer (OR, 1.41; 95% CI, 1.05-1.86); those who had previous cancer diagnoses (OR, 1.90; 95% CI, 1.40-2.56); and those aged 65 to 69 years (OR, 1.23; 95% CI, 1.06-1.44) or 70 to 74 years (OR, 1.17; 95% CI, 1.00-1.37). Utilization also varied significantly across states. CONCLUSIONS Having a related health condition whereby participants were sensitized to the benefits of early screening (ie, another cancer diagnosis, presence of chronic respiratory conditions) and having insurance coverage were associated with higher LDCT screening uptake. Providers should engage LDCT-eligible patients through informed and shared decision making to increase preference-sensitive screening decisions.
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Affiliation(s)
- Anja Zgodic
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - David P Miller
- Associate Director, Clinical and Translational Science Institute, Wake Forest School of Medicine; Director, KL2 Training Program, Wake Forest School of Medicine; Department of Internal Medicine and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jamie L Studts
- Professor, Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine; Scientific Director, Behavioral Oncology, Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; University of Colorado Cancer Center, Aurora, Colorado
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Director, Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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24
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Moore JB, Dilley JR, Singletary CR, Skelton JA, Miller DP, Heboyan V, De Leo G, Turner-McGrievy G, McGrievy M, Ip EH. A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study. JMIR Res Protoc 2020; 9:e18098. [PMID: 32348291 PMCID: PMC7305562 DOI: 10.2196/18098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. Objective This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. Methods Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. Results This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. Conclusions The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. International Registered Report Identifier (IRRID) PRR1-10.2196/18098
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Affiliation(s)
- Justin B Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Joshua R Dilley
- Department of Plastic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Camelia R Singletary
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Vahé Heboyan
- Department of Interdisciplinary Health Sciences, Augusta University, Augusta, GA, United States
| | - Gianluca De Leo
- Department of Interdisciplinary Health Sciences, Augusta University, Augusta, GA, United States
| | - Gabrielle Turner-McGrievy
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Matthew McGrievy
- Office of Operations and Accreditation, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Edward H Ip
- Department of Biostatistics & Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Latulipe C, Mazumder SF, Wilson RKW, Talton JW, Bertoni AG, Quandt SA, Arcury TA, Miller DP. Security and Privacy Risks Associated With Adult Patient Portal Accounts in US Hospitals. JAMA Intern Med 2020; 180:845-849. [PMID: 32364562 PMCID: PMC7199170 DOI: 10.1001/jamainternmed.2020.0515] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Patient portals can help caregivers better manage care for patients, but how caregivers access the patient portal could threaten patient security and privacy. OBJECTIVE To identify the proportions of hospitals that provide proxy accounts to caregivers of adult patients, endorse password sharing with caregivers, and enable patients to restrict the types of information seen by their caregivers. DESIGN, SETTING, AND PARTICIPANTS This national cross-sectional study included a telephone survey and was conducted from May 21, 2018, to December 20, 2018. The randomly selected sample comprised 1 independent hospital and 1 health system-affiliated general medical hospital from every US state and the District of Columbia. Specialty hospitals and those that did not have a patient portal in place were excluded. An interviewer posing as the daughter of an older adult patient called each hospital to ask about the hospital's patient portal practices. The interviewer used a structured questionnaire to obtain information on proxy account availability, password sharing, and patient control of their own information. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of hospitals that provided proxy accounts to caregivers of adult patients. Secondary outcomes were the proportion of hospitals with personnel who endorsed password sharing and the proportion that allowed adult patients to limit the types of information available to caregivers. RESULTS After exclusions, a total of 102 (51 health system-affiliated and 51 independent) hospitals were included in the study. Of these hospitals, 69 (68%) provided proxy accounts to caregivers of adult patients and 26 (25%) did not. In 7 of 102 hospitals (7%), the surveyed personnel did not know if proxy accounts were available. In the 94 hospitals asked about password sharing between the patient and caregiver, personnel in 42 hospitals (45%) endorsed the practice. Among hospitals that provided proxy accounts, only 13 of the 69 hospitals (19%) offered controls that enabled patients to restrict the types of information their proxies could see. CONCLUSIONS AND RELEVANCE This study found that almost half of surveyed hospital personnel recommended password sharing and that few hospitals enabled patients to limit the types of information seen by those with proxy access. These findings suggest that hospitals and electronic health record (HER) vendors need to improve the availability and setup process of proxy accounts in a way that allows caregivers to care for patients without violating their privacy.
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Affiliation(s)
- Celine Latulipe
- Department of Computer Science, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Software and Information Systems, The University of North Carolina at Charlotte, Charlotte
| | - Syeda Fatema Mazumder
- Department of Software and Information Systems, The University of North Carolina at Charlotte, Charlotte
| | - Rachel K W Wilson
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jennifer W Talton
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alain G Bertoni
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sara A Quandt
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Patel N, Miller DP, Snavely AC, Bellinger C, Foley KL, Case D, McDonald ML, Masmoudi YR, Dharod A. A Comparison of Smoking History in the Electronic Health Record With Self-Report. Am J Prev Med 2020; 58:591-595. [PMID: 31982229 PMCID: PMC7533103 DOI: 10.1016/j.amepre.2019.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Knowing patients' smoking history helps guide who may benefit from preventive services such as lung cancer screening. The accuracy of smoking history electronic health records remains unclear. METHODS This was a secondary analysis of data collected from a portal-based lung cancer screening decision aid. Participants of an academically affiliated health system, aged 55-76 years, completed an online survey that collected a detailed smoking history including years of smoking, years since quitting, and smoking intensity. Eligibility for lung cancer screening was defined using the Centers for Medicare and Medicaid Services criteria. Data analysis was performed May-December 2018, and data collection occurred between November 2016 and February 2017. RESULTS A total of 336 participants completed the survey and were included in the analysis. Of 175 participants with self-reported smoking intensity, 72% had packs per day and 62% had pack-years recorded in the electronic health record. When present, smoking history in the electronic health records correlated well with self-reported years of smoking (r =0.78, p≤0.0001) and years since quitting (r =0.94, p≤0.0001). Self-reported smoking intensity, including pack-years (r =0.62, p<0.0001) and packs per day (r =0.65, p≤0.0001), was less correlated. Of those participants eligible for lung cancer screening by self-report, only 35% met criteria for screening by electronic health records data alone. Others were either incorrectly classified as ineligible (23%) or had incomplete data (41%). CONCLUSIONS The electronic health records frequently misses critical elements of a smoking history, and when present, it often underestimates smoking intensity, which may impact who receives lung cancer screening.
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Affiliation(s)
- Nikhil Patel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - David P Miller
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christina Bellinger
- Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristie L Foley
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Doug Case
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Malcolm L McDonald
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Youssef R Masmoudi
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ajay Dharod
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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27
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Foley KL, Miller DP, Weaver K, Sutfin EL, Petty WJ, Bellinger C, Spangler J, Stone RJ, Lawler D, Davis W, Dressler E, Lesser G, Chiles C. The OaSiS trial: A hybrid type II, national cluster randomized trial to implement smoking cessation during CT screening for lung cancer. Contemp Clin Trials 2020; 91:105963. [PMID: 32087340 PMCID: PMC7378998 DOI: 10.1016/j.cct.2020.105963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION When the Centers for Medicare and Medicaid Services announced coverage for low dose CT lung cancer screening, they also mandated that imaging centers offer smoking cessation services. We designed the Optimizing Lung Screening (OaSiS) trial to evaluate strategies to implement the Public Health Service Guidelines for Treating Tobacco Use and Dependence during CT screening for lung cancer. METHODS AND DESIGN OaSiS was implemented using a pragmatic effectiveness-implementation hybrid design in 26 imaging clinics across the United States affiliated with the National Cancer Institute's National Community Oncology Research Program (NCORP). The 26 sites selected for participation in the OaSiS trial were randomized to receive either a compendium of implementation strategies to add or enhance smoking cessation services during lung screening or to usual care. Usual care sites were given the option to receive the full compendium of implementation strategies at the conclusion of data collection. We have evaluated both the effectiveness of the implementation strategies to improve smoking cessation at six months among patients undergoing LDCT screening as well as the adoption and sustainability of evidence-based tobacco cessation strategies in imaging clinics. DISCUSSION The OaSiS trial was designed to identify opportunities for implementing evidence-based smoking cessation into LDCT lung cancer screening imaging facilities and to establish the effectiveness of these services. We report our study design and evaluation, including strengths of the pragmatic design and the inclusion of a diverse range of screening programs. Establishing these tobacco cessation services will be critical to reducing smoking related morbidity and mortality.
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Affiliation(s)
- Kristie Long Foley
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America.
| | - David P Miller
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Internal Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Kathryn Weaver
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Social Sciences and Health Policy, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Erin L Sutfin
- Social Sciences and Health Policy, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - W Jeffrey Petty
- Hematology and Oncology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Christina Bellinger
- Pulmonology and Critical Care, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - John Spangler
- Family and Community Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Rebecca J Stone
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Donna Lawler
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Whitney Davis
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Emily Dressler
- Biostatistics and Data Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Glenn Lesser
- Internal Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Hematology and Oncology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Caroline Chiles
- Radiology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
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Stinson JA, Palmer CR, Miller DP, Li AB, Lightner K, Jost H, Weldon WC, Oberste MS, Kluge JA, Kosuda KM. Thin silk fibroin films as a dried format for temperature stabilization of inactivated polio vaccine. Vaccine 2020; 38:1652-1660. [PMID: 31959422 PMCID: PMC7176408 DOI: 10.1016/j.vaccine.2019.12.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/21/2019] [Accepted: 12/28/2019] [Indexed: 02/01/2023]
Abstract
Current inactivated polio vaccine (IPV) products are sensitive to both freezing and elevated temperatures and therefore must be shipped and stored between 2 °C and 8 °C, a requirement that imposes financial and logistical challenges for global distribution. As such, there is a critical need for a robust, thermally stable IPV to support global polio eradication and post-eradication immunization needs. Here, we present the development of air-dried thin films for temperature stabilization of IPV using the biomaterial silk fibroin. Thin-film product compositions were optimized for physical properties as well as poliovirus D-antigen recovery and were tested under accelerated and real-time stability storage conditions. Silk fibroin IPV films maintained 70% D-antigen potency after storage for nearly three years at room temperature, and greater than 50% potency for IPV-2 and IPV-3 serotypes at 45 °C for one year. The immunogenicity of silk fibroin IPV films after 2-week storage at 45 °C was assessed in Wistar rats and the stressed films generated equivalent neutralizing antibody responses to commercial vaccine for IPV-1 and IPV-2. However, the absence of IPV-3 responses warrants further investigation into the specificity of ELISA for intact IPV-3 D-antigen. By demonstrating immunogenicity post-storage, we offer the air-dried silk film format as a means to increase IPV vaccine access through innovative delivery systems such as microneedles.
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Affiliation(s)
- Jordan A Stinson
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Carter R Palmer
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - David P Miller
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Adrian B Li
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Kandice Lightner
- IHRC, 2 Ravinia Drive, Suite 1200, Atlanta, GA 30346, USA, contracted to CDC
| | - Heather Jost
- Centers for Disease Control and Prevention (CDC), Division of Viral Diseases, 1600 Clifton Road NE, Mailstop H17-6, Atlanta, GA 30329, USA
| | - William C Weldon
- Centers for Disease Control and Prevention (CDC), Division of Viral Diseases, 1600 Clifton Road NE, Mailstop H17-6, Atlanta, GA 30329, USA
| | - M Steven Oberste
- Centers for Disease Control and Prevention (CDC), Division of Viral Diseases, 1600 Clifton Road NE, Mailstop H17-6, Atlanta, GA 30329, USA
| | - Jonathan A Kluge
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA
| | - Kathryn M Kosuda
- Vaxess Technologies, Inc., 790 Memorial Drive, Suite 200, Cambridge, MA 02139, USA.
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Brooks AK, Miller DP, Fanning JT, Suftin EL, Reid MC, Wells BJ, Leng X, Hurley RW. A Pain eHealth Platform for Engaging Obese, Older Adults with Chronic Low Back Pain in Nonpharmacological Pain Treatments: Protocol for a Pilot Feasibility Study. JMIR Res Protoc 2020; 9:e14525. [PMID: 31895042 PMCID: PMC6966554 DOI: 10.2196/14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background Low back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain. Objective The Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools. Methods Using a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale. Results Qualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019. Conclusions The PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions. International Registered Report Identifier (IRRID) DERR1-10.2196/14525
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Affiliation(s)
- Amber K Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - David P Miller
- Department of General Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Jason T Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Erin L Suftin
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - M Carrington Reid
- Division of Geriatric and Palliative Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Brian J Wells
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Xiaoyan Leng
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Robert W Hurley
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
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Abstract
The learning health system (LHS) has gained traction as a powerful framework for improving the cost and quality of healthcare. The goal of an LHS is to systematically integrate internal data and experience with external evidence so patients receive higher-quality, safer, and more efficient care. However, if the goal of an LHS is to improve health, as well as healthcare, it must account for and mitigate the negative impact of social and economic factors on health, known as the social determinants of health. In this paper, we discuss the critical role the LHS can play in addressing patients' social risk factors. We also discuss how integrating data on the social determinants and activities to reduce patients' social risk factors could advance the mission of the LHS to enhance patient engagement, improve the delivery of personalized care, and more accurately evaluate the effectiveness of care. Without the collection and integration of data on the social determinants of health, the LHS may fail to reach its full potential to improve health and healthcare.
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Affiliation(s)
- Deepak Palakshappa
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
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Abstract
Oral supra- and subgingival biofilms are complex communities in which hundreds of bacteria, viruses, and fungi reside and interact. In these social environments, microbes compete and cooperate for resources, such as living space and nutrients. The metabolic activities of bacteria can transform their microenvironment and dynamically influence the fitness and growth of cohabitating organisms. Biofilm communities are temporally and spatially organized largely due to cell-to-cell communication, which promotes synergistic interactions. Metabolic interactions maintain biofilm homeostasis through mutualistic cross-feeding, metabolic syntrophy, and cross-respiration. These interactions include reciprocal metabolite exchanges that promote the growth of physiologically compatible bacteria, processive catabolism of complex substrates, and unidirectional interactions that are globally important for the polymicrobial community. Additionally, oral bacterial interactions can lead to detoxification of oxidative compounds, which will provide protection to the community at large. It has also been established that specific organisms provide terminal electron acceptors to partner species that result in a shift from fermentation to respiration, thus increasing ATP yields and improving fitness. Indeed, many interspecies relationships are multidimensional, and the net outcome can be spatially and temporally dependent. Cross-kingdom interactions also occur as oral yeast are antagonistic to some oral bacteria, while numerous mutualistic interactions contribute to yeast-bacterial colonization, fitness in the oral community, and the pathogenesis of caries. Consideration of this social environment reveals behaviors and phenotypes that are not apparent through the study of microbes in isolation. Here, we provide a comprehensive overview of the metabolic interactions that shape the oral microbial community.
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Affiliation(s)
- D P Miller
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY, USA
| | - Z R Fitzsimonds
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY, USA
| | - R J Lamont
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY, USA
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Latulipe C, Quandt SA, Melius KA, Bertoni A, Miller DP, Smith D, Arcury TA. Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study. J Med Internet Res 2018; 20:e10524. [PMID: 30389654 PMCID: PMC6240158 DOI: 10.2196/10524] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 01/22/2023] Open
Abstract
Background Electronic patient portals have become common and offer many potential benefits for patients’ self-management of health care. These benefits could be especially important for older adult patients dealing with significant chronic illness, many of whom have caregivers, such as a spouse, adult child, or other family member or friend, who help with health care management. Patient portals commonly contain large amounts of personal information, including diagnoses, health histories, medications, specialist appointments, lab results, and billing and insurance information. Some health care systems provide proxy accounts for caregivers to access a portal on behalf of a patient. It is not well known how much and in what way caregivers are using patient portals on behalf of patients and whether patients see any information disclosure risks associated with such access. Objective The objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers. Methods We conducted semistructured interviews with 10 older adult patients with chronic illness. We asked them about their relationship with their caregivers, their use of their patient portal, their caregiver’s use of the portal, and their perceptions about the benefits and risks of their caregiver’s use of the portals. We also asked them about their comfort level with caregivers having access to information about a hypothetical diagnosis of a stigmatized condition. Two investigators conducted a thematic analysis of the qualitative data. Results All patients identified caregivers. Some had given caregivers access to their portals, in all cases by sharing log-in credentials, rather than by setting up an official proxy account. Patients generally saw benefits in their caregivers having access to the information and functions provided by the portal. Patients generally reported that they would be uncomfortable with caregivers learning of stigmatized conditions and also with caregivers (except spouses) accessing financial billing information. Conclusions Patients share their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but are unaware of all the information those caregivers can access. Better portal design could alleviate these unwanted information disclosures.
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Affiliation(s)
- Celine Latulipe
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Kathryn Altizer Melius
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Alain Bertoni
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Douglas Smith
- Greene County Health Care, Inc, Snow Hill, NC, United States
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Arcury TA, Sandberg JC, Melius KP, Quandt SA, Leng X, Latulipe C, Miller DP, Smith DA, Bertoni AG. Older Adult Internet Use and eHealth Literacy. J Appl Gerontol 2018; 39:141-150. [PMID: 30353776 DOI: 10.1177/0733464818807468] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We examine Internet use and eHealth literacy among older adults (aged 55+ years) who were patients at clinics serving low-income populations. Participants included 200 minority and White adults who completed interviews based on a technology acceptance conceptual model. A total of 106 participants (53.0%) used the Internet; utilization was associated with personal characteristics (age, ethnicity, education, poverty), computer characteristics (number of e-devices, computer stress), social support (marital status), and health knowledge and attitudes (health literacy, medical decision making, health information sources), but not health status. Of the 106 participants who used the Internet, 52 (49.1%) had high eHealth literacy; eHealth literacy was associated with computer characteristics (number of e-devices, computer stress), and health knowledge and attitudes (medical decision making, health information sources). In multivariate analysis, computer stress maintained a significant inverse association with eHealth literacy. Educational interventions to help older adults successfully use technology and improve eHealth literacy must be identified.
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Affiliation(s)
| | | | | | - Sara A Quandt
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Xiaoyan Leng
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Miller DP, Wang Q, Weinberg A, Lamont RJ. Transcriptome analysis of Porphyromonas gingivalis and Acinetobacter baumannii in polymicrobial communities. Mol Oral Microbiol 2018; 33:364-377. [PMID: 29939498 DOI: 10.1111/omi.12238] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2018] [Indexed: 02/07/2023]
Abstract
Acinetobacter baumannii is a nosocomial, opportunistic pathogen that causes several serious conditions including meningitis, septicemia, endocarditis, and pneumonia. It can be found in the oral biofilm, which may be a reservoir for pneumonia and chronic obstructive pulmonary disease. Subgingival colonization by A. baumannii is associated with chronic and aggressive periodontitis as well as refractory periodontal disease. Porphyromonas gingivalis, a keystone periodontal pathogen localized to subgingival plaque, is also implicated in several chronic conditions including aspiration pneumonia. Although both bacteria are found together in subgingival plaque and can cause multiple polymicrobial infections, nothing is known about the interactions between these two important human pathogens. In this study, we used RNA sequencing to understand the transcriptional response of both species as they adapt to heterotypic communities. Among the differentially regulated genes were those encoding a number of important virulence factors for both species including adhesion, biofilm formation, and protein secretion. Additionally, the presence of A. baumannii increased the abundance of P. gingivalis in model dual-species communities. Collectively these results suggest that both P. gingivalis and A. baumannii adapt to each other and have synergistic potential for increased pathogenicity. In identifying the mechanisms that promote pathogenicity and refractory disease, novel approaches to mitigate polymicrobial synergistic interactions may be developed to treat or prevent associated diseases.
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Affiliation(s)
- D P Miller
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, Kentucky
| | - Q Wang
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, Kentucky
| | - A Weinberg
- Department of Biological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - R J Lamont
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, Kentucky
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Miller DP, Denizard-Thompson N, Weaver KE, Case LD, Troyer JL, Spangler JG, Lawler D, Pignone MP. Effect of a Digital Health Intervention on Receipt of Colorectal Cancer Screening in Vulnerable Patients: A Randomized Controlled Trial. Ann Intern Med 2018; 168. [PMID: 29532054 PMCID: PMC6033519 DOI: 10.7326/m17-2315] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Screening for colorectal cancer (CRC) reduces mortality, yet more than one third of age-eligible Americans are unscreened. OBJECTIVE To examine the effect of a digital health intervention, Mobile Patient Technology for Health-CRC (mPATH-CRC), on rates of CRC screening. DESIGN Randomized clinical trial. (ClinicalTrials.gov: NCT02088333). SETTING 6 community-based primary care practices. PARTICIPANTS 450 patients (223 in the mPATH-CRC group and 227 in usual care) scheduled for a primary care visit and due for routine CRC screening. INTERVENTION An iPad application that displays a CRC screening decision aid, lets patients order their own screening tests, and sends automated follow-up electronic messages to support patients. MEASUREMENTS The primary outcome was chart-verified completion of CRC screening within 24 weeks. Secondary outcomes were ability to state a screening preference, intention to receive screening, screening discussions, and orders for screening tests. All outcome assessors were blinded to randomization. RESULTS Baseline characteristics were similar between groups; 37% of participants had limited health literacy, and 53% had annual incomes less than $20 000. Screening was completed by 30% of mPATH-CRC participants and 15% of those receiving usual care (logistic regression odds ratio, 2.5 [95% CI, 1.6 to 4.0]). Compared with usual care, more mPATH-CRC participants could state a screening preference, planned to be screened within 6 months, discussed screening with their provider, and had a screening test ordered. Half of mPATH-CRC participants (53%; 118 of 223) "self-ordered" a test via the program. LIMITATION Participants were English speakers in a single health care system. CONCLUSION A digital health intervention that allows patients to self-order tests can increase CRC screening. Future research should identify methods for implementing similar interventions in clinical care. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- David P Miller
- Wake Forest School of Medicine, Winston-Salem, North Carolina (D.P.M., N.D., K.E.W., L.D.C., J.G.S., D.L.)
| | - Nancy Denizard-Thompson
- Wake Forest School of Medicine, Winston-Salem, North Carolina (D.P.M., N.D., K.E.W., L.D.C., J.G.S., D.L.)
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Winston-Salem, North Carolina (D.P.M., N.D., K.E.W., L.D.C., J.G.S., D.L.)
| | - L Doug Case
- Wake Forest School of Medicine, Winston-Salem, North Carolina (D.P.M., N.D., K.E.W., L.D.C., J.G.S., D.L.)
| | - Jennifer L Troyer
- Belk College of Business at University of North Carolina at Charlotte, Charlotte, North Carolina (J.L.T.)
| | - John G Spangler
- Wake Forest School of Medicine, Winston-Salem, North Carolina (D.P.M., N.D., K.E.W., L.D.C., J.G.S., D.L.)
| | - Donna Lawler
- Wake Forest School of Medicine, Winston-Salem, North Carolina (D.P.M., N.D., K.E.W., L.D.C., J.G.S., D.L.)
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Arcury TA, Quandt SA, Sandberg JC, Miller DP, Latulipe C, Leng X, Talton JW, Melius KP, Smith A, Bertoni AG. Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study. JMIR Med Inform 2017; 5:e47. [PMID: 29138129 PMCID: PMC5705857 DOI: 10.2196/medinform.8026] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/03/2017] [Accepted: 09/21/2017] [Indexed: 12/03/2022] Open
Abstract
Background Patient portals can improve patient communication with providers, provide patients with greater health information access, and help improve patient decision making, if they are used. Because research on factors facilitating and limiting patient portal utilization has not been conceptually based, no leverage points have been indicated for improving utilization. Objective The primary objective for this analysis was to use a conceptual framework to determine potentially modifiable factors affecting patient portal utilization by older adults (aged 55 years and older) who receive care at clinics that serve low income and ethnically diverse communities. The secondary objective was to delineate how patient portal utilization is associated with perceived usefulness and usability. Methods Patients from one urban and two rural clinics serving low income patients were recruited and completed interviewer-administered questionnaires on patient portal utilization. Results A total of 200 ethnically diverse patients completed questionnaires, of which 41 (20.5%) patients reported utilizing portals. Education, social support, and frequent Internet utilization improve the odds of patient portal utilization; receiving health care at a rural clinic decreases the odds of portal utilization. Conclusions Leverage points to address disparities in patient portal utilization include providing training for older adults in patient portal utilization, involving spouses or other care partners in this training, and making information technology access available at public places in rural and urban communities.
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Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Joanne C Sandberg
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Celine Latulipe
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Xiaoyan Leng
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jenifer W Talton
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Kathryn P Melius
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Alden Smith
- Greene County Health Care, Inc, Snow Hill, NC, United States
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Pinsky PF, Bellinger CR, Miller DP. False-positive screens and lung cancer risk in the National Lung Screening Trial: Implications for shared decision-making. J Med Screen 2017; 25:110-112. [DOI: 10.1177/0969141317727771] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Low-dose computed tomography lung cancer screening has been shown to reduce lung cancer mortality but has a high false-positive rate. The precision medicine approach to low-dose computed tomography screening assesses subjects’ benefits versus harms based on their personal lung cancer risk, where harms include false-positive screens and resultant invasive procedures. We assess the relationship between lung cancer risk and the rate of false-positive LDCT screens. Methods The National Lung Screening Trial randomized high-risk subjects to three annual screens with low-dose computed tomography or chest radiographs. Following the completion of National Lung Screening Trial, the Lung CT Screening Reporting and Data System (Lung-RADS) classification system was developed and retrospectively applied to National Lung Screening Trial low-dose computed tomography findings. The rate of false-positive screens (by Lung-RADS) and the resultant invasive procedures were examined as a function of lung cancer risk estimated by a model. Results Of 26,722 subjects randomized to the low-dose computed tomography arm, 26,309 received a baseline screen and were included in the analysis. The proportion with any false positive over three screening rounds increased from 12.9% to 25.9% from lowest to highest risk decile, and the proportion with an invasive procedure following a false positive also significantly increased from 0.7% to 2.0% from lowest to highest risk decile. Conclusion These findings indicate a need for personalized low-dose computed tomography lung cancer screening decision aids to accurately convey the benefits to harm trade-off.
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Affiliation(s)
- Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | | | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, USA
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Affiliation(s)
- Michael Pignone
- Department of Medicine, Dell Medical School, University of Texas, Austin
- LiveStrong Cancer Institute, Austin, Texas
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Miller DP, Weaver KE, Case LD, Babcock D, Lawler D, Denizard-Thompson N, Pignone MP, Spangler JG. Usability of a Novel Mobile Health iPad App by Vulnerable Populations. JMIR Mhealth Uhealth 2017; 5:e43. [PMID: 28400354 PMCID: PMC5405290 DOI: 10.2196/mhealth.7268] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/07/2017] [Accepted: 03/09/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Recent advances in mobile technologies have created new opportunities to reach broadly into populations that are vulnerable to health disparities. However, mobile health (mHealth) strategies could paradoxically increase health disparities, if low socioeconomic status individuals lack the technical or literacy skills needed to navigate mHealth programs. OBJECTIVE The aim of this study was to determine whether patients from vulnerable populations could successfully navigate and complete an mHealth patient decision aid. METHODS We analyzed usability data from a randomized controlled trial of an iPad program designed to promote colorectal cancer (CRC) screening. The trial was conducted in six primary care practices and enrolled 450 patients, aged 50-74 years, who were due for CRC screening. The iPad program included a self-survey and randomly displayed either a screening decision aid or a video about diet and exercise. We measured participant ability to complete the program without assistance and participant-rated program usability. RESULTS Two-thirds of the participants (305/450) were members of a vulnerable population (limited health literacy, annual income < US $20,000, or black race). Over 92% (417/450) of the participants rated the program highly on all three usability items (90.8% for vulnerable participants vs 96.6% for nonvulnerable participants, P=.006). Only 6.9% (31/450) of the participants needed some assistance to complete the program. In multivariable logistic regression, being a member of a vulnerable population was not associated with needing assistance. Only older age, less use of text messaging (short message service, SMS), and lack of Internet use predicted needing assistance. CONCLUSIONS Individuals who are vulnerable to health disparities can successfully use well-designed mHealth programs. Future research should investigate whether mHealth interventions can reduce health disparities.
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Affiliation(s)
- David P Miller
- Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, NC, United States
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Winston-Salem, NC, United States
| | - L Doug Case
- Wake Forest School of Medicine, Department of Biostatistical Sciences, Winston-Salem, NC, United States
| | - Donald Babcock
- Wake Forest Health Sciences, Enterprise Information Management, Winston-Salem, NC, United States
| | - Donna Lawler
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Winston-Salem, NC, United States
| | - Nancy Denizard-Thompson
- Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, NC, United States
| | - Michael P Pignone
- University of Texas Dell Medical School, Department of Internal Medicine, Austin, TX, United States
| | - John G Spangler
- Wake Forest School of Medicine, Department of Family & Community Medicine, Winston-Salem, NC, United States
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Petkov VI, Miller DP, Howlader N, Baehner FL, Penberthy L, Shak S. Abstract PD7-06: SEER study of breast cancer-specific mortality in patients with poorly differentiated tumors treated based on recurrence score results. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd7-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The SEER Program of the NCI is an authoritative source of cancer incidence and survival statistics. Linking the 21-gene assay Recurrence Score® (RS) results to the SEER Registries (N=44,825) demonstrated very low 5-year breast cancer-specific mortality (BCSM) with RS <18 across many key clinical-pathological subgroups, such as age, nodal status, tumor grade, and size (npj Breast Cancer. 2016;2:16017). Given the large sample size and specific interest in outcomes as a function of tumor grade, further stratification of patients with poorly differentiated tumors was performed to determine BCSM when examined by both tumor grade and tumor size.
Methods: Patients were eligible if node negative (N0), HR+, HER2-negative (by RT-PCR), had no prior malignancy, had poorly differentiated (G3) tumors, and were diagnosed between Jan 2004 (test available in Jan 2004) and Dec 2011 (SEER survival updated through 2012). BCSM was defined according to pre-existing robust methodology (J Natl Cancer Inst. 2010;102:1584). RS was categorized according to the cutpoints of 18 and 31 established in the NSABP B-14 study. Five-year BCSM was estimated using actuarial methods.
Results: Among 6,666 eligible patients with G3 tumors, 4,683 had tumors ≤2 cm and 1,983 had tumors >2 cm. Median age was 57 years; 99.1% were female. Median follow-up was 39 months. The proportion of patients with RS <18 was 29% among those with tumors ≤2 cm and 25% among those with tumors >2 cm, somewhat lower than the overall population. For RS <18, 5-year BCSM was 0.3% (G3; ≤2 cm) and 1.4% (G3; >2 cm); reported chemotherapy use was 10% and 16%, respectively. 5-year BCSM for all groups are provided in Table. An additional year of BCSM follow-up in N0 G3 disease, as well as results for patients with node positive (micrometastases or 1-3 positive nodes) G3 disease, will be available for presentation.
N0, G3 tumor, RS <18N0, G3 tumor, RS 18-30N0, G3 tumor, RS ≥31Tumor sizeN5-y BCSM (95% CI)N5-y BCSM (95% CI)N5-y BCSM (95% CI)≤2 cm13620.3% (0.1%, 1.2%)21482.1% (1.3%, 3.3%)11732.9% (1.8%, 4.7%)>2 cm4861.4% (0.4%, 4.6%)8514.6% (2.7%, 7.8%)6469.0% (6.0%, 13.4%)
Conclusions: Although patients with poorly differentiated tumors have worse prognosis in general, the RS identifies a sizable proportion of patients who can expect good outcomes without chemotherapy and its associated toxicity.
Citation Format: Petkov VI, Miller DP, Howlader N, Baehner FL, Penberthy L, Shak S. SEER study of breast cancer-specific mortality in patients with poorly differentiated tumors treated based on recurrence score results [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD7-06.
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Affiliation(s)
- VI Petkov
- National Cancer Institute, Bethesda, MD; Genomic Health, Inc., Redwood City, CA
| | - DP Miller
- National Cancer Institute, Bethesda, MD; Genomic Health, Inc., Redwood City, CA
| | - N Howlader
- National Cancer Institute, Bethesda, MD; Genomic Health, Inc., Redwood City, CA
| | - FL Baehner
- National Cancer Institute, Bethesda, MD; Genomic Health, Inc., Redwood City, CA
| | - L Penberthy
- National Cancer Institute, Bethesda, MD; Genomic Health, Inc., Redwood City, CA
| | - S Shak
- National Cancer Institute, Bethesda, MD; Genomic Health, Inc., Redwood City, CA
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Xiao R, Qi X, Patino A, Fagg AH, Kolobe TH, Miller DP, Ding L. Characterization of infant mu rhythm immediately before crawling: A high-resolution EEG study. Neuroimage 2017; 146:47-57. [DOI: 10.1016/j.neuroimage.2016.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022] Open
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Taylor AG, Miller DP. An Interview with Arlene G. Taylor. Cataloging & Classification Quarterly 2016. [DOI: 10.1080/01639374.2016.1237399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Arlene G. Taylor
- School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Liu C, Miller DP, Wang Y, Merchant M, Lamont RJ. Structure-function aspects of the Porphyromonas gingivalis tyrosine kinase Ptk1. Mol Oral Microbiol 2016; 32:314-323. [PMID: 27498608 DOI: 10.1111/omi.12173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 02/05/2023]
Abstract
The development of synergistically pathogenic communities of Porphyromonas gingivalis and Streptococcus gordonii is controlled by a tyrosine-phosphorylation-dependent signaling pathway in P. gingivalis. The Ptk1 bacterial tyrosine (BY) kinase of P. gingivalis is required for maximal community development and for the production of extracellular polysaccharide. We show that the consensus BY kinase Walker A and B domains, the RK cluster, and the YC domain of Ptk1 are necessary for autophosphorylation and for substrate phosphorylation. Mass spectrometry showed that six tyrosine residues in a 16-amino-acid C-terminal region were phosphorylated in recombinant (r) Ptk1. Complementation of a ptk1 mutant with the wild-type ptk1 allele in trans restored community development between P. gingivalis and S. gordonii, and extracellular polysaccharide production by P. gingivalis. In contrast, complementation of Δptk1 with ptk1 containing a mutation in the Walker A domain failed to restore community development or extracellular polysaccharide production. rPtk1 was capable of phosphorylating the tyrosine phosphatase Ltp1 and the transcriptional regulator CdhR, both of which are involved in the development of P. gingivalis communities with S. gordonii.
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Affiliation(s)
- C Liu
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY, USA.,State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - D P Miller
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY, USA
| | - Y Wang
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY, USA.,Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - M Merchant
- Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, USA
| | - R J Lamont
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY, USA
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Abstract
BACKGROUND Over one quarter of American adults binge drink, resulting in significant alcohol-related morbidity and mortality. Although brief interventions can decrease patients' alcohol use, many physicians in training do not provide this service. This study examines the prevalence of binge drinking among primary care residents, and the association of resident drinking behaviors with addressing patients' hazardous alcohol use. METHODS Between July 2013 and August 2014, the authors surveyed all trainees in 6 primary care residency programs. The survey assessed self-reported frequency of binge drinking, confidence working with hazardous drinkers, and the performance of brief interventions when hazardous drinking was detected in patients. RESULTS 221 of 246 residents completed the survey (response rate 89.8%). Half of residents (109/221) reported at least one episode of binge drinking in the prior year, and 18% (39/221) reported binge drinking at least once a month. In multivariable analysis, monthly binge drinking was associated with male gender (OR 2.5, 95% CI 1.1-5.4) and year of training (OR 0.25 for Year 3 vs. Year 1, 95% CI 0.07-0.90). Few residents felt confident they could help patients cut down or quit alcohol, regardless of personal binge drinking history (19% for those who binged monthly, 24% for those who binged 1-11 times a year, and 27% for those who never binged, p for trend = 0.31). Performance of brief interventions did not vary by personal binge drinking history. CONCLUSIONS Binge drinking is common among primary care residents. In addition to training residents to effectively intervene with hazardous drinkers, residency programs should address the high prevalence of binge drinking by their physicians in training.
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Affiliation(s)
- Magdalena Greene
- a Department of Internal Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - J Aaron Johnson
- b Institute of Public and Preventive Health, Augusta University , Augusta , Georgia , USA
| | - J Paul Seale
- c Department of Family Medicine , Mercer University School of Medicine , Macon , Georgia , USA
| | - Allen Tindol
- d Department of Internal Medicine , Mercer University School of Medicine , Macon , Georgia , USA
| | - Kristy B Le
- a Department of Internal Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - Diana D Clemow
- e Department of Family Medicine , AnMed Health , Anderson , South Carolina , USA
| | - Ann H Barham
- f Department of Family & Community Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - David P Miller
- a Department of Internal Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
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Abstract
OBJECTIVES To determine whether sharing laboratory charge and personal utilization information with physicians can reduce laboratory test orders and expenditures, thereby decreasing the overutilization of laboratory testing. METHODS This was a prospective study. By querying our electronic medical records, we calculated the median laboratory charges per patient/per day (PP/PD) and median laboratory tests ordered PP/PD for the resident general internal medicine and hospitalist services. For 10 weeks, we shared this team-based information with physicians with weekly updates. We calculated total laboratory charges for the 10 most common discharge diagnoses to capture laboratory charges for entire episodes of care. RESULTS During the intervention, the mean number of laboratory tests ordered PP/PD by resident service decreased from 5.56 to 5.17 (-0.389, P <0.001); the mean charge PP/PD decreased from $488 to $461 (-$27, P < 0.001). The hospitalist service decreased the number of laboratory tests ordered PP/PD from 3.54 to 3.36 (-0.18, P = 0.77) and the mean charge PP/PD decreased from $331 to $301 (-$30, P = 0.96). The statistically significant decline in laboratory charges persisted after controlling for the 10 most common discharge diagnoses. Compared with the 3-month period before the study began, physicians in the 10-week intervention period ordered 1464 fewer laboratory tests, resulting in a $188,000 reduction in charges and a 3% to 4% reduction in utilization. CONCLUSIONS Informing physicians of the charges for laboratory tests and their personal utilization patterns can reduce the number of laboratory tests ordered and laboratory expenditures, especially for physicians in training.
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Affiliation(s)
- Bernard Tawfik
- From the Department of Internal Medicine, Wake Forest School of Medicine, the Department of Biostatistical Sciences, Wake Forest Baptist Health Performance Improvement, and the Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - J B Collins
- From the Department of Internal Medicine, Wake Forest School of Medicine, the Department of Biostatistical Sciences, Wake Forest Baptist Health Performance Improvement, and the Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nora F Fino
- From the Department of Internal Medicine, Wake Forest School of Medicine, the Department of Biostatistical Sciences, Wake Forest Baptist Health Performance Improvement, and the Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David P Miller
- From the Department of Internal Medicine, Wake Forest School of Medicine, the Department of Biostatistical Sciences, Wake Forest Baptist Health Performance Improvement, and the Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Miller DP, Latulipe C, Melius KA, Quandt SA, Arcury TA. Primary Care Providers' Views of Patient Portals: Interview Study of Perceived Benefits and Consequences. J Med Internet Res 2016; 18:e8. [PMID: 26772771 PMCID: PMC4733220 DOI: 10.2196/jmir.4953] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/15/2015] [Accepted: 11/05/2015] [Indexed: 12/04/2022] Open
Abstract
Background The United States government is encouraging physicians to adopt patient portals—secure websites that allow patients to access their health information. For patient portals to recognize their full potential and improve patient care, health care providers’ acceptance and encouragement of their use will be essential. However, little is known about provider concerns or views of patient portals. Objective We conducted this qualitative study to determine how administrators, clinic staff, and health care providers at practices serving a lower income adult population viewed patient portals in terms of their potential benefit, areas of concern, and hopes for the future. Methods We performed in-depth interviews between October 2013 and June 2014 with 20 clinic personnel recruited from health centers in four North Carolina counties. Trained study personnel conducted individual interviews following an interviewer guide to elicit perceptions of the benefits and disadvantages of patient portals. Interviews were recorded and transcribed. Research team members reviewed transcribed interviews for major themes to construct a coding dictionary. Two researchers then coded each transcript with any coding discrepancies resolved through discussion. Results The interviews revealed that clinic personnel viewed patient portals as a mandated product that had potential to improve communication and enhance information sharing. However, they expressed many concerns including portals’ potential to generate more work, confuse patients, alienate non-users, and increase health disparities. Clinic personnel expected few older and disadvantaged patients to use a portal. Conclusions Given that clinic personnel have significant concerns about portals’ unintended consequences, their uptake and impact on care may be limited. Future studies should examine ways portals can be implemented in practices to address providers’ concerns and meet the needs of vulnerable populations.
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Affiliation(s)
- David P Miller
- Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, NC, United States.
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Zech SG, Kohlmann A, Zhou T, Li F, Squillace RM, Parillon LE, Greenfield MT, Miller DP, Qi J, Thomas RM, Wang Y, Xu Y, Miret JJ, Shakespeare WC, Zhu X, Dalgarno DC. Novel Small Molecule Inhibitors of Choline Kinase Identified by Fragment-Based Drug Discovery. J Med Chem 2016; 59:671-86. [PMID: 26700752 DOI: 10.1021/acs.jmedchem.5b01552] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Choline kinase α (ChoKα) is an enzyme involved in the synthesis of phospholipids and thereby plays key roles in regulation of cell proliferation, oncogenic transformation, and human carcinogenesis. Since several inhibitors of ChoKα display antiproliferative activity in both cellular and animal models, this novel oncogene has recently gained interest as a promising small molecule target for cancer therapy. Here we summarize our efforts to further validate ChoKα as an oncogenic target and explore the activity of novel small molecule inhibitors of ChoKα. Starting from weakly binding fragments, we describe a structure based lead discovery approach, which resulted in novel highly potent inhibitors of ChoKα. In cancer cell lines, our lead compounds exhibit a dose-dependent decrease of phosphocholine, inhibition of cell growth, and induction of apoptosis at low micromolar concentrations. The druglike lead series presented here is optimizable for improvements in cellular potency, drug target residence time, and pharmacokinetic parameters. These inhibitors may be utilized not only to further validate ChoKα as antioncogenic target but also as novel chemical matter that may lead to antitumor agents that specifically interfere with cancer cell metabolism.
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Affiliation(s)
- Stephan G Zech
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Anna Kohlmann
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Tianjun Zhou
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Feng Li
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Rachel M Squillace
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Lois E Parillon
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Matthew T Greenfield
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - David P Miller
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Jiwei Qi
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - R Mathew Thomas
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Yihan Wang
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Yongjin Xu
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Juan J Miret
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - William C Shakespeare
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Xiaotian Zhu
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - David C Dalgarno
- ARIAD Pharmaceuticals, Inc. , 26 Landsdowne Street, Cambridge, Massachusetts 02139, United States
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Xiao R, Qi X, Fagg AH, Kolobe THA, Miller DP, Ding L. Spectra of infant EEG within the first year of life: A pilot study. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:4753-6. [PMID: 26737356 DOI: 10.1109/embc.2015.7319456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rhythmic activities in electroencephalography (EEG) have been extensively studied in adults and classic rhythms are found to correlate with specific human brain functions. However, less has been investigated in infant EEG, and EEG rhythms in infants at early ages have not been well characterized in terms of their frequency ranges. In the present pilot study, we investigated rhythmic activities in infant EEG recorded weekly from 4-8 months using high-density EEG sensor nets. The developmental changes of EEG rhythms in different frequency bands along maturation were evaluated through spectral analysis. Their longitudinal scalp maps were also studied to understand their plausible functional correlates. The present study aims to enrich the sparse knowledge about the developing patterns of EEG rhythms within the first year of life from EEG recordings of high temporal and spatial resolutions.
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Weaver KE, Ellis SD, Denizard-Thompson N, Kronner D, Miller DP. Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3:e100. [PMID: 26537553 PMCID: PMC4704950 DOI: 10.2196/mhealth.4651] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/11/2015] [Accepted: 09/22/2015] [Indexed: 11/27/2022] Open
Abstract
Background mHealth interventions that incorporate text messages have great potential to increase receipt of preventive health services such as colorectal cancer screening. However, little is known about older adult perspectives regarding the receipt of text messages from their health care providers. Objective To assess whether older adults would value and access text messages from their physician’s practice regarding colorectal cancer screening. Methods We conducted four focus groups with 26 adults, aged 50 to 75 years, who had either recently completed or were overdue for colorectal cancer screening. A trained moderator followed a semistructured interview guide covering participant knowledge and attitudes regarding colorectal cancer screening, potential barriers to colorectal cancer screening, attitudes about receiving electronic communications from a doctor’s office, and reactions to sample text messages. Results Participant responses to three primary research questions were examined: (1) facilitators and barriers to colorectal cancer screening, (2) attitudes toward receiving text messages from providers, and (3) characteristics of appealing text messages. Two themes related to facilitators of colorectal cancer screening were perceived benefits/need and family experiences and encouragement. Themes related to barriers included unpleasantness, discomfort, knowledge gaps, fear of complications, and system factors. Four themes emerged regarding receipt of text messages from health care providers: (1) comfort and familiarity with technology, (2) privacy concerns/potential for errors, (3) impact on patient-provider relationship, and (4) perceived helpfulness. Many participants expressed initial reluctance to receiving text messages but responded favorably when shown sample messages. Participants preferred messages that contained content that was important to them and were positive and reassuring, personalized, and friendly to novice texters (eg, avoided the use of texting shorthand phrases and complicated replies); they did not want messages that contain bad news or test results. They wanted the ability to choose alternative options such as email or phone calls. Conclusions Older adults are receptive to receiving cancer screening text messages from health care providers. Sharing sample messages with patients may increase acceptance of this tool in the clinic setting. Supportive tailored text messaging reminders could enhance uptake of colorectal cancer screening by enhancing patient self-efficacy and providing cues to action to complete colonoscopy or fecal occult blood testing.
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Affiliation(s)
- Kathryn E Weaver
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, NC, United States.
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Le KB, Johnson JA, Seale JP, Woodall H, Clark DC, Parish DC, Miller DP. Primary care residents lack comfort and experience with alcohol screening and brief intervention: a multi-site survey. J Gen Intern Med 2015; 30:790-6. [PMID: 25666210 PMCID: PMC4441659 DOI: 10.1007/s11606-015-3184-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Approximately one in six adults in the United States (U.S.) binge drinks. The U.S. Preventive Services Task Force recommends that primary care physicians screen patients for such hazardous alcohol use, and when warranted, deliver a brief intervention. OBJECTIVE We aimed to determine primary care residents' current practices, perceived barriers and confidence with conducting alcohol screening and brief interventions (SBI). DESIGN This was a multi-site, cross-sectional survey conducted from March 2010 through December 2012. PARTICIPANTS We invited all residents in six primary care residency programs (three internal medicine programs and three family medicine programs) to participate. Of 244 residents, 210 completed the survey (response rate 86 %). MAIN MEASURES Our survey assessed residents' alcohol screening practices (instruments used and frequency of screening), perceived barriers to discussing alcohol, brief intervention content, and self-rated ability to help hazardous drinkers. To determine the quality of brief interventions delivered, we examined how often residents reported including the three key recommended elements of feedback, advice, and goal-setting. KEY RESULTS Most residents (60 %, 125/208) reported "usually" or "always" screening patients for alcohol misuse at the initial clinic visit, but few residents routinely screened patients at subsequent acute-care (17 %, 35/208) or chronic-care visits (33 %, 68/208). Only 19 % (39/210) of residents used screening instruments capable of detecting binge drinking. The most frequently reported barrier to SBI was lack of adequate training (54 %, 108/202), and only 21 % (43/208) of residents felt confident they could help at -risk drinkers. When residents did perform a brief intervention, only 24 % (49/208) "usually" or "always" included the three recommended elements. CONCLUSIONS A minority of residents in this multi-site study appropriately screen or intervene with at-risk alcohol users. To equip residents to effectively address hazardous alcohol use, there is a critical need for educational and clinic interventions to support alcohol-related SBI.
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Affiliation(s)
- Kristy Barnes Le
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA,
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