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Ammar A, Smith JD, Aslan U, Balan V, Robertson ML, Karim A. Pressure Indicator Composite Films via Compressive Deformation of a Translucent Matrix Containing a Contrasting Filler. ACS Appl Mater Interfaces 2024; 16:19432-19441. [PMID: 38588483 DOI: 10.1021/acsami.3c18380] [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] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
A neglected mechanism for pressure-responsive color change is demonstrated using cellulose acetate composites prepared by direct (solvent) immersion annealing (DIA), with different loadings of activated charcoal filler. Namely, compressive plastic deformation of the translucent cellulose acetate leads to a decrease in the optical path length and a concomitant increase in the visibility of the opaque contrasting filler. Composites bearing 1-7 wt% activated charcoal exhibited a linear relationship between applied pressure and resulting pressure mark brightness in the range of 12-56 MPa. Comparison of pressure mark patterns with cross-sectional scanning electron microscopy (SEM) supports the importance of the porous morphology arising from DIA for the tuning of the pressure indicator sensitivity. A simple ball drop test is used to illustrate the robustness and utility of these indicators in optical impact assessment.
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Affiliation(s)
- Ali Ammar
- William A. Brookshire Department of Chemical and Biomolecular Engineering, Cullen College of Engineering, University of Houston, Houston, Texas 77204, United States
| | - Justin D Smith
- William A. Brookshire Department of Chemical and Biomolecular Engineering, Cullen College of Engineering, University of Houston, Houston, Texas 77204, United States
| | - Ugur Aslan
- William A. Brookshire Department of Chemical and Biomolecular Engineering, Cullen College of Engineering, University of Houston, Houston, Texas 77204, United States
| | - Venkatesh Balan
- Department of Engineering Technology, Cullen College of Engineering, University of Houston, Sugarland, Texas 77479, United States
| | - Megan L Robertson
- William A. Brookshire Department of Chemical and Biomolecular Engineering, Cullen College of Engineering, University of Houston, Houston, Texas 77204, United States
| | - Alamgir Karim
- William A. Brookshire Department of Chemical and Biomolecular Engineering, Cullen College of Engineering, University of Houston, Houston, Texas 77204, United States
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Asare AO, Stagg BC, Sharareh N, Stipelman C, Del Fiol G, Smith JD. Vision Loss in Children from Immigrant and Nonimmigrant Households: Evidence from the National Survey of Children's Health 2018-2020. J Immigr Minor Health 2024:10.1007/s10903-024-01597-3. [PMID: 38581597 DOI: 10.1007/s10903-024-01597-3] [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] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
The aim of this study was to determine whether immigrant generation is associated with caregiver-reported vision loss in children adjusting for sociodemographic characteristics. Nationally representative data from the National Survey of Children's Health (2018-2020) was used. The primary exposure was immigrant generation defined as: first (child and all reported parents were born outside the United States); second (child was born in the United States and at least one parent was born outside the United States); third or higher (all parents in the household were born in the United States). The main outcome was caregiver-reported vision loss in child. Adjusted odds ratios (aOR) and 95% confidence intervals were computed based on immigration generation. The study sample included 84,860 US children aged 3-17 years. First generation children had higher adjusted odds of caregiver-reported vision loss (aOR 2.30; 95% CI 1.21, 4.35) than third or higher generation children after adjusting for demographic characteristics and social determinants of health. For Hispanic families, first generation (aOR 2.99; 95% CI 1.34, 6.66), and second-generation children (aOR 1.70; 95% CI 1.06, 2.74) had a higher adjusted odds of vision loss compared with third or higher generation children. Even when adjusting for sociodemographic characteristics, first generation children had greater odds of vision loss, especially in Hispanic households, than third generation children. Immigration generation should be treated as an independent risk factor for vision loss for children and is a social determinant of eye health.
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Affiliation(s)
- Afua O Asare
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA.
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT, 84108, USA.
| | - Brian C Stagg
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT, 84108, USA
| | - Nasser Sharareh
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT, 84108, USA
| | - Carole Stipelman
- Department of Pediatrics, Division of General Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT, 84108, USA
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Merle JL, Benbow N, Li DH, Zapata JP, Queiroz A, Zamantakis A, McKay V, Keiser B, Villamar JA, Mustanski B, Smith JD. Improving Delivery and Use of HIV Pre-Exposure Prophylaxis in the US: A Systematic Review of Implementation Strategies and Adjunctive Interventions. AIDS Behav 2024:10.1007/s10461-024-04331-0. [PMID: 38564136 DOI: 10.1007/s10461-024-04331-0] [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] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
Implementation of pre-exposure prophylaxis (PrEP) to prevent HIV transmission is suboptimal in the United States. To date, the literature has focused on identifying determinants of PrEP use, with a lesser focus on developing and testing change methods to improve PrEP implementation. Moreover, the change methods available for improving the uptake and sustained use of PrEP have not been systematically categorized. To summarize the state of the literature, we conducted a systematic review of the implementation strategies used to improve PrEP implementation among delivery systems and providers, as well as the adjunctive interventions used to improve the uptake and persistent adherence to PrEP among patients. Between November 2020 and January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer reviewed articles. We identified 44 change methods (18 implementation strategies and 26 adjunctive interventions) across a variety of clinical and community-based service settings. We coded implementation strategies and adjunctive interventions in accordance with established taxonomies and reporting guidelines. Most studies focused on improving patient adherence to PrEP and most conducted pilot trials. Just over one-third of included studies demonstrated a positive effect on outcomes. In order to end the human immunodeficiency virus (HIV) epidemic in the U.S., future, large scale HIV prevention research is needed that develops and evaluates implementation strategies and adjunctive interventions for target populations disproportionately affected by HIV.
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Affiliation(s)
- James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Seattle, WA, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Dennis H Li
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Seattle, WA, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Juan P Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Virginia McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Brennan Keiser
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Juan A Villamar
- Public Health and Epidemiology Unit, Westat, Rockville, MD, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Seattle, WA, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
- Department of Infectious Diseases, Northwestern University, Seattle, WA, USA
- Medical Social Sciences Department, Northwestern University, Seattle, WA, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Mehus CJ, Buchanan G, Ballard J, Berkel C, Borowsky IW, Estrada Y, Klein JD, Kuklinski M, Prado G, Shaw D, Smith JD. Multiple Perspectives on Motivating Parents in Pediatric Primary Care to Initiate Participation in Parenting Programs. Acad Pediatr 2024; 24:469-476. [PMID: 37543083 PMCID: PMC10838364 DOI: 10.1016/j.acap.2023.07.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/22/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To use multiple perspectives to identify the key components of pediatric primary care conversations for motivating parents to utilize parenting programs. We aim to develop an actionable framework that primary care clinicians (PCCs) can follow for effective conversations with parents. METHODS We conducted focus groups and interviews with researchers (n = 6) who have experience delivering parenting interventions through primary care, clinical personnel in federally qualified health centers (FQHCs) (n = 9), parents of 3-5-year olds who receive services at a FQHC pediatric clinic (n = 6), and parent educators (n = 5). Groups and interviews were informed by nominal group technique, and researchers triangulated consolidated strategies across the groups. RESULTS Key strategies for PCCs to motivate parents to utilize parenting programs followed three steps: 1) learning about a parent's questions and concerns, 2) sharing resources, and 3) following up. PCCs can learn about parents' needs by empathizing, listening and responding, and asking questions that acknowledge parents' expertise. When sharing resources, PCCs can motivate participation in parenting programs by explaining each resource and its benefits, providing options that support parents' autonomy, and framing resources as strengthening rather than correcting parents' existing strategies or skills. Finally, PCCs can continue to engage parents by scheduling follow-up conversations or designating a staff member to check-in with parents. We provide examples for each strategy. CONCLUSIONS Findings provide guidance from multiple perspectives on strategies to motivate parents in pediatric primary care setting for utilizing parenting programs.
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Affiliation(s)
| | - Gretchen Buchanan
- Center for Mental Health Services Research, Brown School of Social Work and Public Health, Washington University, St. Louis
| | - Jaime Ballard
- Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul MN
| | - Cady Berkel
- REACH Institute, College of Health Solutions, Arizona State University, Phoenix AZ
| | - Iris Wagman Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis MN
| | - Yannine Estrada
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL
| | - Margaret Kuklinski
- Social Development Research Group, School of Social Work University of WA, Seattle, WA
| | - Guillermo Prado
- University of Miami (Y Estrada and G Prado), Coral Gables, Fla
| | - Daniel Shaw
- University of Pittsburgh (D Shaw), Pittsburgh, Pa
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
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Counts NZ, Feinberg ME, Lee JK, Smith JD. Modeling Long-Term Budgetary Impacts of Prevention: An Overview of Meta-analyses of Relationships Between Key Health Outcomes Across the Life-Course. J Prev (2022) 2024; 45:177-192. [PMID: 38157132 DOI: 10.1007/s10935-023-00744-0] [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] [Accepted: 08/09/2023] [Indexed: 01/03/2024]
Abstract
Budget analysis entities often cannot capture the full downstream impacts of investments in prevention services, programs, and interventions. This study describes and applies an approach to synthesizing existing literature to more fully account for these effects. This study reviewed meta-analyses in PubMed published between Jan 1, 2010 and Dec 31, 2019. The initial search included meta-analyses on the association between health risk factors, including maternal behavioral health, intimate partner violence, child maltreatment, depression, and obesity, with a later health condition. Through a snowball sampling-type approach, the endpoints of the meta-analyses identified became search terms for a subsequent search, until each health risk was connected to one of the ten costliest health conditions. These results were synthesized to create a path model connecting the health risks to the high-cost health conditions in a cascade. Thirty-seven meta-analyses were included. They connected early-life health risk factors with six high-cost health conditions: hypertension, diabetes, asthma and chronic obstructive pulmonary disorder, mental disorders, heart conditions, and trauma-related disorders. If confounders could be controlled for and causality inferred, the cascading associations could be used to more fully account for downstream impacts of preventive interventions. This would support budget analysis entities to better include potential savings from investments in chronic disease prevention and promote greater implementation at scale.
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Affiliation(s)
- Nathaniel Z Counts
- Mental Health America, 500 Montgomery St, Suite 820, Alexandria, VA, 22314, USA.
| | - Mark E Feinberg
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Jin-Kyung Lee
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Bartholomew TS, Plesons M, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, Chueng TA, Ciraldo K, Brooks J, Smith JD, Barocas JA, Tookes HE. Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services. Addict Sci Clin Pract 2024; 19:21. [PMID: 38528570 PMCID: PMC10964520 DOI: 10.1186/s13722-024-00447-9] [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] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP). METHODS The CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs. DISCUSSION The CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are. TRIAL REGISTRATION ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.
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Affiliation(s)
- Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Marina Plesons
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jimmie Brooks
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Szymczak JE, Petty LA, Gandhi TN, Neetz RA, Hersh A, Presson AP, Lindenauer PK, Bernstein SJ, Muller BM, White AT, Horowitz JK, Flanders SA, Smith JD, Vaughn VM. Protocol for a parallel cluster randomized trial of a participatory tailored approach to reduce overuse of antibiotics at hospital discharge: the ROAD home trial. Implement Sci 2024; 19:23. [PMID: 38439076 PMCID: PMC10910678 DOI: 10.1186/s13012-024-01348-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Antibiotic overuse at hospital discharge is common, costly, and harmful. While discharge-specific antibiotic stewardship interventions are effective, they are resource-intensive and often infeasible for hospitals with resource constraints. This weakness impacts generalizability of stewardship interventions and has health equity implications as not all patients have access to the benefits of stewardship based on where they receive care. There may be different pathways to improve discharge antibiotic prescribing that vary widely in feasibility. Supporting hospitals in selecting interventions tailored to their context may be an effective approach to feasibly reduce antibiotic overuse at discharge across diverse hospitals. The objective of this study is to evaluate the effectiveness of the Reducing Overuse of Antibiotics at Discharge Home multicomponent implementation strategy ("ROAD Home") on antibiotic overuse at discharge for community-acquired pneumonia and urinary tract infection. METHODS This 4-year two-arm parallel cluster-randomized trial will include three phases: baseline (23 months), intervention (12 months), and postintervention (12 months). Forty hospitals recruited from the Michigan Hospital Medicine Safety Consortium will undergo covariate-constrained randomization with half randomized to the ROAD Home implementation strategy and half to a "stewardship as usual" control. ROAD Home is informed by the integrated-Promoting Action on Research Implementation in Health Services Framework and includes (1) a baseline needs assessment to create a tailored suite of potential stewardship interventions, (2) supported decision-making in selecting interventions to implement, and (3) external facilitation following an implementation blueprint. The primary outcome is baseline-adjusted days of antibiotic overuse at discharge. Secondary outcomes include 30-day patient outcomes and antibiotic-associated adverse events. A mixed-methods concurrent process evaluation will identify contextual factors influencing the implementation of tailored interventions, and assess implementation outcomes including acceptability, feasibility, fidelity, and sustainment. DISCUSSION Reducing antibiotic overuse at discharge across hospitals with varied resources requires tailoring of interventions. This trial will assess whether a multicomponent implementation strategy that supports hospitals in selecting evidence-based stewardship interventions tailored to local context leads to reduced overuse of antibiotics at discharge. Knowledge gained during this study could inform future efforts to implement stewardship in diverse hospitals and promote equity in access to the benefits of quality improvement initiatives. TRIAL REGISTRATION Clinicaltrials.gov NCT06106204 on 10/30/23.
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Affiliation(s)
- Julia E Szymczak
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.
| | - Lindsay A Petty
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tejal N Gandhi
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Robert A Neetz
- MyMichigan Medical Center Midland, MyMichigan Health, Midland, MI, USA
| | - Adam Hersh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Peter K Lindenauer
- Baystate Medical Center Department of Healthcare Delivery and Population Science, Center for Quality of Care Research, Springfield, MA, USA
| | - Steven J Bernstein
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, Division of General Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Brandi M Muller
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Andrea T White
- Department of Internal Medicine, Division of General Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Jennifer K Horowitz
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Scott A Flanders
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Justin D Smith
- Department of Population Health Sciences, Division of Health System Innovation & Research, University of Utah School of Medicine, Salt Lake City, USA
| | - Valerie M Vaughn
- Department of Internal Medicine, Division of General Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
- Department of Internal Medicine, Division of General Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
- Department of Population Health Sciences, Division of Health System Innovation & Research, University of Utah School of Medicine, Salt Lake City, USA.
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Blajeski S, Smith MJ, Harrington M, Johnson J, Ross B, Weaver A, Razzano LA, Pashka N, Brown A, Prestipino J, Nelson K, Lieberman T, Jordan N, Oulvey EA, Mueser KT, McGurk SR, Bell MD, Smith JD. A Mixed-Methods Implementation Evaluation of Virtual Reality Job Interview Training in IPS Supported Employment. Psychiatr Serv 2024; 75:228-236. [PMID: 37644829 PMCID: PMC10902191 DOI: 10.1176/appi.ps.20230023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Employment rates among individuals with serious mental illness may be improved by engagement in the individual placement and support (IPS) model of supported employment. Results from a recent randomized controlled trial (RCT) indicate that virtual reality job interview training (VR-JIT) improves employment rates among individuals with serious mental illness who have been actively engaged in IPS for at least 90 days. This study reports on an initial implementation evaluation of VR-JIT during the RCT in a community mental health agency. METHODS A sequential, complementary mixed-methods design included use of qualitative data to improve understanding of quantitative findings. Thirteen IPS staff trained to lead VR-JIT implementation completed VR-JIT acceptability, appropriateness, and feasibility surveys. Participants randomly assigned to IPS with VR-JIT completed acceptability (N=42) and usability (N=28) surveys after implementation. The authors also conducted five focus groups with IPS staff (N=11) and VR-JIT recipients (N=13) and semistructured interviews with IPS staff (N=9) and VR-JIT recipients (N=4), followed by an integrated analysis process. RESULTS Quantitative results suggest that IPS staff found VR-JIT to be highly acceptable, appropriate for integration with IPS, and feasible for delivery. VR-JIT was highly acceptable to recipients. Qualitative results add important context to the quantitative findings, including benefits of VR-JIT for IPS staff as well as adaptations for delivering technology-based interventions to individuals with serious mental illness. CONCLUSIONS These qualitative and quantitative findings are consistent with each other and were influenced by VR-JIT's adaptability and perceived benefits. Tailoring VR-JIT instruction and delivery to individuals with serious mental illness may help optimize VR-JIT implementation within IPS.
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Affiliation(s)
- Shannon Blajeski
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Matthew J Smith
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Meghan Harrington
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Jeffery Johnson
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Brittany Ross
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Addie Weaver
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Lisa A Razzano
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Nicole Pashka
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Adrienne Brown
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - John Prestipino
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Karley Nelson
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Tovah Lieberman
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Neil Jordan
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Eugene A Oulvey
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Kim T Mueser
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Susan R McGurk
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Morris D Bell
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Justin D Smith
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
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9
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Wakschlag LS, Davis MM, Smith JD. A vision for implementing equitable early mental health and resilience support in pediatric primary care: A transdiagnostic, developmental approach. Fam Syst Health 2024; 42:6-17. [PMID: 38647490 DOI: 10.1037/fsh0000884] [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] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Primary care is at the forefront of addressing the pediatric mental health (MH) crisis due to its broad reach to young children and prevention and health promotion orientation. However, the promise of the delivery system for population impact remains unrealized due to several barriers, including pragmatic screening, decisional uncertainty, and limited access to evidence-based services. METHOD This article lays the conceptual foundations for the articles in this Special Section on Mental Health, Earlier in Pediatric Primary Care, which all apply a translational mindset to proposed strategies and solutions to overcome the barriers that have limited the potential of pediatric primary care for improving the MH and wellbeing of all children. RESULTS Valid, pragmatic, transdiagnostic, developmentally-based screening measures to identify children at heightened risk are needed. Risk screening for MH problems should assess and empirically weight socioecological risk and protective factors, as well as the child's own assets for resilience to determine probabilistic risk. Pediatric clinicians require clear clinical cutoffs and guidelines for action when risk for MH problems is identified. DISCUSSION These strategies-a developmentally-based screener with associated risk calculator that offers clear guidance to pediatric clinicians-address decisional uncertainty regarding when to worry and when to act. The communication of probabilistic risk requires additional client-centered communication skills to overcome different types of biases (e.g., implicit, benevolent, and cognitive) that contribute to MH inequities and decisional uncertainty in acting on identified risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine & Institute for Innovations in Developmental Sciences, Northwestern University
| | - Matthew M Davis
- Department of Pediatrics, Feinberg School of Medicine & Institute for Innovations in Developmental Sciences, Northwestern University
| | - Justin D Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine, University of Utah
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Wakschlag LS, MacNeill LA, Pool LR, Smith JD, Adam H, Barch DM, Norton ES, Rogers CE, Ahuvia I, Smyser CD, Luby JL, Allen NB. Predictive Utility of Irritability "In Context": Proof-of-Principle for an Early Childhood Mental Health Risk Calculator. J Clin Child Adolesc Psychol 2024; 53:231-245. [PMID: 36975800 PMCID: PMC10533737 DOI: 10.1080/15374416.2023.2188553] [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: 03/29/2023]
Abstract
OBJECTIVE We provide proof-of-principle for a mental health risk calculator advancing clinical utility of the irritability construct for identification of young children at high risk for common, early onsetting syndromes. METHOD Data were harmonized from two longitudinal early childhood subsamples (total N = 403; 50.1% Male; 66.7% Nonwhite; Mage = 4.3 years). The independent subsamples were clinically enriched via disruptive behavior and violence (Subsample 1) and depression (Subsample 2). In longitudinal models, epidemiologic risk prediction methods for risk calculators were applied to test the utility of the transdiagnostic indicator, early childhood irritability, in the context of other developmental and social-ecological indicators to predict risk of internalizing/externalizing disorders at preadolescence (Mage = 9.9 years). Predictors were retained when they improved model discrimination (area under the receiver operating characteristic curve [AUC] and integrated discrimination index [IDI]) beyond the base demographic model. RESULTS Compared to the base model, the addition of early childhood irritability and adverse childhood experiences significantly improved the AUC (0.765) and IDI slope (0.192). Overall, 23% of preschoolers went on to develop a preadolescent internalizing/externalizing disorder. For preschoolers with both elevated irritability and adverse childhood experiences, the likelihood of an internalizing/externalizing disorder was 39-66%. CONCLUSIONS Predictive analytic tools enable personalized prediction of psychopathological risk for irritable young children, holding transformative potential for clinical translation.
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Affiliation(s)
- Lauren S. Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Leigha A. MacNeill
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Lindsay R. Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Justin D. Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT
| | - Hubert Adam
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Deanna M. Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Elizabeth S. Norton
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cynthia E. Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Isaac Ahuvia
- Department of Clinical Psychology, Stony Brook University, Stony Brook, NY
| | - Christopher D. Smyser
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Joan L. Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Norrina B. Allen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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11
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Scherr CL, Getachew-Smith H, Moe S, Knapp AA, Carroll AJ, Mohanty N, Shah S, Spencer AE, Beidas RS, Wakschlag LS, Smith JD. Possible unintended consequences of pediatric clinician strategies for communicating about social-emotional and developmental concerns in diverse young children. Fam Syst Health 2024; 42:18-33. [PMID: 38647491 DOI: 10.1037/fsh0000882] [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] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Screening to promote social-emotional well-being in toddlers has positive effects on long-term health and functioning. Communication about social-emotional well-being can be challenging for primary care clinicians for various reasons including lack of time, training and expertise, resource constraints, and cognitive burden. Therefore, we explored clinicians' perspectives on identifying and communicating with caregivers about social-emotional risk in toddlers. METHOD In 2021, semistructured interviews were conducted with pediatric clinicians (N = 20) practicing in Federally Qualified Health Centers in a single metropolitan area. Most participants identified as female (n = 15; 75%), white non-Hispanic/Latino (n = 14; 70%), and were Doctors of Medicine or Osteopathic Medicine (n = 14; 70%). Thematic analysis was conducted on audio-recorded interview transcripts. RESULTS Clinicians used various approaches to identify social-emotional concerns which were sometimes difficult to distinguish from other developmental concerns. The clinician-caregiver relationship guided identification and communication practices and cut-across themes. Themes include: starting with caregivers' concerns, communicating concerns with data and sensitivity, navigating labels, culture, and stigma, and limiting communication based on family capacity and interest. DISCUSSION Prioritizing the clinician-caregiver relationship is consistent with best practice and family-centered care. Yet, the dearth of standardized decision support may undermine clinician confidence and impede timely conversations about social-emotional concerns. An evidence-based approach with developmentally based culturally informed quantitative tools and standardized decision supports could help ensure equitable management and decision making about young children's social and emotional well-being and development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | - Sydney Moe
- Department of Communication Studies, Northwestern University
| | - Ashley A Knapp
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Nivedita Mohanty
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University
| | - Seema Shah
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University
| | - Andrea E Spencer
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Justin D Smith
- Division of Health Systems Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah
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Carroll AJ, Knapp AA, Villamar JA, Mohanty N, Coldren E, Hossain T, Limaye D, Mendoza D, Minier M, Sethi M, Brown CH, Franklin PD, Davis MM, Wakschlag LS, Smith JD. Engaging primary care clinicians in the selection of implementation strategies for toddler social-emotional health promotion in community health centers. Fam Syst Health 2024; 42:50-67. [PMID: 37956064 DOI: 10.1037/fsh0000852] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Social-emotional risk for subsequent behavioral health problems can be identified at toddler age, a period where prevention has a heightened impact. This study aimed to meaningfully engage pediatric clinicians, given the emphasis on health promotion and broad reach of primary care, to prepare an Implementation Research Logic Model to guide the implementation of a screening and referral process for toddlers with elevated social-emotional risk. METHOD Using an adaptation of a previously published community partner engagement method, six pediatricians from community health centers (CHCs) comprised a Clinical Partner Work Group. The group was engaged in identifying determinants (barriers/facilitators), selecting and specifying strategies, strategy-determinant matching, a modified Delphi approach for strategy prioritization, and user-centered design methods. The data gathered from individual interviews, two group sessions, and a follow-up survey resulted in a completed Implementation Research Logic Model. RESULTS The Clinical Partner Work Group identified 16 determinants, including barriers (e.g., patient access to electronic devices) and facilitators (e.g., clinician buy-in). They then selected and specified 14 strategies, which were prioritized based on ratings of feasibility, effectiveness, and priority. The highest-rated strategies (e.g., integration of the screener into the electronic health record) provided coverage of all identified barriers and comprised the primary implementation strategy "package" to be used and tested. CONCLUSIONS Clinical partners provided important context and insights for implementation strategy selection and specification to support the implementation of social-emotional risk screening and referral in pediatric primary care. The methodology described herein can improve partner engagement in implementation efforts and increase the likelihood of success. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Ashley A Knapp
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Juan A Villamar
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | | | | | | | | | | | | | | | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Patricia D Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Matthew M Davis
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
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Wakschlag LS, Carroll AJ, Friedland S, Walkup J, Wiggins JL, Mohanty N, Papacek E, Bridi S, Carroll R, Drelicharz D, Hasan Z, Kotagal T, Davis MM, Smith JD. Making it "EASI" for pediatricians to determine when toddler tantrums are "more than the terrible twos": Proof-of-concept for primary care screening with the Multidimensional Assessment Profiles-Early Assessment Screener for Irritability (MAPS-EASI). Fam Syst Health 2024; 42:34-49. [PMID: 38647492 DOI: 10.1037/fsh0000868] [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] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Up to 20% of youth have impairing mental health problems as early as age 3. Early identification and intervention of mental health risks in pediatric primary care could mitigate this crisis via prevention prior to disease onset. The purpose of this study was to establish the feasibility and acceptability of implementing a brief transdiagnostic screening instrument in pediatric primary care for irritability and corollary impairment. METHOD Five pediatric clinicians in a Midwest clinic implemented the Multidimensional Assessment Profiles-Early Assessment Screener of Irritability (MAPS-EASI) for toddlers (24-30 months) and their families. MAPS-EASI (psychometrically derived from the well-validated MAPS-Scales) includes six items (scored 0-5) about symptoms (e.g., tantrums, grumpy mood), context, and frequency and two items (scored 0-3) assessed impairment. Positive screens (MAPS-EASI ≥ 5 plus impairment ≥ 2) were referred to an evidence-based parenting intervention. We assessed reach and outcomes of MAPS-EASI screening. Follow-up interviews with clinicians assessed perspectives on irritability screening and MAPS-EASI implementation. RESULTS Of 201 eligible families, 100 (49.8%) completed the screener for a 24- or 30-month well-child visit. Mean MAPS-EASI scores were 5.8 (SD = 3.2), mean impairment scores were 0.9 (SD = 0.9), and 24 (24.0%) screened positive. Clinicians indicated that irritability screening for toddlers was aligned with their prevention-oriented, developmentally based practice. MAPS-EASI had face validity and increased clinician decision-making confidence. Finally, clinicians identified barriers and facilitators to large-scale implementation. CONCLUSIONS MAPS-EASI proved to be feasible and acceptable in pediatric primary care. Further tailoring will be needed as the MAPS-EASI processes are scaled out to new contexts and populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Allison J Carroll
- Department of Psychiatry, Northwestern University Feinberg School of Medicine
| | - Susan Friedland
- Town & Country Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - John Walkup
- Department of Psychiatry, Northwestern University Feinberg School of Medicine
| | | | | | - Ellen Papacek
- Town & Country Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Sacha Bridi
- Town & Country Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Ryan Carroll
- Town & Country Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago
| | | | - Zeba Hasan
- Town & Country Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Tara Kotagal
- Town & Country Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago
| | | | - Justin D Smith
- Department of Psychiatry, Northwestern University Feinberg School of Medicine
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Davis MM, Heffernan ME, Bilaver LA, Wakschlag LS, Jordan N, Smith JD. Potential parental determinants of the pace of evidence-based practice change in children's mental health care. Fam Syst Health 2024; 42:68-75. [PMID: 38647493 DOI: 10.1037/fsh0000878] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Strength of evidence is key to advancing children's mental health care but may be inadequate for driving practice change. The Designing for Accelerated Translation (DART) framework proposes a multifaceted approach: pace of implementation as a function of evidence of effectiveness, demand for the intervention, sum of risks, and costs. To inform empirical applications of DART, we solicited caregiver preferences on key elements. METHOD In March-April 2022, we fielded a population-representative online survey in Illinois households (caregivers N = 1,326) with ≥1 child <8 years old. Six hypothetical scenarios based on the DART framework were used to elucidate caregivers' preferences on a 0-10 scale (0 = never; 10 = as soon as possible) for pace of implementation of a family-based program to address mental health concerns. RESULTS Caregivers' pace preference scores varied significantly for each scenario. The highest mean score (7.28, 95% confidence interval [95% CI: 7.06, 7.50]) was for a scenario in which the child's provider thinks the program would be helpful (effectiveness) and the caregiver believes the program is needed (demand). In contrast, the lowest mean score (5.13, 95% CI [4.91, 5.36]) was for a scenario in which online information implies the program would be helpful (effectiveness) and the parent is concerned about the program's financial costs (cost). Caregivers' pace preference scores did not vary consistently by sociodemographic factors. CONCLUSION In this empirical exploration of the DART framework, factors such as demand, cost, and risk, in combination with evidence of effectiveness, may influence caregivers' preferred pace of implementation for children's mental health interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine
| | - Marie E Heffernan
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Lucy A Bilaver
- Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine & Institute for Innovations in Developmental Sciences, Northwestern University
| | - Neil Jordan
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Justin D Smith
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine, University of Utah
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Ye J, Sanuade OA, Hirschhorn LR, Walunas TL, Smith JD, Birkett MA, Baldridge AS, Ojji DB, Huffman MD. Interventions and contextual factors to improve retention in care for patients with hypertension in primary care: Hermeneutic systematic review. Prev Med 2024; 180:107880. [PMID: 38301908 PMCID: PMC10919242 DOI: 10.1016/j.ypmed.2024.107880] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Regular engagement over time in hypertension care, or retention, is a crucial but understudied step in optimizing patient outcomes. This systematic review leverages a hermeneutic methodology to identify, evaluate, and quantify the effects of interventions and contextual factors for improving retention for patients with hypertension. METHODS We searched for articles that were published between 2000 and 2022 from multiple electronic databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and WHO International Trials Registry. We followed the latest version of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to report the findings for this review. We also synthesized the findings using a hermeneutic methodology for systematic reviews, which used an iterative process to review, integrate, analyze, and interpret evidence. RESULTS From 4686 screened titles and abstracts, 18 unique studies from 9 countries were identified, including 10 (56%) randomized controlled trials (RCTs), 3 (17%) cluster RCTs, and 5 (28%) non-RCT studies. The number of participants ranged from 76 to 1562. The overall mean age range was 41-67 years, and the proportion of female participants ranged from 0% to 100%. Most (n = 17, 94%) studies used non-physician personnel to implement the proposed interventions. Fourteen studies (78%) implemented multilevel combinations of interventions. Education and training, team-based care, consultation, and Short Message Service reminders were the most common interventions tested. CONCLUSIONS This review presents the most comprehensive findings on retention in hypertension care to date and fills the gaps in the literature, including the effectiveness of interventions, their components, and contextual factors. Adaptation of and implementing HIV care models, such differentiated service delivery, may be more effective and merit further study. REGISTRATION CRD42021291368. PROTOCOL REGISTRATION PROSPERO 2021 CRD42021291368. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291368.
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Affiliation(s)
- Jiancheng Ye
- Weill Cornell Medicine, NY, New York, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Theresa L Walunas
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | | | - Abigail S Baldridge
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Washington University in St. Louis, St. Louis, MO, USA; The George Institute for Global Health, Sydney, Australia
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Mckay V, Zamantakis A, Pachicano AM, Merle J, Purrier M, Swan M, Li D, Mustanski B, Smith JD, Hirschhorn L, Benbow N. Establishing Evidence Criteria for Implementation Strategies: A Delphi Study for HIV Services. Res Sq 2024:rs.3.rs-3979631. [PMID: 38464091 PMCID: PMC10925451 DOI: 10.21203/rs.3.rs-3979631/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND There are no criteria specifically for evaluating the quality of implementation research and recommend implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Rubric, a set of criteria to evaluate the evidence supporting implementation strategies, in the context of HIV. METHODS We developed the Best Practices Rubric from 2022-2023 in three phases. (1) We purposively selected and recruited by email participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. We developed a draft rubric and criteria based on a literature review and key informant interviews. (2) The rubric was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate, and the rubric and criteria were revised. (3) We then applied the rubric to a set of research studies assessing 18 implementation strategies designed to promote the adoption and uptake of pre-exposure prophylaxis, an HIV prevention medication, to assess reliable application of the rubric and criteria. RESULTS Our initial literature review yielded existing rubrics and criteria for evaluating intervention-level evidence. For a strategy-level rubric, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains - research design, implementation outcomes, limitations and rigor, strategy specification, and equity - and four evidence levels - best practice, promising practice, more evidence needed, and harmful practices. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies. CONCLUSIONS We developed a rubric to evaluate the evidence supporting implementation strategies for HIV services. Although the rubric is specific to HIV, this tool is adaptable for evaluating strategies in other health areas.
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17
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Smith JD, Li DH, Merle JL, Keiser B, Mustanski B, Benbow ND. Adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations. Implement Sci 2024; 19:10. [PMID: 38331832 PMCID: PMC10854146 DOI: 10.1186/s13012-024-01345-z] [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] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Implementation science groups change methods into two categories: (1) clinical, behavioral, or biomedical intervention targeting recipient's health outcomes and (2) implementation strategies targeting the delivery system. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing their effects to health or implementation outcomes. However, in coordinating 200+ HIV implementation research projects and conducting systematic reviews, we identified change methods that had characteristics of both interventions and strategies that were inconsistently categorized. To alleviate confusion and improve change method specification, we propose that implementation science should adopt an extant but rarely used term-adjunctive interventions-to classify change methods that are distinct from the common intervention/strategy taxonomy. MAIN TEXT Adjunctive interventions as change methods that target recipients (e.g., patients, participants) of a health intervention but are designed to increase recipients' motivation, self-efficacy, or capacity for initiating, adhering to, complying with, or engaging with the health intervention over time. In two of our published reviews on implementation of HIV interventions, 25 out of 45 coded change methods fell into this gray area between strategy and intervention. We also noted instances in which the same change method was labelled as the intervention ("the thing"), as an adjunctive intervention, or an implementation strategy in different studies-further muddying the waters. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients' attitudes and behaviors to engage with the intervention and have an indirect causal link to the health outcome via increasing the probability of recipients' utilization and adherence to the intervention. Adjunctive interventions are incapable of directly producing the health outcome and will themselves require implementation strategies to effectively impact sustained uptake, utilization, and adherence. Case examples, logic modeling, and considerations (e.g., relationship to consumer engagement strategies) for adjunctive intervention research are provided. CONCLUSION Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness, and the specification of mechanisms and outcomes.
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Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Dennis H Li
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brennan Keiser
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Third Coast Center for AIDS Research, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nanette D Benbow
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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18
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Roy KR, Smith JD, Li S, Vonesch SC, Nguyen M, Burnett WT, Orsley KM, Lee CS, Haber JE, St Onge RP, Steinmetz LM. Dissecting quantitative trait nucleotides by saturation genome editing. bioRxiv 2024:2024.02.02.577784. [PMID: 38352467 PMCID: PMC10862795 DOI: 10.1101/2024.02.02.577784] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Genome editing technologies have the potential to transform our understanding of how genetic variation gives rise to complex traits through the systematic engineering and phenotypic characterization of genetic variants. However, there has yet to be a system with sufficient efficiency, fidelity, and throughput to comprehensively identify causal variants at the genome scale. Here we explored the ability of templated CRISPR editing systems to install natural variants genome-wide in budding yeast. We optimized several approaches to enhance homology-directed repair (HDR) with donor DNA templates, including donor recruitment to target sites, single-stranded donor production by bacterial retrons, and in vivo plasmid assembly. We uncovered unique advantages of each system that we integrated into a single superior system named MAGESTIC 3.0. We used MAGESTIC 3.0 to dissect causal variants residing in 112 quantitative trait loci across 32 environmental conditions, revealing an enrichment for missense variants and loci with multiple causal variants. MAGESTIC 3.0 will facilitate the functional analysis of the genome at single-nucleotide resolution and provides a roadmap for improving template-based genome editing systems in other organisms.
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Affiliation(s)
- Kevin R Roy
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Justin D Smith
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Shengdi Li
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany
| | - Sibylle C Vonesch
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany
- Laboratory for Genome Editing and Systems Genetics, VIB-KU Leuven Center for Microbiology, Leuven, Belgium
- KU Leuven Center for Microbial and Plant Genetics, Department M2S, Leuven, Belgium
| | - Michelle Nguyen
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Wallace T Burnett
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin M Orsley
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Cheng-Sheng Lee
- Brandeis University, Rosenstiel Basic Medical Sciences Research Center and Department of Biology, Waltham, MA
| | - James E Haber
- Brandeis University, Rosenstiel Basic Medical Sciences Research Center and Department of Biology, Waltham, MA
| | - Robert P St Onge
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Lars M Steinmetz
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany
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19
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Finlay-Jones AL, Ang JE, Brook J, Lucas JD, MacNeill LA, Mancini VO, Kottampally K, Elliott C, Smith JD, Wakschlag LS. Systematic Review and Meta-Analysis: Early Irritability as a Transdiagnostic Neurodevelopmental Vulnerability to Later Mental Health Problems. J Am Acad Child Adolesc Psychiatry 2024; 63:184-215. [PMID: 36863413 PMCID: PMC10460834 DOI: 10.1016/j.jaac.2023.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 01/16/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Irritability is a transdiagnostic indicator of child and adolescent internalizing and externalizing problems that is measurable from early life. The objective of this systematic review was to determine the strength of the association between irritability measured from 0 to 5 years and later internalizing and externalizing problems, to identify mediators and moderators of these relationships, and to explore whether the strength of the association varied according to irritability operationalization. METHOD Relevant studies published in peer-reviewed, English-language journals between the years 2000 and 2021 were sought from EMBASE, PsycINFO, MEDLINE, CINAHL, and ERIC. We synthesized studies that included a measure of irritability within the first 5 years of life and reported associations with later internalizing and/or externalizing problems. Methodological quality was assessed using the JBI-SUMARI Critical Appraisal Checklist. RESULTS Of 29,818 identified studies, 98 met inclusion criteria, with a total number of 932,229 participants. Meta-analysis was conducted on 70 studies (n = 831,913). Small, pooled associations were observed between infant irritability (0-12 months) and later internalizing (r = 0.14, 95% CI = 0.09, 0.20) and externalizing symptoms (r = 0.16, 95% CI = 0.11, 0.21) symptoms. For toddler/preschool irritability (13-60 months), small-to-moderate pooled associations were observed for internalizing (r = 0.21, 95% CI = 0.14, 0.28) and externalizing (r = 0.24, 95% CI = 0.18, 0.29) symptoms. These associations were not moderated by the lag between irritability and outcome assessment, although the strength of the associations varied according to irritability operationalization. CONCLUSION Early irritability is a consistent transdiagnostic predictor of internalizing and externalizing symptoms in childhood and adolescence. More work is required to understand how to accurately characterize irritability across this developmental period, and to understand mechanisms underlying the relationship between early irritability and later mental health problems. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. STUDY PREREGISTRATION INFORMATION Early irritability as a transdiagnostic neurodevelopmental vulnerability to early onset mental health problems: A systematic review; https://www.crd.york.ac.uk/prospero/; CRD42020214658.
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Affiliation(s)
- Amy L Finlay-Jones
- Telethon Kids Institute, Nedlands, Western Australia; Curtin University, Bentley, Western Australia; University of Western Australia, Crawley, Western Australia.
| | | | - Juliet Brook
- Telethon Kids Institute, Nedlands, Western Australia
| | | | | | | | | | - Catherine Elliott
- Telethon Kids Institute, Nedlands, Western Australia; Curtin University, Bentley, Western Australia
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20
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Mustanski B, Queiroz A, Merle JL, Zamantakis A, Zapata JP, Li DH, Benbow N, Pyra M, Smith JD. A Systematic Review of Implementation Research on Determinants and Strategies of Effective HIV Interventions for Men Who Have Sex with Men in the United States. Annu Rev Psychol 2024; 75:55-85. [PMID: 37722749 PMCID: PMC10872355 DOI: 10.1146/annurev-psych-032620-035725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/20/2023]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers-particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nanette Benbow
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Pyra
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Aschieri F, Fantini F, Antonelli A, Van Ryzin M, Smith JD. Therapeutic Assessment in a University Counseling Center: A Replicated Single-Case Time-Series Pilot Study. J Pers Assess 2024:1-12. [PMID: 38180034 DOI: 10.1080/00223891.2023.2296065] [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] [Received: 07/05/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
In this study, we pilot tested Therapeutic Assessment (TA) in a university counseling center using a replicated single-case design to generate hypotheses on the effectiveness and applicability for this setting and population. We aimed to see whether TA could be an effective brief intervention to address students' presenting mental health concerns. Further, we explored whether different types of presenting concerns were associated with differential symptomatic improvement during the intervention. An independent clinician interviewed participants before the baseline period to develop individualized rating scales pertaining to their presenting concerns. Eight consecutive students accessing the counseling center enrolled in the study and rated their presenting problems across baseline, intervention, and follow-up periods. The intervention involved five TA sessions. The results suggested that TA is associated with statistically significant reductions in clients' symptoms in the context of a university counseling center. Idiographic trajectory analysis of participant data who experienced significant and insignificant change was used to test whether changes were associated with the onset of TA. The findings suggest TA might be more effective for certain presenting concerns than for others. The implications for the implementation of TA in university counseling centers is discussed.
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Affiliation(s)
- Filippo Aschieri
- European Center for Therapeutic Assessment, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesca Fantini
- European Center for Therapeutic Assessment, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Justin D Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, Utah
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22
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Smith JD, Naoom SF, Saldana L, Shantharam S, Smith TA, Kohr JM. Preventing and Managing Chronic Disease Through Implementation Science: Editor's Introduction to the Supplemental Issue. Prev Sci 2023:10.1007/s11121-023-01617-y. [PMID: 38038892 DOI: 10.1007/s11121-023-01617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, 295 Chipeta Way, 84108, Salt Lake City, UT, USA.
| | | | - Lisa Saldana
- Chestnut Health Systems, Lighthouse Institute, Eugene, OR, USA
| | - Sharada Shantharam
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, GA, USA
| | | | - Jennifer M Kohr
- Centers for Disease Control and Prevention, Performance and Evaluation Office, Atlanta, GA, USA
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23
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Smith JD, Norton WE, Mitchell SA, Cronin C, Hassett MJ, Ridgeway JL, Garcia SF, Osarogiagbon RU, Dizon DS, Austin JD, Battestilli W, Richardson JE, Tesch NK, Cella D, Cheville AL, DiMartino LD. The Longitudinal Implementation Strategy Tracking System (LISTS): feasibility, usability, and pilot testing of a novel method. Implement Sci Commun 2023; 4:153. [PMID: 38017582 PMCID: PMC10683230 DOI: 10.1186/s43058-023-00529-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Systematic approaches are needed to accurately characterize the dynamic use of implementation strategies and how they change over time. We describe the development and preliminary evaluation of the Longitudinal Implementation Strategy Tracking System (LISTS), a novel methodology to document and characterize implementation strategies use over time. METHODS The development and initial evaluation of the LISTS method was conducted within the Improving the Management of SymPtoms during And following Cancer Treatment (IMPACT) Research Consortium (supported by funding provided through the NCI Cancer MoonshotSM). The IMPACT Consortium includes a coordinating center and three hybrid effectiveness-implementation studies testing routine symptom surveillance and integration of symptom management interventions in ambulatory oncology care settings. LISTS was created to increase the precision and reliability of dynamic changes in implementation strategy use over time. It includes three components: (1) a strategy assessment, (2) a data capture platform, and (3) a User's Guide. An iterative process between implementation researchers and practitioners was used to develop, pilot test, and refine the LISTS method prior to evaluating its use in three stepped-wedge trials within the IMPACT Consortium. The LISTS method was used with research and practice teams for approximately 12 months and subsequently we evaluated its feasibility, acceptability, and usability using established instruments and novel questions developed specifically for this study. RESULTS Initial evaluation of LISTS indicates that it is a feasible and acceptable method, with content validity, for characterizing and tracking the use of implementation strategies over time. Users of LISTS highlighted several opportunities for improving the method for use in future and more diverse implementation studies. CONCLUSIONS The LISTS method was developed collaboratively between researchers and practitioners to fill a research gap in systematically tracking implementation strategy use and modifications in research studies and other implementation efforts. Preliminary feedback from LISTS users indicate it is feasible and usable. Potential future developments include additional features, fewer data elements, and interoperability with alternative data entry platforms. LISTS offers a systematic method that encourages the use of common data elements to support data analysis across sites and synthesis across studies. Future research is needed to further adapt, refine, and evaluate the LISTS method in studies with employ diverse study designs and address varying delivery settings, health conditions, and intervention types.
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Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, School of Medicine, University of Utah, Spencer Fox Eccles, Salt Lake City, UT, USA.
- Departments of Psychiatry and Behavioral Science and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Wynne E Norton
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Christine Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael J Hassett
- Departments of Medical Oncology and Quality & Patient Safety, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Sofia F Garcia
- Departments of Psychiatry and Behavioral Science and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Raymond U Osarogiagbon
- Multidisciplinary Thoracic Oncology Program, Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, TN, USA
| | - Don S Dizon
- Division of Hematology-Oncology, Department of Medicine, Legoretta Cancer Center, The Warren Alpert Medical School of Brown University, and Lifespan Cancer Institute, Providence, USA
| | - Jessica D Austin
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Whitney Battestilli
- Center for Clinical Research Informatics, RTI International, Durham, NC, USA
| | - Joshua E Richardson
- Center for Health Informatics, RTI International, Research Triangle Park, Fayetteville, NC, USA
| | - Nathan K Tesch
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Lisa D DiMartino
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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24
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Abbasi RU, Allen MG, Arimura R, Belz JW, Bergman DR, Blake SA, Shin BK, Buckland IJ, Cheon BG, Fujii T, Fujisue K, Fujita K, Fukushima M, Furlich GD, Gerber ZR, Globus N, Hibino K, Higuchi R, Honda K, Ikeda D, Ito H, Iwasaki A, Jeong S, Jeong HM, Jui CH, Kadota K, Kakimoto F, Kalashev OE, Kasahara K, Kawata K, Kharuk I, Kido E, Kim SW, Kim HB, Kim JH, Kim JH, Komae I, Kubota Y, Kuznetsov MY, Lee KH, Lubsandorzhiev BK, Lundquist JP, Matthews JN, Nagataki S, Nakamura T, Nakazawa A, Nonaka T, Ogio S, Ono M, Oshima H, Park IH, Potts M, Pshirkov S, Remington JR, Rodriguez DC, Rott C, Rubtsov GI, Ryu D, Sagawa H, Sakaki N, Sako T, Sakurai N, Shin H, Smith JD, Sokolsky P, Stokes BT, Stroman TS, Takahashi K, Takeda M, Taketa A, Tameda Y, Thomas S, Thomson GB, Tinyakov PG, Tkachev I, Tomida T, Troitsky SV, Tsunesada Y, Udo S, Urban FR, Wong T, Yamazaki K, Yuma Y, Zhezher YV, Zundel Z. An extremely energetic cosmic ray observed by a surface detector array. Science 2023; 382:903-907. [PMID: 37995237 DOI: 10.1126/science.abo5095] [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] [Received: 02/08/2022] [Accepted: 10/19/2023] [Indexed: 11/25/2023]
Abstract
Cosmic rays are energetic charged particles from extraterrestrial sources, with the highest-energy events thought to come from extragalactic sources. Their arrival is infrequent, so detection requires instruments with large collecting areas. In this work, we report the detection of an extremely energetic particle recorded by the surface detector array of the Telescope Array experiment. We calculate the particle's energy as [Formula: see text] (~40 joules). Its arrival direction points back to a void in the large-scale structure of the Universe. Possible explanations include a large deflection by the foreground magnetic field, an unidentified source in the local extragalactic neighborhood, or an incomplete knowledge of particle physics.
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Affiliation(s)
- R U Abbasi
- Physics Department, Loyola University Chicago, Chicago, IL, USA
| | - M G Allen
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - R Arimura
- Graduate School of Science, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - J W Belz
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - D R Bergman
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - S A Blake
- Stellar Science, Albuquerque, NM, USA
| | - B K Shin
- Department of Physics, Ulsan National Institute of Science and Technology, 44919, Ulsan, Korea
| | - I J Buckland
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - B G Cheon
- Department of Physics and The Research Institute of Natural Science, Hanyang University, Seongdong-gu, Seoul, Korea
| | - T Fujii
- Graduate School of Science, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
- Hakubi Center for Advanced Research and Graduate School of Science, Kyoto University, Sakyo, Kyoto, 606-8502, Japan
- Nambu Yoichiro Institute of Theoretical and Experimental Physics, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - K Fujisue
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - K Fujita
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - M Fukushima
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - G D Furlich
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - Z R Gerber
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - N Globus
- Institute of Physical and Chemical Research, 2-1 Hirosawa, Wako, Saitama, 351-0198 Japan
| | - K Hibino
- Faculty of Engineering, Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa-ku, Yokohama 221-8686, Japan
| | - R Higuchi
- Institute of Physical and Chemical Research, 2-1 Hirosawa, Wako, Saitama, 351-0198 Japan
| | - K Honda
- University of Yamanashi, Kofu, 400-8510, Japan
| | - D Ikeda
- Faculty of Engineering, Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa-ku, Yokohama 221-8686, Japan
| | - H Ito
- Institute of Physical and Chemical Research, 2-1 Hirosawa, Wako, Saitama, 351-0198 Japan
| | - A Iwasaki
- Graduate School of Science, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - S Jeong
- Department of Physics, SungKyunKwan University, Jang-an-gu, Suwon 16419, Korea
| | - H M Jeong
- Department of Physics, SungKyunKwan University, Jang-an-gu, Suwon 16419, Korea
| | - C H Jui
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - K Kadota
- Department of Natural Sciences, Tokyo City University, Setagaya-ku, Tokyo 158-8557, Japan
| | - F Kakimoto
- Faculty of Engineering, Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa-ku, Yokohama 221-8686, Japan
| | - O E Kalashev
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - K Kasahara
- Shibauta Institute of Technology and Sicence, Fukasaku 307, Minuma-ku, Saitama, Japan
| | - K Kawata
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - I Kharuk
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - E Kido
- Institute of Physical and Chemical Research, 2-1 Hirosawa, Wako, Saitama, 351-0198 Japan
| | - S W Kim
- Department of Physics, SungKyunKwan University, Jang-an-gu, Suwon 16419, Korea
| | - H B Kim
- Department of Physics and The Research Institute of Natural Science, Hanyang University, Seongdong-gu, Seoul, Korea
| | - J H Kim
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - J H Kim
- Physics Division, Argonne National Laboratory, Lemont, IL, USA
| | - I Komae
- Graduate School of Science, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Y Kubota
- Academic Assembly School of Science and Technology Institute of Engineering, Shinshu University, Nagano, Nagano, 380-8553, Japan
| | - M Y Kuznetsov
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - K H Lee
- Department of Physics, SungKyunKwan University, Jang-an-gu, Suwon 16419, Korea
| | - B K Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - J P Lundquist
- Center for Astrophysics and Cosmology, University of Nova Gorica, Nova Gorica, Slovenia
| | - J N Matthews
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - S Nagataki
- Institute of Physical and Chemical Research, 2-1 Hirosawa, Wako, Saitama, 351-0198 Japan
| | - T Nakamura
- Academic Assembly School of Science and Technology Institute of Engineering, Shinshu University, Nagano, Nagano, 380-8553, Japan
| | - A Nakazawa
- Academic Assembly School of Science and Technology Institute of Engineering, Shinshu University, Nagano, Nagano, 380-8553, Japan
| | - T Nonaka
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - S Ogio
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - M Ono
- Institute of Physical and Chemical Research, 2-1 Hirosawa, Wako, Saitama, 351-0198 Japan
- Institute of Astronomy and Astrophysics, Academia Sinica, Taipei 10617, Taiwan
| | - H Oshima
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - I H Park
- Department of Physics, SungKyunKwan University, Jang-an-gu, Suwon 16419, Korea
| | - M Potts
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - S Pshirkov
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - J R Remington
- NASA Marshall Space Flight Center, Martin Road, Huntsville, AL, USA
| | - D C Rodriguez
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
- Integrated Support Center for Nuclear Nonproliferation and Nuclear Security, Japan Atomic Energy Agency, Tokai-mura, Ibaraki 319-1195, Japan
| | - C Rott
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
- Department of Physics, SungKyunKwan University, Jang-an-gu, Suwon 16419, Korea
| | - G I Rubtsov
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - D Ryu
- Department of Physics, Ulsan National Institute of Science and Technology, 44919, Ulsan, Korea
| | - H Sagawa
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - N Sakaki
- Institute of Physical and Chemical Research, 2-1 Hirosawa, Wako, Saitama, 351-0198 Japan
| | - T Sako
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - N Sakurai
- Faculty of Design Technology, 3-1-1 Nakagaito, Daito City, Osaka, Japan
| | - H Shin
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - J D Smith
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - P Sokolsky
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - B T Stokes
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - T S Stroman
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - K Takahashi
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - M Takeda
- Institute for Cosmic Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba, 277-8582, Japan
| | - A Taketa
- Earthquake Research Institute, University of Tokyo, Bunkyo-ku, Tokyo, 113-0032, Japan
| | - Y Tameda
- Department of Engineering Science, Faculty of Engineering, Osaka Electro-Communication University, Neyagawa-shi, Osaka 572-8530, Japan
| | - S Thomas
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - G B Thomson
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - P G Tinyakov
- Universite Libre de Bruxelles, bvd du Triomphe CP225, Brussels, Belgium
| | - I Tkachev
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - T Tomida
- Academic Assembly School of Science and Technology Institute of Engineering, Shinshu University, Nagano, Nagano, 380-8553, Japan
| | - S V Troitsky
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - Y Tsunesada
- Graduate School of Science, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
- Nambu Yoichiro Institute of Theoretical and Experimental Physics, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - S Udo
- Faculty of Engineering, Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa-ku, Yokohama 221-8686, Japan
| | - F R Urban
- The Central European Institute for Cosmology and Fundamental Physics, Institute of Physics of the Czech Academy of Sciences, Na Slovance 1999/2, 182 21 Prague, Czech Republic
| | - T Wong
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - K Yamazaki
- College of Engineering, Chubu University, 1200 Matsumoto, Kasugai, Aichi 487-8501, Japan
| | - Y Yuma
- Academic Assembly School of Science and Technology Institute of Engineering, Shinshu University, Nagano, Nagano, 380-8553, Japan
| | - Y V Zhezher
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - Z Zundel
- High Energy Astrophysics Institute and Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
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Wiggins JL, Ureña Rosario A, Zhang Y, MacNeill L, Yu Q, Norton E, Smith JD, Wakschlag LS. Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood. Int J Methods Psychiatr Res 2023; 32:e1989. [PMID: 37723907 PMCID: PMC10654830 DOI: 10.1002/mpr.1989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVES In light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for a pragmatic irritability measure to identify at-risk infant-toddlers. METHODS Data comprised N = 350 diverse infant-toddlers and their mothers assessed at ∼14 months old for irritability (Multidimensional Assessment Profiles- Temper Loss-Infant/Toddler (MAPS-TL-IT) and impairment (Early Childhood Irritability-Related Impairment Interview, E-CRI; and Family Life Impairment Scale (FLIS). Bimonthly follow-up surveys assessed impairment (FLIS) over the following year. RESULTS Stepwise logistic regression indicated that 5 MAPS-TL-IT items were most informative for differentiating concurrent impairment on the FLIS: "frustrated about small things"; "hit, bite, or kick during tantrums"; "trouble cheering up when grumpy"; "grumpy during fun activities" and "tantrums in public". With this summed score, Receiver Operating Characteristics analysis differentiating concurrent impairment on the E-CRI indicated good classification accuracy for (Area under the curve = 0.755, p < 0.05), with a cutoff of 5 maximizing sensitivity (71.4%) and specificity (70.6%). Elevated irritability on this MAPS-TL-IT clinically optimized screener increased likelihood of persistently elevated FLIS impairment trajectories over the following year more than fourfold (OR = 4.37; Confidence intervals = 2.40-7.97, p < 0.001). CONCLUSIONS Our findings represent the first step toward a pragmatic tool for screening for transdiagnostic mental health risk in toddlers, optimized for feasibility in clinical care. This has potential to strengthen resilience pathways via earlier identification of mental health risk and corollary prevention in toddlers.
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Affiliation(s)
- Jillian Lee Wiggins
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
- San Diego State University/University of California, San DiegoJoint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Ana Ureña Rosario
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
- Alliant International UniversitySan DiegoCaliforniaUSA
| | - Yudong Zhang
- Department of Medical Social SciencesFeinberg School of MedicineChicagoIllinoisUSA
- Institute for Innovations in Developmental SciencesNorthwestern University School of MedicineChicagoIllinoisUSA
| | - Leigha MacNeill
- Department of Medical Social SciencesFeinberg School of MedicineChicagoIllinoisUSA
- Institute for Innovations in Developmental SciencesNorthwestern University School of MedicineChicagoIllinoisUSA
| | - Qiongru Yu
- San Diego State University/University of California, San DiegoJoint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Elizabeth Norton
- Department of Medical Social SciencesFeinberg School of MedicineChicagoIllinoisUSA
- Institute for Innovations in Developmental SciencesNorthwestern University School of MedicineChicagoIllinoisUSA
- Department of Communication Sciences and DisordersSchool of CommunicationNorthwestern UniversityChicagoIllinoisUSA
| | - Justin D. Smith
- Department of Population Health SciencesSpencer Fox Eccles School of Medicine at the University of UtahSalt Lake CityUtahUSA
| | - Lauren S. Wakschlag
- Department of Medical Social SciencesFeinberg School of MedicineChicagoIllinoisUSA
- Institute for Innovations in Developmental SciencesNorthwestern University School of MedicineChicagoIllinoisUSA
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Wiggins JL, Ureña Rosario A, MacNeill LA, Krogh‐Jespersen S, Briggs‐Gowan M, Smith JD, Wakschlag LS. Prevalence, stability, and predictive utility of the Multidimensional Assessment of Preschoolers Scales clinically optimized irritability score: Pragmatic early assessment of mental disorder risk. Int J Methods Psychiatr Res 2023; 32:e1991. [PMID: 37728118 PMCID: PMC10654826 DOI: 10.1002/mpr.1991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES Characterizing the scope and import of early childhood irritability is essential for real-world actualization of this reliable indicator of transdiagnostic mental health risk. Thus, we utilize pragmatic assessment to establish prevalence, stability, and predictive utility of clinically significant early childhood irritability. METHODS Data included two independent, diverse community samples of preschool age children (N = 1857; N = 1490), with a subset enriched for risk (N = 425) assessed longitudinally from early childhood through preadolescence (∼4-9 years old). A validated, brief (2-item) scale pragmatically assessed clinically significant irritability. In the longitudinal subsample, clinical interviews assessed internalizing/externalizing disorders. RESULTS One in five preschool-age children had clinically significant irritability, which was independently replicated. Irritability was highly stable through preadolescence. Children with versus without clinically significant early childhood irritability had greater odds of early onset, persistent internalizing/externalizing disorders. The pragmatic assessment effectively screened out low-risk children and identified 2/3 of children with early-onset, persistent psychopathology. CONCLUSIONS Clinically significant early childhood irritability prevalence is akin to the pediatric obesity epidemic and may warrant similar universal screening/intervention. Also, irritability's stability demonstrates the common guidance "they'll grow out of it" to be false. Finally, pragmatic irritability assessment has transdiagnostic predictive power and addresses a need for feasible measures to flag risk.
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Affiliation(s)
- Jillian Lee Wiggins
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Ana Ureña Rosario
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Leigha A. MacNeill
- Department of Medical Social SciencesFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Institute for Innovations in Developmental SciencesNorthwestern UniversityEvanstonIllinoisUSA
| | - Sheila Krogh‐Jespersen
- Institute for Innovations in Developmental SciencesNorthwestern UniversityEvanstonIllinoisUSA
| | | | - Justin D. Smith
- Department of Population Health SciencesUniversity of UtahSalt Lake CityUtahUSA
| | - Lauren S. Wakschlag
- Department of Medical Social SciencesFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Institute for Innovations in Developmental SciencesNorthwestern UniversityEvanstonIllinoisUSA
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27
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Smith AW, DiMartino L, Garcia SF, Mitchell SA, Ruddy KJ, Smith JD, Wong SL, Cahue S, Cella D, Jensen RE, Hassett MJ, Hodgdon C, Kroner B, Osarogiagbon RU, Popovic J, Richardson K, Schrag D, Cheville AL. Systematic symptom management in the IMPACT Consortium: rationale and design for 3 effectiveness-implementation trials. JNCI Cancer Spectr 2023; 7:pkad073. [PMID: 37930033 PMCID: PMC10627528 DOI: 10.1093/jncics/pkad073] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/30/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023] Open
Abstract
Cancer and its treatment produce deleterious symptoms across the phases of care. Poorly controlled symptoms negatively affect quality of life and result in increased health-care needs and hospitalization. The Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium was created to develop 3 large-scale, systematic symptom management systems, deployed through electronic health record platforms, and to test them in pragmatic, randomized, hybrid effectiveness and implementation trials. Here, we describe the IMPACT Consortium's conceptual framework, its organizational components, and plans for evaluation. The study designs and lessons learned are highlighted in the context of disruptions related to the COVID-19 pandemic.
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Affiliation(s)
- Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Lisa DiMartino
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Austin, TX, USA
- RTI International, Washington, DC, USA
| | - Sofia F Garcia
- Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | | | - Justin D Smith
- Division of Health Systems Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - September Cahue
- American Academy of Allergy, Asthma and Immunology, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christine Hodgdon
- Guiding Researchers and Advocates to Scientific Partnerships, Baltimore, MD, USA
| | | | | | | | | | - Deborah Schrag
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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28
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Shah KP, Khan SS, Baldridge AS, Grady KL, Cella D, Goyal P, Allen LA, Smith JD, Lagu TC, Ahmad FS. Health Status in Heart Failure and Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020. JACC Heart Fail 2023:S2213-1779(23)00678-9. [PMID: 37930290 DOI: 10.1016/j.jchf.2023.10.003] [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] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND People with heart failure (HF) and cancer experience impaired physical and mental health status. However, health-related quality of life (HRQOL) has not been directly compared between these conditions in a contemporary population of older people. OBJECTIVES The authors sought to compare HRQOL in people with HF vs those with lung, colorectal, breast, and prostate cancers. METHODS The authors performed a pooled analysis of Medicare Health Outcomes Survey data from 2016 to 2020 in participants ≥65 years of age with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer. They used the Veterans RAND-12 physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on the U.S. general population) and an SD of 10. The authors used pairwise Student's t-tests to evaluate for differences in PCS and MCS between groups. RESULTS Among participants with HF (n = 71,025; 54% female, 16% Black), mean PCS was 29.5 and mean MCS 47.9. Mean PCS was lower in people with HF compared with lung (31.2; n = 4,165), colorectal (35.6; n = 4,270), breast (37.7; n = 14,542), and prostate (39.6; n = 17,670) cancer (all P < 0.001). Participants with HF had a significantly lower mean MCS than those with lung (31.2), colon (50.0), breast (52.0), and prostate (53.0) cancer (all P < 0.001). CONCLUSIONS People with HF experience worse HRQOL than those with cancer actively receiving treatment. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions that target physical and mental health status and scale multidisciplinary clinics.
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Affiliation(s)
- Kriti P Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail S Baldridge
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Kathleen L Grady
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Patient-Centered Outcomes, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Parag Goyal
- Program for the Care and the Study of the Aging Heart, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tara C Lagu
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Health Information Partnerships, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Sierra-Velez D, Gundewar A, Persaud A, Simione M, Castro I, Perkins M, Lindros J, Salmon J, Smith JD, Taveras EM, Fiechtner L. Stakeholders' perception of factors influencing adoption of a pediatric weight management intervention: a qualitative study. Front Public Health 2023; 11:1045618. [PMID: 37900042 PMCID: PMC10613059 DOI: 10.3389/fpubh.2023.1045618] [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: 10/17/2022] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background Childhood obesity is highly prevalent in the United States and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the factors influencing successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites. Methods We interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME). Results In pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described. Conclusion Understanding the factors influencing adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.
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Affiliation(s)
- Desiree Sierra-Velez
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Anisha Gundewar
- Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Alicia Persaud
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Ines Castro
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, United States
| | - Jeremiah Salmon
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, United States
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
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Simmons RG, Baayd J, Tak C, Turok DK, Elliott S, Smith JD. A stakeholder-developed logic model to improve utilization of pharmacy-prescribed contraception in Utah. Implement Sci Commun 2023; 4:124. [PMID: 37821957 PMCID: PMC10565968 DOI: 10.1186/s43058-023-00503-6] [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: 04/03/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Currently, 20 states in the USA have passed policies allowing pharmacists to prescribe short-acting hormonal contraception, including pills, patches, and vaginal rings. Yet, utilization of these services remains limited. The purpose of this study was to (a) assess barriers and facilitators of pharmacy contraceptive dispensing among contraceptive users, pharmacists, and healthcare providers in Utah and (b) adapt and propose an evidence-based contraceptive intervention in the pharmacy environment. METHODS We conducted 6 focus groups among contraceptive users, pharmacists, and healthcare providers assessing current barriers and facilitators to pharmacy prescribing. We coded transcripts of these focus groups to the Consolidated Framework for Implementation Research, Version 2.0 (CFIR) and characterized the findings based on the Expert Recommendations for Implementing Change (ERIC) Barrier-Busting tool. Based on the CFIR findings and ERIC strategies output, we adapted an existing evidence-based intervention (a contraceptive access initiative) to the Utah pharmacy environment. We then convened a pharmacy stakeholder meeting and presented elements of an Implementation Research Logic Model and obtained feedback. We coded this feedback to the CFIR framework to finalize an Implementation Research Logic Model for a proposed implementation approach to improving contraceptive prescribing. RESULTS Initial focus group responses clustered around specific implementation barriers including financial barriers (cost for patients, as well as lack of reimbursement for pharmacist's time); lack of awareness of the service (on the part of patients, pharmacists, and health care providers); need for updated tools for contraceptive counseling and scheduling; and need for increased pharmacists education to conduct contraceptive counseling. Proposed adaptations to the existing contraceptive access intervention included development of a technology-based patient/pharmacist screener tool and a healthcare provider/pharmacist contraceptive referral network. Stakeholders identified pharmacist reimbursement as the top priority for improving utilization. CONCLUSIONS Elements of contraceptive access initiatives mapped well as proposed implementation strategies to improving utilization of contraceptive prescribing in pharmacies.
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Affiliation(s)
- Rebecca G Simmons
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA.
- Division of Family Planning, Health Educators, Leaders and Innovation Complex Suite #5050, University of Utah, 30 N. Mario Capecci Dr, Salt Lake City, UT, 84112, USA.
| | - Jami Baayd
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
| | - Casey Tak
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
| | - David K Turok
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
| | - Sarah Elliott
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
| | - Justin D Smith
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
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Stadnick NA, Laurent LC, Cain KL, Seifert M, Burola ML, Salgin L, Watson P, Oswald W, Munoz FA, Velasquez SF, Smith JD, Zou J, Rabin BA. Community-engaged optimization of COVID-19 rapid evaluation and testing experiences: roll-out implementation optimization trial. Implement Sci 2023; 18:46. [PMID: 37784200 PMCID: PMC10544564 DOI: 10.1186/s13012-023-01306-y] [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: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There continues to be a need for COVID-19 testing that is pragmatic, community-centered, and sustainable. This study will refine and test implementation strategies prioritized by community partners: (1) walk-up no-cost testing, (2) community health worker (promotores)-facilitated testing and preventive care counseling, (3) vending machines that dispense no-cost, self-testing kits. METHODS A co-designed Theory of Change from an earlier study phase and the Practical, Robust Implementation and Sustainment Model (PRISM) will guide the study design, measures selection, and evaluation. The first aim is to refine and operationalize a multi-component implementation strategy bundle and outcome measures for COVID-19 testing. A Community and Scientific Advisory Board (CSAB) will be established and include community members, clinical providers/staff from the partnering Federally Qualified Health Center (FQHC), public health researchers, policymakers, and a county health department ambassador. Engagement of CSAB members will be assessed through structured ethnography and a survey about the quality and quantity of engagement practices. The second aim is to implement and evaluate the impact of the implementation strategy bundle to optimize COVID-19 testing in communities using a roll-out implementation optimization (ROIO) design. Seven thousand and five hundred community members will be enrolled across four FQHC clinics over 18 months. Participants will be invited to complete an electronic survey about their demographics, health, and COVID-19 testing results and experiences. CSAB members and clinic partners will participate in PRISM fit and determinant assessments prior to each clinic rollout and post-trial. Interviews will be conducted with 60 community participants and 12 providers/staff following a 3-month rollout period at each clinic, inquiring about their experiences with the implementation strategies. Quantitative data will be analyzed using hierarchical multilevel models to determine the impact of implementation strategies. Qualitative data will be analyzed using rapid qualitative approaches to summarize implementation experiences and identify necessary changes prior to subsequent rollouts. A matrix approach will be used to triangulate data from quantitative and qualitative sources based on PRISM domains. DISCUSSION This is one of the first pragmatic implementation trials to use a ROIO design and aims to co-create a sustainable and equitable COVID-19 testing program. Findings are likely to generalize to other public health prevention efforts. TRIAL REGISTRATION NCT05894655 March 2, 2023.
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Affiliation(s)
- Nicole A Stadnick
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA.
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Louise C Laurent
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Kelli L Cain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Marva Seifert
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Maria Linda Burola
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Linda Salgin
- San Ysidro Health, San Diego, CA, USA
- Joint Doctoral Program in Public Health School, UC San Diego and San Diego State University, San Diego, CA, USA
| | - Paul Watson
- The Global Action Research Center, San Diego, CA, USA
| | | | | | | | - Justin D Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Borsika A Rabin
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Krefman AE, Ciolino JD, Kan AK, Maki B, McHugh M, Smith JD, Bannon J, Carroll AJ, Bustamante P, Frye C, Hitsman B, Day A, Walunas TL. Rationale and design for Healthy Hearts for Michigan (HH4M): A pragmatic single-arm hybrid effectiveness-implementation study. Contemp Clin Trials Commun 2023; 35:101199. [PMID: 37671245 PMCID: PMC10475469 DOI: 10.1016/j.conctc.2023.101199] [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: 05/18/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
Background The burden of cardiovascular disease (CVD) is particularly high in several US states, which include the state of Michigan. Hypertension and smoking are two major risk factors for mortality due to CVD. Rural Michigan is disproportionally affected by CVD and by primary care shortages. The Healthy Hearts for Michigan (HH4M) study aims to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts and is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery. Methods Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M, a pragmatic, single-arm hybrid Type 2 effectiveness-implementation study during which practice facilitation was delivered at the practice level for 12 months, followed by a 3-month maintenance period. Results Fifty-four practices were enrolled over a 12-month recruitment period. At baseline, the mean proportion (standard deviation) of patients at the practice level meeting the clinical quality measures were: blood pressure, 0.72 (0.12); tobacco screening, 0.80 (0.30); tobacco cessation intervention, 0.57 (0.28); tobacco screening and cessation intervention: 0.78 (0.26). Conclusion This three-year research program will evaluate the ability of rural and medically underserved primary care practices to implement the quality improvement model by identifying drivers of and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation.
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Affiliation(s)
- Amy E. Krefman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jody D. Ciolino
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ann K. Kan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Megan McHugh
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin D. Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Jennifer Bannon
- Division of General Internal Medicine and Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Allison J. Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Patricia Bustamante
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anya Day
- Altarum Institute, Ann Arbor, MI, USA
| | - Theresa L. Walunas
- Department of Medicine, Division of General Internal Medicine and Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, USA
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Martin M, Shenderovich Y, Caron EB, Smith JD, Siu G, Breitenstein SM. The Case for Assessing and Reporting on Facilitator Fidelity: Introducing the Fidelity of Implementation in Parenting Programs Guideline. Glob Implement Res Appl 2023; 4:1-10. [PMID: 38371716 PMCID: PMC10873439 DOI: 10.1007/s43477-023-00092-5] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/27/2023] [Indexed: 02/20/2024]
Abstract
The sizeable body of evidence indicating that parenting programs have a positive impact on children and families highlights the potential public health benefits of their implementation on a large scale. Despite evidence and global attention, beyond the highly controlled delivery of parenting programs via randomized trials, little is known about program effectiveness or how to explain the poorer results commonly observed when implemented in community settings. Researchers, practitioners, and policymakers must work together to identify what is needed to spur adoption and sustainment of evidence-based parenting programs in real-world service systems and how to enhance program effectiveness when delivered via these systems. Collecting, analyzing, and using facilitator fidelity data is an important frontier through which researchers and practitioners can contribute. In this commentary, we outline the value of assessing facilitator fidelity and utilizing the data generated from these assessments; describe gaps in research, knowledge, and practice; and recommend directions for research and practice. In making recommendations, we describe a collaborative process to develop a preliminary guideline-the Fidelity of Implementation in Parenting Programs Guideline or FIPP-to use when reporting on facilitator fidelity. Readers are invited to complete an online survey to provide comments and feedback on the first draft of the guideline. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-023-00092-5.
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Affiliation(s)
- Mackenzie Martin
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Community-University Partnership for the Study of Children, Youth and Families, School of Public Health, University of Alberta, Edmonton, Canada
| | - Yulia Shenderovich
- Wolfson Centre for Young People’s Mental Health, Cardiff University, Cardiff, UK
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHER), School of Social Sciences, Cardiff University, Cardiff, UK
| | - E. B. Caron
- Department of Psychology, University of Hartford, West Hartford, Connecticut USA
| | - Justin D. Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah USA
| | - Godfrey Siu
- Child Health and Development Centre, Makerere University, Kampala, Uganda
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Meadows JJ, Bauser-Heaton H, Petit CJ, Goldstein BH, Qureshi AM, McCracken CE, Kelleman MS, Nicholson GT, Law MA, Zampi JD, Shahanavaz S, Chai PJ, Romano JC, Batlivala SP, Maskatia SA, Asztalos IB, Eilers L, Kamsheh AM, Healan SJ, Smith JD, Ligon RA, Dailey-Schwartz A, Pettus JA, Pajk AL, Glatz AC, Mascio CE. Comparison of treatment strategies for neonates with tetralogy of Fallot and pulmonary atresia. J Thorac Cardiovasc Surg 2023; 166:916-925.e6. [PMID: 36828672 DOI: 10.1016/j.jtcvs.2023.01.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) but no major aorta-pulmonary collaterals are dependent on the arterial duct for pulmonary blood flow and require early intervention, either by primary (PR) or staged repair (SR) with initial palliation (IP) followed by complete repair (CR). The optimal approach has not been established. METHODS Neonates with TOF/PA who underwent PR or SR were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Outcomes were compared between PR and SR (IP + CR) strategies. Propensity scoring was used to adjust for baseline differences. The primary outcome was mortality. Secondary outcomes included complications, length of stay, cardiopulmonary bypass and anesthesia times, reintervention (RI), and pulmonary artery (PA) growth. RESULTS Of 282 neonates, 106 underwent PR and 176 underwent SR (IP: 144 surgical, 32 transcatheter). Patients who underwent SR were more likely to have DiGeorge syndrome and greater rates of mechanical ventilation before the initial intervention. Mortality was not significantly different. Duration of mechanical ventilation, inotrope use, and complication rates were similar. Cumulative length of stay, cardiopulmonary bypass, and anesthesia times favored PR (P ≤ .001). Early RI was more common in patients who underwent SR (rate ratio, 1.42; P = .003) but was similar after CR (P = .837). Conduit size at the time of CR was larger with SR. Right PA growth was greater with PR. CONCLUSIONS In neonates with TOF/PA, SR is more common in greater-risk patients. Accounting for this, SR and PR strategies have similar mortality. Perioperative morbidities, RI, and right PA growth generally favor PR, whereas SR allows for larger initial conduit implantation.
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Affiliation(s)
- Jeffery J Meadows
- Department of Pediatrics, University of California, San Francisco, San Francisco, Calif; Benioff Children's Hospital, San Francisco, Calif.
| | - Holly Bauser-Heaton
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Christopher J Petit
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga; Division of Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Bryan H Goldstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio; Department of Pediatrics, Heart Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Courtney E McCracken
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Michael S Kelleman
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - George T Nicholson
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Mark A Law
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Jeffrey D Zampi
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Shabana Shahanavaz
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Paul J Chai
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Jennifer C Romano
- Section of Pediatric Cardiothoracic Surgery, Department of Cardiac Surgery, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Sarosh P Batlivala
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Shiraz A Maskatia
- Moore Children's Heart Center, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, Calif
| | - Ivor B Asztalos
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Lindsay Eilers
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Alicia M Kamsheh
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Steven J Healan
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Justin D Smith
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - R Allen Ligon
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Andrew Dailey-Schwartz
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Joelle A Pettus
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Amy L Pajk
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Andrew C Glatz
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Washington University Heart Center at St Louis Children's Hospital, St. Louis, Mo
| | - Christopher E Mascio
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, WVa
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McHugh M, Heinrich J, Philbin S, Bishop D, Smith JD, Knapke JM, Day A, Walunas TL. Declining Participation in Primary Care Quality Improvement Research: A Qualitative Study. Ann Fam Med 2023; 21:388-394. [PMID: 37748906 PMCID: PMC10519762 DOI: 10.1370/afm.3007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE There are numerous supportive quality improvement (QI) projects to facilitate the implementation of evidence-based practices in primary care, but recruiting physician practices to join these projects is challenging, costly, and time consuming. We aimed to identify factors leading primary care practices to decline participation in QI projects, and strategies to improve the feasibility and attractiveness of QI projects in the future. METHODS For this qualitative study, we contacted 109 representatives of practices that had declined participation in 1 of 4 Agency for Healthcare Research and Quality-funded EvidenceNOW projects. The representatives were invited to participate in a 15-minute interview or complete a 5-question questionnaire. Thematic analysis was used to organize and characterize findings. RESULTS Representatives from 31 practices (28.4% of those contacted) responded. Overwhelmingly, respondents indicated that staff turnover, staffing shortages, and general time constraints, exacerbated by the pandemic, prevented participation in the QI projects. Challenges with electronic health records, an expectation of greater financial compensation for participation, and confidence in the practices' current care practices were secondary reasons for declining participation. Tying participation to value-based programs and offering greater compensation were identified as strategies to facilitate recruitment. None of the respondents' recommendations, however, addressed the primary issues of staffing challenges and time constraints. CONCLUSIONS Staffing challenges and general time constraints, exacerbated by the pandemic, are compromising primary care practices' ability to engage in QI research projects. To encourage participation, policy makers should consider direct supports for primary care, which may also help to alleviate burnout.
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Affiliation(s)
- Megan McHugh
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer Heinrich
- Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah Philbin
- Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Justin D Smith
- Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | | | | | - Theresa L Walunas
- Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Petit CJ, Glatz AC, Goldstone AB, Law MA, Romano JC, Maskatia SA, Chai PJ, Zampi JD, Meadows JJ, Nicholson GT, Shahanavaz S, Qureshi AM, McCracken CE, Mascio CE, Batlivala SP, Asztalos IB, Healan SJ, Smith JD, Pettus JA, Beshish A, Raulston JEB, Hock KM, Pajk AL, Goldstein BH. Pulmonary Artery Hypoplasia in Neonates With Tetralogy of Fallot. J Am Coll Cardiol 2023; 82:615-627. [PMID: 37558375 DOI: 10.1016/j.jacc.2023.05.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Neonates with symptomatic tetralogy of Fallot (sTOF) with hypoplastic pulmonary arteries (hPA) are considered high risk. Data are needed to inform the impact of hPA on outcomes, and the ideal management strategy. OBJECTIVES The objectives of this study were to quantify the impact of hPA on outcomes in neonates with sTOF and measure the impact of strategy on pulmonary artery (PA) growth in this population. METHODS Neonates with sTOF from 2005 to 2017 were reviewed from the Congenital Cardiac Research Collaborative. Criteria for hPA included a unilateral PA z score <-2.0 and contralateral PA z score <0. Primary outcome was mortality. Secondary outcomes included reintervention and PA growth. RESULTS We included 542 neonates with sTOF, including 188 (35%) with hPA and 354 (65%) with normal PA, with median follow-up of 4.1 years. Median right and left hPA z scores were -2.19 (25th-75th percentile: -2.55 to -1.94) and -2.23 (25th-75th percentile: -2.64 to -1.91), respectively. Staged repair (vs primary TOF repair) was less common in the hPA cohort (36 vs 44%; P = 0.07). Survival was similar between groups (unadjusted P = 0.16; adjusted P = 0.25). Reintervention was more common in the hPA group (HR: 1.28; 95% CI: 1.01-1.63; P = 0.044); there was no difference after definitive repair (HR: 1.21; 95% CI: 0.93-1.58; P = 0.16). PA growth at 1 year was greater in the hPA cohort, particularly for the right PA (P < 0.001). CONCLUSIONS Despite perception, the presence of hPA in neonates with sTOF conferred no increase in overall hazard of mortality or reintervention after definitive repair. PA growth was superior in the hPA cohort. These findings suggest that the presence of hPA does not adversely impact outcomes in sTOF.
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Affiliation(s)
- Christopher J Petit
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
| | - Andrew C Glatz
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Pediatric Cardiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri, USA
| | - Andrew B Goldstone
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mark A Law
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Jennifer C Romano
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Shiraz A Maskatia
- University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, California, USA
| | - Paul J Chai
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jeffrey D Zampi
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Jeffery J Meadows
- University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, California, USA
| | - George T Nicholson
- Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shabana Shahanavaz
- Division of Pediatric Cardiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri, USA; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Athar M Qureshi
- Baylor College of Medicine, Texas Children's Hospital, Waco, Texas, USA
| | - Courtney E McCracken
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christopher E Mascio
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of West Virginia School of Medicine, Morgantown, West Virginia, USA
| | | | - Ivor B Asztalos
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven J Healan
- Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin D Smith
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Joelle A Pettus
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Asaad Beshish
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - James E B Raulston
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Krissie M Hock
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Amy L Pajk
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bryan H Goldstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Johansson SA, Dulermo T, Jann C, Smith JD, Pryszlak A, Pignede G, Schraivogel D, Colavizza D, Desfougères T, Rave C, Farwick A, Merten CA, Roy KR, Wei W, Steinmetz LM. Large scale microfluidic CRISPR screening for increased amylase secretion in yeast. Lab Chip 2023; 23:3704-3715. [PMID: 37483015 PMCID: PMC7614956 DOI: 10.1039/d3lc00111c] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Key to our ability to increase recombinant protein production through secretion is a better understanding of the pathways that interact to translate, process and export mature proteins to the surrounding environment, including the supporting cellular machinery that supplies necessary energy and building blocks. By combining droplet microfluidic screening with large-scale CRISPR libraries that perturb the expression of the majority of coding and non-coding genes in S. cerevisiae, we identified 345 genes for which an increase or decrease in gene expression resulted in increased secretion of α-amylase. Our results show that modulating the expression of genes involved in the trafficking of vesicles, endosome to Golgi transport, the phagophore assembly site, the cell cycle and energy supply improve α-amylase secretion. Besides protein-coding genes, we also find multiple long non-coding RNAs enriched in the vicinity of genes associated with endosomal, Golgi and vacuolar processes. We validated our results by overexpressing or deleting selected genes, which resulted in significant improvements in α-amylase secretion. The advantages, in terms of precision and speed, inherent to CRISPR based perturbations, enables iterative testing of new strains for increased protein secretion.
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Affiliation(s)
- S Andreas Johansson
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany.
| | - Thierry Dulermo
- Lesaffre Institute of Science & Technology, Lesaffre, 59700 Marcq-en-Baroeul, France
| | - Cosimo Jann
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany.
| | - Justin D Smith
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
| | - Anna Pryszlak
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany.
| | - Georges Pignede
- Lesaffre Institute of Science & Technology, Lesaffre, 59700 Marcq-en-Baroeul, France
| | - Daniel Schraivogel
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany.
| | - Didier Colavizza
- Lesaffre Institute of Science & Technology, Lesaffre, 59700 Marcq-en-Baroeul, France
| | - Thomas Desfougères
- Lesaffre Institute of Science & Technology, Lesaffre, 59700 Marcq-en-Baroeul, France
| | - Christophe Rave
- Lesaffre Institute of Science & Technology, Lesaffre, 59700 Marcq-en-Baroeul, France
| | - Alexander Farwick
- Lesaffre Institute of Science & Technology, Lesaffre, 59700 Marcq-en-Baroeul, France
| | - Christoph A Merten
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany.
| | - Kevin R Roy
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
| | - Wu Wei
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
| | - Lars M Steinmetz
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany.
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Genome Technology Center, Stanford University, Palo Alto, California, USA
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Rafferty M, Stoff L, Smith JD, Hansen P, Briody M, Diaz C, O'Donnell L, Heinemann AW, Brown CH, Lieber RL. Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation. Arch Phys Med Rehabil 2023; 104:1289-1299. [PMID: 36924817 PMCID: PMC10502191 DOI: 10.1016/j.apmr.2023.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/09/2022] [Revised: 01/16/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To evaluate changes in clinicians' use of evidence-based practice (EBP), openness toward EBP, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations. DESIGN Three repeated surveys of clinicians before, 7-9 months, and 2.5 years after transition to the new facility. SETTING Inpatient rehabilitation hospital. PARTICIPANTS Physicians, nurses, therapists, and other health care professionals (n=410, 442, and 448 respondents at Times 1, 2, and 3, respectively). INTERVENTIONS Implementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations. MAIN OUTCOME MEASURES Adapted versions of the Evidence-Based Practice Questionnaire (EBPQ), the Evidence-Based Practice Attitudes Scale (EBPAS), and the Organizational Change Recipients' Beliefs Scale (OCRBS) were used. Open-ended survey questions were analyzed through exploratory content analysis. RESULTS Response rates at Times 1, 2, and 3 were 67% (n=410), 69% (n=422), and 71% (n=448), respectively. After accounting for familiarity with the model of care, there was greater reported use of EBP at Time 3 compared with Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; P=.043). Attitudes toward EBPs were similar over time. Acceptance of the new model of care was lower at Time 2 compared with Time 1, but rebounded at Time 3 (adjusted meant1=3.44, SE=0.04; adj. meant2=3.19, SE=0.04; P<.0001; adj. meant3=3.51, SE=0.04; P<.0001). Analysis of open-ended responses suggested that clinicians' optimism for the model of care was greater over time, but continued quality improvement should focus on cultivating communication between clinicians and researchers. CONCLUSIONS Accelerating clinician-researcher collaborations in a rehabilitation setting requires sustained effort for successful implementation beyond novel physical changes. Organizations must be responsive to clinicians' changing concerns to adapt and sustain a collaborative translational medicine model and allow sufficient time, probably years, for such transitions to occur.
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Affiliation(s)
- Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | | | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, UT
| | - Piper Hansen
- Shirley Ryan AbilityLab, Chicago, IL; Occupational Therapy Department, Rush University, Chicago, IL
| | | | - Carmen Diaz
- Northwestern University, Kellogg School of Management, Chicago, IL
| | | | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Hines V.A. Medical Center, Hines, IL
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Smith MJ, Sherwood K, Sung C, Williams ED, Ross B, Sharma S, Sharma A, Harrington M, Brown C, Telfer D, Bond J, Toda S, Kearon D, Morrow S, Lovelace T, Dababnah S, Kattari SK, Magaña S, Watkins T, Liggett C, Riddle E, Smith JD, Hume K, Dawkins T, Baker-Ericzén M, Eack SM, Sinco B, Burke-Miller JK, Olsen D, Elkins J, Humm L, Steacy C. Enhancing pre-employment transition services: A type 1 hybrid randomized controlled trial protocol for evaluating WorkChat: A Virtual Workday among autistic transition-age youth. Contemp Clin Trials Commun 2023; 34:101153. [PMID: 37456506 PMCID: PMC10338963 DOI: 10.1016/j.conctc.2023.101153] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 07/18/2023] Open
Abstract
Autistic transition-age youth experience high rates of unemployment and underemployment, in part due to the social challenges they may face when having conversations in the workplace. In an effort to help enhance conversational abilities in the workplace, our collaborative team partnered to develop WorkChat: A Virtual Workday. Specifically, our team of scientists, community partners, and diversity and inclusion experts participated in a community-engaged process to develop WorkChat using iterative feedback from autistic transition-age youth and their teachers. With initial development complete, this study reports on the protocol that our collaborative team developed, reviewed, and approved to conduct a randomized controlled trial (RCT) to evaluate the real-world effectiveness and initial implementation process outcomes of WorkChat when integrated into post-secondary pre-employment transition services (Pre-ETS). Our aims are to: 1) evaluate whether services-as-usual in combination with WorkChat, compared to services-as-usual with an attention control, enhances social cognition and work-based social ability (between pre- and post-test); reduces anxiety about work-based social encounters (between pre- and post-test), and increases sustained employment by 9-month follow-up; 2) evaluate whether social cognitive ability and work-based social ability mediate the effect of WorkChat on sustained employment; and 3) conduct a multilevel, mixed-method process evaluation of WorkChat implementation.
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Affiliation(s)
- Matthew J. Smith
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Kari Sherwood
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
- University of Michigan, Department of Psychology, Ann Arbor, MI, USA
| | - Connie Sung
- Michigan State University, East Lansing, MI, USA
| | - Ed-Dee Williams
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Brittany Ross
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Sagun Sharma
- Michigan State University, East Lansing, MI, USA
| | - Apara Sharma
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | | | | | | | - Justine Bond
- Michigan Rehabilitation Services, Lansing, MI, USA
| | - Sen Toda
- Michigan Career and Technical Institute, Plainwell, MI, USA
| | | | | | - Temple Lovelace
- Advanced Education Research & Development Fund, Oakland, CA, USA
| | - Sarah Dababnah
- University of Maryland, School of Social Work, Baltimore, MD, USA
| | - Shanna K. Kattari
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
- University of Michigan, Department of Women's and Gender Studies, Ann Arbor, MI, USA
| | - Sandra Magaña
- University of Texas, School of Social Work, Austin, TX, USA
| | - Tikia Watkins
- Walled Lake Consolidated Schools, Walled Lake, MI, USA
| | | | | | - Justin D. Smith
- University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Kara Hume
- University of North Carolina, School of Education, Chapel Hill, NC, USA
| | - Tamara Dawkins
- University of North Carolina, Department of Psychiatry, Chapel Hill, NC, USA
| | - Mary Baker-Ericzén
- San Diego State University, Interwork Institute and Department of Administration, Rehabiliation, and Post-Secondary Education, San Diego, CA, USA
| | - Shaun M. Eack
- University of Pittsburgh, School of Social Work and Department of Psychiatry, Pittsburgh, PA, USA
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Knapp AA, Hersch E, Wijaya C, Herrera MA, Kruzan KP, Carroll AJ, Lee S, Baker A, Gray A, Harris V, Simmons R, Kour Sodhi D, Hannah N, Reddy M, Karnik NS, Smith JD, Brown CH, Mohr DC. "The library is so much more than books": considerations for the design and implementation of teen digital mental health services in public libraries. Front Digit Health 2023; 5:1183319. [PMID: 37560198 PMCID: PMC10409481 DOI: 10.3389/fdgth.2023.1183319] [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: 03/09/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
Background Adolescence is a vulnerable developmental period, characterized by high rates of mental health concerns, yet few adolescents receive treatment. Public libraries support adolescents by providing them with access to teen programming, technological resources, and have recently been providing mental health services. Digital mental health (DMH) services may help libraries provide scalable mental health solutions for their adolescent patrons and could be well positioned to address the mental health needs of historically underrepresented racial and ethnic (HURE) adolescents; however, little research has been conducted on the compatibility of DMH services with adolescent patron mental health needs or resource needs of library workers supporting them. Methods The research team formed a partnership with a public library, which serves a large HURE adolescent population. We conducted needs assessment and implementation readiness interviews with 17 library workers, including leadership, librarians, and workers with specialized areas of practice. Interview questions focused on library infrastructure, as well as library needs and preferences around the design and implementation of DMH services for adolescents. We used the Consolidated Framework for Implementation Research as guiding implementation determinant framework to code and analyze the interview transcripts. Results Our findings revealed library workers play an important role in guiding patrons to desired resources and share a goal of implementing adolescent DMH resources into the library and elevating marginalized adolescents' voices. Existing library resources, such as the library's role as a safe space for adolescents in the community, close relationships with external and community organizations, and availability of no-cost technological resources, could help facilitate the implementation of DMH services. Barriers related to community buy-in, mental health stigma, and library worker confidence in supporting adolescent mental health could affect service implementation. Conclusions Our findings suggest public libraries are highly promising settings to deploy DMH services for adolescents. We identified important determinants that may impact the implementation of DMH services in public library settings. Special considerations are needed to design services to meet the mental health needs of HURE adolescent populations and those adolescents' most experiencing health inequities.
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Affiliation(s)
- Ashley A. Knapp
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Emily Hersch
- Department of Psychology, University of Massachusetts Boston, Boston, MA, United States
| | - Clarisa Wijaya
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Miguel A. Herrera
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kaylee P. Kruzan
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Allison J. Carroll
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sydney Lee
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alex Baker
- Department of Psychology, The University of North Texas, Denton, TX, United States
| | - Alanna Gray
- Oak Park Public Library, Oak Park, IL, United States
| | - Vann Harris
- Oak Park Public Library, Oak Park, IL, United States
| | | | - Deepika Kour Sodhi
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Nanette Hannah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Madhu Reddy
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA, United States
| | - Niranjan S. Karnik
- College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Justin D. Smith
- School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - C. Hendricks Brown
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David C. Mohr
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Hasan MM, Rafferty MR, Tawfik S, Tawfik A, Beestrum M, Smith JD, Hirschhorn LR, Roth EJ, Woods DM. Implementation of Home-Based Telerehabilitation of Patients With Stroke in the United States: Protocol for a Realist Review. JMIR Res Protoc 2023; 12:e47009. [PMID: 37432721 PMCID: PMC10369311 DOI: 10.2196/47009] [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: 03/05/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Stroke is a common cause of mortality and morbidity. Insufficient and untimely rehabilitation has been associated with inadequate recovery. Telerehabilitation provides an opportunity for timely and accessible services for individuals with stroke, especially in remote areas. Telerehabilitation is defined as a health care team's use of a communication mode (eg, videoconferencing) to remotely provide rehabilitation services. Telerehabilitation is as effective as facility-based rehabilitation; however, it is infrequently used due to implementation barriers. OBJECTIVE The aim of the study is to explore the interaction between the implementation strategies, context, and outcomes of telerehabilitation of patients with stroke. METHODS This review will follow four steps: (1) defining the review scope, (2) literature search and quality appraisal, (3) data extraction and evidence synthesis, and (4) narrative development. PubMed via MEDLINE, the PEDro database, and CINAHL will be queried till June 2023 and supplemented with citation tracking and a gray literature search. The relevance and rigor of papers will be appraised using the TAPUPAS (Transparency, Accuracy, Purposivity, Utility, Propriety, Accessibility, and Specificity) and Weight of Evidence frameworks. The reviewers will extract and synthesize data iteratively and develop explanatory links between contexts, mechanisms, and outcomes. The results will be reported according to the Realist Synthesis publication standards set by Wong and colleagues in 2013. RESULTS The literature search and screening will be completed in July 2023. Data extraction and analysis will be completed in August 2023, and findings will be synthesized and reported in October 2023. CONCLUSIONS This will be the first realist synthesis, uncovering the causal mechanisms to explain how, why, and to what extent implementation strategies impact telerehabilitation adoption and implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47009.
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Affiliation(s)
- Mohamed Mosaad Hasan
- Center for Healthcare Studies, Institute of Public Health and Medicine, Feniberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sara Tawfik
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Ahmed Tawfik
- The Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, United States
| | - Molly Beestrum
- Galter Health Sciences Library & Learning Center, Northwestern University, Chicago, IL, United States
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Elliot J Roth
- Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Donna M Woods
- Department of Pediatrics, Feinberg School of Medicine, Chicago, IL, United States
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Harris A, Jordan N, Carroll AJ, Graham AK, Wilson C, Wilson FA, Berkel C, Smith JD. A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI. Implement Sci Commun 2023; 4:59. [PMID: 37277878 DOI: 10.1186/s43058-023-00429-z] [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: 08/16/2022] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation. METHODS We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016-June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity-namely, ambulatory pediatric care clinicians-was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices. RESULTS The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1-15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333-$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524-$21,836 ($164-$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160-$94,208 ($497-$834 per family). CONCLUSIONS This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up. TRIAL REGISTRATION This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).
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Affiliation(s)
- Alexandra Harris
- Health Sciences Integrated PhD Program, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison J Carroll
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Fernando A Wilson
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, Spencer Fox Eccles School of Medicine, College of Social and Behavioral Science Department of Economics, Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA
| | - Cady Berkel
- Population Health & Integrated Behavioral Health, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Smith JD, Agrawal A, Wicklund C, Duquette D, Friedewald J, Rasmussen LV, Gacki-Smith J, Tandon SD, Muhammad LN, Yancy CW, Dong S, Cooper M, Gilbert A, Shetty A, Gordon EJ. Implementation of a culturally competent APOL1 genetic testing programme into living donor evaluation: A two-site, non-randomised, pre-post trial design. BMJ Open 2023; 13:e067657. [PMID: 37188469 PMCID: PMC10186444 DOI: 10.1136/bmjopen-2022-067657] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION While living donor (LD) kidney transplantation is the optimal treatment for patients with kidney failure, LDs assume a higher risk of future kidney failure themselves. LDs of African ancestry have an even greater risk of kidney failure post-donation than White LDs. Because evidence suggests that Apolipoprotein L1 (APOL1) risk variants contribute to this greater risk, transplant nephrologists are increasingly using APOL1 genetic testing to evaluate LD candidates of African ancestry. However, nephrologists do not consistently perform genetic counselling with LD candidates about APOL1 due to a lack of knowledge and skill in counselling. Without proper counselling, APOL1 testing will magnify LD candidates' decisional conflict about donating, jeopardising their informed consent. Given cultural concerns about genetic testing among people of African ancestry, protecting LD candidates' safety is essential to improve informed decisions about donating. Clinical 'chatbots', mobile apps that provide genetic information to patients, can improve informed treatment decisions. No chatbot on APOL1 is available and no nephrologist training programmes are available to provide culturally competent counselling to LDs about APOL1. Given the shortage of genetic counsellors, increasing nephrologists' genetic literacy is critical to integrating genetic testing into practice. METHODS AND ANALYSIS Using a non-randomised, pre-post trial design in two transplant centres (Chicago, IL, and Washington, DC), we will evaluate the effectiveness of culturally competent APOL1 testing, chatbot and counselling on LD candidates' decisional conflict about donating, preparedness for decision-making, willingness to donate and satisfaction with informed consent and longitudinally evaluate the implementation of this intervention into clinical practice using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. ETHICS AND DISSEMINATION This study will create a model for APOL1 testing of LDs of African ancestry, which can be implemented nationally via implementation science approaches. APOL1 will serve as a model for integrating culturally competent genetic testing into transplant and other practices to improve informed consent. This study involves human participants and was approved by Northwestern University IRB (STU00214038). Participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04910867. Registered 8 May 2021, https://register. CLINICALTRIALS gov/prs/app/action/SelectProtocol?sid=S000AWZ6&selectaction=Edit&uid=U0001PPF&ts=7&cx=-8jv7m2 ClinicalTrials.gov Identifier: NCT04999436. Registered 5 November 2021, https://register. CLINICALTRIALS gov/prs/app/action/SelectProtocol?sid=S000AYWW&selectaction=Edit&uid=U0001PPF&ts=11&cx=9tny7v.
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Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
- Departments of Psychiatry and Behavioral Sciences and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Akansha Agrawal
- Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Catherine Wicklund
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Debra Duquette
- Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John Friedewald
- Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Luke V Rasmussen
- Division of Health and Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Gacki-Smith
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - S Darius Tandon
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lutfiyya N Muhammad
- Department of Preventive Medicine-Division of Biostatistics, Northwestern University, Chicago, Illinois, USA
| | - Clyde W Yancy
- Department of Medicine-Division of Cardiology, Northwestern University, Evanston, Illinois, USA
| | - Siyuan Dong
- Department of Preventive Medicine-Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Cooper
- Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alexander Gilbert
- Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Aneesha Shetty
- Medicine, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
| | - Elisa J Gordon
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Cella D, Garcia SF, Cahue S, Smith JD, Yanez B, Scholtens D, Lancki N, Bass M, Kircher S, Flores AM, Jensen RE, Smith AW, Penedo FJ. Implementation and evaluation of an expanded electronic health record-integrated bilingual electronic symptom management program across a multi-site Comprehensive Cancer Center: The NU IMPACT protocol. Contemp Clin Trials 2023; 128:107171. [PMID: 36990275 PMCID: PMC10164083 DOI: 10.1016/j.cct.2023.107171] [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: 09/20/2022] [Revised: 03/25/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND People with cancer experience symptoms that adversely affect quality of life. Despite existing interventions and clinical guidelines, timely symptom management remains uneven in oncology care. We describe a study to implement and evaluate an electronic health record (EHR)-integrated symptom monitoring and management program in adult outpatient cancer care. METHODS Our cancer patient-reported outcomes (cPRO) symptom monitoring and management program is a customized EHR-integrated installation. We will implement cPRO across all Northwestern Memorial HealthCare (NMHC) hematology/oncology clinics. We will conduct a cluster randomized modified stepped-wedge trial to evaluate patient and clinician engagement with cPRO. Further, we will embed a patient-level randomized clinical trial to evaluate the impact of an additional enhanced care (EC; cPRO plus web-based symptom self-management intervention) relative to usual care (UC; cPRO alone). The project uses a Type 2 hybrid effectiveness-implementation approach. The intervention will be implemented across seven regional clusters within the healthcare system comprising 32 clinic sites. A 6-month prospective pre-implementation enrollment period will be followed by a post-implementation enrollment period, during which newly enrolled, consenting patients will be randomly assigned (1:1) to EC or UC. We will follow patients for 12 months post-enrollment. Patients randomized to EC will receive evidence-based symptom-management content on cancer-related concerns and approaches to enhance quality of life, using a web-based tool ("MyNM Care Corner"). This design allows for within- and between-site evaluation of implementation plus a group-based comparison to demonstrate effectiveness on patient-level outcomes. DISCUSSION The project has potential to guide implementation of future healthcare system-level cancer symptom management programs. http://ClinicalTrials.gov # NCT03988543.
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Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America.
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America.
| | - September Cahue
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, United States of America.
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Michael Bass
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Sheetal Kircher
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America; Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Roxanne E Jensen
- Outcomes Research Branch Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America.
| | - Ashley Wilder Smith
- Outcomes Research Branch Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States of America; Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, FL, United States of America.
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Carroll AJ, Huffman MD, Wileyto EP, Khan SK, Fox E, Smith JD, Bauer AM, Leone FT, Schnoll RA, Hitsman B. Change in cardiovascular health among adults with current or past major depressive disorder enrolled in intensive smoking cessation treatment. J Affect Disord 2023; 333:527-534. [PMID: 37119868 DOI: 10.1016/j.jad.2023.04.089] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Elevated depressive symptoms and cigarette smoking are independently associated with poorer cardiovascular health (CVH), but it is unknown whether their treatment can synergistically improve CVH. We sought to characterize CVH of adults with comorbid depression and smoking and examine changes in CVH associated with changes in smoking and depression. METHODS Participants (N = 300, 55 % women) were adult smokers (≥1 cigarette/day) with lifetime major depressive disorder enrolled in a 12-week intervention trial targeting depression and smoking. Multiple linear regression examined prospective associations between changes in depression (Beck Depression Inventory-II), smoking (past 24-hour cigarettes or smoking abstinence), and modified CVH score (per American Heart Association, excluding smoking: diet, physical activity, body mass index, blood glucose, cholesterol, blood pressure). RESULTS Baseline mean CVH score was 5.87/12 points (SD = 2.13). No participants met "ideal" on all CVH components (blood glucose: 48 %, cholesterol: 46 %, physical activity: 38 %, body mass index: 24 %, blood pressure: 22 %, diet: 3 %). CVH scores did not change from baseline to end-of-treatment (M = 0.18 points, SD = 1.36, p = .177), nor did change in depression × smoking predict change in CVH (p = .978). However, greater reductions in depression were significantly associated with greater improvement in CVH (β = -0.04, SE = 0.01, p = .015). LIMITATIONS This study was limited by a short follow-up period, missing blood glucose and cholesterol data, and treatment-seeking smokers. CONCLUSIONS Adults with comorbid depression and smoking had poor CVH. Although integrated treatment for depression and smoking improved both conditions, only reductions in depression were associated with improvements in CVH. These findings have implications for integrating psychosocial treatment into CVH promotion efforts. REGISTRATION NCT02378714 (clinicaltrials.gov).
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Affiliation(s)
- Allison J Carroll
- Departments of Psychiatry and Behavioral Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Mark D Huffman
- Department of Medicine, Washington University School of Medicine, St. Louis MO, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - E Paul Wileyto
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sadiya K Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Erica Fox
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, UT, United States of America
| | - Anna-Marika Bauer
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Brian Hitsman
- Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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Carroll AJ, Tedla YG, Padilla R, Jain A, Segovia E, Moin A, Wallace AS, Sanuade OA, Langman CB, Mohanty N, Smith JD. Adherence to the 2017 Clinical Practice Guidelines for Pediatric Hypertension in Safety-Net Clinics. JAMA Netw Open 2023; 6:e237043. [PMID: 37058305 PMCID: PMC10105315 DOI: 10.1001/jamanetworkopen.2023.7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Importance The 2017 Clinical Practice Guideline (CPG) for the diagnosis and management of pediatric hypertension (PHTN) categorizes a greater proportion of children with elevated blood pressure and PHTN, yet several barriers to CPG adherence have been noted. Objective To assess adherence to the 2017 CPG for the diagnosis and management of PHTN and use of a clinical decision support (CDS) tool to calculate blood pressure percentiles. Design, Setting, and Participants This cross-sectional study used electronic health record-extracted data from January 1, 2018, to December 31, 2019, among patients visiting 1 of 74 federally qualified health centers in AllianceChicago, a national Health Center Controlled Network. Children and adolescents (aged 3-17 years; hereinafter referred to as children) who attended at least 1 visit and had at least 1 blood pressure reading at or above the 90th percentile or diagnosis of elevated blood pressure or PHTN were eligible for data to be included in the analysis. Data were analyzed from September 1, 2020, to February 21, 2023. Exposures Blood pressure at or above the 90th or 95th percentile. Main Outcomes and Measures Diagnosis of PHTN (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10], code I10) or elevated blood pressure (ICD-10 code R03.0) and CDS tool use; blood pressure management (antihypertensive medication, lifestyle counseling, referral); and follow-up visit attendance. Descriptive statistics described the sample and rates of guideline adherence. Logistic regression analyses identified patient- and clinic-level associations with guideline adherence. Results The sample consisted of 23 334 children (54.9% boys; 58.6% White race; median age, 8 [IQR, 4-12] years). Guideline-adherent diagnosis was observed in 8810 children (37.8%) with blood pressure at or above the 90th percentile and 146 of 2542 (5.7%) with blood pressure at or above the 95th percentile at 3 or more visits. The CDS tool was used to calculate blood pressure percentiles in 10 524 cases (45.1%) and was associated with significantly greater odds of PHTN diagnosis (odds ratio, 2.14 [95% CI, 1.10-4.15]). Among 15 422 children with blood pressure at or above the 95th percentile, antihypertensive medication was prescribed to 831 (5.4%), lifestyle counseling was provided to 14 841 (96.2%), and blood pressure-related referrals were given to 848 (5.5%). Guideline-adherent follow-up was observed in 8651 of 19 049 children (45.4%) with blood pressure at or above the 90th percentile and 2598 of 15 164 (17.1%) with blood pressure at or above the 95th percentile. Differences in guideline adherence by patient- and clinic-level factors were observed. Conclusions and Relevance In this study, fewer than 50% of children with elevated blood pressure had a guideline-adherent diagnosis code or attended guideline-adherent follow-up. Using a CDS tool was associated with guideline-adherent diagnosis, but the tool was underused. Further work is needed to understand how to best support implementation of tools promoting PHTN diagnosis, management, and follow-up.
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Affiliation(s)
- Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yacob G Tedla
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Anoosh Moin
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Andrea S Wallace
- Division of Health Systems and Community-Based Care, University of Utah College of Nursing, Salt Lake City
| | - Olutobi A Sanuade
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City
| | - Craig B Langman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Justin D Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City
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Mustanski B, Saber R, Jones JP, Macapagal K, Benbow N, Li DH, Brown CH, Janulis P, Smith JD, Marsh E, Schackman BR, Linas BP, Madkins K, Swann G, Dean A, Bettin E, Savinkina A. Keep It Up! 3.0: Study protocol for a type III hybrid implementation-effectiveness cluster-randomized trial. Contemp Clin Trials 2023; 127:107134. [PMID: 36842763 PMCID: PMC10249332 DOI: 10.1016/j.cct.2023.107134] [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: 11/07/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Despite evidence that eHealth approaches can be effective in reducing HIV risk, their implementation requirements for public health scale up are not well established, and effective strategies to bring these programs into practice are still unknown. Keep It Up! (KIU!) is an online program proven to reduce HIV risk among young men who have sex with men (YMSM) and ideal candidate to develop and evaluate novel strategies for implementing eHealth HIV prevention programs. KIU! 3.0 is a Type III Hybrid Effectiveness-Implementation cluster randomized trial designed to 1) compare two strategies for implementing KIU!: community-based organizations (CBO) versus centralized direct-to-consumer (DTC) recruitment; 2) examine the effect of strategies and determinants on variability in implementation success; and 3) develop materials for sustainment of KIU! after the trial concludes. In this article, we describe the approaches used to achieve these aims. METHODS Using county-level population estimates of YMSM, 66 counties were selected and randomized 2:1 to the CBO and DTC approaches. The RE-AIM model was used to drive outcome measurements, which were collected from CBO staff, YMSM, and technology providers. Mixed-methods research mapped onto the domains of the Consolidated Framework for Implementation Research will examine determinants and their relationship with implementation outcomes. DISCUSSION In comparing our implementation recruitment models, we are examining two strategies which have shown effectiveness in delivering health technology interventions in the past, yet little is known about their comparative advantages and disadvantages in implementation. The results of the trial will further the understanding of eHealth prevention intervention implementation.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America.
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Justin Patrick Jones
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Patrick Janulis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, 295 Chipeta Way, Williams Building, Salt Lake City, UT 84108, United States of America
| | - Elizabeth Marsh
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Benjamin P Linas
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
| | - Krystal Madkins
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Abigael Dean
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Emily Bettin
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Alexandra Savinkina
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
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McHugh M, Philbin S, Carroll AJ, Vu MH, Ciolino JD, Maki B, Day A, Smith JD, Walunas T. An Approach to Evaluating Multisector Partnerships to Support Evidence-Based Quality Improvement in Primary Care. Jt Comm J Qual Patient Saf 2023; 49:199-206. [PMID: 36739267 DOI: 10.1016/j.jcjq.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Quality improvement (QI) interventions in primary care are increasingly designed and implemented by multisector partnerships, yet little guidance exists on how to best monitor or evaluate these partnerships. The goal of this project was to describe an approach for evaluating the development and effectiveness of a multisector partnership using data from the first year of the Healthy Hearts for Michigan (HH4M) Cooperative, a multisector partnership of nine organizations tasked with designing and implementing evidence-based QI strategies for hypertension management and tobacco cessation in 50 rural primary care practices. METHODS The researchers developed a 49-item online survey focused on factors that facilitate or hinder multisector partnerships, drawing on implementation science and partnership, engagement, and collaboration research. The team surveyed all 44 members of the HH4M Cooperative (79.5% response rate) and conducted interviews with 14 members. The interviews focused on implementation phase-specific goals, accomplishments, and challenges. Descriptive analysis was used for the survey results, and thematic analysis for the interview data. RESULTS Respondents reported strong overall performance by the Cooperative during its first year, which facilitated the successful completion of several intervention design tasks. Strengths included having a clear purpose and trust and respect among members. Areas for improvement included a need for common terminology, clarification of roles and functions, and improvement in communication across workgroups. Lack of engagement from physician practices due to capacity constraints, exacerbated by the COVID-19 pandemic, was the Cooperative's biggest challenge. CONCLUSION This multimethod approach to evaluating the development and effectiveness of a multisector partnership yielded practical, actionable feedback to program leaders.
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Yanez B, Czech KA, Buitrago D, Smith JD, Schueller SM, Taub CJ, Kircher S, Garcia SF, Bass M, Mercer AM, Silvera CA, Scholtens D, Peipert JD, Psihogios AM, Duffecy J, Cella D, Antoni MH, Penedo FJ. Effectiveness and implementation of an electronic health record-integrated digital health intervention for managing depressive symptoms in ambulatory oncology: The My Well-Being Guide study rationale and protocol. Contemp Clin Trials 2023; 127:107121. [PMID: 36805073 PMCID: PMC10846504 DOI: 10.1016/j.cct.2023.107121] [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: 11/15/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Rates of clinically elevated depressive symptoms among ambulatory oncology patients are higher than in the general population and are associated with poorer health-related quality of life. Furthermore, a reduction in depressive symptoms may be associated with improved cancer survival. Several interventions have demonstrated efficacy in reducing oncologic depressive symptoms, including cognitive-behavioral stress management (CBSM). However, more work is needed to understand how to best implement CBSM into practice, such as through stepped-care approaches and digital health interventions linked to electronic health records (EHR). This manuscript presents the protocol of the My Well-Being Guide study, a pragmatic type 1 effectiveness-implementation hybrid study. This trial will test the effectiveness of My Well-Being Guide, a seven-week structured, CBSM-based digital health intervention designed to reduce depressive symptoms. This trial will also evaluate My Well-Being Guide's implementation across two health systems. METHODS The final sample (N = 4561) will be oncology patients at Northwestern Medicine or University of Miami Health System who are ≥18 years of age; have a cancer diagnosis; elevated depressive symptoms on the Patient-Reported Outcomes Measurement Information System Depression; and primary language is English or Spanish. Data collection will occur at baseline, and 2-, 6-, and 12-months post baseline. Outcome domains include depressive symptoms and implementation evaluation. DISCUSSION This study may provide valuable data on the effectiveness of our depressive symptom management digital health intervention linked to the EHR and the scalability of digital health interventions in general.
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Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Katherine A Czech
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, United States of America
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, CA, United States of America
| | - Chloe J Taub
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Sheetal Kircher
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America
| | - Michael Bass
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ambrosine M Mercer
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Carlos A Silvera
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, FL, United States of America
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Alexandra M Psihogios
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States of America
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Michael H Antoni
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States of America; Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America; Department of Psychology, University of Miami, Coral Gables, FL, United States of America
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States of America; Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, FL, United States of America
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Carroll AJ, Mohanty N, Wallace AS, Langman C, Smith JD. Perspectives of Primary Care Clinicians on the Diagnosis and Treatment of Pediatric Hypertension. Fam Community Health 2023; 46:123-127. [PMID: 36799945 PMCID: PMC9942119 DOI: 10.1097/fch.0000000000000358] [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: 05/24/2023]
Abstract
The purpose of this study was to contextualize the challenges of diagnosing and managing pediatric hypertension (pHTN) in federally qualified health centers. We conducted a survey among primary care clinicians (N = 72) who treat children (3-17 years old) in a national network of health centers. Clinicians reported practices of blood pressure (BP) measurement, barriers to diagnosis and management of pHTN, and use of population health tools. Most clinicians (83%) used electronic devices to measure BP, only 49% used manual BP readings for follow-up measurements, and more than half measured BP at each encounter. The highest-rated barrier to pHTN management was lack of comfort with antihypertensive medications (71% of respondents). Few clinicians (10%) had used population health tools, but most (78%) indicated they would like to use them for pHTN. These results offer clinician-level insights regarding implementation of the pHTN guideline in pediatric primary care settings.
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Affiliation(s)
- Allison J. Carroll
- Psychiatry and Behavioral Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago IL USA
| | - Nivedita Mohanty
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and AllianceChicago, Chicago IL USA
| | | | - Craig Langman
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago IL USA
| | - Justin D. Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City UT USA
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