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Lower Electronic Health Record Adoption and Interoperability in Rural Versus Urban Physician Participants: a Cross-Sectional Analysis From the CMS Quality Payment Program
Get PDFBACKGROUND: The Health Information Technology for Economic and Clinical Health Act of 2009 introduced the Meaningful Use program to incentivize the adoption of electronic health records (EHRs) in the U.S. This study investigates the disparities in EHR adoption and interoperability between rural and urban physicians in the context of federal programs like the Medicare Access and CHIP Reauthorization Act of 2015 and the 21st Century Cures Act.
METHODS: A cross-sectional analysis was conducted using the 2021 Quality Payment Program Experience Report Public Use File to compare EHR adoption and Promoting Interoperability scores (PISs) between urban and rural physician participants. Data were linked with the Certified Health IT Product List to assess certified EHR adoption and interoperability.
RESULTS: The study included 209,152 physician participants, 12% of whom practiced in rural communities. EHR adoption was significantly higher in urban (74%) than in rural areas (64%). Epic Systems dominated the market in both settings. Multivariable logistic regression indicated lower odds of EHR adoption among rural physicians (OR: 0.79, CI: 0.76-0.82). Rural physicians also had lower PISs (β: -3.5, CI: -4.1 to -3.0). Factors like extreme hardship, small practitioner status, and location in a health professional shortage area significantly impacted EHR adoption and PISs.
CONCLUSIONS: Significant disparities exist in EHR adoption and interoperability between rural and urban physicians. These disparities highlight the need for targeted interventions to enhance EHR adoption and interoperability in rural settings to ensure equitable access to healthcare technologies and improved patient outcomes across all communities
Elucidating the Mechanism of the Polymeric Drug PAMD-CH17’S Novel Anti-Leukemic Effects
No full textAcute leukemias are highly heterogenous blood cancers with current frontline treatment regimens relying on traditional chemotherapeutics such as cytarabine, doxorubicin, and vincristine. These drugs are critically limited by their poor tolerance with significant side effects and inability to cure all patients. Recent efforts have focused on targeting specific mutations with designer small molecule inhibitors, but the inhibitor’s utility is limited to the subset of patients with the mutation and is also unable to cure the disease. A drug that not only has anti-leukemic effects all by itself, but can also modularly target different mutations, could significantly improve outcomes.
The class of polymeric drugs, called PAMDs, could be such therapeutics. PAMDs are polymers synthesized from the CXCR4 inhibitor AMD3100 (Plerixafor) that can form nanoparticles with nucleic acids. Previous work examining one variant, PAMD-Ch17 with cholesterol modifications, in AML showed that the drug can not only deliver siRNAs against key oncogenes to induce leukemia cell death, but can also kill leukemia cells by itself. These results imply that PAMD-Ch17 could be a powerful, modular anti-leukemic agent. Investigating its mechanism of action will be critical to developing this class of drugs for patients.
We therefore further investigated this novel cytotoxicity and found that PAMD-Ch17 is cytotoxic against both myeloid and lymphoblastic acute leukemia cells. Curiously, while it inhibits its target receptor CXCR4, it does not mediate its effects through the receptor. Rather, whole transcriptome sequencing suggested that PAMD-Ch17 mediated its anti-leukemic effects through mitochondrial dysfunction. We subsequently showed that PAMD-Ch17 colocalized to the mitochondria, induced mitochondria superoxide, loss of membrane potential, and mitochondrial dysfunction. We confirmed these findings in mouse primary T-ALL cells and human primary T-ALL cells, and that these effects are significantly less in healthy mouse and human hematopoietic cells. Thus, PAMD-Ch17 may be mediating its selective anti-leukemic effects through a mitochondrial dysfunction mechanism. For the first time, we provide a potential mechanism of action for this drug’s novel anti-leukemic effects and show that these effects are independent of its target receptor, while simultaneously highlighting a metabolic vulnerability in leukemia. Our study not only provides a strong rationale for preclinical studies, but also insight into leukemia metabolism and developing the next generation of polymeric drugs as well
App Assisted Depression Self-Management in Integrated Primary Care: A Pilot Study Exploring Patient and Provider Experiences
Get PDFThe integrated primary care (IPC) setting is currently the de facto institution for accessing mental healthcare among underserved populations. However, many barriers exist for these populations when seeking regular and adequate mental healthcare, including provider availability and transportation challenges. This study piloted the incorporation of mindLAMP, a mHealth app, into IPC treatment to offer a low-resource intervention designed to improve and expand access to mental healthcare for underserved patients between face-to-face visits. This study gathered data from a sample of both behavioral health providers and patients (N = 6) in IPC settings to pilot the use of the mindLAMP app among traditionally underserved patients with depression. The Patient Activation Measure and Patient Health Questionnaire were used to assess patient outcomes in addition to conducting a directed content analysis on qualitative data obtained with interviews of both patients and providers. Results from the mixed methods study design indicate that implementing this digital intervention in the IPC setting is feasible and positively experienced by both patients and providers. Perceived positive outcomes were reported by both patients and providers after incorporating the mHealth app into their mental healthcare. However, both patients and providers discussed barriers to mHealth app use that need to be addressed in order to accommodate more widespread use. Further, constraints and barriers at the provider, patient, and healthcare system levels were discussed and need to be examined further to increase the implementation of this multilevel digital intervention
How to Study 30-Day Readmissions: A Framework for Risk Stratification and Methodological Rigor
Get PDFBackground: The 2010 Affordable Care Act (ACA) catalyzed a shift toward value-based care. This introduced reimbursement penalties tied to hospital performance metrics, such as the Hospital Readmission Reduction Program (HRRP) which deducts reimbursement for institutions with excessive 30-day readmission rates. Although more than 25% of hospital readmissions are considered potentially avoidable, the methods of evaluation are often inconsistent, and overlook medically complex patients and those who experience recurrent readmissions.
Objective: To identify methodologies used in current 30-day readmission studies and to propose improved methodological framework for population inclusion, demographic considerations, and statistical analysis to allow for proper risk stratification.
Methods: A scoping literature review across pulmonology, otolaryngology, nephrology, cardiology, and internal medicine to identify and map how 30-day readmissions are studied in various fields. Key characteristics such as determination of inclusion criteria, consideration of recurrent readmissions and competing risk of death, and presentation of patient demographics and socioeconomic disparities were examined and reported. Strengths of various statistical models such as Cox proportional hazards, Prentice-Williams-Peterson (PWP-TT), and Fine & Gray subdistribution hazard modeling were defined.
Results: Many studies fail to account for critically ill patient populations, multiple encounters, and demographic variability - vital metrics in quality improvement. Proper risk stratification must be done on readmissions in order to properly use 30-day readmits as a quality metric, distinguishing between avoidable readmissions and those that necessitate additional care.
Conclusion: This review presents a framework for designing and evaluating 30-day readmission studies. By outlining use cases for population inclusion criteria, demographic reporting, and statistical analysis methods, it supports improved study methodology through intentional design. This approach aims to enhance the validity of 30-day readmission studies as a value-based evaluation metric.https://digitalcommons.unmc.edu/com_msrs/1005/thumbnail.jp
Heart Failure in Rheumatoid Arthritis: Epidemiology, Determinants, and Gaps in Risk Stratification
Get PDFRheumatoid arthritis (RA) is a systemic autoimmune disease with its primary manifestation as a small joint, symmetric inflammatory arthritis. RA is associated with substantial morbidity and premature mortality, owed to systemic inflammation causing extra-articular manifestations such as cardiovascular disease (CVD). CVD is the most common cause of death in RA; however, the specific burden, mechanisms, and ability to predict heart failure (HF) development, a leading cause of hospitalization and death in the U.S., remain poorly characterized in RA populations. In this dissertation, I examine the epidemiology and determinants of HF in RA and identify key gaps in HF risk stratification through three, large-scale studies. First, leveraging a national cohort enriched with echocardiographic data derived from validated natural language processing algorithms, I demonstrate that patients with RA experience a significantly increased risk of both HF with preserved (HFpEF) and reduced ejection fraction (HFrEF), with HFpEF being the more frequent, over-represented, and severe manifestation. Notably, this heightened risk has not improved over the last two decades despite advances in RA treatment. Second, I address the underexplored contribution of valvular heart disease (VHD, an established HF risk factor) to CVD risk in RA. Using national data, I show that RA is associated with a nearly 50% increased risk of incident aortic stenosis (AS), the most common cause of VHD-related death in the U.S., as well as an increased risk of aortic valve intervention and AS-related mortality. Finally, I evaluate the performance of the Predicting Risk of cardiovascular EVENTs (PREVENT) CVD risk calculator, the first to include a model for HF prediction, in a national-level RA cohort. I find that the calculator underestimates both atherosclerotic CVD and HF risk in RA, which may be driven in part by paradoxical effects of obesity and serum lipids on CVD risk in RA, as well as indicators of risk severity such as hemoglobin A1c. Together, these studies establish HF as high-burden and inadequately predicted complication of RA. These findings underscore the need for RA-specific strategies to improve HF risk prediction, prevention, and management, and lay a foundation for future research to improve CVD-related outcomes in RA
Targeting TREM1: A Novel Therapeutic Approach to Mitigate Necrotizing Enterocolitis Injury in Murine Neonates
No full textNecrotizing enterocolitis (NEC) is a severe gastrointestinal disease primarily affecting premature infants. The high mortality rate, ranging from 20-50%, mandates new therapeutic targets and treatment strategies. The present study demonstrates that TNBS (2,4,6-trinitrobenzenesulfonic acid) induced NEC-like injury is associated with the requirement of monocytes in the neonatal intestine with expressing TREM-1 (Triggering Receptor Expressed on Myeloid Cells-1). Consistent with the elevated expression of TREM-1 on monocytes, we notably found higher iFABP (intestinal fatty acid binding protein) expression, intestinal injury, and elevated inflammatory cytokines. Similarly, surgically removed intestinal specimens from human patients with NEC, we found CD14+ monocytes co-localized with TREM-1. Inhibition of TREM-1 by LP17 (LQVTDSGLYRCVIYHPP, an inhibitory peptide), in lipopolysaccharide-treated murine macrophage (RAW 264.7) cells showed decreased inflammatory cytokine production when compared to the vehicle controls. Furthermore, the administration of LP17 to NEC-like injured mice was found to reduce the intestinal injury, inflammatory response, and improve survival by inhibiting TREM1. These findings provide valuable information that TREM-1 could constitute a new therapeutic target during NEC
Interventions Designed to Increase Scholarly Activity and Achieve Promotion Among Primarily Junior Clinical Faculty in the United States: A Scoping Review
No full textBACKGROUND: For many U.S. academic physicians, direct patient care is the primary focus of daily work and the most important professional responsibility. Concurrently, some degree of scholarly activity is often required for career advancement. Junior clinical faculty often face challenges that limit their success in this area such as heavy clinical workloads or other time constraints, a lack of personal expertise or experience, mentorship, and institutional infrastructure. Support systems and faculty development interventions may mitigate these challenges and contribute to increased academic productivity and promotion. The objective of this study was to perform a scoping review of literature on strategies which increase scholarly activity among junior clinical faculty in the United States to determine the extent to which this topic has been scientifically investigated, the form of the employed strategies for supporting junior clinical faculty scholarly activity, the types of scholarly activity measured, and the research methods used.
METHODS: An online search of PubMed, CINAHL, Cochrane Library, Embase, ERIC and APA PsycINFO databases was conducted and supplemented by a manual search of references and citations. Articles published between January 1, 2012, and February 7, 2025, that described faculty development interventions designed to increase scholarly productivity of junior clinical faculty in the United States were included. We employed a structured data extraction algorithm, extracted data in dyads, and resolved any inconsistencies using a third extractor. Included publications were categorized by the primary intervention strategy they employed.
RESULTS: Eighteen publications are included in this scoping review. The most common primary strategies for supporting scholarly activity were peer-mentoring (5/18, 28%) and traditional mentoring (5/18, 28%). Other strategies included grants and funding (4/18, 22%), faculty development and training (2/18, 11%), and protected time (1/18, 6%). Two of the 18 publications included a control group.
CONCLUSIONS: Mentoring was the most common strategy to support scholarly activity of junior clinical faculty followed by faculty development programs. Scholarly activity is often measured by publications, grant funding, and presentations. A major gap in the current literature is the absence of any high-quality research demonstrating a beneficial effect on the scholarly activity of junior clinical faculty
Descriptive Analysis of Student Diagnostic and Documentation Skill Development in a Low Fidelity Simulation in Psychiatric Nurse Practitioner Education
Get PDFThis is an abstract from the Spotlight on Scholarship event in 2025
Cathepsin G as a Mechanistic Driver of Tumor Growth and Osteolytic Bone Metastasis
Get PDFBreast cancer is one of the leading causes of cancer-related mortality, largely due to its tendency to metastasize to bone. Our lab has demonstrated that tumor-bone interaction is important in this osteolytic bone metastasis mediated by the dysregulation of a unique set of genes. Among these genes, several proteases are up-regulated at the tumor-bone interface, including Cathepsin G, a serine protease, which is primarily secreted by neutrophils. These proteases act as mediators between the tumor and the stroma. Previously, we have shown that malignant cells and osteoclasts at the TB interface express higher levels of Cathepsin G, which is critical for osteolytic bone metastasis. The precise role of tumor and host-derived Cathepsin G in osteolytic bone metastasis is unknown. This study aims to investigate the functional significance of both tumor-derived and neutrophil-derived CTSG in regulating breast cancer cell proliferation, aggregation, and migration. We used recombinant CTSG protein, CTSG overexpression in tumor cells, and direct co-culture with primary neutrophils (MPRO) to evaluate its effects on CI66 murine breast cancer cells. Overall, our findings show that CTSG significantly suppresses breast cancer cell proliferation, while paradoxically enhancing tumor cell aggregation and collective migration. Live-cell imaging and migration assays indicate a shift toward cohesive, cluster-based motility associated with metastatic potential. Both neutrophil-derived and tumor-intrinsic CTSG contribute to this dual phenotype, highlighting CTSG as a potential therapeutic target to interrupt early metastatic progression.https://digitalcommons.unmc.edu/surp2025/1007/thumbnail.jp
Microbiome and Metabolome Association Network Analysis Identifies
Get PDFThe common marmoset (Callithrix jacchus), a nonhuman primate species, is a model organism of great interest due to its translational value in a variety of research settings, including the field of microbiomics. While the composition of the marmoset\u27s gut microbiome has been somewhat described in captivity, little is known about how gut microbiota interact with each other over time and how they relate to metabolite production. To help answer this, we characterized interactions in the gut microbiome of the common marmoset by calculating the Spearman correlation coefficient between 16S rDNA-derived relative genera abundance data and targeted metabolomics data collected longitudinally from 10 captive marmosets. Association network graphs were used to visualize significant correlations and identify genera and metabolites that have high degree centrality, marking them as more influential within the microbiome. The genus Clostridium_sensu_stricto_1 engaged in the most metabolomic associations, indicating that it potentially plays a gatekeeping role over metabolites involved in microbial growth and signaling. Its associations with downregulated taurine and bile acids further suggest Clostridium_sensu_stricto_1 modifies bile acids to exert its influence. Flavonifractor and several Bacteroidales members had the most bacterial associations and were negatively associated with Bifidobacterium, indicating a potential competitive relationship. To further characterize microbiome interactions, we performed hierarchical clustering on significant within-dataset associations and developed a new Keystone Candidate Score metric that identified Clostridium_sensu_stricto_1 and Alloprevotella as the most influential bacteria (so-called candidate keystone genera) in the marmoset gut microbiome.IMPORTANCEPrevious studies have identified significant individuality within the gut microbiome of common marmosets. The reasons for this inter-subject variability and how it relates to health in captivity are poorly understood, owing to a lack of knowledge regarding dynamic interactions between specific microbiota. To that end, this study characterized significant temporal associations between the gut microbiome and metabolome of healthy captive marmosets. Our findings suggest that certain microbial taxa exert a stronger influence within the gut than others. Specifically, Bifidobacterium was the most abundant genus and primary driving force behind subject-specific microbiome differences, while Clostridium_sensu_stricto_1 and bacteria from the order Bacteroidales were the main sources, respectively, for significant bacteria-metabolite and bacteria-bacteria associations. Together, this suggests that Bifidobacterium may compete with the other taxa for resources and a metabolic niche in the marmoset microbiome