Jacobs Institute of Women's Health
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Preferences for HIV preexposure prophylaxis care among gay, bisexual, and other MSM: a large discrete choice experiment
No full textOBJECTIVE: We aimed to identify preferences for preexposure prophylaxis (PrEP) care among diverse gay, bisexual, and other MSM (GBM) in the United States with discrete choice experiment (DCE). DESIGN: We conducted two DCEs to elicit care delivery preferences for starting and continuing PrEP among 16-49-year-old GBM who were HIV-negative and not using PrEP from across the United States. DCEs assessed preferences for care options including location, formulation (pills, injectable), lab testing, and costs. Participants completed 16 choice tasks, and utility scores and relative importance were estimated. We performed latent class analyses to identify groups within each DCE, and multivariable logistic regression to identify sociodemographic characteristics associated with class membership. RESULTS: Among 1514 participants, 46.5% identified as Latino, 21.4% Black, and 25.2 White. For Starting PrEP DCE, two latent classes were identified: \u27In-Person\u27 (28.5%), which preferred in-person care and lab testing, and \u27Virtual\u27 (71.5%), which preferred telehealth and at-home lab testing. For Continuing PrEP DCE, two latent classes were identified: \u27Pills\u27 (23.6%), which preferred oral PrEP with low-cost options and \u27No cost/injectable\u27 (76.4%), which strongly preferred no-costs and injectable PrEP. In multivariable models for Starting PrEP and for Continuing PrEP, latent class membership was significantly associated with a range of sociodemographic characteristics, including race/ethnicity, income, housing instability, and provider and PrEP stigma. CONCLUSION: The preferences identified for PrEP care in this diverse GBM sample indicate the need for multiple care and formulation choices, including elimination of costs to improve PrEP uptake. DCE findings can guide implementation efforts to improve equitable access to PrEP
Ethics in the Emergency Department: Withholding or Terminating Resuscitation
No full textTerminating cardiopulmonary resuscitation (ToR) in pediatric emergency department settings requires complicated clinical and ethical decision-making. This review focuses on providing physicians and advanced practice providers with practical guidance for assessing indicators of prognosis and navigating ethical considerations during the resuscitation of pediatric patients. Clinical indicators such as physical exam findings, arrest etiology, cardiopulmonary resuscitation (CPR) duration, and end-tidal carbon dioxide levels serve as benchmarks to guide resuscitation efforts. Ethical principles, including beneficence and non-maleficence, are critical in balancing the potential benefits of resuscitation with the harms of prolonged CPR, such as dysthanasia, moral distress, and adverse neurological outcomes. Underscored is the importance of compassionate communication with families, the appropriateness of clinician directiveness in ToR decisions, and the role of slow codes in the emergency department setting
Cardiorespiratory Fitness and Colorectal Cancer Incidence in US Veterans: A Cohort Study
No full textOBJECTIVE: To evaluate the association between cardiorespiratory fitness (CRF), objectively measured by standardized exercise treadmill test (ETT), and colorectal cancer incidence. METHODS: The study involved 643,583 US veterans nationwide (41,968 women) from the Exercise Testing and Health Outcomes Study (ETHOS) cohort. None had cancer diagnosis before ETT or had cancer other than colorectal after ETT. Participants completed an ETT (Bruce) with no evidence of ischemia and were stratified into CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved: least fit (n=119,673; METs: 4.8±1.5), low fit (n=157,059; METs: 7.3±1.4), moderate fit (n=122,194; METs: 8.6±1.4), fit (n=170,324; METs: 10.5±1.0), and high fit (n= 74,333; METs: 13.6±1.8). RESULTS: During a median follow-up period of 10.0 years, totaling 6,632,561 person-years, 8190 participants had colorectal cancer (12.4 events per 10,000 person-years). Cardiorespiratory fitness was inversely associated to colorectal cancer risk, independent of comorbidities, with a 9% risk reduction per 1-MET higher in CRF (hazard ratio [HR], 0.91; 95% CI, 0.90 to 0.92), for men and women and across all races. Compared with least fit, the risk of those in the next CRF category (low fit) was 14% lower (HR, 0.86; 95% CI, 0.81 to 0.91). The risk declined progressively with increased CRF and was 57% lower (HR, 0.43; 95% CI, 0.29 to 0.48) for those in the high-fit group. CONCLUSION: We observed an inverse and graded association between CRF and colorectal cancer incidence, across races and sexes, independent of comorbidities. The lower risk was evident in those with a peak CRF of approximately 8.5 to 10.5 METs, a relatively moderate CRF status attainable by most middle-aged and older individuals
Innovative approaches to reducing variability in Doctor of Nursing Practice education, roles, and outcomes through collaborative healthcare partnerships
No full textPlatelet and Fibrinogen Contribution to Clot Strength in Premature Neonates with Sepsis
No full text: Platelet transfusions are administered to preterm neonates with thrombocytopenia prophylactically to decrease their bleeding risk. The amplitude difference between the extrinsic rotational thromboelastometry (EXTEM) and the fibrinogen rotational thromboelastometry (FIBTEM) assays is considered an index of platelet contribution to clot strength, guiding transfusion management. The difference in maximum clot elasticity (MCE) (namely the platelet contribution to clot elasticity-MCEplatelet) is considered highly accurate. Limited data exist to specify the contribution of platelets and fibrinogen in clot formation during sepsis in neonates with thrombocytopenia. We investigated the potential of MCFplatelet (platelet contribution to clot firmness) and MCEplatelet in reflecting platelet count and function in septic preterm neonates. We simultaneously assessed the contribution of both platelets and fibrinogen to clot strength during sepsis. : We compared 28 preterm neonates with sepsis born (gestational age 24-34) with 30 healthy counterparts by using rotational thromboelastometry (ROTEM) and platelet flow cytometry. : MCEplatelet showed a higher association with platelet count in the sepsis group than MCFplatelet (R = 47.66% vs. R = 18.79%). MCEplatelet (AUC = 0.81) had better discrimination capability than MCFplatelet (AUC = 0.78) in platelet count \u3c100 × 10/L. MCEplatelet was poorly associated with platelet function. The contribution of platelets was significantly lower (MCEplatelet = 84.03 vs. 89.21; p \u3c 0.001) compared with fibrinogen (36.9 vs. 25.92; p \u3c 0.001) in the sepsis group. : MCEplatelet has a better predictive value than MCFplatelet. In clinical practice, the elasticity difference between EXTEM and FIBTEM may replace the amplitude difference. The higher contribution of fibrinogen in clot strength during neonatal sepsis results in higher MCF, even in neonates with thrombocytopenia
CT derived fractional flow reserve: Part 1 - Comprehensive review of methodologies
No full textAdvancements in cardiac computed tomography angiography (CCTA) have enabled the extraction of physiological data from an anatomy-based imaging modality. This review outlines the key methodologies for deriving fractional flow reserve (FFR) from CCTA, with a focus on two primary methods: 1) computational fluid dynamics-based FFR (CT-FFR) and 2) plaque-derived ischemia assessment using artificial intelligence and quantitative plaque metrics. These techniques have expanded the role of CCTA beyond anatomical assessment, allowing for concurrent evaluation of coronary physiology without the need for invasive testing. This review provides an overview of the principles, workflows, and limitations of each technique and aims to inform on the current state and future direction of non-invasive coronary physiology assessment
Addressing conceptual and design gaps in the oncology nutrition evidence base during chemotherapy: contributions of the Exercise and Nutrition Interventions to Improve Cancer Treatment-Related Outcomes Consortium
No full textEvidence to support the development of practice guidelines on nutrition interventions during active cancer treatment is limited despite the established role of nutrition in cancer prevention and long-term survivorship. To address this gap, the National Cancer Institute (NCI) funded the Exercise and Nutrition Interventions to Improve Cancer Treatment-Related Outcomes (ENICTO) research consortium. This manuscript focuses on the nutrition-specific work within the ENICTO Consortium. We present a conceptual framework describing how nutritional interventions may enhance cancer treatment tolerance and timely completion of chemotherapy. We also describe how each ENICTO research project selected specific nutrition-related data items and collection methods to test hypotheses outlined in the conceptual framework. Research and consortium-wide projects are described in relation to advancing the scientific rigor of research in the field, including the standardization of nutrition assessment tools and measures. We conclude with a call to action for further research to support the development of evidence-based oncology nutrition practice guidelines relevant to the treatment period within the cancer continuum
Acute Ischemic Stroke in the Incarcerated: Comparison of Treatment Rates and Clinical Outcomes With the United States General Population
No full textJAGS Remains Committed to Scientific Principles That Support Better Health and Function for All Older Adults: Disparities, Diversity in Research, and Respectful Discourse
No full textAssessment of PredictSURE IBD Assay in a Multinational Cohort of Patients With Inflammatory Bowel Disease
No full textBACKGROUND AND AIMS: PredictSURE IBD is a prognostic blood test that classifies newly diagnosed, treatment-naïve Inflammatory Bowel Disease (IBD) patients into \u27IBDhi\u27 (high-risk) or \u27IBDlo\u27 (low-risk) groups (risk of future aggressive disease). We evaluated this assay in a multinational cohort and explored the effect of concomitant corticosteroids on its discrimination. METHODS: One hundred thirty-six (71 Ulcerative colitis [UC], 65 Crohn\u27s Disease [CD]) and 41 (15 UC, 26 CD) patients with active IBD were \u27unexposed\u27 and \u27exposed\u27, respectively, to corticosteroids at baseline blood sampling. The number of treatment escalations, time to first escalation, and need for repeated escalations were compared between the biomarker subgroups. Another 20 patients (13 UC, 7 CD) were longitudinally sampled over 6 weeks after commencing corticosteroids. RESULTS: In corticosteroids-naïve UC and CD patients, all bowel surgeries (n = 6) and multiple therapy escalations (n = 10) occurred in IBDhi patients. IBDhi UC patients required significantly more treatment escalations, had a shorter time to first escalation, and a greater need for multiple escalations than IBDlo patients. No statistically significant differences were observed among CD patients. In corticosteroid-exposed patients, 66.6% of \u27misclassifications\u27 were IBDlo patients who required escalations. Among corticosteroid-treated patients with longitudinal sampling, 81.3% of those classified as IBDhi before steroids switched to IBDlo during therapy. CONCLUSIONS: No significant differences in treatment escalations were observed between biomarker-defined subgroups in CD. However, IBDhi UC patients required significantly earlier and more frequent therapy escalations, highlighting the need to further investigate PredictSURE IBD in UC. Notably, the discrimination ability of the biomarker was unreliable in patients receiving corticosteroid therapy