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Evaluating the Prevalence of Suicide Risk Screening Practices in Accredited Hospitals
Get PDFBackground: The Joint Commission's National Patient Safety Goal (NPSG) on suicide prevention (NPSG.15.01.01) requires accredited hospitals to screen all patients aged 12 years and older who are being evaluated or treated for behavioral health conditions as their primary reason for care for suicidal ideation using a validated screening tool. Some hospitals have expanded screening to include nonbehavioral health care patients.
Methods: This cross-sectional observational study explored the prevalence and challenges of suicide risk screening practices among Joint Commission-accredited hospitals. An online questionnaire was sent to 859 general medical/surgical hospitals. Chi-square tests were used to evaluate differences in response rates, and responses were adjusted by hospital characteristics (bed capacity, location, system, and teaching status).
Results: A total of 284 (33.1%) hospitals responded. The majority (n = 225 [79.2%]) reported screening all patients hospitalwide, and 185 (65.1%) had implemented a suicide prevention framework that includes protocols for positive screens and risk assessment. Challenges for implementing a comprehensive universal suicide risk screening and assessment protocol included insufficient staffing and lack of secure environments for at-risk patients. Of the 59 organizations not conducting hospitalwide screening, 94.9% indicated multiple reasons, including negative impact on workflow (30 [50.8%]), burden on providers (30 [50.8%]), not a requirement (29 [49.2%]), and workflow feasibility (28 [47.5%]).
Conclusion: Results suggest the majority of accredited hospitals have implemented suicide risk screening practices that exceed current Joint Commission requirements. The lack of sufficient resources to adequately address patients who screen positive for suicide risk remains a key challenge to universal screening.No embarg
Where are all the job candidates?: geographic considerations for early career librarian recruitment in health sciences libraries
No full textAnecdotal evidence suggests that hiring managers and hiring committees are seeing small numbers of applicants for vacancies at their health sciences libraries, making recruitment difficult. Several challenges are often cited for this, but little has been said about geographic considerations. Our objective was to analyze early career health sciences job postings in the United States for one year, and identify any geographic disparities relevant to recruitment. We explored medical and health science librarian job postings from MLA's website, ALA's joblist, medlib-l, and caucus listservs, which were compiled from January to December 2023. Early career postings were determined based on predefined criteria. Based on the medical/health science librarian job postings from 2023, there were 216 total postings including 105 early career positions (requiring one year or less of experience), reflecting approximately 49% of all job postings during this period. A plurality of early career postings (27%) were located in the Mid-Atlantic region while the fewest (5%) were from the Mountain West. Researchers analyzed the early career postings finding that instruction (67%) and reference (58%) duties were most prominent. Geography is important, as a new LIS graduate living in a region with fewer opportunities may be forced to move in order to obtain a medical library position, and optimal approaches to recruitment will vary depending on the employer's location. As this highlights just one aspect of the challenge, there are further research directions that may be taken from this analysis.No embarg
A New CAHPS Measure of Patient Experiences With Mental Health and Substance Use Care
No full textObjective: To examine the psychometric characteristics of a survey about the experiences of people seeking mental health care and substance use services, the CAHPS Outpatient Mental Health (MH) survey.
Study settings and design: Field tests were conducted in two Northeastern states-one among a state's Medicaid enrollees and the other in family medicine practices where psychologists and social workers were collocated with primary care providers. The survey asked about psychiatric medicines and counseling services received in the last 6 months.
Data sources and analytic sample: In each study, questionnaires were mailed to sampled patients with an option to complete a web survey. Study 1 included 5508 Medicaid enrollees 21 years and older from four health plans. Study 2 included 3328 patients 18 years and older who visited one of four family medicine practices. Samples included patients with mental health or substance use disorders or both.
Principal findings: Response rates were 9.98% (n = 470) and 13.00% (n = 416) for the Medicaid and family medicine surveys, respectively. About 20% of respondents reported difficulty getting appointments with mental health medicine prescribers. From 10% to 30% of respondents had difficulties finding a counselor, and 15% reported problems making appointments with counselors. Many respondents reported no mental health care in the last 6 months. Composite measures for communication with counselors had excellent internal consistency, but the measure for access to counseling services was modest (0.68 and 0.52 for the two studies). Inter-unit reliability (IUR) was modest for the survey (IUR for all measures was lower than 0.60; highest for rating of counselors).
Conclusions: Both studies had uniformly good distributions of responses to specific questions, although communication and respect questions about counselors were positively skewed. The survey performs better for respondents with any mental health condition and less well for those with only substance use disorders.No embarg
Integrating Legal Aid into HIV Care: Evaluating the Impact of a Medical-Legal Partnership on Viral Suppression Outcomes
No full textSocial and structural determinants of health (SSDoH), including legal challenges related to housing, employment, and public benefits, often obstruct HIV care adherence and viral suppression. Medical-Legal Partnerships (MLPs) have emerged as a promising structural intervention to mitigate these barriers but are underutilized in HIV service settings. This feasibility and acceptability trial evaluated the impact of an MLP intervention compared to treatment-as-usual (TAU) among people with HIV (PWH) in Philadelphia, Pennsylvania. Two matched service organizations were randomized to MLP or TAU. The MLP included interdisciplinary training, standardized legal screening by peer navigators, and integration of legal services from a legal aid organization. A total of 202 participants were enrolled using a multi-pronged recruitment strategy that included venue-based outreach, online recruitment methods, and peer referrals. Kaplan-Meier survival analyses and logistic regressions assessed the time to viral suppression and likelihood of achieving undetectable viral load at 3 and 6 months. Participants in the MLP site achieved undetectable viral load faster than those in the TAU site in both conservative and robust survival analyses. At 3-month follow-up, MLP participants were significantly more likely to achieve viral suppression (OR = 2.42, 95% CI: 1.06, 5.49, p = .03). Although the 6-month odds ratio was reduced (OR = 2.28, 95% CI: 0.79, 6.57), it did not reach statistical significance. Findings suggest that MLPs can accelerate viral suppression among PWH by addressing health-harming legal needs. This study supports the integration of legal services into HIV care as a promising strategy to improve outcomes and reduce disparities.No embarg
Prevalence of Chronic Overlapping Pain Conditions in Participants With Chronic Low Back Pain Enrolled in a Pragmatic Trial of Mindfulness-Based Stress Reduction
No full textBackground: Chronic low back pain (cLBP) is extremely common and is one of the Chronic Overlapping Pain Conditions (COPCs), 10 conditions thought to have similar underlying pathophysiology. Little is known about the prevalence and co-occurrence of cLBP with other commonly accepted conditions referred to as COPCs.
Methods: We assessed participants enrolled in a pragmatic trial of mindfulness-based stress reduction for cLBP to determine the prevalence of co-occurring COPCs using a validated COPC screener. We compared psychosocial and physical functioning among participants with only cLBP and participants with cLBP and additional COPCs using Student's t-tests, chi-squared tests and multivariable linear regression.
Results: Among 285 enrollees (age range: 18-88 years, mean age: 52.2 years, SD = 15.3), 272 (95%) reported pain outside the upper and lower back region. One hundred and twenty-nine people (45%) had one COPC, and 68 (24%) had two or more COPCs not including cLBP. The most common COPCs were irritable bowel syndrome (n = 56, 20%); myalgia encephalomyelitis/chronic fatigue syndrome (n = 54, 19%); and fibromyalgia (n = 42, 15%).
Conclusion: We found strong differences when comparing people with cLBP alone to those with cLBP and COPCs. People with COPCs reported more pain symptoms, higher levels of anxiety, depression, fatigue and scored worse across measures of physical functioning and pain symptoms. An additional COPC was associated with a 7.6-point increase in fatigue scores (95% CI: 5.6, 9.7) on a T-score metric (mean = 50, SD = 10).
Significance statement: Compared to people with low back pain alone, individuals with additional chronic pain experienced more severe pain symptoms, more anxiety, depression and fatigue. In this sample of people with cLBP, overlapping pain conditions were common, affecting 45% of people.
Registration number and registry name: Clinicaltrials.gov identifier NCT04129450.No embarg
Smoking Cessation Among Patients with Chronic Pain in a Comparative Effectiveness Trial
Get PDFBACKGROUND: Many patients with chronic pain smoke cigarettes; they report lacking skills to cope with pain, a smoking trigger.
OBJECTIVE: Test the effectiveness of a telephone-delivered, cognitive-behavioral intervention (CBI) incorporating pain self-management to promote smoking cessation among people with chronic pain compared to a smoking cessation counseling control (Standard).
DESIGN: Randomized trial.
PARTICIPANTS: Current cigarette smoking, willingness to make a quit attempt, pain for ≥ 3 months with worst past week pain intensity of ≥ 4 on the 0-10 pain numerical rating scale.
INTERVENTIONS: CBI included 5 telephone sessions integrating smoking cessation and pain self-management, and combination nicotine replacement therapy (NRT). Standard included 5 telephone sessions and NRT.
MAIN MEASURES: Primary outcome used for power analysis was 14-day prolonged abstinence at 6 months. Other smoking outcomes included 7-day and 30-day point prevalence abstinence and 7-day prolonged abstinence at 6 and 12 months and 14-day prolonged abstinence at 12 months. Secondary outcomes included change in pain intensity and interference at 6 and 12 months.
KEY RESULTS: Patients were randomly assigned to CBI (n = 189) and Standard (n = 182), stratified by sex. Patients (88% men, median age = 60 years) smoked a median of 15 cigarettes per day with moderate pain intensity (5.2 (SD = 1.6)) and pain interference (5.5 (SD = 2.2)). Participation in all 5 counseling calls was higher in CBI (38% vs. 29%), and there was no difference in NRT use (47% vs. 45%). There were no differences by arm in smoking or pain outcomes.
CONCLUSIONS: Our study did not detect a difference in smoking cessation between standard counseling and counseling with enhanced content around pain self-management.
TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT02971137 Registered 2016-11-16.No embarg
Fazekas score predicts cognitive decline & frailty in older adults: insights from the SAGE-AF cohort study
Get PDFBackground: Atrial fibrillation (AF) is a common condition in older adults, often associated with increased risks of cognitive decline and frailty. White matter hyperintensities (WMH), visible on neuroimaging and quantified by the Fazekas score, have been linked to both cognitive and physical impairments. However, the relationship between WMH, cognitive decline, and frailty in older adults with AF remains relatively underexplored.
Methods: This study analyzed data from 86 participants in the SAGE-AF cohort, a two-year prospective multicenter cohort study of older adults with AF, who also had neuroimaging performed for clinical indications. WMH severity was assessed by independent reviewers using Fazekas scores from brain imaging. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA), and frailty was assessed at baseline as well as 1- and 2-year follow-up visits by trained examiners as part of the SAGE-AF study protocol. Participants were characterized based on the severity of their white matter hyperintensities and compared to baseline and two-year cognitive and physical functional status. Longitudinal regression models were used to adjust for demographic, clinical, and geriatric covariates.
Results: Participants with higher Fazekas scores (grades 2-3) demonstrated significantly lower baseline and follow-up MoCA scores and were more likely to meet frailty criteria over a two-year follow-up period. After adjusting for multiple factors known to influence cognitive decline, greater white matter hyperintensity (Fazekas grades 2-3) remained associated with a 2.6-fold increased risk of cognitive impairment at (p = 0.04) and a 2.7-fold increased risk of frailty at (p = 0.02).
Conclusion: Higher Fazekas scores are related to cognitive decline and frailty in older adults with AF, emphasizing WMH as a critical biomarker for aging-related impairments. Neuroimaging tools like Fazekas scoring could enhance risk stratification and inform targeted interventions for this vulnerable population.No embarg
Evolution of KoRV-A transcriptional silencing in wild koalas
No full textKoala retrovirus-A (KoRV-A) is spreading through wild koalas in a north-to-south wave while transducing the germ line, modifying the inherited genome as it transitions to an endogenous retrovirus. Previously, we found that KoRV-A is expressed in the germ line, but unspliced genomic transcripts are processed into sense-strand PIWI-interacting RNAs (piRNAs), which may provide an initial "innate" form of post-transcriptional silencing. Here, we show that this initial post-transcriptional response is prevalent south of the Brisbane River, whereas KoRV-A expression is suppressed, promoters are methylated, and sense and antisense piRNAs are equally abundant in a subpopulation of animals north of the river. These animals share a KoRV-A provirus in the MAP4K4 gene's 3' UTR that is spreading through northern koalas and produces hybrid transcripts that are processed into antisense piRNAs, which guide transcriptional silencing. We speculate that this provirus triggers adaptive transcriptional silencing of KoRV-A and is sweeping to fixation.No embarg
Physician Perception of Trust and Communication with Asian Patients with Serious Illness and Their Families in the United States: An Exploratory Qualitative Study
No full textBACKGROUND: Asians in the United States receive less palliative care and enter hospice less than Whites, disproportionately receive more invasive mechanical ventilation, and report less involvement in decision-making with physicians than they would like. Despite the growing literature addressing serious illness in diverse patient populations, communication with Asians is understudied. This study aimed to explore U.S. physician perceptions of clinical interactions with Asian patients with serious illness and barriers and facilitators to physician-patient communication.
METHODS: This is an exploratory qualitative descriptive study using semistructured interviews with U.S. physicians who cared for Asian patients with serious illness. We used an inductive content analysis approach to identify themes related to facilitators and barriers to communication between Asian patients, their families, and physicians.
RESULTS: We conducted 10 physician interviews between February and April 2024. Of participants, 50% were White and 50% were Asian, the majority were male, and 50% specialized in palliative care. Three major themes arose: (1) trust cannot be assumed; (2) understanding and honoring the role of family are key; and (3) honoring the patient's preferences for communication can build trust.
CONCLUSION: This study is a step in illustrating how a cross-cultural approach to communication needs to align physicians, patients, and families on the process of communication and shared decision-making and not only on the goals for care. Moving toward a cultural adaptive approach can empower clinicians to engage in a trust-building process of inquiry, observation, and understanding of how sociocultural factors impact patient preferences for health care.No embarg
Adverse cardiometabolic impacts of sleep fragmentation and estradiol suppression: An experimental model of menopause
No full textContext: Risk of cardiometabolic disease increases in women transitioning to postmenopause, during which estradiol declines universally. Most of these women experience fragmentation of sleep due to nocturnal hot flashes, without a reduction in total sleep time.
Objective: We examined the independent impact of estradiol suppression, sleep, and their combination on cardiometabolic outcomes categorized as satiety and hunger, lipid profile, cardiac vital signs, and glucoregulation.
Design: Participants completed 5-night inpatient studies under eucaloric conditions, once during mid-follicular phase/estrogenized and again under estrogen suppressed conditions, using the same experimental protocol both times. For all participants, sleep was unfragmented the first two nights and then experimentally fragmented without reducing total sleep time the next three nights.
Setting: Inpatient Intensive Physiological Monitoring research facility.
Participants: 38 healthy premenopausal women.
Intervention(s): Clinical experimental induced menopause model including gonadotropin-releasing hormone agonist-induced hypoestrogenism and sleep fragmentation.
Main outcome measure(s): Leptin and satiety.
Results: Estradiol suppression significantly decreased leptin and increased lipid profiles (FDR-adjusted p≤0.05). Sleep fragmentation significantly increased heart rate (FDR-adjusted p=0.002) and trended to increase fasting glucose (FDR-adjusted p=0.08). Estradiol suppression and sleep fragmentation worsened individual cardiometabolic outcomes by (median, IQR) 4.0% (1.5%, 6.3%) from normalized baseline values. Sleep fragmentation worsened a composite cardiometabolic index derived from individual clinical cardiometabolic measures by an additional 103% over estradiol suppression alone.
Conclusions: Independent of aging, there are significant adverse changes in cardiometabolic health induced by core components of the transition to postmenopause, including novel effects of sleep fragmentation, a modifiable target.1 year2026-11-0