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Agile implementation for hypertension control in primary care
No full textBackground: Hypertension is a leading cause of morbidity and mortality, affecting 48% of US adults, with nearly three quarters of them remaining uncontrolled. Despite evidence-based guidelines for the management of hypertension, gaps persist in their clinical application. The aim of this study was to improve blood pressure control rates among nonpregnant adult patients in primary care.
Methods: We applied the Agile Implementation process to address barriers to guideline implementation. Using an iterative quality improvement approach, we implemented the AI process in a clinic serving minority and underserved populations from January 2023 to December 2023.
Results: The AI process increased hypertension control rates from 43 to 58%, using a target blood pressure below 140/90 mmHg.
Conclusions: The AI process effectively improved hypertension control rates in an underserved primary care setting, offering a scalable approach for enhancing outcomes in similar populations.
Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-025-12941-0
A randomized trial of grant writing coaching groups: Baseline analysis of early-career scientists' research background, demographics, and mentorship variables
No full textIntroduction: Racial, ethnic, and gender disparities in academic career advancement persist in biomedical disciplines. One approach to addressing this problem is systematizing access to mentorship in critical skills such as grant writing. This report summarizes the baseline characteristics of early-career investigators who enrolled in a randomized trial of a group coaching intervention focused on National Institutes of Health (NIH) grant application development.
Methods: Surveys assessed participants' demographic characteristics, research focus, prior publications and grant submissions, self-efficacy for grantsmanship and career advancement, and access to mentorship. Two-sided t-test and Fisher's exact test were performed to compare baseline variables by gender identity (male/female) and by background from a racial or ethnic population that is an underrepresented minority group in biomedical research (non-URM/URM).
Results: The study sample includes 271 faculty and 96 postdoctoral fellows. Sixty-two percent of faculty and 76.0% of postdoctoral fellows identified as female. Nearly half (45.4% of faculty, 49.0% of postdocs) were from URM populations in biomedical research. At baseline, most were conducting clinical and translational research at institutions with high levels of research activity. Past submission of NIH R-series applications was limited; 29.9% of faculty had submitted K applications. On average, participants had moderate levels of self-efficacy (in grantsmanship and career advancement) and research-related mentoring support. Male and non-URM participants had a higher mean number of previous publications. For the remaining variables, there were no or minimal differences by gender identity and URM status.
Conclusions: Early-career investigators from diverse backgrounds are motivated to engage in external grant writing coaching programs regardless of existing mentorship and other supports at their home institutions, suggesting that grant coaching can provide complementary value
A Qualitative Examination of Resilience Among Grandparents Raising Grandchildren Using the Resilience Portfolio Model
No full textIUIGrandparents in the United States continue to show up and support their families in difficult times when parents are not able to do so. This indicates a form of strength and resilience worthy of study to expand literature, policy, and practice centered on caregiving with grandchildren. Although some studies have explored areas such as grandparents’ resourcefulness, positive caregiving appraisal, protective factors, and social support separately, there is a call for more holistic examination of their strength and resilience. To bridge this gap in literature, this study adopted the resilience portfolio model (RPM) using a qualitative method to examine the experience of grandparents raising grandchildren. A thematic analysis was conducted after semi-structured interviews with 13 GRG living in a mid-western state. Findings reveal a holistic view of how GRG demonstrate strengths and resilience in four different areas including 1) how they respond to daily challenges/crises, 2) the positive strategies they use to promote family well-being 3) how their earlier experiences in life influence their parenting experience with their grandchildren and 4) how they not only protect their families from future crises but how others are testifying of seeing positive changes in their lives of their grandchildren. The result of this study show the pertinency of the RPM in studying the experiences of GRG and the critical strengths and resilience that grandparents possess that could help not only in developing interventions that are more effective and efficient for GRG but also further policy and research with grandparents raising grandchildren
Intrapartum and Postpartum Antibiotic Use in Seven Low- and Middle-Income Countries: Findings from the A-PLUS Trial
No full textObjective: To describe the intrapartum and postpartum use of non-study antibiotics in low- and middle-income countries (LMICs) during the double-blinded NICHD Global Network Azithromycin in Labor (A-PLUS) trial.
Design: The antibiotic use sub-study was a planned prospective, observational sub-study of the A-PLUS trial.
Settings: The study was carried out in hospitals or health centres affiliated with eight sites of the Global Network for Women's and Children's Health Research (Global Network) in seven countries: Bangladesh, Pakistan, India (two sites), Kenya, Zambia, The Democratic Republic of the Congo (DRC) and Guatemala.
Population: Totally, 29 278 pregnant women enrolled in the A-PLUS trial.
Methods: We collected data on 29 278 pregnant women admitted to a facility for delivery related to non-study antibiotic use overall and during three time periods: (1) in the facility prior to delivery, (2) after delivery until facility discharge and (3) after discharge to 42 days post-partum.
Main outcome measures: Non-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods.
Results: Of the 29 278 women in the study, 5020 (17.1%; 95% CI 16.7%-17.6%) received non-study antibiotics in the facility prior to delivery, 11 956 (40.8%; 95% CI 40.3%-41.4%) received non-study antibiotics in the facility after delivery, and 13 390 (47.6%; 95% CI 47.0%-48.2%) women received non-study antibiotics after delivery and after facility discharge. Antibiotics were prescribed more often among women in the Asian and Guatemalan sites than in the African sites. In the three time-periods, among those receiving antibiotics, prophylaxis was the indication in 82.3%, 97.7% and 90.7% of the cases, respectively. The type of antibiotics used varied substantially by time-period and site, but generally, penicillin-type drugs, cephalosporin-type drugs and metronidazole were used more frequently than other types.
Conclusions: Across the eight sites of the Global Network, in the facility before delivery, and in the post-partum periods before and after facility discharge, antibiotics were used frequently, but use was highly variable by site and time-period
Global Health Curriculum in US Family Medicine Residencies
No full textIntroduction: Interest in training opportunities and ethical engagement in global health among medical trainees continues to increase. Preparation activities and formal curriculum for trainees traveling for international rotations vary widely across programs, and alignment with ethical best practice guidelines among US family medicine (FM) residency programs is unknown.
Methods: We surveyed FM residency programs about their global health (GH) curricula, with focus on practice alignment with ethical guiding principles for pretravel training in GH programs. We analyzed the responses by type of residency program and availability of faculty lead with expertise in GH.
Results: Fifty programs were included in analysis of GH curriculum specifics. Programs with expert leads were significantly more likely to have a formal GH curriculum and/or pretravel training, to offer formal and informal faculty mentorship on cultural expectations and global health ethics, and to include scope of practice (P=.001) and pretravel safety training with a standard institutional process (P=.011). Program type was not significantly correlated with global health curriculum specifics, except for availability of journal club. Small sample sizes limited our analysis of residency type.
Conclusion: Programs with an expert GH faculty lead were more likely to have formal GH curriculum or pretravel training with inclusion of elements recommended by the WEIGHT ethical best practices for GH training. Residency programs should consider designating lead faculty to formalize GH curriculum and mentorship in alignment with Accreditation Council for Graduate Medical Education competency requirements and with WEIGHT ethical best practices
Variational autoencoder-based model improves polygenic prediction in blood cell traits
No full textGenetic prediction of complex traits, enabled by large-scale genomic studies, has created new measures to understand individual genetic predisposition. Polygenic risk scores (PRSs) offer a way to aggregate information across the genome, enabling personalized risk prediction for complex traits and diseases. However, conventional PRS calculation methods that rely on linear models are limited in their ability to capture complex patterns and interaction effects in high-dimensional genomic data. In this study, we seek to improve the predictive power of PRS through applying advanced deep learning techniques. We show that the variational autoencoder-based model for PRS construction (VAE-PRS) outperforms currently state-of-the-art methods for biobank-level data in 14 out of 16 blood cell traits, while being computationally efficient. Through comprehensive experiments, we found that the VAE-PRS model offers the ability to capture interaction effects in high-dimensional data and shows robust performance across different pre-screened variant sets. Furthermore, VAE-PRS is easily interpretable via assessing the contribution of each individual marker to the final prediction score through the Shapley additive explanations method, providing potential new insights in identifying trait-associated genetic variants. In summary, VAE-PRS presents a measure to genetic risk prediction for blood cell traits by harnessing the power of deep learning methods given appropriate training sample size, which could further facilitate the development of personalized medicine and genetic research
Tick-borne coinfections modulate CD8+ T cell response and progressive leishmaniosis
No full textLeishmania infantum causes human visceral leishmaniasis and leishmaniosis (CanL) in reservoir host, dogs. As infection progresses to disease in both humans and dogs, there is a shift from controlling type 1 immunity to a regulatory, exhausted T cell phenotype. In endemic areas, the association between tick-borne coinfections (TBCs) and Leishmania diagnosis and/or clinical severity has been demonstrated. To identify immune factors correlating with disease progression, we prospectively evaluated a cohort of L. infantum-infected dogs from 2019 to 2022. The cohort was TBC-negative with asymptomatic leishmaniosis at the time of enrollment. We measured TBC serology, anti-Leishmania antigen T cell immunity, CanL serological response, parasitemia, and disease severity to probe how nascent TBC perturbs the immune state. At the conclusion, TBC+ dogs with CanL experienced greater increases in anti-Leishmania antibody reactivity and parasite burden compared to dogs that did not have incident TBC during the study. TBC+ dogs were twice as likely to experience moderate (LeishVet stage 2) or severe/terminal disease (LeishVet stage 3/4). Prolonged exposure to TBC was associated with a shift in Leishmania antigen-induced interferon gamma (IFN-γ)/interleukin-10 (IL-10) and enhanced CD8 T cell proliferation. Frequency of proliferating CD8 T cells significantly correlated with parasitemia and antibody reactivity. TBC exacerbated parasite burden and immune exhaustion. These findings highlight the need for combined vector control efforts as prevention programs for dogs in Leishmania endemic areas to reduce transmission to humans. Public health education efforts should aim to increase awareness of the connection between TBC and leishmaniosis
ERAS Including Minimal Narcotic Pain Management is Successful After Heart Transplant and LVAD Implantation: A Single Center Review
No full textObjective: To assess the outcomes of an enhanced recovery after surgery (ERAS) protocol for heart failure patients receiving heart transplant or left ventricular assist device (LVAD) surgery.
Methods: A single center, retrospective IRB study reviewed consecutive heart transplant and LVAD implantation patients from May 2020 to May 2022. Patients received an organized ERAS protocol. The following data points were evaluated: demographics, medication history, date of surgery, acute medication use, nutrition and bowel function assessment, time to liberate from mechanical ventilation, delirium screening, pain scores, functional status, time from implant to hospital discharge, and pain medications at both discharge and 30-day follow-up.
Results: Thirty-two patients received ERAS: 18 heart transplants and 14 LVAD implants. One heart transplant was excluded from ERAS protocol due to delayed sternal closure for 72 hours after surgery. For a seven-day postoperative observation period, three patients (9%) had a positive delirium score. Pain scores were acceptable. The mean morphine milligram equivalent (MME) was 26.25 mg per day. No patient developed gastrointestinal complications. The average length of stay after surgery was 25 days for heart transplant, and 19 days for LVAD implant. No patients were prescribed opioids at discharge, and no patients reported opioid use over baseline at 30-days.
Conclusion: For heart transplant and LVAD surgery, ERAS reduced opioid consumption, preserved mechanical ventilation time, and limited acute delirium. ERAS limited postoperative opioid induced gastroparesis while preserving acceptable pain scores, maintained the length of hospitalization, and prevented unnecessary opioid prescribing at discharge up to and including 30 days thereafter
Effects of using different rural measurements on estimates of hospitalizations for depression and substance use
No full textBackground/purpose: To examine how the choice of rural measurements affects estimates of hospitalization rates for depression and substance use disorders (SUD).
Methods: We conducted cross-sectional analyses using the 2018 State Inpatient Database (SID) for 5 states, including Arizona, Kentucky, Maryland, Washington, and Florida, to determine how (1) estimates of hospitalization rates for depression and SUDs; and (2) patient characteristics among those hospitalized differ. Five measurements of rurality including rural-urban commuting areas (RUCA) codes, core-based statistical areas (CBSA), urban-rural category four (URCategory4) and two definitions of rural urban continuum codes (RUCC) were used. For each measurement, we calculated frequencies and percentages for age, race, sex, and insurance type. We conducted Spearman's rank correlations to compare associations and internal agreement. We created an UpSet chart to visualize the overlap in different measurements.
Results: There were 152,771 hospitalizations for depression and 43,760 hospitalizations for SUDs. The percentage of hospitalizations for depression or SUD differed significantly (3.2-8.1% for depression and 5.0-11.6% for SUDs ) based on rurality measure. Race and insurance characteristics of those identified as rural varied by rural measurement for depression and SUD hospitalizations. Spearman's correlations were higher for hospitalizations for SUD than for depression, ranging from r = 0.61 (RUCC and RUCA) to r = 0.99 (CBSA and URCategory4).
Conclusions: Different rurality measurements result in differing estimates of hospitalizations for SUD or depression. Stakeholders should be aware that the choice of rural measurements can impact policy decisions and resource allocation for programs intended to improve care in rural areas
Integrating a risk prediction score in a clinical decision support to identify patients with health-related social needs in the emergency department
No full textObjectives: To improve the identification of patients with health-related social needs (HRSNs) in the emergency department (ED), we developed and integrated a risk prediction score into an existing Fast Healthcare Interoperability Resources (FHIR)-based clinical decision support (CDS).
Materials and methods: We conducted 2 phases of individual semi-structured qualitative interviews with ED clinicians to identify HRSN risk score design preferences for CDS integration. Following this, we used patient HRSN screening survey, health information exchange (HIE), and clinical data to run logistic regressions, developing an HRSN risk score aligned with ED clinician preferences.
Results: Emergency department clinicians preferred HRSN risk scores displayed via visual cues like color-coding with different ranges (low, medium, and high) with higher model sensitivity to avoid missing patients with HRSNs. The overall performance of the risk prediction model was modest. Risk scores for food insecurity, transportation barriers, and financial strain were more sensitive, aligning with users' preference for inclusivity and accurately identifying patients likely to screen positive for these HRSNs.
Discussion: The design and risk score model choices, such as visual displays with additional data, higher sensitivity thresholds, and use of different thresholds for fairness, may support effective CDS use by ED clinicians.
Conclusion: Using HIE data and an external CDS is a feasible route for including patient HRSNs information in the ED. We relied on clinician preferences for incorporation into the existing CDS and were attentive to performance fairness. While the predictive performance of our risk score is modest, providing risk scores in this manner may potentially improve the identification of patients' HRSNs in the ED