Faculty Bibliography

OBJECTIVE/UNASSIGNED:To examine how exposure to advertising channels is associated with e-cigarette use among youth in the United States. METHODS/UNASSIGNED:This study included 161,700 middle and high school students aged 9-18 years from the 2014-2022 National Youth Tobacco Survey data. Multivariate logistic regressions estimated adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) for the association between exposure to advertising channels and ever e-cigarette use. Annual percent change (APC) for ever e-cigarette use and exposure to each advertising channel were analyzed using Joinpoint regression. Data for 2014-2018 and 2019-2022 were analyzed separately due to the change in survey format and weighting procedure. RESULTS/UNASSIGNED:Ever e-cigarette use prevalence increased (APC = + 2.78: 95 % CI -13.65, 21.38) between 2014 and 2018, then declined (APC = -18.20 %: 95 % CI -27.11, 8.36) between 2019 and 2022. Exposure to retail (2014-2018 aOR = 1.36: 95 % CI 1.29, 1.43; 2019-2022 aOR = 1.46: 95 % CI 1.38, 1.54) and internet advertising (2014-2018 aOR = 1.43: 95 % CI 1.35, 1.51; 2019-2022 aOR = 1.19: 95 % CI 1.13, 1.25) were associated with higher odds of ever e-cigarette use. CONCLUSIONS/UNASSIGNED:Exposure to retail and internet marketing increased the likelihood of ever-use of e-cigarettes among youth in the US. Additional regulations for point-of-sale and internet advertisements should be implemented.

BACKGROUND/UNASSIGNED:Lung cancer remains the leading cause of cancer-related mortality worldwide, with low-dose computed tomography screening demonstrating an approximately 20% reduction in mortality among high-risk individuals. Despite this benefit, screening prevalence remains suboptimal, with often less than 20% of eligible individuals reported to be up to date on screening. Shared decision-making is essential for effective lung cancer screening (LCS) implementation, with decision aids shown to enhance patient knowledge and engagement. OBJECTIVE/UNASSIGNED:The aim of this study is to identify patient preferences, concerns, and design considerations through qualitative evaluation of MyLungHealth, a personalized patient-facing educational tool for LCS integrated with electronic health records, and to describe how these findings informed iterative design modifications. METHODS/UNASSIGNED:We employed qualitative research methods through focus groups (n=34) and individual interviews (n=18) with individuals who met screening eligibility criteria. Participants were recruited from the University of Utah Health and New York University Langone Health between May and December 2023. Feedback was analyzed using Braun and Clarke's thematic analysis principles. RESULTS/UNASSIGNED:Six themes were organized into three overarching domains. Domain A included interpretation and impact of personalized risk information: theme 1, difficulties interpreting risk information, and theme 2, varied impacts of risk information on motivation. Domain B included autonomy, privacy, and user interface preferences: theme 3, desire for autonomy and control over personal health data, and theme 4, preference for straightforward language and multiple information formats. Domain C included integration with clinical workflows and patient portal systems: theme 5, expectations for integration with health care provider workflows, and theme 6, mixed experiences with personal health record systems. These insights led to key design modifications, including simplified risk presentation, multimodal content delivery options (video and text), and implementation of electronic health record alerts for clinicians. CONCLUSIONS/UNASSIGNED:The user-centered design process for MyLungHealth revealed important considerations for developing effective patient education tools for LCS. The findings highlighted the need for simplified risk presentation, personalized information delivery, and integration with clinical workflows. These findings underscore the importance of balancing comprehensive risk communication with user accessibility.

BACKGROUND/UNASSIGNED:Clinical decision support (CDS) tools embedded in electronic health records in the form of integrated clinical prediction rules provide a potentially effective intervention to reduce inappropriate antibiotic prescribing for acute respiratory infections. However, their effectiveness has been limited by workflow barriers and low adoption by health care providers. Nurses are well positioned to implement evidence-based protocols using CDS tools. In a multicenter randomized controlled trial, a nurse-led implementation strategy for acute respiratory infection integrated clinical prediction rules was evaluated for use in primary care and urgent care settings. OBJECTIVE/UNASSIGNED:This study aimed to examine nurse and nurse leader perspectives on the sustainability of an electronic health record-integrated CDS tool for antibiotic stewardship and explored factors influencing its potential long-term integration into ambulatory nursing practice beyond the clinical trial. METHODS/UNASSIGNED:We interviewed 22 nurses and nurse leaders from 37 clinics across 3 academic medical centers that participated in the clinical trial. Two semistructured interview guides, one for nurses and one for nursing leadership, were developed to understand the barriers and facilitators to implementing a decision aid tool for nurses and to elicit challenges specific to nursing interactions with the CDS tool. Interviews were recorded and transcribed. Using thematic content analysis and iterative coding, our team collaboratively identified emerging themes related to sustainability and refined the results with consensus. RESULTS/UNASSIGNED:Five themes emerged: (1) importance of staffing stability and capacity, (2) impact of dedicated clinic resource availability, (3) variable nurse readiness with CDS-guided clinical care, (4) influence of openness to change and a nurse-supportive clinic culture, and (5) ongoing need for training and support. Specific recommendations for future actions were also noted. CONCLUSIONS/UNASSIGNED:Our findings revealed specific barriers and facilitators to the sustainability of a CDS tool from the nursing perspective that can inform further implementation of nurse-led delegation protocols in the ambulatory setting. Future solutions should consider mapping physical workflows, scheduling specific to nurse visits, continuing education, and treating cough and sore throat as 2 distinct processes.

IMPORTANCE/UNASSIGNED:Lung cancer screening (LCS) with low-dose computed tomography (CT) remains underused in the US, partly because of incomplete smoking history documentation in electronic health records (EHRs) and limited time for shared decision-making in primary care. OBJECTIVE/UNASSIGNED:To determine whether a patient-facing, EHR-integrated tool combined with clinician-facing clinical decision support improves the identification of LCS-eligible patients and the ordering of low-dose CT compared with clinician-facing tools alone. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This pragmatic, unstratified, randomized clinical trial with parallel groups was conducted from March 29, 2024, to March 28, 2025, at primary care clinics at University of Utah Health and New York University Langone Health. Adults aged 50 to 79 years with a documented smoking history, an active patient portal account, and a primary care visit in the preceding year were included. Study 1 enrolled patients with uncertain LCS eligibility (10 to 19 pack-years, unknown pack-years, or missing quit date); study 2 enrolled patients with documented eligibility (20 or more pack-years and currently smoking or quit smoking within 15 years). INTERVENTIONS/UNASSIGNED:The control included the clinician-facing Decision Precision+ tool (preventive care reminders and a shared decision-making tool). The intervention included the Decision Precision+ tool as well as the MyLungHealth tool, which collected detailed smoking history (study 1) and delivered personalized education and risk/benefit information (studies 1 and 2) via the patient portal in English and Spanish. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcomes were the proportion of patients newly identified as eligible for LCS (study 1) and low-dose CT ordering rates (study 2) over 12 months. Analyses used intention-to-treat mixed-effects logistic regression. RESULTS/UNASSIGNED:There were 31 303 randomized participants, including 26 729 in study 1 (13 144 [49.2%] female; 13 580 [50.8%] male; median [IQR] age, 62 [55-69] years) and 4574 in study 2 (2230 [48.8%] female; 2344 [51.2%] male; median [IQR] age, 63 [56-69] years). In study 1, the MyLungHealth tool increased new LCS eligibility identification (635 of 13 412 [4.7%] vs 308 of 13 317 [2.3%]; adjusted odds ratio, 2.19; 95% CI, 1.99-2.42; P < .001). In study 2, low-dose CT ordering was higher in the intervention arm (474 of 2312 [20.5%] vs 434 of 2262 [19.2%]; adjusted odds ratio, 1.16; 95% CI, 1.04-1.30; P = .008). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this randomized clinical trial, integrating a patient-centered tool into primary care EHR workflows increased the identification of patients eligible for LCS and the ordering of low-dose CTs. The relative increases in these primary outcomes were substantial, but absolute increases were more modest. Research on more intensive interventions is warranted to evaluate their ability to further improve LCS screening. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT06338592.

INTRODUCTION/BACKGROUND:Colorectal cancer (CRC) screening rates among patients receiving care at multiple federally qualified health care centers (FQHCs) in New York city are low. Proactive outreach through mailed fecal immunochemical tests (FIT), reminders and navigation are evidence based interventions to improve CRC screening rates but remain untested in this study population. OBJECTIVE:To evaluate the effectiveness, implementation, and cost-effectiveness of a multilevel proactive outreach strategy to improve CRC screening rates among underserved adults in Brooklyn, New York. METHODS:This is a randomized controlled trial across five FQHCs serving predominantly Black and low-income populations. Adults aged 45-75 who are overdue for CRC screening are randomized to usual care or a multi-level proactive intervention. The intervention includes mailed education and FIT kits, patient navigation, and support for colonoscopy scheduling and follow-up. The primary outcome is CRC screening completion (FIT or colonoscopy) within six months. Secondary outcomes include colonoscopy follow-up after a positive FIT, implementation barriers and facilitators, and cost-effectiveness. RESULTS:A total of 1379 participants have been enrolled through May 2025. DISCUSSION/CONCLUSIONS:This trial addresses a critical gap in CRC prevention by testing a scalable, multilevel outreach model tailored to underserved populations. Findings will inform future strategies to enhance screening rates while reducing screening disparities through sustainable FQHC-based programs.

BACKGROUND/UNASSIGNED:With rising patient volumes and a focus on quality, our health system had the objective to create a more efficient way to ensure accurate documentation of colorectal cancer (CRC) screening intervals from inbound colonoscopy reports to ensure timely follow-up. We developed an integrated end-to-end workflow solution using machine learning (ML) and robotic process automation (RPA) to extract and update electronic health record (EHR) follow-up dates from unstructured data. OBJECTIVE/UNASSIGNED:This study aimed to automate data extraction from external, free-text colonoscopy reports to identify and document recommended follow-up dates for CRC screening in structured EHR fields. METHODS/UNASSIGNED:As proof of concept, we outline the process development, validity, and implementation of an approach that integrates available tools to automate data retrieval and entry within the EHR of a large academic health system. The health system uses Epic Systems as its EHR platform, and the ML model used was trained on health system patient colonoscopy reports. This proof-of-concept process study consisted of six stages: (1) identification of gaps in documenting recommendations for follow-up CRC screening from external colonoscopy reports, (2) defining process objectives, (3) identification of technologies, (4) creation of process architecture, (5) process validation, and (6) health system-wide implementation. A chart review was performed to validate process outcomes and estimate impact. RESULTS/UNASSIGNED:We developed an automated process with 3 primary steps leveraging ML and RPA to create a fully orchestrated workflow to update CRC screening recall dates based on colonoscopy reports received from external sources. Process validity was assessed with 690 scanned colonoscopy reports. During process validation, the overall automated process achieved an accuracy of 80.7% (557/690, 95% CI 77.8%-83.7%) for correctly identifying the presence or absence of a valid follow-up date and a follow-up date false negative identification rate of 32.9% (130/395, 95% CI 29.4%-36.4%). From the organization-wide implementation to go-live until December 31, 2024, the system processed 16,563 external colonoscopy reports. Of these, 35.3% (5841/16,563) had a follow-up date meeting the relevant ML model threshold and thus were identified as ready for RPA processing. CONCLUSIONS/UNASSIGNED:Implementation of an automated workflow to extract and update CRC screening follow-up dates from colonoscopy reports is feasible and has the potential to improve accuracy in patient recall while reducing documentation burden. By standardizing data ingestion, extending this approach to various unstructured data types can address deficiencies in structured EHR documentation and solve for a lack of data integration and reporting for quality measures. Automated workflows leveraging ML and RPA offer practical solutions to overcome interoperability challenges and the use of unstructured data within health care systems.

BACKGROUND:Glaucoma Research Foundation's third Catalyst for a Cure team (CFC3) was established in 2019 to uncover new therapies for glaucoma, a leading cause of blindness. In the 2021 meeting "Solving Neurodegeneration," (detailed in Mol Neurodegeneration 17(1), 2022) the team examined the failures of investigational monotherapies, issues with translatability, and other significant challenges faced when working with neurodegenerative disease models. They emphasized the need for novel, humanized models and proposed identifying commonalities across neurodegenerative diseases to support the creation of pan-neurodegenerative disease therapies. Since then, the fourth Catalyst for a Cure team (CFC4) was formed to explore commonalities between glaucoma and other neurodegenerative diseases. This review summarizes outcomes from the 2023 "Solving Neurodegeneration 2" meeting, a forum for CFC3 and CFC4 to share updates, problem solve, plan future research collaborations, and identify areas of unmet need or opportunity in glaucoma and the broader field of neurodegenerative disease research. MAIN BODY/METHODS:We summarize the recent progress in the field of neurodegenerative disease research and present the newest challenges and opportunities moving forward. While translatability and disease complexity continue to pose major challenges, important progress has been made in identifying neuroprotective targets and understanding neuron-glia-vascular cell interactions. New challenges involve improving our understanding of the disease microenvironment and timeline, identifying the optimal approach(es) to neuronal replacement, and finding the best drug combinations and synergies for neuroprotection. We propose solutions to common research questions, provide prescriptive recommendations for future studies, and detail methodologies, strategies, and approaches for addressing major challenges at the forefront of neurodegenerative disease research. CONCLUSIONS:This review is intended to serve as a research framework, offering recommendations and approaches to validating neuroprotective targets, investigating rare cell types, performing cell-specific functional characterizations, leveraging novel adaptations of scRNAseq, and performing single-cell sorting and sequencing across neurodegenerative diseases and disease models. We focus on modeling neurodegeneration using glaucoma and other neurodegenerative pathologies to investigate the temporal and spatial dynamics of neurodegenerative disease pathogenesis, suggesting researchers aim to identify pan-neurodegenerative drug targets and drug combinations leverageable across neurodegenerative diseases.

BACKGROUND/UNASSIGNED:Electronic cigarettes (EC) may serve as a potential smoking harm reduction tool by addressing both nicotine and behavioral dependence. This qualitative study reports the feasibility and acceptability of using EC and telehealth counseling among individuals in treatment programs for opioid use disorders (OUD) who smoke combustible cigarette, and was conducted as part of a randomized controlled trial. We report findings among participants in the EC arm. METHODS/UNASSIGNED:Qualitative interviews were conducted from March to May 2021. The interviews were audio recorded, transcribed, and de-identified. An inductive approach guided by the Theoretical Framework of Acceptability was used. We developed and refined a codebook through a collaborative iterative process and team discussions. Five analysts coded the transcripts using Quirkos, with independent double coding for each transcript to achieve consensus and ensure inter-coder reliability. In-depth thematic analysis was conducted via synthesizing relevant codes that were described and exemplified using representative quotes. Saturation was achieved when no additional codes emerged. RESULTS/UNASSIGNED:Eleven participants randomized to EC were interviewed: average age = 55 years (range = 39-69), 88% were male, 41% non-Hispanic black, and 35% non-Hispanic white. Four main themes identified included inciting sense of accountability toward cigarette smoking reduction; acknowledging the value of telehealth counseling; noting positive attributes such as addressing craving, as well as challenges in utilizing EC such as the need to remember charging the EC; and finally, participants' expression of the satisfaction with their perceived improvements in their health and other behavioral aspects. CONCLUSION/UNASSIGNED:The intervention combining telehealth counseling with EC was perceived as acceptable and helpful for reducing cigarette smoking, as well as resulting in other positive health benefits. ECs were easy to use and seemed to address craving; albeit with some challenges that can be addressed in future trials. EC combined with telehealth counseling carries great promise in smoking reduction among individuals with OUD.

BACKGROUND:The design and integration of technology within inpatient hospital rooms has a critical role in supporting nursing workflows, enhancing provider experience, and improving patient care. As health care technology evolves, there is a need to design "future-proofed" physical environments that integrate technology in ways that support workflows and maintain clinical performance. Assessing how current technologies affect nursing workflows can help inform the development of these future environments. OBJECTIVE:We assessed the current challenges nursing staff face in inpatient rooms, gather insights on technology, and build environment interactions to envision the design of a technology-integrated "Inpatient Room of the Future." METHODS:A qualitative study was conducted involving semistructured interviews, shadowing, and focus groups among nursing staff in the inpatient setting. Methods including horizon scanning, scenario analysis, technology assessment, and backcasting facilitated a comprehensive qualitative analysis of current technology use and needs in inpatient nursing workflows to inform exploratory design considerations for technology-integrated envisioned futures solutions. RESULTS:In total, 26 nursing staff across 4 inpatient hospital units participated in this study. Analysis identified four major themes considered central to designing a technology-integrated inpatient room that enhances nursing workflow and experience: (1) the need for seamless integration of technologies advocating for a unified system that minimizes fragmented technology use and enhances efficiency; (2) the potential for technology to reduce cognitive load, alleviate mental strain, and streamline complex workflows; (3) a focus on enhancing interpersonal communication with specific emphasis on tools that facilitate clear and efficient communication among clinicians and with patients; and (4) the importance of improved staff well-being with design considerations aimed at promoting both physical and mental health for health care workers in the inpatient setting. Envisioned future solutions included enhanced patient monitoring with automated measurements and actions through computer vision and data triangulation, a smart electronic health record-integrated supply management system using computer vision to detect supply shortages and auto-delivery of needed supplies, and a personal tech smart assistant capable of real-time patient monitoring and escalation, task prioritization, and hands-free clinical documentation and communication. CONCLUSIONS:While current technologies address specific tasks, there are significant opportunities for better technology integration, reducing cognitive load, enhancing communication, and promoting the physical and mental well-being of nursing staff. Future research should focus on seamless technology integration aligned with clinical workflows and implementing supportive technologies that do not interfere with clinician judgment and critical thinking. Policy recommendations include oversight mechanisms for evaluating artificial intelligence-enabled devices, safeguarding patient information, and ensuring nurses are actively involved at every stage of technology development and implementation. Future inpatient unit designs should actively engage input from both nursing professionals and technologists in developing future-proofed clinical spaces to ensure the creation of integrated systems that foster a cohesive and harmonious user experience.