Faculty Bibliography
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department:Medicine. General Internal Medicine
recentyears:2
school:SOM
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14544
Care Coordination for Mosunetuzumab Therapy in Patients With Follicular Lymphoma in Community Practices: Learnings From the MorningSun Study Investigators
BACKGROUND:Preliminary data from the MorningSun study have demonstrated that outpatient subcutaneous mosunetuzumab can be safely administered. AIMS/OBJECTIVE:This publication describes how community centers in the MorningSun phase 2 study of outpatient subcutaneous mosunetuzumab in B-cell non-Hodgkin lymphomas prepared workflow and logistics (staff coordination, practice networks, and patient support) to monitor patients for cytokine release syndrome (CRS) and other toxicities. MATERIALS AND METHODS/METHODS:Ten investigators at US community practice study sites (one rural, seven urban, and two rural/urban) were interviewed between January 12 and February 22, 2024. Interview transcripts were analyzed qualitatively to identify key themes. RESULTS:Prior to the study, 7/10 had limited/no experience administering bispecific antibodies for lymphoma. Regarding preparation before treatment, staff education was the most frequent need (7/10). All sites provided in-service training for staff involved with treatment administration. Most respondents (6/10) had multidisciplinary plans and agreed these eased logistical concerns. Out of hours, patients either called the triage team, a dedicated on-call number, the physician, or the emergency department. Most practices had preexisting relationships with hospitals for CRS management. All practices established methods for outpatient CRS monitoring; patient education and caregivers played important roles, and all respondents encouraged patients to use self-monitoring devices. Each community practice had different workflow and logistics based on their setting and infrastructure. CONCLUSION/CONCLUSIONS:Community practices can leverage other sites' experiences and adopt an individualized approach to implementing bispecific antibodies safely and efficiently. Designating a physician champion could provide a local resource to address staff questions and concerns.
PMCID:12117195
PMID: 40432369
ISSN: 2045-7634
CID: 5999192
When Accelerated MD Program Is Not the Right Path: The Why and How to Support Accelerated Learners in the Transition to the 4-Year Program
Accelerated 3-year medical school programs (A3YP) allow students to complete medical school in 3 years rather than the traditional 4-year program (4YP). This paper describes the perspective of 14 A3YPs, exploring the rate of and reasons for transition out of an accelerated pathway into a traditional 4YP. As of 2023, 19% of students in A3YP transitioned to 4YP. The authors provide practical recommendations to guide transitions based on pooled experiences and expert consensus from members of the Consortium of Accelerated Medical Pathway Programs (CAMPP). Having clear policies that define academic, clinical, and professional expectations and processes to guide transition is important.
PMCID:12228619
PMID: 40625988
ISSN: 2156-8650
CID: 5890562
Nurse Work Environment and Hospital Readmission Disparities Between Patients With and Without Limited English Proficiency
Minimal progress has been made in narrowing disparities between patients with and without limited English proficiency (LEP). Using 2016 data from RN4CAST-US, New Jersey Discharge Data Collection System, and AHA Annual Hospital Survey, multivariable logistic regression models were employed to examine whether and to what extent the hospital nurse work environment, defined as the conditions that nurses work in, is associated with decreased disparities in 7-day hospital readmissions between patients with and without LEP. Existing literature has established associations between nurse work environments and outcomes disparities of various minoritized populations; however, no literature has examined this relationship in the context of hospitalized patients with LEP. In a sample of 424,745 hospitalized adults (n = 38,906 with LEP), patients with LEP, compared to those without LEP, were younger (63.4 vs 64 years old, p < 0.001), more likely to be insured by Medicaid (8.9% vs 5.5%) or uninsured (7.5% vs 2%, p < 0.001), and readmitted (4.5% vs 3.9%, p < 0.001). Adjusting for patient and hospital characteristics, LEP patients had 33% higher odds of a 7-day readmission, as compared to patients without LEP (OR 1.33, 95% CI [1.19-1.47]). A significant interaction was found between patients' LEP status and the nurse work environment (OR 0.83, 95% CI [0.70-0.99]), such that patients with LEP experienced lower odds of 7-day readmission in more favorable nurse work environments, compared to patients without LEP. Hospitals dedicated to providing equitable healthcare may consider enhancing nurses' working conditions as a potential way to reduce disparities in readmission rates.
PMID: 40126025
ISSN: 1098-240x
CID: 5820392
Scholars in Health Equity: A Program of Structured Physician Faculty Development
BACKGROUND:Structured faculty development programs focused on integrating health equity into medical education curricula remain limited. AIM/OBJECTIVE:To describe an interdisciplinary faculty development program grounded in adult learning theory and to assess its impact on participants' professional growth. SETTING AND PARTICIPANTS/METHODS:Twenty-one faculty members across six academic-affiliated health systems. PROGRAM DESCRIPTION/METHODS:Fourteen 2-h monthly sessions were delivered over one full year. Course topics included health equity, adult learning theory, curriculum development, implicit bias, social determinants of health, racism, oppression, and collaborating with community partners. Educational strategies included reflections, small group discussions, logic models, and capstone development. PROGRAM EVALUATION/RESULTS:Using a Likert-type scale, participants rated all aspects of the program highly favorably, with median ratings ranging from 4 (agree) to 5 (strongly agree). Focus group results demonstrated that faculty experienced well-needed personal empowerment and professional growth in unexpected ways and identified several opportunities for programmatic growth. DISCUSSION/CONCLUSIONS:Program strengths included its interdisciplinary nature, creating a space to address isolation experienced by faculty working to advance health equity within their departments, advancement of skills to integrate health equity into their teaching contexts, and the opportunity for participants to envision their scholarship as part of a more extensive approach within the social determinants of health, health equity, and community health framework.
PMID: 39707094
ISSN: 1525-1497
CID: 5765012
Genome-wide analyses identify 30 loci associated with obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) affects ~1% of children and adults and is partly caused by genetic factors. We conducted a genome-wide association study (GWAS) meta-analysis combining 53,660 OCD cases and 2,044,417 controls and identified 30 independent genome-wide significant loci. Gene-based approaches identified 249 potential effector genes for OCD, with 25 of these classified as the most likely causal candidates, including WDR6, DALRD3 and CTNND1 and multiple genes in the major histocompatibility complex (MHC) region. We estimated that ~11,500 genetic variants explained 90% of OCD genetic heritability. OCD genetic risk was associated with excitatory neurons in the hippocampus and the cortex, along with D1 and D2 type dopamine receptor-containing medium spiny neurons. OCD genetic risk was shared with 65 of 112 additional phenotypes, including all the psychiatric disorders we examined. In particular, OCD shared genetic risk with anxiety, depression, anorexia nervosa and Tourette syndrome and was negatively associated with inflammatory bowel diseases, educational attainment and body mass index.
PMID: 40360802
ISSN: 1546-1718
CID: 5844232
Development and pilot of Trainers in Oncofertility Reproductive Communication and Health (TORCH) program
PURPOSE/OBJECTIVE:To evaluate outcomes from the Trainers in Oncofertility Reproductive Communication and Health (TORCH) program, which trains Allied Health Professionals (AHPs) to become leaders in counseling AYA cancer patients on reproductive health. METHODS:ECHO-TORCH was developed for alumni of the Enriching Communication Skills for Health Professionals in Oncofertility (ECHO) program. It included web-based modules on evidence-based content, adult learning principles, and a simulation exercise for skill practice. Evaluation involved pre/post-tests, skills assessments during simulation via standardized learners (SLs) and faculty observers, and online focus groups. RESULTS:ECHO-TORCH learners (n = 10) showed improved knowledge, from 76% on pre-test to 86% on post-test (p < 0.01). Both SLs (86%) and faculty observers (90%) showed high likelihood of inviting learners back for future presentations. In online focus groups, participants described the modules as clear, relevant, and highly satisfying. Learners appreciated the opportunity for practice and structured review of the ECHO content. CONCLUSIONS:The ECHO-TORCH program improved AHPs' knowledge and skills in teaching reproductive health content to AYA cancer patients. The train-the-trainer model empowers AHPs to disseminate knowledge within their institutions, ultimately improving care quality and empowering AYA patients to make informed decisions about reproductive health. IMPLICATIONS FOR CANCER SURVIVORS/CONCLUSIONS:Continued development of professionals in reproductive healthcare will significantly enhance cancer survivors' quality of life by supporting informed decision-making regarding their reproductive health.
PMID: 40413370
ISSN: 1932-2267
CID: 5855002
Real-World Evidence Linking the Predicting Risk of Cardiovascular Disease Events Risk Score and Coronary Artery Calcium
PMID: 40396415
ISSN: 2047-9980
CID: 5853092
Expectancy Effects, Failure of Blinding Integrity, and Placebo Response in Trials of Treatments for Psychiatric Disorders: A Narrative Review
IMPORTANCE/UNASSIGNED:Expectancy effects are significant confounding factors in psychiatric randomized clinical trials (RCTs), potentially affecting the interpretation of study results. This narrative review is the first, to our knowledge, to explore the relationship between expectancy effects, compromised blinding integrity, and the effects of active treatment/placebo in psychiatric RCTs. Additionally, we present statistical and experimental approaches that may help mitigate the confounding impact of expectancy effects. The review concludes with recommendations to enhance the reliability of RCTs in psychiatry. OBSERVATIONS/UNASSIGNED:The placebo response comprises both specific and nonspecific elements, with expectation being a key specific component. Evidence from experimental and clinical studies suggests that expectancy can influence treatment responses in RCTs. Blinding integrity may be compromised by perceived treatment efficacy and adverse effects, introducing bias into outcome assessments. Treatment expectations can lead to unblinding during RCTs, and meta-analytic data from studies in the fields of psychedelics and anxiety disorders indicate that this can influence effect sizes. Therefore, controlling for expectancy effects is essential when interpreting RCT results. Novel statistical methods, though still in need of further validation, offer strategies to address this issue. Another approach may involve experimental medicine models, which aim to develop objective improvement markers (readouts) less affected by expectancy effects. CONCLUSIONS AND RELEVANCE/UNASSIGNED:Expectancy effects represent a significant confound in psychiatric RCTs. We recommend collecting data on treatment expectations alongside monitoring blinding integrity to more accurately interpret study results. Additionally, developing objective readouts that are less confounded by expectancy effects offers another promising avenue for mitigating these confounding influences in psychiatric RCTs.
PMID: 40072447
ISSN: 2168-6238
CID: 5808482
Coaching in GME: Lessons Learned From 3 Unique Coaching Programs
PMCID:12080498
PMID: 40386485
ISSN: 1949-8357
CID: 5852782
The Impact of Telehealth on Buprenorphine Prescribing at a Large Federally Qualified Health Center during COVID-19
OBJECTIVES/OBJECTIVE:This study aims to explore the impact of telehealth on buprenorphine prescribing and retention in care for patients with opioid use disorder (OUD) seen at a large federally qualified health center (FQHC) the year prior to and following the start of the COVID-19 pandemic. METHODS:We conducted a retrospective study of patients with OUD and at least one medical visit to the FQHC between March 1, 2019, and February 28, 2021. This study utilized March 1, 2020, to delineate the beginning of COVID as the FQHC widely instituted telehealth during the month in response to the pandemic. We examined buprenorphine prescribing before and during year 1 of the pandemic; we applied logistic regression to estimate the association between telehealth and buprenorphine prescribing and we assessed buprenorphine retention through survival analysis. RESULTS:In the year before COVID, 24% of patients (502/2090) received buprenorphine compared with 31% (656/2110) during the first year of COVID ( P < 0.01). Patients with at least one telehealth visit were three times more likely to receive buprenorphine compared to those without telehealth (odds ratio: 3.2, confidence interval: 2.1-5.0). Among those who received buprenorphine, those with at least one telehealth visit were retained in buprenorphine care longer (hazard ratio: 2.7, confidence interval: 1.8-3.9). CONCLUSIONS:During the first year of COVID, telehealth was associated with increased likelihood that patients received buprenorphine; those who had telehealth remained in buprenorphine care longer compared to those who only had office-based visits. Increasing buprenorphine access through telehealth can play a significant role in retention in care for OUD.
PMID: 39560280
ISSN: 1935-3227
CID: 5779772
