Faculty Bibliography

Purpose of study Enhanced emergent literacy, child language scores, and school readiness as a result of Reach Out and Read (ROR) are well described. Less is known about clinicians' subjective experience of implementing the intervention. The purpose of this study was to better understand what clinicians find meaningful about ROR. Methods used This study was a collaboration between ROR and Continuity Research Network (CORNET). Faculty and residents at participating CORNET sites completed an online survey. Participants were asked 'What has been the most meaningful experience you have encountered with using ROR?' and 'Is there anything else you would like to add?' Responses were randomly assigned to 1 of 3 groups, each group of responses was coded by 2 researchers, who came to consensus through discussion; then all coding was discussed by all 6 coders until consensus was reached. Summary of results Qualitative responses were provided by >500 faculty members and residents from 42 institutions. Four themes emerged 1) Child/Family Impact: 'Seeing a child read for the first time' and 'Better interaction and understanding about the importance of reading from the parents.' 2) Physician Impact: 'It is my favorite part of the WCC.' 'I have been able to use the books provided as a way to connect with patients and their families.' 3) Impact on clinic practice: 'I enjoy modeling for parents and use the books to assess my patients' development' and 'helping a child who is verbally delayed catch up through ROR.' 4) Social Determinants of Health: 'The books provided are an invaluable resource to our underserved population. At times there are no books in the home besides the ones we provide the family during clinic visits.' Conclusions Clinicians who implement ROR find that it has a positive impact on their pediatric patients and families, an impact on their own satisfaction, and on the way they practice. In addition, clinicians value the fact that the program addresses social determinants of health and facilitates developmental surveillance. Further study is needed to better understand how clinician's perspectives affect, and are affected by, their practice experiences

Implementing uncontrolled donation after circulatory determination of death (uDCDD) in the United States could markedly improve supply of donor lungs for patients in need of transplants. Evidence from U.S. pilot programs suggests families support uDCDD, but only if they are asked permission for using invasive organ preservation procedures prior to initiation. However, non-invasive strategies that confine oxygenation to lungs may be applicable to the overwhelming majority of potential uDCDD donors that have airway devices in place as part of standard resuscitation. We propose an ethical framework for lung uDCDD by: (1) initiating post mortem preservation without requiring prior permission to protect the opportunity for donation until an authorized party can be found; (2) using non-invasive strategies that confine oxygenation to lungs; and (3) maintaining strict separation between the healthcare team and the organ preservation team. Attempting uDCDD in this way has great potential to obtain more transplantable lungs while respecting donor autonomy and family wishes, securing public support, and enabling authorized persons to affirm or cease preservation decisions without requiring evidence of prior organ donation intent. It ensures prioritization of life-saving, the opportunity to allow willing donors to donate, and respect for bodily integrity while adhering to current ethical norms.

Objectives:The purpose of the present study was to examine associations between life stress and incarceration history in relation to sexual health risk practices among a sample of cisgender Black gay, bisexual and other men who have sex with men (MSM) in the Deep South. Methods: Using data from a sample of 355 cisgender Black MSM in Mississippi and Georgia, multivariable logistic regression analyses were conducted to examine associations between life stress and sexual risk practices. In addition, we assessed whether stress may interact with experiences of incarceration to influence sexual health risk practices. Results: After controlling for sociodemographic characteristics, stress was associated with some sexual risk practices (e.g. alcohol and drug use during sex and group sex). Further, when an interaction with incarceration was assessed, among participants who had been incarcerated, high compared with low levels of stress were associated with alcohol use during sex (adjusted odds ratio (aOR) 4.59, 95% confidence interval (CI) 2.11-9.99, P < 0.001), drug use during sex (aOR 3.92, 95% CI 1.79-8.60, P < 0.001), condomless sex with casual partners (aOR 2.83, 95% CI 1.31-6.12, P < 0.001), having six or more casual partners (aOR 2.77, 95% CI 1.09-7.06, P = 0.02) and participating in group sex (aOR 5.67, 95% CI 2.07-15.51, P < 0.001). Stress and incarceration produced a dose-response effect for each association; similar associations with stress were not observed among men who had not been incarcerated. Conclusions: Among people with experiences of incarceration, there are several possible ways our findings could be applied practically, including through safer sex and stress management interventions designed specifically for Black MSM following their release.

Objectives: * Identify components of a new mode of palliative care delivery for the growing population of patients with advanced illness discharged from the ED. * Discuss success and challenges for the delivery of a nurse-led telephonic palliative care program. Original Research Background: The demand for palliative care has outstripped the supply of trained physicians. Nurse-led telephonic palliative care is a potential model to address the growing need for palliative care. Research Objectives:: * Describe the development of a novel nurse-led telephonic palliative care program for seriously ill patients who are discharged from the Emergency Department (ED). * Describe the program implementation. * Share preliminary operational and clinical outcomes.
Method(s): The nurse-led telephonic palliative care program is part of the EMPallA research study, a large Patient-Centered Outcomes Research Institute (PCORI)-funded randomized controlled trial comparing facilitated, outpatient specialty palliative care to nurse-led telephonic case management for seriously ill patients after an ED visit. Three palliative care certified nurses, under supervision of a Hospice and Palliative Medicine (HPM) physician, provided telephonic care to patients across seven states. Patients received weekly calls from the telephonic nurse for six months.
Result(s): Of the first 100 patients who completed the telephonic arm intervention, 78 patients (78%) were actively engaged, while 9 patients were lost to follow-up and 13 patients withdrew. Eighteen patients (18%) died during the intervention and, of those, 11 (61%) enrolled in hospice prior to death. The average caseload per nurse was 18 patients per week and an average of 10 calls were made to each patient over the six-month period. Telephonic nurses made a total of 206 outgoing calls or emails to the patient's care teams and received an average of 222 responses.
Conclusion(s): Preliminary results show that seriously ill patients and their caregivers are willing to engage with telephonic nurses. A majority of patients remained engaged throughout the six-month intervention, and nearly two-thirds of patients who died utilized hospice prior to death. Implications for Research, Policy or Practice: This model has the potential to augment traditional physician-led outpatient palliative care and may be preferable for many patients who have difficulty traveling to a clinic setting for palliative care.
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BACKGROUND:Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. OBJECTIVE:This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. METHODS:We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. RESULTS:We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. CONCLUSIONS:These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485.

Fields as diverse as human genetics and sociology are increasingly using polygenic scores based on genome-wide association studies (GWAS) for phenotypic prediction. However, recent work has shown that polygenic scores have limited portability across groups of different genetic ancestries, restricting the contexts in which they can be used reliably and potentially creating serious inequities in future clinical applications. Using the UK Biobank data, we demonstrate that even within a single ancestry group (i.e., when there are negligible differences in linkage disequilibrium or in causal alleles frequencies), the prediction accuracy of polygenic scores can depend on characteristics such as the socio-economic status, age or sex of the individuals in which the GWAS and the prediction were conducted, as well as on the GWAS design. Our findings highlight both the complexities of interpreting polygenic scores and underappreciated obstacles to their broad use.

Background/UNASSIGNED:Cigarette smoking is the most common form of tobacco consumption but other methods have grown in popularity. In the United Arab Emirates and other Gulf countries, smoking dokha, a form of tobacco mixed with herbs and spices in a midwakh pipe, is common. Aims/UNASSIGNED:The aim of this study was to determine the prevalence of midwakh use in school students in Lebanon and factors associated with its use. Methods/UNASSIGNED:Data on tobacco use from the Lebanon Global School-based Student Health Survey (GSHS), 2017 were analysed, including current midwakh use (defined as midwakh use at least once in the 30 days before the survey). The survey includes school students in grades 7-12 (12-18 years). Current midwakh use was analysed according to sociodemographic and tobacco-related variables using bivariate and logistic regression analyses. Results/UNASSIGNED:Of the 5590 students included in the analysis, 4.6% were current midwakh users. Current midwakh use was significantly more prevalent in students 13 years and older and in male students (P < 0.01). Current use was also statistically significantly more prevalent in students in public than private schools. Current cigarette smoking (OR = 15.22; 95% CI: 11.08-20.90), ever use of a waterpipe (OR = 9.61; 95% CI: 6.66-13.86) and parental smoking (OR = 1.56; 95% CI: 1.05-2.31) were also significantly associated with current midwakh use. Conclusion/UNASSIGNED:Although midwakh use is low in Lebanon, the patterns of association of midwakh use are similar to those of cigarette and waterpipe smoking in young people. Further research is needed to understand the context of midwakh use and prevent it from spreading.

BACKGROUND:The emergency department is a critical juncture in the trajectory of care of patients with serious, life-limiting illness. Implementation of a clinical decision support (CDS) tool automates identification of older adults who may benefit from palliative care instead of relying upon providers to identify such patients, thus improving quality of care by assisting providers with adhering to guidelines. The Primary Palliative Care for Emergency Medicine (PRIM-ER) study aims to optimize the use of the electronic health record by creating a CDS tool to identify high risk patients most likely to benefit from primary palliative care and provide point-of-care clinical recommendations. METHODS:A clinical decision support tool entitled Emergency Department Supportive Care Clinical Decision Support (Support-ED) was developed as part of an institutionally-sponsored value based medicine initiative at the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health. A multidisciplinary approach was used to develop Support-ED including: a scoping review of ED palliative care screening tools; launch of a workgroup to identify patient screening criteria and appropriate referral services; initial design and usability testing via the standard System Usability Scale questionnaire, education of the ED workforce on the Support-ED background, purpose and use, and; creation of a dashboard for monitoring and feedback. RESULTS:The scoping review identified the Palliative Care and Rapid Emergency Screening (P-CaRES) survey as a validated instrument in which to adapt and apply for the creation of the CDS tool. The multidisciplinary workshops identified two primary objectives of the CDS: to identify patients with indicators of serious life limiting illness, and to assist with referrals to services such as palliative care or social work. Additionally, the iterative design process yielded three specific patient scenarios that trigger a clinical alert to fire, including: 1) when an advance care planning document was present, 2) when a patient had a previous disposition to hospice, and 3) when historical and/or current clinical data points identify a serious life-limiting illness without an advance care planning document present. Monitoring and feedback indicated a need for several modifications to improve CDS functionality. CONCLUSIONS:CDS can be an effective tool in the implementation of primary palliative care quality improvement best practices. Health systems should thoughtfully consider tailoring their CDSs in order to adapt to their unique workflows and environments. The findings of this research can assist health systems in effectively integrating a primary palliative care CDS system seamlessly into their processes of care. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov Identifier: NCT03424109. Registered 6 February 2018, Grant Number: AT009844-01.