Faculty Bibliography

BACKGROUND/OBJECTIVES/OBJECTIVE:Lean (a.k.a.: Sizzurp, Purple Drank) is a recreational beverage that commonly contains codeine cough syrup. Despite its popularization in the hip-hop music scene, few epidemiologic studies have examined use. This study examined prevalence and correlates of use among a population at high-risk for drug use-electronic dance music (EDM) party attendees. METHODS:A total of 1029 EDM party attendees (ages 18-40) were surveyed in New York City in 2018 using time-space sampling. Prevalence and correlates of use of Lean were estimated. RESULTS:An estimated 15.5% of attendees have ever used Lean, and 3.4% of attendees have used in the past year. Only an estimated 0.2% have used in the past month, but 14.2% would use in the next month if offered by a friend. Three-quarters (75.4%) of users believed their Lean ever contained codeine and 32.4% believed it always or usually contained codeine. Past-year use was strongly associated with past-year nonmedical prescription opioid use (adjusted odds ratio = 10.77, P = 0.003), but not past-year use of other illegal drugs. Attendees who are black or bisexual are at higher odds for past-year use, and those with a college degree or higher are at lower odds for past-year use. DISCUSSION AND CONCLUSIONS/CONCLUSIONS:While use of Lean is not as prevalent as use of various other drugs (eg, ecstasy) in this high-risk population, over a tenth have tried it and/or are willing to use it if offered. SCIENTIFIC SIGNIFICANCE/CONCLUSIONS:Prevention efforts need to target potential users as frequent use of beverages containing codeine products can lead to dependence. (Am J Addict 2019:1-6).

The current study tests whether accuracy and reaction time (RT) on the Hearts and Flowers (HF) task, a common assessment tool used across wide age ranges, can be leveraged as joint indicators of child executive function (EF) ability. Although previous studies have tended to use accuracy or RT, either alone or as separate indicators, one open question is whether these 2 metrics can be yoked together to enhance our measurement of EF ability. We test this question using HF data collected from first-grade children who participated in the Family Life Project. Specifically, we model the independent and interactive effects of HF accuracy and RT on several criterion outcomes representing child academic and behavioral competence. Our findings indicate that among early-elementary-aged children, accuracy and RT interact in the prediction of child outcomes, with RT being a more informative index of EF ability for children who perform at high levels of accuracy. The main effect of accuracy remained significant in the presence of these interactive effects. This pattern of findings was similar for different task blocks (i.e., mixed, flower-only) and for different child outcome domains (i.e., academic, behavioral). Our finding of an interaction between accuracy and RT contributes to a growing literature that attempts to jointly consider accuracy and RT as indicators of underlying ability, which has important implications for how EF task scores are constructed and interpreted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

There are many avenues by which early life poverty relates to the development of school readiness. Few studies, however, have examined the extent to which sustained attention, a central component of self-regulation in infancy, mediates relations between poverty-related risk and cognitive and emotional self-regulation at school entry. To investigate longitudinal relations among poverty-related risk, sustained attention in infancy, and self-regulation prior to school entry, we analyzed data from the Family Life Project, a large prospective longitudinal sample (N = 1292) of children and their primary caregivers in predominantly low-income and nonurban communities. We used structural equation modeling to assess the extent to which a latent variable of infant sustained attention, measured in a naturalistic setting, mediated the associations between cumulative poverty-related risk and three domains of self-regulation. We constructed a latent variable of infant sustained attention composed of a measure of global sustained attention and a task-based sustained attention measure at 7 and 15 months of age. Results indicated that infant sustained attention was negatively associated with poverty-related risk and positively associated with a direct assessment of executive function abilities and teacher-reported effortful control and emotion regulation in pre-kindergarten. Mediation analysis indicated that the association between poverty-related risk and each self-regulation outcome was partially mediated by infant attention. These results provide support for a developmental model of self-regulation whereby attentional abilities in infancy act as a mechanism linking the effects of early-life socioeconomic adversity with multiple aspects of self-regulation in early childhood.

Introduction & Objectives: Effective multifaceted dissemination and implementation are warranted for clinical practice guidelines to close the knowledge-to-action gap and promote guideline adherence. Digital media have transformed information exchange in the medical field, yet their potential for guideline dissemination has not been investigated yet. We aimed to perform a systematic review on digital dissemination strategies for clinical practice guidelines and to report from 4 years of experience within the @Uroweb #eauguidelines group. Material(s) and Method(s): We conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)guidelines searching both PubMed and the grey literature to identify articles on digital dissemination strategies for clinicalpractice guidelines. Using a step-wise approach, titles, abstracts and full texts were screened and assessed for inclusion according to pre-defined population, intervention, comparison, outcome, and study design (PICOS)criteria. Moreover, we collected outcome data for dissemination strategies employed by the EAU Guidelines Office Dissemination Committee. Result(s): After screening of 271 sources, 7 studies were included for qualitativenarrative synthesis. Dissemination strategies included internet-based e-learning interventions, interactive spaced education using email, abbreviated-teaching-tools, wireless technology enabling point-of-care guideline access and novel Social Media dissemination. The EAU Guidelines Office Dissemination Committee used the following strategies for multifaceted dissemination of guideline content (9-months-period): Twitter: #eauguidelines activity: 5,672 tweets by 1,522 participants leading to 11.2 million impressions. Facebook: 9 posts leading to 520 likes, 144 shares, 1,943 post clicks and a reach of 25,723. Instagram: 8 posts leading to 636 likes, 10,646 views and a reach of 6,589 unique visitors. Visual abstracts: 9 posts on Twitter and Facebook leading to a total reach >160,000. Homepage: 50% of uroweb.org traffic is guideline related. Conclusion(s): Reports on digital dissemination strategies for clinical practice guidelines are scarce and small-scale and include internet-based elearning interventions, interactive spaced education using email, abbreviated-teaching-tools, wireless technology enabling point-of-care guideline access and Social Media dissemination. Novel multifaceted digital dissemination strategies harnessing Twitter, Facebook, Instagram, Visual abstracts and web traffic lead to a high outreach and show potential for optimized dissemination of clinical practice guidelines.

Introduction & Objectives: In the United States, there are more than 115 deaths per day from an overdose of opioids. Previous studies from the US have reported that approximately 5% of opioid-naive surgical patients become chronic opioid users after a single prescription postoperatively. The aim of our study was to examine the risk of chronic opioid use following radical prostatectomy (RP)in a different health care system. Material(s) and Method(s): We assessed filled prescriptions for opioids in 25,703 men in Prostate Cancer data Base Sweden (PCBaSe)[1]who had undergone retropubic or robot-assisted RP in 2007-2018. Opioid use was examined in three time periods: preoperative (13 months to 1 month before RP), perioperative (1 month before and 1 month after RP), and postoperative (1 to 12 months after RP). Multivariable logistic regression was used to assess the risk of transition to chronic opioid use, defined as one or more opioid prescription(s)in three consecutive months more than two months after surgery. Result(s): The median age at RP was 64 years and 86% of men had a Charlson comorbidity index of 0. A total of 1.9% of men had filled an opioid prescription in the preoperative period, followed by a spike in the perioperative period (59%), which sharply decreased in the second month. In the postoperative period, the percentage of men who had filled an opioid prescription was 2.3% (i.e 0.4% higher than in the preoperative period). Among chronic late users, 43% were new users. Unmarried status, low educational level, retropubic RP, high comorbidity, and more advanced risk category were predictors of transition to chronic use of opioids. Conclusion(s): Slightly more than half of Swedish men received opioid prescriptions surrounding radical prostatectomy. The absolute number of patients who became chronic opioid users after surgery was low. Socioeconomic status, comorbidity, cancer characteristics, and surgical approach were all associated with risk of becoming a new chronic user after radical prostatectomy.

Background: Hypertension (HTN) is common among older adults and increases the risks for adverse outcomes. Blood pressure (BP) control for older adults is complex and nuanced, balancing medi-cation effects and competing risks. We implemented a patient-entered HTN control intervention in an urban geriatric medicine clinic.
Method(s): We identified patients with HTN at Bellevue Hospital's Geriatric Clinic age 65-75 with BPs >140/90 from the electronic medi-cal record. We asked each patient's primary care physician (PCP) to assign a BP goal and identify high-risk patients. We contacted patients determined by their PCP to need intensive BP management includ-ing medication side-effects and compliance assessment. We also developed a multi-pronged BP-control intervention clinic-wide for all patients, which included training nursing, medical assistant, and PCPs in best practices in BP measurement. We also ensured proper documentation, repeat measurement of all BP >150/90 and educa-tional materials for patients in English and Spanish. We scheduled a focused BP visit with a nurse within 2 weeks and if BP was not at goal, the patient would be seen by a physician for repeat BP measurement, compliance assessment and treatment optimization. We continued close follow up with these patients until they reached their BP goal.
Result(s): Pre-intervention, we identified 128 patients, of whom 71% had diabetes, 12% had a stroke, 20% had coronary artery disease, 15% had dementia, 8% problems with dizziness, and 69% problems with medication compliance per their PCP. The percentage of patients assigned to goal of BP<130/90 was 13%, 82% to a goal of <140/90, and 5% to a goal of <150/90. After PCP review, 42% (54 of 128) were at their specific BP goal based on home readings or proper in clinic measurement. After 4 months, among the 73 patients identified as needing further BP management, 52.1% were controlled. Clinic-wide, the percentage of patients whose blood pressure is <140/80improved from 66% to 74% within 4 months since program initiation. Our inter-vention is currently ongoing.
Conclusion(s): BP management among older adults requires indi-vidualized goals and intervention. Our interventions which empha-sized proper BP measurement and documentation, formal education of both providers and patients, and focused BP visits have improved BP control for our clinic population

Background: Forty percent of Americans are expected to develop type 2 diabetes mellitus (DM) within their lifetime, and up to one third of older adults with DM face co-occurring cognitive impair-ment and/or Alzheimer's disease and Related Dementia (ADRD). These co-morbidities create significant challenges in management for both patient and care partner, which is further compounded by a lack of consensus regarding optimal care. We conducted a systematic liter-ature review to better characterize the evidence guiding care for older patients with DM-ADRD.
Method(s): We used the PRISMA method to guide this system-atic review. A specialized librarian searched PubMed (Medline) using relevant search terms related to the management of DM and ADRD. This process yielded 2,158 DM studies and 1,401 ADRD studies. We included studies that were applicable to adults over 60 years old, published within the past 5 years, conducted within a primary care setting and written in English. Our review returned 267 DM and 104 ADRD focused results, of which 50 DM and 40 ADRD studies were included after abstract and full text review requiring two expert votes. Additionally, through expert opinion, we identified an additional 40 DM and 60 ADRD studies for inclusion.
Result(s): Based on this evidence, we identified methods for screening, diagnosis and management of patients with DM and ADRD as well as general principles related to care partner support, geriat-ric care, geriatric syndromes and goals for blood pressure and lipid management.
Conclusion(s): A review of the literature suggested the importance of individualizing care while monitoring and managing care partner stress, geriatric conditions, cognitive changes, complication risks, and glycemic, blood pressure, and cholesterol targets in order to achieve high quality care. The next steps are to use this information to generate decisional guidance for providers of older adults with DM-ADRD

Background: As many as 25% of older adults with diabetes (DM) may have co-occurring Alzheimer's Disease and Related Dementias (ADRD), complicated by over-and under-treatment, caregiver burden, and excess healthcare utilization. Despite these co-occurring conditions, there is no specific clinical guidance forsafe and high-quality treatment to achieve health outcomes that matter to patients andcaregivers. describe potential barriers and facilitators to implementing a quality improvement intervention focused on management of patients with DM-ADRD; and explore the support needs of patients and their family caregivers.
Method(s): This qualitative study was conducted in the forma-tive phase of "Enhanced Quality in Primary care for Elders with DM-ADRD (EQUIPED-ADRD) a pragmatic randomized controlled trial in a large, diverse healthcare system. Key stakeholder interviews with clinic staff, providers and caregivers (n=11) guided by a semi-structured interview guide elicited in-depth descriptions of current processes in clinical management including strengths and weaknesses; identified potential barriers and facilitators to the proposed intervention and explored patient and caregiver needs. Qualitative data were analyzed using content analysis and findings were used to refine the intervention.
Result(s): The overarching theme across all stakeholders was that DM-ADRD management should address the unique and individ-ualized needs of patients and caregivers without disrupting patient-provider relationships. Coordinated communication across teams and with patients/caregivers is essential. Caregivers reported increasing burden and need for resources to help manage day to day caregiver responsibilities including tangible (education, transportation, e.g.,) and emotional support.
Conclusion(s): An EQUPED-ADRD toolbox to facilitate interven-tion training and utilization and promote communication among the healthcare team and with patients/caregivers will support implemen-tation success. Activating existing available resources (social/nurs-ing services, respite care) and care coordination may help caregivers especially, as patient care needs increase over time. Health education should focus on DM and ADRD with ongoing re-education as care needs change

Background: Although the population of older adults is rising rapidly, the number of physicians seeking specialty training in geriat-rics is decreasing. This study of fellows in geriatrics training programs across the United States explored motivating factors that led fellows to pursue geriatrics as a career in order to inform the recruiting of more trainees to the field.
Method(s): 10-15 fellows were sought for interviews, until satu-ration was reached. 30-minute semi-structured telephone interviews were conducted by the primary investigator with fifteen geriatrics fellows from academic medical centers across the United States, 14 of whom were at Claude D. Pepper Older Americans Independence Centers. This qualitative study involved interviews that were tran-scribed and descriptively coded by two independent reviewers. A thematic analysis of the codes was summarized.
Result(s): Fifteen geriatrics fellows in seven different states partic-ipated in the study, and they revealed that mentorship and early clin-ical exposure to geriatrics were some of the most influential factors affecting career choice. Having positive attitudes and close relation-ships with older adults prior to medical school are other critical factors in influencing trainees to pursue careers in geriatrics.
Conclusion(s): The results of this study have the potential for a large impact, helping to inform best practices in encouraging trainees to enter the field, and enhancing medical student and resident exposure to geriatrics and mentorship from geriatricians. As the number of older individuals rises, we need innovative ways to draw medical students and residents to geriatrics. This study demonstrates the need for geri-atricians to serve not only as mentors to trainees but also as proactive ambassadors to the field

Background: The United States is experiencing a demographic shift, where the older adult population is expected to more than double from 32 million in 2012 to more than 88 million in 2050. Coupled with the current and anticipated shortage of providers, there is a need to identify alternative ways for clinicians to serve the healthcare needs of older adults. This is especially relevant in post-acute care (PAC) where one of the greatest challenges in providing comprehensive healthcare services is a lack of access. Alternative delivery models such as telehealth can allow providers to evaluate a resident with a change of condition, provide specialist consultations or manage care continuum transitions in place. Despite its benefits, telehealth adop-tion in PAC has been limited. Challenges in information dissemination on how telehealth can be used in PAC and lack of specific guidance on implementation for staff contributes to the lack of proliferation of telehealth models. Thus, there is a need for informative and guiding resources to assist PAC facilities in the implementation and utilization of telehealth tools and processes.
Method(s): The West Health Institute convened leading tele-health organizations to understand best practices for telehealth in PAC settings. The leading organizations that participated in this endeavor are Curavi Health, TripleCare, Avera eCARE, AGS, AMDA, Cobble Hill, CCHP, Foley & Lardner, LLC, SHARP HealthCare and UC San Diego Health.
Result(s): This collaboration developed and shared recommenda-tions on critical components of telehealth implementation to empower PAC settings to improve access and quality of care with telehealth. The completed implementation manual includes guidelines and recommendations on topics such as: Needs Assessments, Readiness Assessments, Financial and Reimbursement models, Implementation, Legal and Policy considerations and Performance Monitoring and Sustainability.
Conclusion(s): Through this extensive network of telehealth advocates, the goal of the collaboration is to disseminate learnings to advance telehealth implementation and enable older adults to success-fully age in place. With informative and guiding resources to assist staff, we can provide them with necessary tools to implement and utilize telehealth and help shape the next generation of post-acute care clinicians