Faculty Bibliography

ObjectivesThis quality improvement project evaluated trends in guideline-concordant statin prescription rates during implementation of an email-based nudge intervention among healthcare providers at a large FQHC network.MethodsEligible encounters included patients meeting UDS guideline criteria but not receiving treatment. On the morning of each eligible visit, providers received an email nudge. Providers were categorized as early adopters or non-early adopters, with early adopters defined as opening >50% of emails during this period. Outcomes included provider-level prescribing rates, and encounter-level prescribing stratified by email engagement. This study was designed, conducted, and reported in accordance with SQUIRE 2.0 guidelines.ResultsSeventy-five providers who received ≥5 nudges within the first three months were included in the early adopter analysis, and a total of 124 providers with 1,236 unique patient encounters were analyzed over 12 months for encounter-level prescribing rates. Guideline-concordant statin prescribing was modestly higher over time in both groups (early adopters: 85.6% to 89.2%, p < 0.001; non-early adopters: 83.3% to 89.4%, p < 0.001), with no significant evidence of differences between groups over the 1-year period (p = 0.734). At the encounter level, while successful prescribing occurred in 21.8% of visits when the email was opened prior to the encounter compared with 19.5% when it was not opened, this difference was not statistically significant (p = 0.442).ConclusionGuideline-concordant statin prescribing was modestly higher over the study period, though no differential association by email engagement was observed. Given that email nudges are scalable and low-cost, they have the potential to serve as useful adjunctive tools, however further research is needed in settings lacking EHR-integrated alerts or with lower baseline adherence.

This practice guideline provides updated evidence-based recommendations regarding the use of pharmacologic migraine prevention in adults. A multidisciplinary panel conducted a systematic review and developed practice recommendations following the process outlined in the 2017 edition of the American Academy of Neurology Clinical Practice Guideline Process Manual. The systematic review includes studies published through June 6, 2024, and is available in a companion publication. Recommendations are supported by structured rationales that integrate evidence from the systematic review, related evidence, principles of care, and inferences from evidence. Recommendations are provided on how to decide when it is appropriate to start a pharmacologic migraine preventive medication and how to decide which migraine preventive medication to start. Recommendations address decision making on appropriate choices of migraine preventive medications in specific situations and populations, including patients with fibromyalgia, obesity, or hypertension; considerations for older adults; treatment during pregnancy and lactation; sex-related factors in choosing medications; and treatment for patients with medication overuse. Recommendations on assessment of treatment efficacy, adverse effects, and discontinuing migraine preventive medications are provided.

Subjective cognitive decline (SCD) refers to cognitive concerns that may occur with or without objective impairment on standardized testing. Studies suggest that SCD may be an early clinical marker of Alzheimer's disease and related dementias, and that it can predict future objective cognitive decline and progression to dementia. However, the research that supports these conclusions is primarily based on samples with homogeneous socioeconomic and cultural backgrounds. The limited studies in samples with more diverse representations of racial, ethnic, gender, and sexual orientation characteristics show varying SCD prevalence, correlates, and outcomes. Here, we review this literature, focusing on how to apply the findings to advance our understanding of SCD. We further evaluate how our findings inform a roadmap for future research. Overall, we conclude that broader investigations across more diverse populations enhance our understanding of the factors that may differentially contribute to SCD and shape its utility as a clinical metric.

INTRODUCTION/BACKGROUND:Repetitive head impacts (RHIs) have been linked to later life neurodegeneration, yet the in vivo structural correlates of cumulative biomechanical loading remain unclear. We examined whether regional ventricular morphology in former American football players reflects exposure burden and traumatic encephalopathy syndrome (TES) classification. METHODS:Participants included 170 male former football players and 54 age-matched asymptomatic male controls from the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy Research Project. Subject-specific manual segmentation quantified lateral ventricle, inferior horn, third ventricle, and fourth ventricle volumes. Group and exposure associations were tested using generalized least squares models. RESULTS:Former players showed larger left inferior lateral ventricle volume than controls, with the largest effects among professional players. Greater cumulative linear and rotational acceleration exposure was associated with enlargement across lateral ventricular and inferior horn regions. DISCUSSION/CONCLUSIONS:Regional ventricular enlargement may represent an in vivo marker of cumulative biomechanical loading after RHI exposure.

INTRODUCTION/UNASSIGNED:Older adults with chronic kidney disease (CKD) likely face higher dementia risk because of vascular injury and chronic inflammation, potentially intensified among racially minoritized groups and those in rural or deprived neighborhoods. We quantified this association and examined variation by race and ethnicity, urbanicity, and neighborhood deprivation. METHODS/UNASSIGNED:We identified 211,321 older adults with CKD stages 3 to 5 from the Medicare 5% sample (2010-2022) using International Classification of Diseases (ICD)-9 and/or ICD-10 codes. Zone Improvement Plan (ZIP)-code level urbanicity was defined using Rural-Urban Commuting Area Codes, and neighborhood deprivation was derived from the American Community Survey. We used cause-specific hazard models with time-varying CKD stage (reference = stage 3) to quantify the adjusted hazard ratio (aHR) of dementia and included interaction terms to test the differential effect of these associations by race and/or ethnicity, urbanicity, and neighborhood deprivation. RESULTS/UNASSIGNED:= 0.04). Among older Black (stage 4 aHR: 1.38, 95% CI: 1.28-1.48; stage 5 aHR: 2.01, 95% CI: 1.88-2.15) and Hispanic adults (stage 4 aHR: 1.33, 95% CI: 1.10-1.62; stage 5 aHR: 1.98, 95% CI: 1.67-2.34), stages 4 and 5 were associated with a higher risk of dementia. Among older adults in high-deprivation neighborhoods, stage 5 was associated with a higher risk of dementia (aHR: 1.89, 95% CI: 1.80-1.99). CONCLUSION/UNASSIGNED:CKD stages 4 and 5 were associated with a higher dementia risk, particularly among older Black adults and those in high-deprivation neighborhoods. These findings may inform targeted interventions for early detection and management of cognitive decline in advanced CKD.

Aside from specific occupational exposures, ingestion is believed to be the primary route of exposure to PFAS, a class of forever chemicals known for their ability to repel oil and water, reduce friction, and resist high temperatures. The goal was to explore the geographic distribution of PFAS water contamination versus human exposure and identify dietary factors that may explain high PFAS levels among rural residents. We performed PFAS analyses among 160 rural participants, who provided blood samples and survey responses in our chemical exposure cross-sectional study. We mapped the geographic distribution of PFAS contamination based on water testing versus human samples results. We also used health surveys and food frequency questionnaire data to identify factors associated with high PFAS levels. The geographic mismatch between the distribution of PFAS water contamination and human exposure highlights the need to assess other potential sources, which identified potential dietary sources of these chemical hazards.

Reproductive health disparities disproportionately affect adolescents of color in the United States, particularly in contraceptive access, utilization, and knowledge. Because parents strongly shape adolescents' contraceptive behaviors, understanding their perspectives is essential for addressing inequities. This scoping review synthesized evidence on parental attitudes toward adolescent contraception in racially and ethnically diverse communities to inform culturally responsive interventions. Following PRISMA-ScR guidelines, seven databases were systematically searched for U.S.-based, peer reviewed studies (2008-2023) examining contraception-related perceptions among parents or guardians of adolescents of color. Twenty studies met inclusion criteria (cross-sectional surveys [n=4], focus groups [n=4], interviews [n=5], quasi-experimental controlled trial [n=1], mixed-methods [n=6]); most addressed contraception broadly rather than specific methods. Study quality, assessed using the Mixed Methods Appraisal Tool, was predominantly high (18/20). Key themes included limited parental contraceptive knowledge, reliance on schools or clinicians for sexual health education, gendered and indirect communication, and cultural or religious norms discouraging adolescent sexual activity. Mistrust of healthcare systems, safety concerns, fear of promoting sexual behavior, and the influence of structural inequities, stigma, and misinformation were common across communities. Addressing parental knowledge gaps, communication barriers, and systemic mistrust is critical to reducing contraceptive disparities through culturally tailored education and strengthened family-healthcare partnerships.

BACKGROUND:Tissue-based gene expression assays provide prognostic information in prostate cancer, but their influence on decisions regarding immediate treatment versus conservative management, including active surveillance (AS) and watchful waiting (WW), remains uncertain. METHODS:Using a linkage with the Surveillance, Epidemiology, and End Results program, we evaluated the association between a 22-gene genomic classifier (GC) and initial management among patients with low or intermediate clinical-risk prostate cancer diagnosed from 2015 through 2018. Initial management was classified as immediate therapy or AS/WW, and GC scores were grouped as low (<0.45), intermediate (0.45-0.60), or high (>0.60). Multivariable logistic regression assessed associations between GC category and immediate treatment, stratified by clinical-risk group and adjusted for demographic and clinical covariates. RESULTS:Among 2,547 patients, 286 of 1,030 (27.8%) with low- and 1,113 of 1,517 (73.4%) with intermediate clinical-risk prostate cancer received initial treatment. Use of initial treatment increased with higher GC category. Among patients with low and intermediate clinical-risk prostate cancer, respectively, 20.5% and 57.5% with low GC, 28.3% and 75.8% with intermediate GC, and 46.2% and 88.3% with high GC scores received initial treatment. Higher GC category was independently associated with greater odds of immediate treatment versus AS/WW (versus low GC: intermediate GC, odds ratio [OR] 1.98, 95% confidence interval [CI] 1.57-2.49, p < 0.001; high GC, OR 4.42, 95% CI 3.41-5.71, p < 0.001). CONCLUSIONS:Higher GC scores were associated with greater use of immediate treatment and less use of AS/WW, underscoring the need to determine whether GC testing also predicts long-term outcomes among patients managed with AS.

BACKGROUND:Public awareness of concussion has grown significantly over the past 2 decades, driven largely by media coverage of sports-related injuries. This has paralleled a rise in traumatic brain injury (TBI)-related emergency department visits, underscoring the need for specialized concussion care centers. Despite this, most existing programs focus on sports or pediatric populations, leaving critical care gaps. RECENT FINDINGS/RESULTS:The NYU Langone Concussion Center was established in 2013 to address these gaps by providing interdisciplinary care for both sports-related and non-sports-related concussions. Approximately 60% of cases seen at the center are not sports related. This article outlines the center's inception, operational model, patient demographics, and evolution over the past decade. IMPLICATIONS FOR PRACTICE/CONCLUSIONS:Lessons learned from the NYU Langone model offer valuable guidance for developing comprehensive concussion programs that can serve diverse urban populations. Key strategies include cross-specialty collaboration, flexible infrastructure, and systems-level integration to address heterogeneous mechanisms of injury and outcomes.

[This corrects the article DOI: 10.1016/j.lana.2024.100895.].