Medicine and Health Sciences Commons^™

Lifestyle Tools For Men’S Health And Disease Prevention: Well-Being Through Nutrition, Physical Activity, Stress Management, And Connection, Leigh A. Frame

Clinical Research and Leadership Faculty Publications

Mental health is an often-overlooked aspect of overall health and wellness (well-being). Mental illness is increasingly common with 1 in 5 American adults experiencing it annually, and 1 in 20 suffering from a serious mental illness each year [1]. Treatment rates for mental illness are lower in men (37.4%) compared to women (51.2%) [1]. Globally, treatment rates are similar with an estimated cost to the global economy of $1 trillion annually, yet less than 2% of government health expenditure is for mental health worldwide [2]. Despite this, only nine studies have been published specifically targeting men’s mental health through lifestyle …

Depression, Burnout, And Professional Outcomes Among Pas., Sarah R Blackstone, Aimee K Johnson, Noël E Smith, Timothy C. Mccall, Whitney R Simmons, Ashley W Skelly

Clinical Research and Leadership Faculty Publications

OBJECTIVE: This study examined the effect of depression and burnout on PA professional fulfillment and medical errors.

METHODS: Eight hundred eighty PAs completed an online survey containing the Professional Fulfillment Index, PHQ-2, GAD-7, and demographic questions. Two serial mediation models examined the relationship between depression, burnout, and professional outcomes.

RESULTS: Burnout fully mediated the relationship between depression and outcomes in both models and the present research indicates that burnout plays a stronger role in job satisfaction than symptoms of depression.

CONCLUSIONS: Understanding the underpinnings of professional satisfaction may mitigate clinician turnover, which in turn may lead to cost savings for …

Telemedicine Visits In An Established Multidisciplinary Central Nervous System Clinic For Radiation Oncology And Neurosurgery (Radians) In A Community Hospital Setting., S C Bowen R, R Gheewala, Wa Paez, B Lucke-Wold, T Mitin, Jn Ciporen

Clinical Research and Leadership Faculty Publications

OBJECTIVE: To determine the impact of telemedicine visits, compared to in-person visits, on patient satisfaction in an established community hospital-based multidisciplinary central nervous system (CNS) clinic.

METHODS: Telemedicine options - virtual visits and teleconferencing - were introduced in July 2020. Both radiation oncologist and neurosurgeon were simultaneously present for the telemedicine visit. Descriptive patient demographics, survey responses, and travel time and distance calculations were analyzed. Satisfaction score was compared to previously published data.

RESULTS: A total of twenty-five telemedicine visits (n=22 video; n=3 phone) were completed since July 2020. Patient demographics are as follows: mean age was 59 years (range=22-81), …

Nutrition, A Tenet Of Lifestyle Medicine But Not Medicine?, Leigh A. Frame

Clinical Research and Leadership Faculty Publications

Nutrition is a foundation of health and one of six pillars of Lifestyle Medicine. The importance of nutrition in clinical care is now widely recognized by health care professionals and the public. However, clinicians are not comfortable counselling their patients on nutrition due to inadequate or lack of training, leaving a significant need in patient care. This gap can be closed with evidence-based curricula in medical schools and in the trainings of other health care professionals. This communication presents the current state of nutrition knowledge in health care, emphasizing nutrition education for physicians, and presents a model of how pre- …

Use Of Mhealth Technology For Patient-Reported Outcomes In Community-Dwelling Adults With Acquired Brain Injuries: A Scoping Review., Shannon B Juengst, Lauren Terhorst, Andrew Nabasny, Tracey Wallace, Jennifer A. Weaver, Candice L Osborne, Suzanne Perea Burns, Brittany Wright, Pey-Shan Wen, Chung-Lin Novelle Kew, John Morris

Clinical Research and Leadership Faculty Publications

The purpose of our scoping review was to describe the current use of mHealth technology for long-term assessment of patient-reported outcomes in community-dwelling individuals with acquired brain injury (ABI). Following PRISMA guidelines, we conducted a scoping review of literature meeting these criteria: (1) civilians or military veterans, all ages; (2) self-reported or caregiver-reported outcomes assessed via mobile device in the community (not exclusively clinic/hospital); (3) published in English; (4) published in 2015-2019. We searched Ovid MEDLINE(R) < 1946 to 16 August 2019, MEDLINE InProcess, EPub, Embase, and PsycINFO databases for articles. Thirteen manuscripts representing 12 distinct studies were organized by type of ABI [traumatic brain injury (TBI) and stroke] to extract outcomes, mHealth technology used, design, and inclusion of ecological momentary assessment (EMA). Outcomes included post-concussive, depressive, and affective symptoms, fatigue, daily activities, stroke risk factors, and cognitive exertion. Overall, collecting patient-reported outcomes via mHealth was feasible and acceptable in the chronic ABI population. Studies consistently showed advantage for using EMA despite variability in EMA timing/schedules. To ensure best clinical measurement, research on post-ABI outcomes should consider EMA designs (versus single time-point assessments) that provide the best timing schedules for their respective aims and outcomes and that leverage mHealth for data collection.

Evaluating Integration In Collaborative Cross-Disciplinary Fda New Drug Reviews Using An Input-Process-Output Model., Kevin Bugin, Gaetano R. Lotrecchiano, Michael O'Rourke, Joan Butler

Clinical Research and Leadership Faculty Publications

Background/Objectives: The US Food and Drug Administration (FDA) is responsible for assessing safety (risks) and effectiveness (benefits) of new drug products using the data provided in a Sponsor's new drug product marketing application before they can be marketed. The FDA forms cross-disciplinary review teams to conduct these assessments. Recently, the FDA began implementing more interdisciplinary approaches to its assessments, reducing redundancy in review processes and documentation by increasing team integration around review issues.

Methods: Through a phenomenological descriptive comparative case study, the impact of FDA's new interdisciplinary approach on review team integration was compared with its traditional multidisciplinary review approach. …

Towards Earlier Identification: Physicians Assistants' Perceptions Of Their Ability To Identify, Diagnose, And Refer Patients With Autism Spectrum Disorder., Denise Rizzolo, Noël E Smith, Timothy C. Mccall

Clinical Research and Leadership Faculty Publications

No abstract provided.

Design For Success: Identifying A Process For Transitioning To An Intensive Online Course Delivery Model In Health Professions Education., Paige L Mcdonald, Kenneth J Harwood, Joan T Butler, Karen S Schlumpf, Carson W Eschmann, Daniela Drago

Clinical Research and Leadership Faculty Publications

Intensive courses (ICs), or accelerated courses, are gaining popularity in medical and health professions education, particularly as programs adopt e-learning models to negotiate challenges of flexibility, space, cost, and time. In 2014, the Department of Clinical Research and Leadership (CRL) at the George Washington University School of Medicine and Health Sciences began the process of transitioning two online 15-week graduate programs to an IC model. Within a year, a third program also transitioned to this model. A literature review yielded little guidance on the process of transitioning from 15-week, traditional models of delivery to IC models, particularly in online learning …

Use Of Placebo In Supplementation Studies-Vitamin D Research Illustrates An Ethical Quandary., Leigh A. Frame, Jonathan P. Fischer, Gail Geller, Lawrence J Cheskin

Clinical Research and Leadership Faculty Publications

History has shown that without explicit and enforced guidelines, even well-intentioned researchers can fail to adequately examine the ethical pros and cons of study design choices. One area in which consensus does not yet exist is the use of placebo groups in vitamin supplementation studies. As a prime example, we focus on vitamin D research. We aim to provide an overview of the ethical issues in placebo-controlled studies and guide future discussion about the ethical use of placebo groups. Research in the field of vitamin D shows variation in how placebo groups are used. We outline four types of control …

Leukocyte Telomere Length, T Cell Composition And Dna Methylation Age., Brian H Chen, Cara L Carty, Masayuki Kimura, Jeremy D Kark, Wei Chen, Shengxu Li, Tao Zhang, Charles Kooperberg, Daniel Levy, Themistocles Assimes, Devin Absher, Steve Horvath, Alexander P Reiner, Abraham Aviv

Clinical Research and Leadership Faculty Publications

Both leukocyte telomere length (LTL) and DNA methylation age are strongly associated with chronological age. One measure of DNA methylation age-the extrinsic epigenetic age acceleration (EEAA)-is highly predictive of all-cause mortality. We examined the relation between LTL and EEAA. LTL was measured by Southern blots and leukocyte DNA methylation was determined using Illumina Infinium HumanMethylation450 BeadChip in participants in the Women's Health Initiative (WHI; n=804), the Framingham Heart Study (FHS; n=909) and the Bogalusa Heart study (BHS; n=826). EEAA was computed using 71 DNA methylation sites, further weighted by proportions of naïve CD8+ T cells, memory CD8+ T cells, and …

Deep Sequencing Transcriptome Analysis Of Murine Wound Healing: Effects Of A Multicomponent, Multitarget Natural Product Therapy-Tr14, Georges St. Laurent Iii, Bernd Seilheimer, Michael Tackett, Jianhua Zhou, Dmitry Shtokalo, Ian Toma, +Several Additional Authors

Clinical Research and Leadership Faculty Publications

Wound healing involves an orchestrated response that engages multiple processes, such as hemostasis, cellular migration, extracellular matrix synthesis, and in particular, inflammation. Using a murine model of cutaneous wound repair, the transcriptome was mapped from 12 h to 8 days post-injury, and in response to a multicomponent, multi-target natural product, Tr14. Using single-molecule RNA sequencing (RNA-seq), there were clear temporal changes in known transcripts related to wound healing pathways, and additional novel transcripts of both coding and non-coding genes. Tr14 treatment modulated >100 transcripts related to key wound repair pathways, such as response to wounding, wound contraction, and cytokine response. …

Doodle Health: A Crowdsourcing Game For The Co-Design And Testing Of Pictographs To Reduce Disparities In Healthcare Communication, Carrie Christensen, Doug Redd, Erica Lake, Jean P. Shipman, Heather Aiono, Roger Altizer Jr., Bruce Bray, Qing Zeng

Clinical Research and Leadership Faculty Publications

Supplementing patient education content with pictographs can improve the comprehension and recall of information, especially patients with low health literacy. Pictograph design and testing, however, are costly and time consuming.

We created a Web-based game, Doodle Health, for crowdsourcing the drawing and validation of pictographs. The objective of this pilot study was to test the usability of the game and its appeal to healthcare consumers. The chief purpose of the game is to involve a diverse population in the co-design and evaluation of pictographs.

We conducted a community-based focus group to inform the game design. Game designers, health sciences librarians, …

Dna Methylation-Based Measures Of Biological Age: Meta-Analysis Predicting Time To Death., B. Chen, R. Marioni, E. Colicino, M. Peters, C. Ward-Caviness, Cara L. Carty, +Several Additional Authors

Clinical Research and Leadership Faculty Publications

Estimates of biological age based on DNA methylation patterns, often referred to as "epigenetic age", "DNAm age", have been shown to be robust biomarkers of age in humans. We previously demonstrated that independent of chronological age, epigenetic age assessed in blood predicted all-cause mortality in four human cohorts. Here, we expanded our original observation to 13 different cohorts for a total sample size of 13,089 individuals, including three racial/ethnic groups. In addition, we examined whether incorporating information on blood cell composition into the epigenetic age metrics improves their predictive power for mortality. All considered measures of epigenetic age acceleration were …

Individual Motivation And Threat Indicators Of Collaboration Readiness In Scientific Knowledge Producing Teams: A Scoping Review And Domain Analysis, Gaetano R. Lotrecchiano, Trudy Mallinson, Tommy Leblanc-Beaudoin, Lisa S. Schwartz, Danielle Lazar, Holly J. Falk-Krzesinski

Clinical Research and Leadership Faculty Publications

This paper identifies a gap in the team science literature that considers intrapersonal indicators of collaboration as motivations and threats to participating in collaborative knowledge producing teams (KPTs). Through a scoping review process, over 150 resources were consulted to organize 6 domains of motivation and threat to collaboration in KPTs: Resource Acquisition, Advancing Science, Building Relationships, Knowledge Transfer, Recognition and Reward, and Maintenance of Beliefs. Findings show how domains vary in their presentation of depth and diversity of motivation and threat indicators as well as their relationship with each other within and across domains. The findings of 51 indicators resulting …

Variant Discovery And Fine Mapping Of Genetic Loci Associated With Blood Pressure Traits In Hispanics And African Americans., Nora Franceschini, Cara L. Carty, Yingchang Lu, Ran Tao, Yun Ju Sung, Ani Manichaikul, +20 Additional Authors

Clinical Research and Leadership Faculty Publications

Despite the substantial burden of hypertension in US minority populations, few genetic studies of blood pressure have been conducted in Hispanics and African Americans, and it is unclear whether many of the established loci identified in European-descent populations contribute to blood pressure variation in non-European descent populations. Using the Metabochip array, we sought to characterize the genetic architecture of previously identified blood pressure loci, and identify novel cardiometabolic variants related to systolic and diastolic blood pressure in a multi-ethnic US population including Hispanics (n = 19,706) and African Americans (n = 18,744). Several known blood pressure loci replicated in African …

Identification And Use Of Frailty Indicators From Text To Examine Associations With Clinical Outcomes Among Patients With Heart Failure., Yijun Shao, April F Mohanty, Ali Ahmed, Charlene R Weir, Bruce E Bray, Rashmee U Shah, Douglas Redd, Qing Zeng-Treitler

Clinical Research and Leadership Faculty Publications

Frailty is an important health outcomes indicator and valuable for guiding healthcare decisions in older adults, but is rarely collected in a quantitative, systematic fashion in routine healthcare. Using a cohort of 12,000 Veterans with heart failure, we investigated the feasibility of topic modeling to identify frailty topics in clinical notes. Topics were generated through unsupervised learning and then manually reviewed by an expert. A total of 53 frailty topics were identified from 100,000 notes. We further examined associations of frailty with age-, sex-, and Charlson Comorbidity Index-adjusted 1-year hospitalizations and mortality (composite outcome) using logistic regression. Frailty (≤ 4 …

Prescribing Multiple Neurostimulants During Rehabilitation For Severe Brain Injury., Amy A. Herrold, Theresa Louise-Bender Pape, Ann Guernon, Trudy Mallinson, Eileen Collins, Neil Jordan

Clinical Research and Leadership Faculty Publications

Background. Despite a lack of clear evidence, multiple neurostimulants are commonly provided after severe brain injury (BI). The purpose of this study is to determine if the number of neurostimulants received during rehabilitation was associated with recovery of full consciousness or improved neurobehavioral function after severe BI.

Method. Data from 115 participants were extracted from a neurobehavioral observational study database for this exploratory, retrospective analysis. Univariate optimal data analysis was conducted to determine if the number of neurostimulants influenced classification of four outcomes: recovery of full consciousness during rehabilitation, recovery of full consciousness within one year of injury, and meaningful …

Genomic Data-Sharing: What Will Be Our Legacy?, Shawneequa L. Callier, Rajah Husain, Rachel Simpson

Clinical Research and Leadership Faculty Publications

Prior to 1974, the Tuskegee Syphilis experiments, expansive use of the HeLa cells, and other blatant instances of research abuse pervaded the medical research field. Discussion today about these challenges have caused the general public to develop a reluctance and distrust for medical research. This has significant implications for the advancement of genomic science, and the public's perception of genomic research.

Defining Collaborative Science In An Age Of Translational Medicine, Gaetano R. Lotrecchiano

Clinical Research and Leadership Faculty Publications

No abstract provided.

Case Studies In Pediatric Team Science, R. Amin, S. Malcolm, S. Bedwell, Gaetano R. Lotrecchiano

Clinical Research and Leadership Faculty Publications

No abstract provided.

The Devil Is In The (Mis) Alignment: Developing Curriculum For Clinical And Translational Science Professionals, Ozgur Ekmekci, Gaetano R. Lotrecchiano, Mary A. Corcoran

Clinical Research and Leadership Faculty Publications

No abstract provided.

Towards “Collaborative Ethics” For Translational Medical Research Teams, Perry W. Payne, Shawneequa L. Callier, Attila J. Hertelendy

Clinical Research and Leadership Faculty Publications

No abstract provided.

The Science-Of-Team-Science, Transdisciplinary Capacity, And Shifting Paradigms For Translational Professionals, Gaetano R. Lotrecchiano

Clinical Research and Leadership Faculty Publications

The Science-of-Team-Science (SciTS) has become an important area of study as collaborative research becomes more normative throughout science inquiry and especially in medical and healthcare sectors. Team science aims for higher and collaborative levels of inquiry that operate within economies of knowledge similar to transdisciplinarity that strive to synthesize knowledge and innovate as a result of newly developed and hybridized methods of approach. This newly becoming and normalizing mode of science will require professionals to be aware of and embrace the shifting realities which have been the consequence of this new economy of knowledge. The next century of inquiry will …

Equality Of Outcome Or Equality Of Opportunity? A Simulation Of Wealth Distribution Using Agent-Based Modeling, Ozgur Ekmekci

Clinical Research and Leadership Faculty Publications

Against the backdrop of calls for a more just form of capitalism, this paper specifically focuses on the notion of equality within capitalist societies and utilizes findings from a computer simulation to explore which of one two fundamental principles, namely: (1) equality of opportunity; or (2) equality of outcome might better inform and guide reform efforts to create more uniform distribution of wealth among members of society. In this study, Agent Based Modeling (ABM), as a form of computer simulation was used to explore how the fundamental principles of equality of opportunity or equality of outcome might impact wealth …

Promoting Collaboration In Health Care Teams Through Interprofessional Education: A Simulation Case Study, Ozgur Ekmekci

Clinical Research and Leadership Faculty Publications

This simulation study explores how the integration of interprofessional components into health care curriculum may impact professional stereotyping and collaborative behavior in care delivery teams comprised of a physician, a registered nurse, a physician’s assistant, a physical therapist, and a radiation therapist. As part of the agent-based modeling simulation, 500 students completed a curriculum with no IPE component and another 500 completed the same curriculum in which 25% of the courses being offered had IPE components embedded. The 500 students completing the non-IPE curriculum were asked to randomly form 100 health care delivery teams consisting of a member from each …

Being There: Establishing Instructor Presence In An Online Learning Environment, Ozgur Ekmekci

Clinical Research and Leadership Faculty Publications

The purpose of this essay is to critically examine course structure and the role it may play in improving teaching presence in an asynchronous online learning environment. The examination is grounded in experiential learning; adult learning principles; case-based and problem-based learning methods; and peer reviews. The discussion is concluded with a proposed course structure and a learning intervention model that might be used to enhance and strengthen teaching presence for instructors engaged in asynchronous online education.

The Development And Testing Of The Continuity Assessment Record And Evaluation (Care) Item Set: Final Report On Care Item Set And Current Assessment Comparisons: Volume 3 Of 3, Barbara Gage, Ann Deutsch, Laura Smith, Carole Schwartz, Jessica Ross, Laurie Coots, Karen Reilly, Judith Hazard Abbate, Kate Shamsuddin, Benjamin Silver, Christopher Murtagh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

No abstract provided.

The Development And Testing Of The Continuity Assessment Record And Evaluation (Care) Item Set: Final Report On Reliability Testing, Volume 2 Of 3, Barbara Gage, Laura Smith, Jessica Ross, Laurie Coots, Tracy Kline, Kate Shamsuddin, Karen Reilly, Judith Hazard Abbate, Zachariah Gage-Croll, Anne Deutsch, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

No abstract provided.

The Development And Testing Of The Continuity Assessment Record And Evaluation (Care) Item Set, Volume 1 Of 3, Barbara Gage, Roberta Constantine, Jyoti Aggarwal, Melissa Morley, Vera Kurlantzick, Shulamit Bernard, Dianne Munevar, Megan Garrity, Laura Smith, Dan Barch, Anne Deutsch, Trudy Mallinson, Linda Ehrlich-Jones

Clinical Research and Leadership Faculty Publications

No abstract provided.

Post-Acute Care Payment Reform Demonstration: Final Report Volume 1 Of 4, Barbara Gage, Melissa Morley, Laura Smith, Melvin Ingber, Anne Deutsch, Tracy Kline, Jill Dever, Judith Abbate, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Kelleher, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …