Digital Commons Network^™

Consensus Recommendations On The Treatment Of Opioid Use Disorder In The Emergency Department, Kathryn Hawk, Jason Hoppe, Eric Ketcham, Alexis Lapietra, Aimee Moulin, Lewis Nelson, Evan Schwarz, Sam Shahid, Donald Stader, Michael P Wilson, Gail D'Onofrio

2020-Current year OA Pubs

The treatment of opioid use disorder with buprenorphine and methadone reduces morbidity and mortality in patients with opioid use disorder. The initiation of buprenorphine in the emergency department (ED) has been associated with increased rates of outpatient treatment linkage and decreased drug use when compared to patients randomized to receive standard ED referral. As such, the ED has been increasingly recognized as a venue for the identification and initiation of treatment for opioid use disorder, but no formal American College of Emergency Physicians (ACEP) recommendations on the topic have previously been published. The ACEP convened a group of emergency physicians …

Predicting The Environmental Suitability For Onchocerciasis In Africa As An Aid To Elimination Planning, Elizabeth A. Cromwell, Ziyad Al-Aly, Et Al

Open Access Publications

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where …

Coding Of Sexual Assault By Emergency Physicians: A Nationally Representative Study, Vithya Murugan, Katherine J Holzer, Michael G Vaughn, Jason T Carbone, Dylan B Jackson, Cindy C Bitter

Open Access Publications

INTRODUCTION: Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. The American College of Emergency Physicians recommends coding such visits as sexual assault rather than adding modifiers such as "alleged."

METHODS: This study reviews factors associated with coding of visits as sexual assault compared to suspected sexual assault using the 2016 Nationwide Emergency Department Sample.

RESULTS: Younger age, female gender, …

Application Of Systems Dynamics And Group Model Building To Identify Barriers And Facilitators To Acute Care Delivery In A Resource Limited Setting, Fiona Muttalib, Ellis Ballard, Josephine Langton, Sara Malone, Yudy Fonseca, Andreas Hansmann, Kenneth Remy, Peter Hovmand, Allan Doctor

2020-Current year OA Pubs

BACKGROUND: Group model building (GMB) is a method to facilitate shared understanding of structures and relationships that determine system behaviors. This project aimed to determine the feasibility of GMB in a resource-limited setting and to use GMB to describe key barriers and facilitators to effective acute care delivery at a tertiary care hospital in Malawi.

METHODS: Over 1 week, trained facilitators led three GMB sessions with two groups of healthcare providers to facilitate shared understanding of structures and relationships that determine system behaviors. One group aimed to identify factors that impact patient flow in the paediatric special care ward. The …

Washington University Magazine, December 2021

Washington University Magazine

No abstract provided.

Washington University Magazine, August 2021

Washington University Magazine

No abstract provided.

Washington University Magazine, April 2021

Washington University Magazine

No abstract provided.

Barriers And Facilitators To Qualitative Data Sharing In The United States: A Survey Of Qualitative Researchers, Jessica Mozersky, Tristan Mcintosh, Heidi A. Walsh, Meredith V. Parsons, Melody Goodman, James M. Dubois

Open Access Publications

Qualitative health data are rarely shared in the United States (U.S.). This is unfortunate because gathering qualitative data is labor and time-intensive, and data sharing enables secondary research, training, and transparency. A new U.S. federal policy mandates data sharing by 2023, and is agnostic to data type. We surveyed U.S. qualitative researchers (N = 425) on the barriers and facilitators of sharing qualitative health or sensitive research data. Most researchers (96%) have never shared qualitative data in a repository. Primary concerns were lack of participant permission to share data, data sensitivity, and breaching trust. Researcher willingness to share would increase …

Development And Validation Of A Multivariable Prediction Model For Missed Hiv Health Care Provider Visits In A Large Us Clinical Cohort, April C. Pettit, Aihua Bian, Cassandra O. Schember, Peter F. Rebeiro, Jeanne C. Keruly, Kenneth H. Mayer, W. Christopher Mathews, Richard D. Moore, Heidi M. Crane, Elvin Geng, Sonia Napravnik, Bryan E. Shepherd, Michael J. Mugavero

Open Access Publications

Background: Identifying individuals at high risk of missing HIV care provider visits could support proactive intervention. Previous prediction models for missed visits have not incorporated data beyond the individual level.

Methods: We developed prediction models for missed visits among people with HIV (PWH) with ≥1 follow-up visit in the Center for AIDS Research Network of Integrated Clinical Systems from 2010 to 2016. Individual-level (medical record data and patient-reported outcomes), community-level (American Community Survey), HIV care site-level (standardized clinic leadership survey), and structural-level (HIV criminalization laws, Medicaid expansion, and state AIDS Drug Assistance Program budget) predictors were included. Models were developed …

Dissemination And Implementation Science In Plastic And Reconstructive Surgery: Perfecting, Protecting, And Promoting The Innovation That Defines Our Specialty, Jana Dengler, William M. Padovano, Kristen Davidge, Virginia Mckay, Andrew Yee, Susan E. Mackinnon

Open Access Publications

No abstract provided.

Identifying The Impact Of Intimate Partner Violence In Humanitarian Settings: Using An Ecological Framework To Review 15 Years Of Evidence, Melissa Meinhart, Ilana Seff, Katrina Troy, Samantha Mcnelly, Luissa Vahedi, Catherine Poulton, Lindsay Stark

Open Access Publications

Intimate partner violence (IPV) is a pervasive form of gender-based violence that exacerbates in humanitarian settings. This systematic review examined the myriad IPV impacts and the quality of existing evidence of IPV in humanitarian settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, a total of 51 articles were included from the 3924 screened. We identified the impact of IPV across two levels of the ecological framework: individual and microsystem. Our findings corroborated previous evidence that indicated IPV to be associated with adverse physical and mental health for survivors. Our findings also uniquely synthesized the intergenerational …

Progress In Diagnosing Primary Ciliary Dyskinesia: The North American Perspective, Michael Glenn O'Connor, Amjad Horani, Adam J Shapiro

Open Access Publications

Primary Ciliary Dyskinesia (PCD) is a rare, under-recognized disease that affects respiratory ciliary function, resulting in chronic oto-sino-pulmonary disease. The PCD clinical phenotype overlaps with other common respiratory conditions and no single diagnostic test detects all forms of PCD. In 2018, PCD experts collaborated with the American Thoracic Society (ATS) to create a clinical diagnostic guideline for patients across North America, specifically considering the local resources and limitations for PCD diagnosis in the United States and Canada. Nasal nitric oxide (nNO) testing is recommended for first-line testing in patients ≥5 years old with a compatible clinical phenotype; however, all low …

Study To Enhance Understanding Of Stent-Associated Symptoms: Rationale And Study Design, Charles D. Scales Jr., H. Henry Lai, Alana C. Desai, Jodi A. Antonelli, Naim M. Maalouf, Gregory E. Tasian, Peter P. Reese, Michele Curatolo, Kevin Weinfurt, Hussein R. Al-Khalidi, Hunter Wessells, Ziya Kirkali, Jonathan D. Harper, Niddk Urinary Stone Disease Research Network

Open Access Publications

No abstract provided.

Home Hazard Removal To Reduce Falls Among Community-Dwelling Older Adults: A Randomized Clinical Trial, Susan Stark, Marian Keglovits, Emily Somerville, Yi-Ling Hu, Abigail Barker, Dave Sykora, Yan Yan

Open Access Publications

Importance: Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults.

Objective: To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging.

Design, Setting, and Participants: This randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible …

Training Leaders To Accelerate Global Mental Health Disparities Research (Lead) Program: A Research Training Program Protocol, Ozge Sensoy Bahar, Patricia Cavazos-Rehg, Fred M Ssewamala, Betsy Abente, Laura Peer, Proscovia Nabunya, Lourdes E Soto De Laurido, Theresa S Betancourt, Arvin Bhana, Tonya Edmond

Open Access Publications

No abstract provided.

Factors Influencing Implementation Of Blood Transfusion Recommendations In Pediatric Critical Care Units, Katherine M Steffen, Philip C Spinella, Laura M Holdsworth, Mackenzie A Ford, Grace M Lee, Steven M Asch, Enola K Proctor, Allan Doctor

Open Access Publications

No abstract provided.

Understanding Drivers Of Coronavirus Disease 2019 (Covid-19) Racial Disparities: A Population-Level Analysis Of Covid-19 Testing Among Black And White Populations, Aaloke Mody, Kristin Pfeifauf, Cory Bradley, Branson Fox, Matifadza G. Hlatshwayo, Will Ross, Vetta Sanders-Thompson, Karen Joynt Maddox, Mat Reidhead, Mario Schootman, William G. Powderly, Elvin H. Geng

Open Access Publications

BACKGROUND: Disparities in coronavirus disease 2019 (COVID-19) testing-the pandemic's most critical but limited resource-may be an important but modifiable driver of COVID-19 inequities.

METHODS: We analyzed data from the Missouri State Department of Health and Senior Services on all COVID-19 tests conducted in the St Louis and Kansas City regions. We adapted a well-established tool for measuring inequity-the Lorenz curve-to compare COVID-19 testing rates per diagnosed case among Black and White populations.

RESULTS: Between 14/3/2020 and 15/9/2020, 606 725 and 328 204 COVID-19 tests were conducted in the St Louis and Kansas City regions, respectively. Over time, Black individuals consistently …

Teaching For Implementation: A Framework For Building Implementation Research And Practice Capacity Within The Translational Science Workforce, Aaron L Leppin, Ana A Baumann, Maria E Fernandez, Brittany N Rudd, Kathleen R Stevens, David O Warner, Bethany M Kwan, Rachel C Shelton

2020-Current year OA Pubs

Implementation science offers a compelling value proposition to translational science. As such, many translational science stakeholders are seeking to recruit, teach, and train an implementation science workforce. The type of workforce that will make implementation happen consists of both implementation researchers and practitioners, yet little guidance exists on how to train such a workforce. We-members of the Advancing Dissemination and Implementation Sciences in CTSAs Working Group-present the Teaching For Implementation Framework to address this gap. We describe the differences between implementation researchers and practitioners and demonstrate what and how to teach them individually and in co-learning opportunities. We briefly comment …

Veterans Health Administration's Whole Health System Of Care: Supporting The Health, Well-Being, And Resiliency Of Employees, Kavitha P Reddy, Tamara M Schult, Alison M Whitehead, Barbara G Bokhour

2020-Current year OA Pubs

The Veterans Health Administration (VHA) is implementing a Whole Health System (WHS) of care that empowers and equips Veterans to take charge of their health and well-being and live their lives to the fullest, and increasingly leaders recognize the need and value in implementing a similar approach to support the health and well-being of employees. The purpose of this paper is to do the following: 1) provide an overview of the WHS of care in VHA and applicability in addressing employee resiliency; 2) provide a brief history of employee well-being efforts in VHA to date; 3) share new priorities from …

Strategies For Effective Dissemination Of Research To United States Policymakers: A Systematic Review, Laura Ellen Ashcraft, Deirdre A Quinn, Ross C Brownson

2020-Current year OA Pubs

BACKGROUND: Research has the potential to influence US social policy; however, existing research in this area lacks a coherent message. The Model for Dissemination of Research provides a framework through which to synthesize lessons learned from research to date on the process of translating research to US policymakers.

METHODS: The peer-reviewed and grey literature was systematically reviewed to understand common strategies for disseminating social policy research to policymakers in the United States. We searched Academic Search Premier, PolicyFile, SocINDEX, Social Work Abstracts, and Web of Science from January 1980 through December 2019. Articles were independently reviewed and thematically analyzed by …

A Patient-Centred, Comprehensive Model For The Care For Heart Failure: The 360° Heart Failure Centre, Ilia G Halatchev, Jay R Mcdonald, Wen-Chin Wu

Open Access Publications

No abstract provided.

Are We Ready To Share Qualitative Research Data? Knowledge And Preparedness Among Qualitative Researchers, Irb Members, And Data Repository Curators, Jessica Mozersky, Heidi Walsh, Meredith Parsons, Tristan Mcintosh, Kari Baldwin, James M Dubois

Open Access Publications

Data sharing maximizes the value of data, which is time and resource intensive to collect. Major funding bodies in the United States (US), like the National Institutes of Health (NIH), require data sharing and researchers frequently share de-identified quantitative data. In contrast, qualitative data are rarely shared in the US but the increasing trend towards data sharing and open science suggest this may be required in future. Qualitative methods are often used to explore sensitive health topics raising unique ethical challenges regarding protecting confidentiality while maintaining enough contextual detail for secondary analyses. Here, we report findings from semi-structured in-depth interviews …

The Current State Of Hiv And Aging: Findings Presented At The 10th International Workshop On Hiv And Aging, Stephanie Shiau, Jane A. O'Halloran, Et Al.

Open Access Publications

No abstract provided.

Defining And Conceptualizing Outcomes For De-Implementation: Key Distinctions From Implementation Outcomes, Beth Prusaczyk, Taren Swindle, Geoffrey Curran

Open Access Publications

BACKGROUND: Increasingly, scholars argue that de-implementation is a distinct concept from implementation; factors contributing to stopping a current practice might be distinct from those that encourage adoption of a new one. One such distinction is related to de-implementation

CONCEPTUALIZATION OF OUTCOMES: We conceptualize each of the outcomes from Proctor and colleagues' taxonomy of implementation outcomes for de-implementation research. First, we suggest key considerations for researchers assessing de-implementation outcomes, such as considering how the cultural or historical significance to the practice may impact de-implementation success and, as others have stated, the importance of the patient in driving healthcare overuse. Second, we …

Washington University Magazine, November 2020

Washington University Magazine

No abstract provided.

The Long-Term Effects Of A Family Based Economic Empowerment Intervention (Suubi+Adherence) On Suppression Of Hiv Viral Loads Among Adolescents Living With Hiv In Southern Uganda: Findings From 5-Year Cluster Randomized Trial, Fred M. Ssewamala, Darejan Dvalishvili, Claude A. Mellins, Elvin H. Geng, Fredderick Makumbi, Torsten B. Neilands, Mary Mckay, Christopher Damulira, Proscovia Nabunya, Ozge Sensoy Bahar, Gertrude Nakigozi, Godfrey Kigozi, William Byansi, Miriam Mukasa, Flavia Namuwonge

Open Access Publications

BACKGROUND: The rapid scale-up of HIV therapy across Africa has failed to adequately engage adolescents living with HIV (ALWHIV). Retention and viral suppression for this group (ALWHIV) is 50% lower than for adults. Indeed, on the African continent, HIV remains the single leading cause of mortality among adolescents. Strategies tailored to the unqiue developmental and social vulnerabilities of this group are urgently needed to enhance successful treatment.

METHODS: We carried out a five-year longitudinal cluster randomized trial (ClinicalTrials.gov ID: NCT01790373) with adolescents living with HIV (ALWHIV) ages 10 to 16 years clustered at health care clinics to test the effect …

Self-Perception Of Physical Function Contributes To Participation In Cognitively- And Physically-Demanding Activities After Stroke, Marjorie L Nicholas, Kari Burch, Julianne R Mitchell, Annie B Fox, Carolyn M Baum, Lisa Tabor Connor

Open Access Publications

No abstract provided.

Mental Health And Weather Extremes In A Southeastern U.S. City: Exploring Group Differences By Race, Lisa Reyes Mason, Bonita B Sharma, Jayme E Walters, Christine C Ekenga

Open Access Publications

The connection between mental health and weather extremes is a public health concern, but less studied to date than physical health. This exploratory study examines the mental health impacts of two kinds of weather extremes increasingly linked to climate change-summer heat waves and extreme winter weather-in a low- to middle-income population in the Southeastern U.S. The distribution of mental health impacts, and potential pathways to them, are examined with a focus on race. Data are from a random-sample survey of 426 participants and are analyzed with bivariate statistics and path analysis. Self-reported mental health impacts, in both seasons, were common …

Understanding Antibiotic Prophylaxis Prescribing In Pediatric Surgical Specialties, Sara M Malone, Natalie S Seigel, Jason G Newland, Jacqueline M Saito, Virginia R Mckay

Open Access Publications

BACKGROUND: Overuse of antibiotics has caused secondary poor outcomes and has led to a current rate of antibiotic resistant infections that constitutes a public health crisis. In pediatric surgical specialties, children continue to receive unnecessary antibiotics.

OBJECTIVE: To understand the factors that contribute to pediatric surgeons' decisions regarding the use of perioperative antibiotic prophylaxis.

METHODS: Focus groups included pediatric proceduralists/surgeons from the following specialties: interventional cardiology, otolaryngology, orthopedic surgery, cardiothoracic surgery, and general surgery.

RESULTS: A total of 23 surgeons with a median of 9 years of experience (range, 0.5-29 years) participated in the focus groups that lasted 30-90 minutes …

Proactive Prevention: Act Now To Disrupt The Impending Non-Communicable Disease Crisis In Low-Burden Populations, Benson Njuguna, Angela Brown, Victor G. Davila-Roman, Et Al.

Open Access Publications

Non-communicable disease (NCD) prevention efforts have traditionally targeted high-risk and high-burden populations. We propose an alteration in prevention efforts to also include emphasis and focus on low-risk populations, predominantly younger individuals and low-prevalence populations. We refer to this approach as "proactive prevention." This emphasis is based on the priority to put in place policies, programs, and infrastructure that can disrupt the epidemiological transition to develop NCDs among these groups, thereby averting future NCD crises. Proactive prevention strategies can be classified, and their implementation prioritized, based on a 2-dimensional assessment: impact and feasibility. Thus, potential interventions can be categorized into a …