User-Centered Design of Trauma Systems Solutions for Retriage of Patients With Injury: Mixed Methods Study.

Background: Retriage is the emergent interhospital transfer of severely injured patients from nontrauma and low-level trauma centers to high-level trauma centers. An estimated 17%-34% of patients with traumatic injury are undertriaged to nontrauma or low-level trauma centers in the United States each year. These patients see 30% increased odds of mortality at 48 hours and nearly 4-fold increased odds of overall mortality.

Leveraging User-Centered Design and Usability and Skills Testing for a Novel Diabetes Survival Skills Toolkit.

Purpose: With the expansion of telemedicine, patient-centered approaches for delivering diabetes mellitus (DM) self-care education in both in-person and remote settings are needed. A novel Diabetes Survival Skills Toolkit (Kit) (physical toolkit, website, paper guide) was developed, using a user-centered design approach. The aim of this study was to develop a hybrid protocol to assess the perceived usability of the Kit and the skills attainment of its users.

The human gut microbiome and its metabolic pathway dynamics before and during HIV antiretroviral therapy.

The human gut microbiome consists of highly complex microbial populations that play important roles in disease pathogenesis. Changes in the gut microbiome are associated with HIV infection. However, it is unclear whether gut microbiome dysbiosis is causally linked to disease or whether it simply reflects disease-induced changes in the host immune and metabolic systems.

Identification of neurological text markers associated with risk of stroke.

Background: Delayed or missed stroke diagnosis is associated with poor outcomes. We utilized natural language processing of notes from non-neurological emergency department (ED) encounters to identify text phrases indicating stroke presentations that are associated with stroke hospitalization 30 days after ED discharge.

Methods: We conducted a retrospective analysis of stroke (case) and gastroenteritis (matched-control) patients at two academic medical centers who had an ED encounter 30 days before index admission diagnosis.

Evaluating Acute Stroke Diagnosis Using Simulation Scenarios.

Study Objective: This study sought to explore the clinical and process factors that, alone or in combination, influence the accuracy of stroke diagnosis in the emergency department (ED) by applying a novel design of experiments methodology.

Methods: We used design of experiments, a branch of applied statistics, to create a screening experiment comprised of patient simulation scenarios in which purposeful changes are made to prespecified factors thought to potentially influence the outcome of interest. We used 4 base case scenarios (typical and atypical acute ischemic stroke, intracerebral hemorrhage, and complex migraine [a stroke mimic]) and 12 prespecified clinical factors thought to influence stroke diagnosis (eg, patient age, history of seizure, and interruption occurring during patient assessment that the physician must attend to [distraction]) based on literature review and expert opinion.

Trends in Preventable Hospitalization Rates for Children With or Without Observation Stay Data.

Importance: Potentially preventable hospitalization rates are widely endorsed quality indicators that have been used to evaluate the impact of policies on access to high-quality primary and ambulatory care for children. Although potentially preventable hospitalization rates have been decreasing, little is known about how these trends are associated with the exclusive reliance on inpatient data, which omit observation status, a common designation for pediatric hospital stays.

Objective: To assess the implications of omitting observation stay data on potentially preventable hospitalization rate calculations over time.

Use of biobehavioral interventions in children undergoing surgery and associated patient-reported outcomes.

Background: Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.

Methods: We conducted an embedded mixed-methods study with a quantitative focus.

Preoperative Glucagon-Like Peptide-1 Receptor Agonist Utilization and Association with Bariatric Surgery Outcomes.

Background: The efficacy of Glucagon-Like Peptide-1 Receptor Agonists (GLP1RA) for the treatment of obesity has led to considerably increased demand for these medications. GLP1RA use prior to bariatric surgery may represent a novel approach to treating obesity. The objectives of this study were to (1) describe trends in pre-bariatric GLP1RA use, (2) investigate social and clinical factors associated with their use, and (3) evaluate differences in clinical outcomes based on preoperative GLP1RA use.

Slow Down Fluids to Speed Up the Intestine - Exploring Postoperative Ileus in Pediatric Gastrointestinal Surgery.

Introduction: Postoperative ileus is a known complication of gastrointestinal (GI) surgery. In adult populations, ileus is associated with higher amounts of intraoperative intravenous (IV) fluids. This study examines the relationship between intraoperative IV fluids and postoperative ileus in pediatric patients undergoing GI surgery.

Assessment of printed lung cancer surgery patient education materials in the United States.

Objective: Well-designed patient education materials (PEMs) increase health literacy, which has been linked to better surgical patient outcomes. The quality of lung cancer surgery PEMs is unknown, however. Here we assessed printed lung cancer surgery PEMs for readability, understandability, actionability, and accessibility.

Barriers to Interconception Care Delivery in Primary Care: Clinician, Staff, and Patient Perspectives.

Purpose: Many reproductive age women, cared for routinely by primary care providers (PCPs), would benefit from interconception care, yet a minority of primary care visits include interconception care. This study assessed barriers to providing interconception care from the perspective of primary care clinicians, staff, and patients.

Materials And Methods: Clinicians ( = 11), staff ( = 14), and patients eligible for interconception care ( = 6) from three primary care clinics in Chicago, Illinois participated in focus groups or interviews.

Acute stroke care coordination in the United States: Variation in state laws for Emergency Medical Services and hospitals.

Background: Lack of care coordination between Emergency Medical Services (EMS) and hospitals contributes to delay of acute stroke (AS) treatment. In the United States, states have adopted laws to improve the quality of EMS and hospital care; the degree to which these laws create regulatory incentives to promote care coordination between them is less well known. We examined state variation in attributes of laws that may influence AS care coordination between EMS and hospitals.

Impact of Consumer Wearables Data on Pediatric Surgery Clinicians' Management: Multi-Institutional Scenario-Based Usability Study.

Background: At present, parents lack objective methods to evaluate their child's postoperative recovery following discharge from the hospital. As a result, clinicians are dependent upon a parent's subjective assessment of the child's health status and the child's ability to communicate their symptoms. This subjective nature of home monitoring contributes to unnecessary emergency department (ED) use as well as delays in treatment.

A multiplexed real-time PCR assay for simultaneous quantification of human immunodeficiency virus and Hepatitis B virus for low-and-middle- income countries.

Due to shared routes of transmission, including sexual contact and vertical transmission, HIV-HBV co-infection is common, particularly in sub-Saharan Africa. Measurement of viral load (VL), for both HIV and HBV, plays a critical role for determining their infectious phase and monitoring response to antiviral therapy. Implementation of viral load testing in clinical settings is a significant challenge in resource-limited countries, notably because of cost and availability issues.

Fidelity of Enhanced Recovery Protocol Implementation With Assessment of Hospital-Specific Materials.

Introduction: Variability in implementation of enhanced recovery protocols (ERPs) often reduces the effects of an intervention on clinical outcomes. This study aimed to evaluate hospital-level implementation fidelity to a pediatric gastrointestinal surgery ERP by assessing site-specific implementation materials.

Methods: This document analysis study operationalized implementation fidelity as adherence to the creation of specified materials at each study site.

Recommendations to Improve Neonatal Circumcision Training.

Background: Although multiple specialties perform neonatal circumcision (NC), overall NC proceduralist availability is limited. The approach to training new practitioners varies. This study aims to describe NC training experiences, current practices, and make suggestions for future improvements.

Mapping the process of ICU care delivery to improve treatment decisions in acute respiratory failure.

Evidence suggests system-level norms and care processes influence individual patients' medical decisions, including end-of-life decisions for patients with critical illnesses like acute respiratory failure. Yet, little is known about how these processes unfold over the course of a patient's critical illness in the intensive care unit (ICU). Our objective was to map current-state ICU care delivery processes for patients with acute respiratory failure and to identify opportunities to improve the process.

Barriers and facilitators to smartwatch-based prehabilitation participation among frail surgery patients: a qualitative study.

Background: For older, frail adults, exercise before surgery through prehabilitation (prehab) may hasten return recovery and reduce postoperative complications. We developed a smartwatch-based prehab program (BeFitMe) for older adults that encourages and tracks at-home exercise. The objective of this study was to assess patient perceptions about facilitators and barriers to prehab generally and to using a smartwatch prehab program among older adult thoracic surgery patients to optimize future program implementation.

Is state trauma funding associated with mortality among injured hospitalized patients?

Background: We sought to quantify the association between state trauma funding and (1) in-hospital mortality and (2) transfers of injured patients.

Methods: We conducted an observational cross-sectional study of states with publicly available trauma funding data. We analyzed in-hospital mortality using linked data from the Nationwide Inpatient Sample (NIS), American Hospital Association (AHA) Annual Survey, and these State Department of Public Health trauma funding data.

Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States.

Objective: To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade.

Methods: The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year.

Physician Perspectives on Performing Newborn Circumcisions: Barriers and Opportunities.

Objective: Over half of infant boys born in the United States undergo newborn circumcision. However, available data indicate that boys who are publicly insured, or Black/African American, have less access to desired newborn circumcision, thus concentrating riskier, more costly operative circumcision among these populations. This study ascertains perinatal physician perspectives about barriers and facilitators to providing newborn circumcisions, with a goal of informing future strategies to ensure more equitable access.

Comparison of web-based information about cell-free DNA prenatal screening: implications for differences of sex development care.

Objective: Cell-free DNA (cfDNA) prenatal screening is a commercially available noninvasive test that detects fetal genetic material in maternal blood. While expectant parents often use it for "gender" determination, there is little information about unintended consequences of testing, such as revelation of a difference of sex development (DSD). The study aimed to characterize currently available website information about cfDNA and compare the cfDNA-related content.