Recent uciem_oapdeposits items

We Need Granular Sharing of De-Identified Data—But Will Patients Engage? Investigating Health System Leaders' and Patients' Perspectives on A Patient-Controlled Data-Sharing Platform

Wed, 17 Jun 2026 00:00:00 +0000

Patient-controlled data-sharing systems are increasingly promoted as a way to empower patients with greater autonomy over their health data. Yet it remains unclear how different stakeholders, especially patients and health system leaders, perceive the benefits and challenges of enabling granular control over the sharing of de-identified medical data for research. To address this gap, we developed a high-fidelity prototype of a patient-controlled, web-based consent platform and conducted a two-phase mixed-methods study: semi-structured interviews with 16 health system leaders and a survey with 523 patient participants. While both groups appreciated the potential of such a platform to enhance transparency and autonomy, their views diverged in meaningful ways. Leaders viewed transparency and granular control through the lens of informed consent and institutional ethics, whereas patients interpreted these factors as safeguards against potential risks and uncertainties. Our findings...

Man with painful tongue lesions

Thu, 21 May 2026 00:00:00 +0000

Man with painful tongue lesions

When AI Writes Back: Ethical Considerations by Physicians on AI-Drafted Patient Message Replies.

Wed, 11 Mar 2026 00:00:00 +0000

The increasing burden of responding to large volumes of patient messages has become a key factor contributing to physician burnout. Generative AI (GenAI) shows great promise to alleviate this burden by automatically drafting patient message replies. The ethical implications of this use have however not been fully explored. To address this knowledge gap, we conducted a qualitative interview study with 21 physicians who participated in a GenAI pilot program. We found that notable ethical considerations expressed by the physician participants included oversight as ethical safeguard, transparency and patient consent of AI use, patient misunderstanding of AI's role, and patient privacy and data security as prerequisites. Additionally, our findings suggest that the physicians believe the ethical responsibility of using GenAI in this context primarily lies with users, not with the technology. These findings may provide useful insights into guiding the future implementation of GenAI in...

Accuracy of Prospective Assessments of 4 Large Language Model Chatbot Responses to Patient Questions About Emergency Care: Experimental Comparative Study (Preprint)

Thu, 26 Feb 2026 00:00:00 +0000

BACKGROUND

Recent surveys indicate that 48% of consumers actively use generative artificial intelligence (AI) for health-related inquiries. Despite widespread adoption and the potential to improve health care access, scant research examines the performance of AI chatbot responses regarding emergency care advice.

OBJECTIVE

We assessed the quality of AI chatbot responses to common emergency care questions. We sought to determine qualitative differences in responses from 4 free-access AI chatbots, for 10 different serious and benign emergency conditions.

METHODS

We created 10 emergency care questions that we fed into the free-access versions of ChatGPT 3.5 (OpenAI), Google Bard, Bing AI Chat (Microsoft), and Claude AI (Anthropic) on November 26, 2023. Each response was graded by 5 board-certified emergency medicine (EM) faculty for 8 domains of percentage accuracy, presence of dangerous information, factual accuracy, clarity, completeness, understandability,...

Striving toward quality metrics for pediatric stroke: time from door to diagnosis

Thu, 29 Jan 2026 00:00:00 +0000

Background/Objective

Most pediatric stroke survivors suffer long-term impairments. To minimize injury, it is essential to quickly restore perfusion to viable brain tissue. Minimizing the time to stroke diagnosis requires recognition of a possible stroke by prehospital and emergency healthcare personnel, and rapid neuroimaging. While CT suffices for diagnosing hemorrhagic stroke, MRI is necessary to diagnose acute ischemic stroke (IS), contributing to significant diagnostic delays and potentially missed opportunities for intervention.

Methods

We conducted a retrospective study of children 1–14 years old with acute neurological symptoms presenting by Emergency Medical Services (EMS) to the study institution from 1/2019–6/2023. We described patient characteristics and neuroimaging studies, then evaluated predictors of MRI acquisition and actionable findings, including stroke. To assess the generalizability of these data we analyzed a secondary retrospective cohort of all children...

Screening emergency department patients for opioid drug use: A qualitative systematic review

Tue, 2 Sep 2025 00:00:00 +0000

INTRODUCTION: The opioid drug epidemic is a major public health concern and an economic burden in the United States. The purpose of this systematic review is to assess the reliability and validity of screening instruments used in emergency medicine settings to detect opioid use in patients and to assess psychometric data for each screening instrument. METHODS: PubMed/MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for articles published up to May 2018. The extracted articles were independently screened for eligibility by two reviewers. We extracted 1555 articles for initial screening and 95 articles were assessed for full-text eligibility. Six articles were extracted from the full-text assessment. RESULTS: Six instruments were identified from the final article list: Screener and Opioid Assessment for Patients...

Investigating the effects of housing instability on depression, anxiety, and mental health treatment in childhood and adolescence.

Fri, 6 Jun 2025 00:00:00 +0000

Housing instability is a widespread phenomenon in the United States. In combination with other social determinants of health, housing instability affects children's overall health and development. Drawing on data from the 2022 National Survey of Children's Health, we employed multiple logistic regression models to understand how sociodemographic factors, especially housing instability, affect mental health outcomes and treatment access for youth aged 6-17 years. Our results show that youth facing housing instability have a higher likelihood of experiencing anxiety (OR: 1.42, p<0.001) and depression (OR: 1.57, p<0.001). Furthermore, youth experiencing both mental health conditions and housing instability are significantly less likely to receive mental health services in the past year, indicating the substantial barriers they face in accessing mental health care. Based on our findings, we highlight opportunities for digital mental health interventions to provide children experiencing...

Using Large Language Models for sentiment analysis of health-related social media data: empirical evaluation and practical tips.

Fri, 6 Jun 2025 00:00:00 +0000

Health-related social media data generated by patients and the public provide valuable insights into patient experiences and opinions toward health issues such as vaccination and medical treatments. Using Natural Language Processing (NLP) methods to analyze such data, however, often requires high-quality annotations that are difficult to obtain. The recent emergence of Large Language Models (LLMs) such as the Generative Pre-trained Transformers (GPTs) has shown promising performance on a variety of NLP tasks in the health domain with little to no annotated data. However, their potential in analyzing health-related social media data remains underexplored. In this paper, we report empirical evaluations of LLMs (GPT-3.5-Turbo, FLAN-T5, and BERT-based models) on a common NLP task of health-related social media data: sentiment analysis for identifying opinions toward health issues. We explored how different prompting and fine-tuning strategies affect the performance of LLMs on social...

Accuracy of Prospective Assessments of 4 Large Language Model Chatbot Responses to Patient Questions About Emergency Care: Experimental Comparative Study

Fri, 25 Apr 2025 00:00:00 +0000

BACKGROUND: Recent surveys indicate that 48% of consumers actively use generative artificial intelligence (AI) for health-related inquiries. Despite widespread adoption and the potential to improve health care access, scant research examines the performance of AI chatbot responses regarding emergency care advice. OBJECTIVE: We assessed the quality of AI chatbot responses to common emergency care questions. We sought to determine qualitative differences in responses from 4 free-access AI chatbots, for 10 different serious and benign emergency conditions. METHODS: We created 10 emergency care questions that we fed into the free-access versions of ChatGPT 3.5 (OpenAI), Google Bard, Bing AI Chat (Microsoft), and Claude AI (Anthropic) on November 26, 2023. Each response was graded by 5 board-certified emergency medicine (EM) faculty for 8 domains of percentage accuracy, presence of dangerous information, factual accuracy, clarity, completeness, understandability, source reliability,...

Discrepancies in Aggregate Patient Data between Two Sources with Data Originating from the Same Electronic Health Record: A Case Study

Mon, 14 Apr 2025 00:00:00 +0000

BACKGROUND: Data exploration in modern electronic health records (EHRs) is often aided by user-friendly graphical interfaces providing "self-service" tools for end users to extract data for quality improvement, patient safety, and research without prerequisite training in database querying. Other resources within the same institution, such as Honest Brokers, may extract data sourced from the same EHR but obtain different results leading to questions of data completeness and correctness. OBJECTIVES: Our objectives were to (1) examine the differences in aggregate output generated by a "self-service" graphical interface data extraction tool and our institution's clinical data warehouse (CDW), sourced from the same database, and (2) examine the causative factors that may have contributed to these differences. METHODS: Aggregate demographic data of patients who received influenza vaccines at three static clinics and three drive-through clinics in similar locations between August...

Cryptocurrency as a new method for participant compensation in research

Fri, 11 Apr 2025 00:00:00 +0000

Public health research relies heavily on participant involvement. Investigators have examined factors that affect participation and found that altruism enables engagement. At the same time, time commitment, family concerns, multiple follow-up visits, and potential adverse events are barriers to engagement. Thus, investigators may need to find new methods to attract and motivate participants to participate, including new compensation methods. As cryptocurrency is being increasingly used and accepted to pay and reimburse people for work activities, this currency should be similarly explored as an option for research participants to attempt to incentivize them to participate in studies and offer new possibilities for study reimbursement. This paper explores the potential use of cryptocurrency as a form of compensation in public health research studies and discusses the pros and cons of its use. Although few studies have used cryptocurrency to compensate participants, cryptocurrency...

Exploring mobility data for enhancing HIV care engagement in Black/African American and Hispanic/Latinx individuals: a longitudinal observational study protocol

Fri, 11 Apr 2025 00:00:00 +0000

INTRODUCTION: Increasing engagement in HIV care among people living with HIV, especially those from Black/African American and Hispanic/Latinx communities, is an urgent need. Mobility data that measure individuals' movements over time in combination with sociostructural data (eg, crime, census) can potentially identify barriers and facilitators to HIV care engagement and can enhance public health surveillance and inform interventions. METHODS AND ANALYSIS: The proposed work is a longitudinal observational cohort study aiming to enrol 400 Black/African American and Hispanic/Latinx individuals living with HIV in areas of the USA with high prevalence rates of HIV. Each participant will be asked to share at least 14 consecutive days of mobility data per month through the study app for 1 year and complete surveys at five time points (baseline, 3, 6, 9 and 12 months). The study app will collect Global Positioning System (GPS) data. These GPS data will be merged with other data sets...

Remote Wearable Neuroimaging Devices for Health Monitoring and Neurophenotyping: A Scoping Review

Fri, 11 Apr 2025 00:00:00 +0000

Digital health tracking is a source of valuable insights for public health research and consumer health technology. The brain is the most complex organ, containing information about psychophysical and physiological biomarkers that correlate with health. Specifically, recent developments in electroencephalogram (EEG), functional near-infra-red spectroscopy (fNIRS), and photoplethysmography (PPG) technologies have allowed the development of devices that can remotely monitor changes in brain activity. The inclusion criteria for the papers in this review encompassed studies on self-applied, remote, non-invasive neuroimaging techniques (EEG, fNIRS, or PPG) within healthcare applications. A total of 23 papers were reviewed, comprising 17 on using EEGs for remote monitoring and 6 on neurofeedback interventions, while no papers were found related to fNIRS and PPG. This review reveals that previous studies have leveraged mobile EEG devices for remote monitoring across the mental health,...

Physician documentation matters. Using natural language processing to predict mortality in sepsis

Fri, 11 Apr 2025 00:00:00 +0000

Background/objective: Sepsis remains without good outcome prediction. Technological advances, specifically, natural language processing (NLP), has an opportunity to approach sepsis mortality prediction in a novel way. Methods: Using the MIMIC III dataset, patients diagnosed with sepsis from 2008 to 2013 had physician progress notes analyzed using NLP. Researchers utilized concepts from analysis to build a model to predict for in-hospital-mortality, using notes in the first 24 hours of a patient admission. This model was retrospectively validated on septic admissions to University of California Irvine Medical Center (UCIMC) from 2013 to 2018 and compared to SOFA and qSOFA. Results: An 80-concept model was developed and validated on 7117 admissions to UCIMC. For severe sepsis, an Area Under Curve or AUC of 0.687 (95% CI 0.618-0.748) was demonstrated which was greater than SOFA at 0.571 (0.497-0.643). Additionally, for simple sepsis the model demonstrated an AUC of 0.696 (0.649-0.738)...

Factors Associated with COVID-19 Testing, Vaccination, and Use of Digital Contact Tracing Apps among Black and Latinx MSM (BLMSM) in Los Angeles

Fri, 11 Apr 2025 00:00:00 +0000

This study examines the factors associated with COVID-19 testing, vaccination intent (both individually and jointly), and willingness to use contact tracing digital apps among a cohort of Black and Latinx men who have sex with men (BLMSM) living in Los Angeles during the initial peak (July 2020) of the COVID-19 pandemic. A questionnaire detailing participants COVID-19 experiences was sent to 300 primarily BLMSM after the first state-wide COVID-19 lockdown. Logistic regression models with random cluster effects were used for analyses. Forty-two percent (42%) tested for COVID-19, 27% were willing to get vaccinated, and about 45% reported willingness to use contact tracing digital apps. Controlling for intervention participation, age, education, marital status, employment, health, tobacco, binge drinking, and self-reported anxiety, those who were depressed had 33% (95% CI: 0.13 to 0.82) odds of using a prevention strategy (either test for COVID-19 or vaccination intent) as the group...

Novel Evaluation Metric and Quantified Performance of ChatGPT-4 Patient Management Simulations for Early Clinical Education: Experimental Study

Wed, 2 Apr 2025 00:00:00 +0000

Background: Case studies have shown ChatGPT can run clinical simulations at the medical student level. However, no data have assessed ChatGPT's reliability in meeting desired simulation criteria such as medical accuracy, simulation formatting, and robust feedback mechanisms. Objective: This study aims to quantify ChatGPT's ability to consistently follow formatting instructions and create simulations for preclinical medical student learners according to principles of medical simulation and multimedia educational technology. Methods: Using ChatGPT-4 and a prevalidated starting prompt, the authors ran 360 separate simulations of an acute asthma exacerbation. A total of 180 simulations were given correct answers and 180 simulations were given incorrect answers. ChatGPT was evaluated for its ability to adhere to basic simulation parameters (stepwise progression, free response, interactivity), advanced simulation parameters (autonomous conclusion, delayed feedback, comprehensive feedback),...

The Potential of Wearable Sensors for Detecting Cognitive Rumination: A Scoping Review

Mon, 3 Mar 2025 00:00:00 +0000

Cognitive rumination, a transdiagnostic symptom across mental health disorders, has traditionally been assessed through self-report measures. However, these measures are limited by their temporal nature and subjective bias. The rise in wearable technologies offers the potential for continuous, real-time monitoring of physiological indicators associated with rumination. This scoping review investigates the current state of research on using wearable technology to detect cognitive rumination. Specifically, we examine the sensors and wearable devices used, physiological biomarkers measured, standard measures of rumination used, and the comparative validity of specific biomarkers in identifying cognitive rumination. The review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines on IEEE, Scopus, PubMed, and PsycInfo databases. Studies that used wearable devices to measure rumination-related physiological responses and...

The prevalence and determinants of alcohol use in the adult population of Tehran: insights from the Tehran Cohort Study (TeCS)

Sat, 1 Mar 2025 00:00:00 +0000

BackgroundAlthough alcohol has been illegal in Iran for over four decades, its consumption persists. This study aims to determine the prevalence and determinants of alcohol consumption in Tehran, the Middle East’s third-largest city, using data from the Tehran Cohort Study (TeCS).MethodsOur study encompasses data from 8420 individuals recorded between March 2016 and March 2019. We defined alcohol use as the lifetime consumption of alcoholic beverages and/or products. We calculated the age- and sex-weighted prevalence of alcohol use in addition to crude frequencies. We also determined the weighted prevalence of alcohol use in both genders. Multivariable logistic regressions were employed to investigate the adjusted odds ratios for the determinants of alcohol use.ResultsThe mean age of participants was 53.8 ± 12.7 years. The lifetime prevalence of alcohol use was 9.9% (95% confidence interval [95% CI]: 8.3–11.8%) among the total population, with a prevalence of 3.3% (95% CI: 2.4–4.5%)...

Shared and distinct parental influences on teen impaired driving in rural and suburban contexts: A mixed methods study of young drivers

Thu, 27 Feb 2025 00:00:00 +0000

OBJECTIVE: To explore shared and distinct parental influences on rural and suburban adolescents' riding with an impaired driver (RWI) and driving while impaired (DWI) behaviors during high school. METHODS: Participants in the NEXT Generation Health Study (NEXT) were classified into four RWI/DWI trajectory classes (i.e., Abstainer, Escalator, Decliner, Persister) which described patterns of RWI/DWI from high school to emerging adulthood. A follow-up, in-depth, qualitative interview was conducted with a purposeful selection of participants from each trajectory class between March and September 2020. Guided by Ecodevelopmental Theory, the interview included questions which explored parent-teen influences on driving and RWI/DWI. RESULTS: Imposition of a curfew was a shared parental influence in rural and suburban contexts. Unique to the rural context, parent modeling of RWI/DWI was described as normative and occurring since childhood. CONCLUSIONS: Prevention interventions targeting...

Longitudinal perspectives of riding with a cannabis-impaired driver

Thu, 27 Feb 2025 00:00:00 +0000

OBJECTIVE: To explore decisions and perceptions of engaging in riding with a cannabis-impaired driver (RWI) during high school and young adulthood to build context around RWI-cannabis events. METHODS: Participants were sampled from the NEXT Generation Health Study (NEXT), a 7-year national cohort study of adolescent health behaviors. Four RWI and driving while impaired (DWI) trajectories classes (i.e., Abstainer, Escalator, Decliner, Persister) were previously derived.A theoretical model based on ecological systems theory guidedin-depth semi-structured interviews to includecomplex, social-developmental and environmental multi-level factors affectingpersonal experiences with RWI-cannabis during high school, after high school, and during young adulthood. Participants (n = 105) were purposively selected from each trajectory class for follow-up, in-depth, qualitative interviews. All interviews were conducted via Zoom between March and September 2020. RESULTS: Two unique...

A study of self-reported personal cannabis use and state legal status and associations with engagement in and perceptions of cannabis-impaired driving

Thu, 27 Feb 2025 00:00:00 +0000

Objective: The objectives of the current study were to (1) characterize predictors of perceived risk of driving within 2 h of cannabis use and driving after cannabis use in a sample of adults who have used cannabis in the past year and (2) determine whether the influence of these predictors vary by state legalizations status.Methods: Data for this study were from online surveys. Study participants from Colorado, Iowa, and Illinois were included if they reported being between 25 and 40 years old and had a history of cannabis use. Outcome variables included (1) days of cannabis use per month, (2) reported driving within 2 h of cannabis use (vs. not driving within 2 h as reference), (3) proportion of driving after cannabis use days per month (days of driving a car within 2 h of cannabis use per month/days of cannabis use per month), and (4) perception of safety of driving after cannabis use. Potential predictors included age of first use of cannabis, gender, education...

Area-Level Socioeconomic Inequalities in Intracranial Injury-Related Hospitalization in Korea: A Retrospective Analysis of Data From Korea National Hospital Discharge Survey 2008–2015

Thu, 27 Feb 2025 00:00:00 +0000

BACKGROUND: Although inequality in traumatic brain injury (TBI) by individual socioeconomic status (SES) exists, interventions to modify individual SES are difficult. However, as interventions for area-based SES can affect the individual SES, monitoring or public health intervention can be planned. We analyzed the effect of area-based SES on hospitalization for TBI and revealed yearly inequality trends to provide a basis for health intervention. METHODS: We included patients who were hospitalized due to intracranial injuries (ICIs) between 2008 and 2015 as a measure of severe TBI with data provided by the Korea National Hospital Discharge Survey. Area-based SES was synthesized using the 2010 census data. We assessed inequalities in ICI-related hospitalization rates using the relative index of inequality and the slope index of inequality for the periods 2008-2009, 2010-2011, 2012-2013, and 2014-2015. We analyzed the trends of these indices for the observation period by age and...

What determines the success of states in reducing alcohol related crash fatalities? A longitudinal analysis of alcohol related crashes in the U.S. from 1985 to 2019.

Thu, 27 Feb 2025 00:00:00 +0000

In the United States, nearly 28 people die in alcohol-related motor vehicle crashes every day (1 fatality every 52 min). Over decades, states have enacted multiple laws to reduce such fatalities. From 1982 to 2019, the proportion of drivers in fatal crashes with a blood alcohol concentration (BAC) above 0.01 g/dl declined from 41% to 22%. States vary in terms of their success in reducing alcohol-related crash fatalities. The purpose of this study was to examine factors associated with changes in fatalities related to alcohol-impaired driving at the state level. We created a panel dataset of 50 states from 1985 to 2019 by merging different data sources and used fixed-effect linear regression models to analyze the data. Our two outcome variables were the ratio of drivers in fatal crashes with BAC ≥ 0.01 g/dl to those with BAC = 0.00, and the ratio of those with BAC ≥ 0.08 g/dl to those with BAC < 0.08 g/dl. Our...

Multimodal Pain Recognition in Postoperative Patients: Machine Learning Approach

Thu, 27 Feb 2025 00:00:00 +0000

BACKGROUND: Acute pain management is critical in postoperative care, especially in vulnerable patient populations that may be unable to self-report pain levels effectively. Current methods of pain assessment often rely on subjective patient reports or behavioral pain observation tools, which can lead to inconsistencies in pain management. Multimodal pain assessment, integrating physiological and behavioral data, presents an opportunity to create more objective and accurate pain measurement systems. However, most previous work has focused on healthy subjects in controlled environments, with limited attention to real-world postoperative pain scenarios. This gap necessitates the development of robust, multimodal approaches capable of addressing the unique challenges associated with assessing pain in clinical settings, where factors like motion artifacts, imbalanced label distribution, and sparse data further complicate pain monitoring. OBJECTIVE: This study aimed to develop and evaluate...

An Evaluation of the User Experience and Privacy Concerns of Individuals Misusing Opioids Using a Location Tracking Mobile Application

Thu, 6 Feb 2025 00:00:00 +0000

Opioid use disorder is a growing public health concern in the United States, causing economic burden and hindered by stigma. New forms of data, including location data, may improve the effectiveness of interventions for preventing and treating opioid use disorder and/or misuse, increase access to treatment and address racial and ethnic disparities. This qualitative study aimed to identify factors that contribute to users' experience with a publicly available location-tracking mobile app - and investigate their privacy and ethical concerns. The study was conducted through two 15-minute interviews within a 48-h time frame. Participants were recruited from a pool of past research participants, Facebook ads, and referrals, and had to meet certain inclusion criteria related to opioid use disorder and/or misuse. The study had a final sample of 30 participants, 15 male and 15 female. The study suggests that a simple onboarding process and convenient experience can enhance participant...

Impact of worklist selection on point-of-care ultrasound workflow – a quality improvement project

Wed, 5 Feb 2025 00:00:00 +0000

BackgroundResearch demonstrates that Point-of-care ultrasound (POCUS) improves clinical outcomes for patients. Improving clinician satisfaction with POCUS should promote utilization into everyday practice, leading to improved clinical outcomes. Despite this benefit, there are still barriers to use including POCUS workflow. This project was undertaken to improve the functionality of the existing POCUS workflow and move toward an “encounter-based” system by automating worklist generation. It aimed to streamline the POCUS workflow, primarily determine if there was improved clinician satisfaction with the new workflow, and secondarily determine the change in revenue generation from decreased errors in data entry.MethodsA new workflow was created which automatically populated every registered Emergency Department (ED) patient into the worklist upon patient registration. Clinician feedback on their use of the new workflow was sought via survey after implementation. The number of medical...

Association of Cardiovascular Risk Factors With Major and Minor Electrocardiographic Abnormalities: A Report From the Cross‐Sectional Phase of Tehran Cohort Study

Sat, 1 Feb 2025 00:00:00 +0000

Background and Aims: In the current study, we aimed to identify the association between major and minor electrocardiographic abnormalities and cardiovascular risk factors. Methods: We used the Tehran cohort study baseline data, an ongoing multidisciplinary, longitudinal study designed to identify cardiovascular disease risk factors in the adult population of Tehran. The electrocardiograms (ECGs) of 7630 Iranian adults aged 35 years and above were analyzed. ECG abnormalities were categorized into major or minor groups based on their clinical importance. Results were obtained by multivariable logistic regression and are expressed as odds ratios (ORs). Results: A total of 756 (9.9%) participants had major ECG abnormalities, while minor abnormalities were detected in 2526 (33.1%). Males comprised 45.8% of the total population, and 41.8% of them had minor abnormalities. Individuals with older age, diabetes (OR = 1.35; 95% CI: 1.11-1.64), and hypertension (OR = 2.21; 95% CI: 1.82-2.68)...

Erector spinae plane block for intractable, nonsurgical abdominal pain: a scoping review

Mon, 27 Jan 2025 00:00:00 +0000

Abdominal pain is one of the most common presenting chief complaints in the emergency department. Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of nonsurgical abdominal pain has not yet been characterized. Our scoping review aims to synthesize current knowledge on the safety and efficacy of ESPB in the management of patients experiencing intractable, nonsurgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for nonsurgical abdominal pain. A total of 14 journal articles were included: 12 case-based studies, one systematic review, and one narrative review. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and no complications were reported in any cases. This scoping review provides support...

Prevalence of obesity and overweight in an adult population of Tehran metropolis

Sat, 4 Jan 2025 00:00:00 +0000

PurposeObesity is a chronic low-grade inflammatory condition with increasing global prevalence and is associated with cardiovascular diseases. In this study, we aimed to investigate the prevalence of obesity in the Tehran cohort study (TeCS) population.MethodsWe used the data collected by systematic random sampling during the recruitment phase of TeCS. The data comprised 4215 households from all districts of the Tehran metropolis, from which 8296 adults aged ≥ 35 years participated between May 2016 and February 2019. Sociodemographic data, medical history, laboratory tests, and anthropometric measurements were gathered from the participants. Participants with missing data were excluded from the final analysis. Finally, the data was analyzed using SPSS version 23, and distribution maps were created by Stata 14.2.ResultsA total of 8211 participants (53.9% women) with an average age of 53.7 ± 12.6 years were studied. The age-weighted prevalence of overweight and obese among...

2024 Mpox outbreak: A rapidly evolving public health emergency of international concern: Introduction of an Updated Mpox Identify-Isolate-Inform (3I) Tool

Mon, 16 Dec 2024 00:00:00 +0000

The declaration of a second Public Health Emergency of International Concern (PHEIC) for mpox in August 2024 underscores the urgent need for a comprehensive understanding of the evolving epidemiology [1] clinical manifestations, and zoonotic potential of this emerging threat [2]. This work delves into the intricate interplay between human and animal mpox infections, with a specific focus on the unique characteristics of various viral clades and their implications for individual and public health. There is a critical need to elucidate the factors driving multiple spillover events and the subsequent emergence of new clades better adapted to human-to-human transmission. We hypothesize that anthropogenic changes, including deforestation, urbanization, and climate change are facilitating increased human-to-animal contact, leading to more frequent zoonotic transmissions and viral adaptations. Our conceptual framework integrates One Health principles, evolutionary virology, and epidemiological...

Evaluation of a pilot implementation of a digital cognitive behavioral therapy platform for isolated older adults in county mental health services

Mon, 11 Nov 2024 00:00:00 +0000

Background: Technology-enabled services (TESs) have the potential to increase access to mental healthcare. However, little research has focused on how TESs can be integrated into publicly funded service settings. As part of the state-wide Help@Hand project, Marin County conducted a pilot implementation of myStrength, a digital cognitive behavioral therapy platform, to explore its potential to reduce loneliness among isolated older adults. We evaluated the pilot impact using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Method: A single-site 6-month pilot implementation recruited English (n = 15) and Spanish-speaking (n = 15) isolated older adults who received a digital literacy course followed by 8 weeks of myStrength access and human support. We evaluated factors related to reach, effectiveness, adoption, and implementation using the perspectives of users and County staff. Descriptive statistics were used to examine reach,...

Prevalence and associated factors of ECG abnormality patterns indicative of cardiac channelopathies among adult general population of Tehran, Iran: a report from the Tehran Cohort Study (TeCS)

Sat, 9 Nov 2024 00:00:00 +0000

BackgroundThe characteristics of electrocardiogram (ECG) abnormalities related to cardiac channelopathies potentially linked to sudden cardiac death (SCD) are not widely recognized in Iran. We examined the prevalence of such ECG patterns and their related factors among adult residents of Tehran, Iran.MethodsThe clinical characteristics and 12-lead ECGs of Tehran Cohort Study participants were examined. Long QT intervals, short QT intervals, Brugada syndrome (BrS) patterns, and early repolarization (ER) were evaluated using computer-based assessment software validated by cardiologists. Logistic regression models were employed to identify the factors associated with the prevalence of different ECG patterns.ResultsOut of 7678 available ECGs, 7350 were included in this analysis. Long QT interval, ER pattern, BrS patterns, and short QT interval were found in 3.08%, 1.43%, 0.31%, and 0.03% of participants, respectively. The prevalence of long QT interval increased with age, opium consumption,...

Trends in Substance Use Disorder–Related Emergency Department Visits in California: An Analysis of 46 Million Visits From 2006 to 2011

Sat, 9 Nov 2024 00:00:00 +0000

INTRODUCTION: To better understand the development of the growing opioid crisis in the early 21st century, the authors studied trends in substance use disorder among 46,132,211 emergency department (ED) visit discharges in California between 2006 and 2011. METHODS: Utilizing the California State Emergency Department Database, the authors identified substance use based on International Classification of Diseases, Ninth Revision codes. Tabular and multivariable analysis methods were applied. ED visits were considered clustered at the level of patient. RESULTS: The authors observed a notable increase in substance use prevalence from 7.32 ± 6.07 to 12.21 ± 9.35 per 1000 ED visits. Nonopioid substance use was more prevalent among individuals aged ≤ 50 years old. Opioid use disorder (OUD) was associated with a higher mortality rate in the ED. In 2011, OUD was significantly higher among American Indians visiting the ED. A multivariable analysis revealed that OUD was an independent predictor...

SEX AND GENOTYPE DEPENDENT DRUG-INDUCED DOPAMINE RELEASE IN ADOLESCENT CHRNA6 3’-UTR RATS

Thu, 7 Nov 2024 00:00:00 +0000

SEX AND GENOTYPE DEPENDENT DRUG-INDUCED DOPAMINE RELEASE IN ADOLESCENT CHRNA6 3’-UTR RATS

Access to the internet and mobile applications in a mixed population emergency department: A repeated cross-sectional survey

Thu, 7 Nov 2024 00:00:00 +0000

Objective: This study aimed to assess patients' interest in education content delivered through electronic modalities and identify trends in internet access and use among emergency department patients of various socioeconomic statuses. Methods: A prospective, cross-sectional survey with 50 questions was completed by 241 English and Spanish-speaking patients in 2014 and repeated with 253 participants in 2019 at the University of California, Irvine Medical Center's Emergency Department (UCIMCED). Results: Internet access increased from 83.8 % in 2014 to 88.1 % in 2019. Most internet-using patients owned smartphones (80.1 % in 2014, 89.7 % in 2019). Patients used electronic devices, such as fit bits and activity trackers, to obtain health information. Email was the preferred method for receiving discharge instructions. Conclusions: As of 2019, 88.1 % of UCIMCED patients have access to the internet or email, making electronic media a reasonable venue for patient...

Electronic Bridge to Mental Health for College Students: A Randomized Controlled Intervention Trial

Wed, 30 Oct 2024 00:00:00 +0000

OBJECTIVE: Suicide is the second leading cause of death among college students in the United States, and the percentage of students reporting suicidal thoughts is increasing. Nevertheless, many students at risk do not seek mental health (MH) services. This randomized controlled trial (RCT) examined the efficacy of Electronic Bridge to Mental Health for College Students (eBridge) for increasing at-risk students' linkage to MH services. METHOD: Students from four universities were recruited via email; 40,347 (22.6%) completed the online suicide risk screen; and 3,363 (8.3%) met criteria for randomization based on suicide risk factors and lack of current treatment (62.2% female, 35.0% male, 2.8% transgender/nonbinary; 73.2% White, 7.0% Black, 19.9% Asian, 11.7% other; 12.4% Hispanic, 76.2% undergraduate). These students were randomized to eBridge [personalized feedback (PF) with option of online counseling] or Control (PF). The primary outcome was linkage to MH services within 6...

Association of emergency department characteristics with presence of recommended pediatric‐specific behavioral health policies

Thu, 19 Sep 2024 00:00:00 +0000

Objectives: In the United States, pediatric emergency department (ED) visits for behavioral health (BH) are increasing. We sought to determine ED-level characteristics associated with having recommended BH-related policies. Methods: We conducted a retrospective serial cross-sectional study of National Pediatric Readiness Project assessments administered to US EDs in 2013 and 2021. Changes in responses related to BH items over time were examined. Multivariable logistic regression models examined ED characteristics associated with the presence of specific BH-related policies in 2021. Results: Of 3554 EDs that completed assessments in 2021, 73.0% had BH-related policies, 66.5% had transfer guidelines for children with BH issues, and 38.6% had access to BH resources in a disaster. Of 2570 EDs that completed assessments in both 2013 and 2021, presence of specific BH-related policies increased from 48.6% to 72.0% and presence of appropriate transfer guidelines increased from 56.2% to...

Sub-chronic nicotine exposure influences methamphetamine self-administration and dopamine overflow in a sex-and genotype-dependent manner in humanized CHRNA6 3′-UTR SNP (rs2304297) adolescent rats

Thu, 19 Sep 2024 00:00:00 +0000

Introduction: The rewarding effects of drugs of abuse are associated with the dopaminergic system in the limbic circuitry. Nicotine exposure during adolescence is linked to increased use of drugs of abuse with nicotine and methamphetamine (METH) commonly used together. Nicotine acts on neuronal nicotinic acetylcholine receptor (nAChR) systems, critical for reward processing and drug reinforcement, while METH leads to a higher dopamine (DA) efflux in brain reward regions. A human single nucleotide polymorphism (SNP) in the 3'-untranslated region (UTR) of the α6 nicotinic receptor subunit gene (CHRNA6, rs2304297), has been linked with tobacco/nicotine and general substance use during adolescence. Using CRISPR-Cas9 genomic engineering, our lab recapitulated the CHRNA6 3'UTR^C123G SNP, generating α6^CC and α6^GG allele carriers in Sprague Dawley rats. We hypothesized the CHRNA6 3'UTR^C123G SNP would sex- and genotype-dependently...

Reliability and Recalibration of the Persian Version of Cumberland Ankle Instability Tool Cut-off Score in Athletes with Functional Ankle Instability

Mon, 16 Sep 2024 00:00:00 +0000

INTRODUCTION: The Cumberland Ankle Instability Tool (CAIT) is a valid instrument for determining the presence and severity of functional ankle instability. This questionnaire was recently cross-culturally adapted into Persian; however, the reliability of the Persian version has not been examined in athletes. CAIT has also been used with various independently-selected cut-off scores to determine instability. OBJECTIVE: The present study was conducted to evaluate the psychometric properties of the Persian version of CAIT and to determine its optimal cut-off score in athletic populations. METHOD: One-hundred and sixteen athletes (volleyball, basketball and track and field players) over 18 years old both with and without ankle instability completed the Persian version of the CAIT. The internal consistency, test-retest reliability and discriminative ability of the tool were assessed. A receiver operating characteristic (ROC) curve was drawn to confirm the cut-off point of the Persian...

Association Between Drive-Through Mobile Vaccination Clinics and Neighborhood-Level Factors

Thu, 12 Sep 2024 00:00:00 +0000

ABSTRACT: Background: In Fall 2020, at the height of the COVID-19 pandemic, the importance of avoiding a simultaneous influenza and COVID-19 “twindemic” led to the implementation of socially distanced, drive-through mobile vaccination clinics. Mobile clinics have been valuable in providing primary and preventative care to underserved populations and expanding healthcare access to individuals marginalized by geographic, social, and structural barriers. Although there are ~2,000 mobile clinics throughout the United States and 120 mobile clinics providing services in California, few studies to date have evaluated neighborhood-level factors to determine whether social drivers of health (SDOH) influence the use of mobile drive-through clinics versus static clinics for immunizations. Methods: We conducted a retrospective cohort study of a total of 25,246 patients, 3,151 of whom received immunizations in 3 mobile clinics and 22,095 of whom received immunizations in 3 static clinics...

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California

Thu, 12 Sep 2024 00:00:00 +0000

Importance: The incidence of opioid-associated out-of-hospital cardiac arrest (OA-OHCA) has grown from less than 1% of OHCA in 2000 to between 7% and 14% of OHCA in recent years; American Heart Association (AHA) protocols suggest that emergency medical service (EMS) clinicians consider naloxone in OA-OHCA. However, it is unknown whether naloxone improves survival in these patients or in patients with undifferentiated OHCA. Objective: To evaluate the association of naloxone with clinical outcomes in patients with undifferentiated OHCA. Design, Setting, and Participants: Retrospective cohort study of EMS-treated patients aged 18 or older who received EMS treatment for nontraumatic OHCA in 3 Northern California counties between 2015 and 2023. Data were analyzed using propensity score-based models from February to April 2024. Exposure: EMS administration of naloxone. Main Outcomes and Measures: The primary outcome was survival to hospital discharge; the secondary outcome was sustained...

Artificial Intelligence (AI) Applications for Point of Care Ultrasound (POCUS) in Low-Resource Settings: A Scoping Review

Wed, 21 Aug 2024 00:00:00 +0000

Advancements in artificial intelligence (AI) for point-of-care ultrasound (POCUS) have ushered in new possibilities for medical diagnostics in low-resource settings. This review explores the current landscape of AI applications in POCUS across these environments, analyzing studies sourced from three databases-SCOPUS, PUBMED, and Google Scholars. Initially, 1196 records were identified, of which 1167 articles were excluded after a two-stage screening, leaving 29 unique studies for review. The majority of studies focused on deep learning algorithms to facilitate POCUS operations and interpretation in resource-constrained settings. Various types of low-resource settings were targeted, with a significant emphasis on low- and middle-income countries (LMICs), rural/remote areas, and emergency contexts. Notable limitations identified include challenges in generalizability, dataset availability, regional disparities in research, patient compliance, and ethical considerations. Additionally,...

The 6 degrees of curriculum integration in medical education in the United States

Mon, 5 Aug 2024 00:00:00 +0000

Despite explicit expectations and accreditation requirements for integrated curriculum, there needs to be more clarity around an accepted common definition, best practices for implementation, and criteria for successful curriculum integration. To address the lack of consensus surrounding integration, we reviewed the literature and herein propose a definition for curriculum integration for the medical education audience. We further believe that medical education is ready to move beyond “horizontal” (1-dimensional) and “vertical” (2-dimensional) integration and propose a model of “6 degrees of curriculum integration” to expand the 2-dimensional concept for future designs of medical education programs and best prepare learners to meet the needs of patients. These 6 degrees include: interdisciplinary, timing and sequencing, instruction and assessment, incorporation of basic and clinical sciences, knowledge and skills-based competency progression, and graduated responsibilities in...

Online Social Networking for HIV Education and Prevention

Fri, 2 Aug 2024 00:00:00 +0000

BACKGROUND: The purpose of this study is to use mixed (qualitative/quantitative) methods to determine (1) the feasibility and acceptability of using online social networking to facilitate HIV-related discussions and (2) the relationship between HIV-related online discussions and requests for a home-based HIV testing kit among men who have sex with men. METHODS: Participants, primarily African American and Latino, were invited to join a "secret" group on the social networking Web site, Facebook. Peer leaders, trained in HIV prevention, posted HIV-related content. Participants were not obligated to respond to discussions or remain within the group. Participant public group conversations were qualitatively and thematically analyzed. Quantitative methods tested associations between qualitative data, participants' demographic information, and likelihood of requesting a home-based HIV testing kit. RESULTS: Latino and African American participants (n = 57) voluntarily used Facebook to...

Suction-Modified Needle Biopsy Technique for the Human Soleus Muscle

Mon, 17 Jun 2024 00:00:00 +0000

INTRODUCTION: The needle biopsy technique for the soleus muscle is of particular interest because of the muscle's unique fiber type distribution, contractile properties, and sensitivity to unloading. Unlike other commonly biopsied muscles, the soleus is not fully superficial and is in close proximity to neurovascular structures, resulting in a more challenging biopsy. Because of this, a standardized protocol for performing needle biopsies on the human soleus muscle that is safe, reliable, and repeatable is presented. METHODS: Ultrasonography was used on an initial set of 12 subjects to determine the optimal biopsy zone, thereby guiding the location of the incision site. There were 45 subjects recruited who attended 2 separate biopsy sessions. Each biopsy session incorporated 3 passes of the biopsy needle proximal, posterior, and distal using suction from a portable vacuum source producing 3 separate muscle specimens. RESULTS: There were 84 soleus muscle biopsy procedures which...

Prospective Analysis of Single Operator Sonographic Optic Nerve Sheath Diameter Measurement for Diagnosis of Elevated Intracranial Pressure

Mon, 17 Jun 2024 00:00:00 +0000

INTRODUCTION: The accurate diagnosis of elevated intracranial pressure (eICP) in the emergent setting is a critical determination that presents significant challenges. Several studies show correlation of sonographic optic nerve sheath diameter (ONSD) to eICP, while others show high inter-observer variability or marginal performance with less experienced sonographers. The objective of our study is to assess the ability of bedside ultrasound measurement of ONSD to identify the presence of eICP when performed by a single experienced sonographer. We hypothesize that ONSD measurement is sensitive and specific for detecting eICP and can be correlated with values obtained by external ventricular device (EVD). METHODS: This was a prospective blinded observational study conducted in a neurocritical care unit of a level 1 trauma center. ONSD measurement was performed on a convenience sample of 27 adult patients who required placement of an invasive intracranial monitor as part of their...

USEFUL: Ultrasound Exam for Underlying Lesions Incorporated into Physical Exam

Mon, 17 Jun 2024 00:00:00 +0000

INTRODUCTION: The Ultrasound Screening Exam for Underlying Lesions (USEFUL) was developed in an attempt to establish a role for bedside ultrasound in the primary and preventive care setting. It is the purpose of our pilot study to determine if students were first capable of performing all of the various scans required of our USEFUL while defining such an ultrasound-assisted physical exam that would supplement the standard hands-on physical exam in the same head-to-toe structure. We also aimed to assess the time needed for an adequate exam and analyze if times improved with repetition and previous ultrasound training. METHODS: Medical students with ranging levels of ultrasound training received a 25-minute presentation on our USEFUL followed by a 30-minute hands-on session. Following the hands-on session, the students were asked to perform a timed USEFUL on 2-3 standardized subjects. All images were documented as normal or abnormal with the understanding that an official detailed...

The role of ultrasound in the management and diagnosis of infectious mononucleosis

Mon, 17 Jun 2024 00:00:00 +0000

Currently, infectious mononucleosis (IM) is a clinically diagnosed condition. According to the American Family Physician criteria for IM, splenomegaly is the key factor that distinguishes IM from other causes of sore throat. Though heterophile antibody tests are often ordered to confirm diagnosis of IM, this test has a high false-negative rate early in the course of the disease. This case report provides an example of how the use of ultrasound to diagnose splenomegaly and subsequently mononucleosis increases diagnostic accuracy.

Depression, Suicidal Ideation, and Suicidal Attempt Presenting to the Emergency Department: Differences Between These Cohorts

Sun, 16 Jun 2024 00:00:00 +0000

INTRODUCTION: The World Health Organization estimates that one million people die by suicide every year. Few studies have looked at factors associated with disposition in patients with chief complaints of depression, suicidal ideation (SI) and suicidal attempts (SA) who present to the emergency department (ED). Our objective was to assess individual determinants associated with ED disposition of patients in depressed patients presenting to the ED. METHODS: We conducted a retrospective study using the National Hospital Ambulatory Medical Care Survey from 2006 to 2008. We used logistic regression to identify factors associated with discharge, in SI, SA and depression patients. Independent variables included socio-demographic information, vital signs, mode of arrival, insurance status, place of residence and concomitant psychiatric diagnosis. RESULTS: Of the 93,030 subjects, 2,314 met the inclusion criteria (1,362 depression, 353 SI and 599 SA). Patients who arrived by ambulance...

Increasing Suicide Rates Among Middle-age Persons and Interventions to Manage Patients with Psychiatric Complaints: In conjunction with the Morbidity and Mortality Weekly Report published by the Centers for Disease Control and Prevention

Sun, 16 Jun 2024 00:00:00 +0000

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to suicide rates in the United States (U.S.). Suicide is the 10th leading cause of death in U.S. adults, and rates are increasing across all geographic regions. There is a significant increase in the suicide rate among adults in the 35-64 age range. We present findings from the CDC's Morbidity and Mortality Weekly Report (MMWR) with commentary on current resources and barriers to psychiatric care.

A HOPE Online Community Peer Support Intervention for Help Seeking: A Randomized Controlled Trial

Tue, 4 Jun 2024 00:00:00 +0000

OBJECTIVE: A 6-week study was conducted to test the effectiveness of the Harnessing Online Peer Education (HOPE) intervention on anxiety, help seeking (requests for electronic resources [e-resources] on anxiety reduction), and online engagement. METHODS: Three hundred participants with moderate to severe anxiety (i.e., seven-item Generalized Anxiety Disorder scale [GAD-7] scores ≥10) were randomly assigned to social media (i.e., Facebook) groups with or without peer leaders. The study was conducted from April 5 to May 17, 2020. GAD-7 scores, e-resource requests, and online engagement were measured at baseline and at weeks 2, 4, and 6. RESULTS: GAD-7 scores improved in both intervention and control groups, with no difference between conditions. Participants in the intervention group were more likely than those in the control group to request e-resources (OR=10.27, 95% CI=4.52-23.35) and engage online (OR=2.84, 95% CI=1.70-4.76). CONCLUSIONS: The HOPE intervention effectively promoted...

Epidemiology and Prevalence of Dyslipidemia Among Adult Population of Tehran: The Tehran Cohort Study

Sat, 27 Apr 2024 00:00:00 +0000

BACKGROUND: Dyslipidemia is among the leading risk factors for cardiovascular diseases (CVDs), with an increasing global burden, especially in developing countries. We investigated the prevalence of dyslipidemia and abnormal lipid profiles in Tehran. METHODS: We used data from 8072 individuals aged≥35 from the Tehran Cohort Study (TeCS) recruitment phase. Fasting serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglyceride were measured. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria, and high LDL/HDL was defined as a ratio>2.5. The age-sex standardized prevalence rates were calculated based on the 2016 national census. Furthermore, the geographical distribution of dyslipidemia and lipid abnormalities was investigated across Tehran's zip code districts. RESULTS: The age-sex standardized prevalence was 82.7% (95% CI: 80.1%, 85.0%)...

Dopamine and Norepinephrine Tissue Levels in the Developing Limbic Brain Are Impacted by the Human CHRNA6 3′-UTR Single-Nucleotide Polymorphism (rs2304297) in Rats †

Fri, 19 Apr 2024 00:00:00 +0000

We previously demonstrated that a genetic single-nucleotide polymorphism (SNP, rs2304297) in the 3' untranslated region (UTR) of the human CHRNA6 gene has sex- and genotype-dependent effects on nicotine-induced locomotion, anxiety, and nicotine + cue-induced reinstatement in adolescent rats. This study aims to investigate how the CHRNA6 3'-UTR SNP influences dopaminergic and noradrenergic tissue levels in brain reward regions during baseline and after the reinstatement of drug-seeking behavior. Naïve adolescent and adult rats, along with those undergoing nicotine + cue reinstatement and carrying the CHRNA6 3'-UTR SNP, were assessed for dopamine (DA), norepinephrine (NE), and metabolites in reward pathway regions. The results reveal age-, sex-, and genotype-dependent baseline DA, NE, and DA turnover levels. Post-reinstatement, male α6^GG rats show suppressed DA levels in the Nucleus Accumbens (NAc) Shell compared to the baseline, while nicotine+ cue-induced...

The Impact of Misinformation and Health Literacy on HIV Prevention and Service Usage

Wed, 17 Apr 2024 00:00:00 +0000

There are an increasing number of online resources people can use to gain access to information, including for health-related issues, such as for HIV prevention. Trend data show that the way individuals obtain news and information has changed from years past. Health literacy, therefore, is an important skill to ensure adequate understanding of the data available about HIV in the media and online. Unfortunately, the proliferation of misinformation is ubiquitous and may have deleterious effects on individual health behavior, and consequently, the public’s health. This commentary focuses on sources of online misinformation as it relates to HIV and how misinformation impacts seeking health services.

Role of Peer Coaches in Digital Interventions for MOUD Initiation and Maintenance

Wed, 17 Apr 2024 00:00:00 +0000

Millions of Americans suffer from opioid use disorder (OUD) in the United States, resulting in thousands of deaths. The ongoing opioid crisis necessitates novel approaches to reduce the morbidity and mortality associated with misusing opioids. Studies using peer support models show success in engaging persons living with OUD in initiating treatment and decreasing relapse. Although most studies have focused on patients in clinical settings, community studies integrating peer community leaders also show promise. This viewpoint paper explores the use of peer coaches in online interventions in the community setting.

Rates, routes, and reasons for attending community college before medical school: An analysis of a subset of Southern California medical students

Fri, 12 Apr 2024 00:00:00 +0000

Community college (CC) has traditionally existed as a bridge between high school and a four-year, baccalaureate-awarding, university. With the ever-increasing number of CCs present in the United States and the rising numbers of applicants to medical school, there will inevitably be a substantial proportion of future physicians who have attended CC. Based on previous research, we surveyed the University of California, Irvine, School of Medicine (UCISOM) student body to assess how many students had attended CC, when and why they attended, and if they intended to practice with underserved communities in the future. A total of 30 (28.6%) of the 105 survey respondents attended CC prior to medical school. Those students cited Academic Flexibility, Financial Reasons/Affordability, and the inability to enroll in a particular course at their four-year institutions as the top three reasons for attending CC. Ten of those students (30%) reported they were informed that attending CC would...

Assessing the Efficacy of a Novel Massive Open Online Soft Skills Course for South Asian Healthcare Professionals

Mon, 8 Apr 2024 00:00:00 +0000

In healthcare professions, soft skills contribute to critical thinking, decision-making, and patient-centered care. While important to the delivery of high-quality medical care, soft skills are often underemphasized during healthcare training in low-and-middle-income countries. Despite South Asia’s large population, the efficacy and viability of a digital soft skills curriculum for South Asian healthcare practitioners has not been studied to date. We hypothesized that a web-based, multilingual, soft skills course could aid the understanding and application of soft skills to improve healthcare practitioner knowledge, confidence, attitudes, and intent-to-change clinical practice.In September 2019 a needs assessment observing soft skills practices was conducted in several Indian states. We developed a communication-focused soft skills curriculum that comprised seven 10-minute video lectures, recorded in spoken English and Hindi. Participants consisted of any practicing healthcare...

How does medical scribes’ work inform development of speech-based clinical documentation technologies? A systematic review

Sun, 7 Apr 2024 00:00:00 +0000

OBJECTIVE: Use of medical scribes reduces clinician burnout by sharing the burden of clinical documentation. However, medical scribes are cost-prohibitive for most settings, prompting a growing interest in developing ambient, speech-based technologies capable of automatically generating clinical documentation based on patient-provider conversation. Through a systematic review, we aimed to develop a thorough understanding of the work performed by medical scribes in order to inform the design of such technologies. MATERIALS AND METHODS: Relevant articles retrieved by searching in multiple literature databases. We conducted the screening process following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in guidelines, and then analyzed the data using qualitative methods to identify recurring themes. RESULTS: The literature search returned 854 results, 65 of which met the inclusion criteria. We found that there is significant variation in scribe expectations...

Mobile Application Use Among Obstetrics and Gynecology Residents

Thu, 28 Mar 2024 00:00:00 +0000

BACKGROUND: Mobile applications (apps) are increasingly used in clinical settings, particularly among resident physicians. Apps available to patients and physicians are rapidly expanding. OBJECTIVE: We aimed to describe obstetrics and gynecology (ob-gyn) residents' use of and attitudes toward ob-gyn-related mobile apps. METHODS: We conducted a cross-sectional survey of residents at all 19 California ob-gyn programs using a web-based questionnaire. Responses were analyzed using descriptive and chi-square statistics. RESULTS: Of 386 residents contacted, 197 (51%) completed the survey. All respondents owned mobile devices (100% smartphone, 74% tablet), and 93% used apps in the clinical setting. Commonly used ob-gyn-related apps were pregnancy wheels (84%), cervical cancer screening algorithms (68%), and contraceptive eligibility guidelines (47%). Only 53% of respondents recommended apps to patients, with many reporting not being aware of appropriate apps. Sixty-two percent of respondents...

Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits

Sat, 2 Mar 2024 00:00:00 +0000

Maternal tobacco use and nicotine exposure during pregnancy have been associated with adverse birth outcomes in infants and can lead to preventable pregnancy complications. Exposure to nicotine and other compounds in tobacco and electronic cigarettes (e-cigarettes) has been shown to increases the risk of miscarriage, prematurity, stillbirth, low birth weight, perinatal morbidity, and sudden infant death syndrome (SIDS). Additionally, recent data provided by clinical and pre-clinical research demonstrates that nicotine exposure during pregnancy may heighten the risk for adverse neurodevelopmental disorders such as Attention-Deficit Hyperactivity (ADHD), anxiety, and depression along with altering the infants underlying brain circuitry, response to neurotransmitters, and brain volume. In the United States, one in 14 women (7.2%) reported to have smoked cigarettes during their pregnancy with the global prevalence of smoking during pregnancy estimated to be 1.7%. Approximately 1.1%...

Epidemiology of substance and opium use among adult residents of Tehran; a comprehensive report from Tehran cohort study (TeCS)

Sat, 2 Mar 2024 00:00:00 +0000

BackgroundThe prevalence and burden of substance and opium use have increased worldwide over the past decades. In light of rapid population changes in Tehran, we aimed to evaluate the prevalence of opium and other substance use among adult residents in Tehran, Iran.MethodFrom March 2016 to March 2019, we utilized data from 8 296 participants in the Tehran Cohort Study recruitment phase (TeCS). We calculated the age-sex-weighted prevalence of substance use and the geographic distribution of substance use in Tehran. We also used logistic regression analysis to determine possible determinants of opium use.ResultWe analyzed data from 8 259 eligible participants with complete substance use data and the average age of participants was 53.7 ± 12.75 years. The prevalence of substance use was 5.6% (95% confidence interval [CI]: 4.6- 7.1%). Substance use was more common in males than females (Prevalence: 10.5% [95% CI: 8.6- 12.6%] vs. 0.5% [95% CI: 0.2- 1.2%], respectively). The age-sex...

Male and Female Sprague Dawley Rats Exhibit Equivalent Natural Reward, Nicotine Self-Administration, Extinction, and Reinstatement During Adolescent-Initiated Behaviors

Thu, 29 Feb 2024 00:00:00 +0000

INTRODUCTION: The initiation of nicotine and tobacco use peaks during adolescence. How adolescent males and females differ based on the acquisition of nicotine use and nicotine-seeking behavior is less understood. Our current studies develop a preclinical intravenous self-administration and reinstatement paradigm in male and female Sprague Dawley rats to evaluate how sex impacts the acquisition of nicotine self-administration and nicotine-seeking, when behavior is initiated during adolescence. AIMS AND METHODS: Male and female adolescent rats were food trained under a fixed-ratio one (FR1) schedule of reinforcement and progressively increased to FR5. Animals were implanted with catheters and began nicotine self-administration (0.015 mg/kg/infusion) at FR5 during adolescence on postnatal day 34. Upon reaching stable reinforced responding, animals were tested for progressive ratio (PR) schedules of reinforcement followed by extinction via the removal of drug and associated cues...

Declared impact of the US President’s statements and campaign statements on Latino populations’ perceptions of safety and emergency care access

Sun, 25 Feb 2024 00:00:00 +0000

Statements about building walls, deportation and denying services to undocumented immigrants made during President Trump's presidential campaign and presidency may induce fear in Latino populations and create barriers to their health care access. To assess how these statements relate to undocumented Latino immigrants' (UDLI) and Latino legal residents/citizens' (LLRC) perceptions of safety and their presentations for emergency care, we conducted surveys of adult patients at three county emergency departments (EDs) in California from June 2017 to December 2018. Of 1,684 patients approached, 1,337 (79.4%) agreed to participate: 34.3% UDLI, 36.9% LLRC, and 29.8% non-Latino legal residents/citizens (NLRC). The vast majority of UDLI (95%), LLRC (94%) and NLRC (85%) had heard statements about immigrants. Most UDLI (89%), LLRC (88%) and NLRC (87%) either thought that these measures were being enacted now or will be enacted in the future. Most UDLI and half of LLRC reported that these...

Variability in the Integration of Peers in a Multi-site Digital Mental Health Innovation Project

Tue, 20 Feb 2024 00:00:00 +0000

Peer support specialists (“peers”) who have the lived experience of, and are in recovery from, mental health challenges are increasingly being integrated into mental health care as a reimbursable service across the US. This study describes the ways peers were integrated into Help@Hand, a multi-site innovation project that engaged peers throughout efforts to develop and offer digital mental health interventions across counties/cities (“sites”) in California. Using a mixed methods design, we collected quantitative data via quarterly online surveys, and qualitative data via semi-annual semi-structured phone interviews with key informants from Help@Hand sites. Quantitative data were summarized as descriptive findings and qualitative data from interviews were analyzed using rapid qualitative analysis methods. In the final analytic phase, interview quotes were used to illustrate the complex realities underlying quantitative responses. 117 quarterly surveys and 46 semi-annual interviews...

“Mm-hm,” “Uh-uh”: are non-lexical conversational sounds deal breakers for the ambient clinical documentation technology?

Mon, 5 Feb 2024 00:00:00 +0000

OBJECTIVES: Ambient clinical documentation technology uses automatic speech recognition (ASR) and natural language processing (NLP) to turn patient-clinician conversations into clinical documentation. It is a promising approach to reducing clinician burden and improving documentation quality. However, the performance of current-generation ASR remains inadequately validated. In this study, we investigated the impact of non-lexical conversational sounds (NLCS) on ASR performance. NLCS, such as Mm-hm and Uh-uh, are commonly used to convey important information in clinical conversations, for example, Mm-hm as a "yes" response from the patient to the clinician question "are you allergic to antibiotics?" MATERIALS AND METHODS: In this study, we evaluated 2 contemporary ASR engines, Google Speech-to-Text Clinical Conversation ("Google ASR"), and Amazon Transcribe Medical ("Amazon ASR"), both of which have their language models specifically tailored to clinical conversations. The empirical...

A qualitative exploration of the potential role of using online social media support communities to increase initiation of Medications for Opioid Use Disorder (MOUD)

Sat, 3 Feb 2024 00:00:00 +0000

Objectives: This study sought to explore the potential role of peer-led online communities to increase use of medications for opioid use disorder. Methods: From January through March 2020, participants with opioid use disorder and their family members/friends were recruited from paid Facebook ads; public health key stakeholders were recruited from referrals from the study team and opioid experts. Thirty participants from California were interviewed; 23 persons reporting opioid misuse, 3 family members/friends of persons misusing opioids, and 4 public health key stakeholders. We conducted semi-structured interviews asking about preferences, barriers and facilitators of treatment options for opioid use disorder, and perspectives around the use of digital/online communities. The categories of participants interviewed were each asked slightly different questions depending upon their role. Results: Results suggest that participants who misuse opioids (1) may prefer to engage in online...

Delays in hospital admissions in patients with fractures across 18 low-income and middle-income countries (INORMUS): a prospective observational study

Fri, 2 Feb 2024 00:00:00 +0000

BACKGROUND: The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. METHODS: In this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital...

Perspectives on Privacy in the Post-Roe Era: A Mixed-Methods of Machine Learning and Qualitative Analyses of Tweets.

Sat, 27 Jan 2024 00:00:00 +0000

Abortion is a controversial topic that has long been debated in the US. With the recent Supreme Court decision to overturn Roe v. Wade, access to safe and legal reproductive care is once again in the national spotlight. A key issue central to this debate is patient privacy, as in the post-HITECH Act era it has become easier for medical records to be electronically accessed and shared. This study analyzed a large Twitter dataset from May to December 2022 to examine the public's reactions to Roe v. Wade's overruling and its implications for privacy. Using a mixed-methods approach consisting of computational and qualitative content analysis, we found a wide range of concerns voiced from the confidentiality of patient-physician information exchange to medical records being shared without patient consent. These findings may inform policy making and healthcare industry practices concerning medical privacy related to reproductive rights and women's health.

Risky Drinking in Adolescents and Emerging Adults: Differences between Individuals Using Alcohol Only versus Polysubstances

Sat, 13 Jan 2024 00:00:00 +0000

BACKGROUND: Factors related to risky drinking (e.g., motives, protective behavioral strategies [PBS]) may vary between youth who engage in polysubstance use compared to those who consume alcohol only. We examined differences in factors among youth who consume alcohol only compared to alcohol with other substances (i.e., polysubstance use), and correlates associated with risky drinking between the groups. METHODS: Participants (N = 955; ages 16-24; 54.5% female) who reported recent risky drinking completed measures of alcohol/substance use, alcohol-related consequences, drinking motives, alcohol PBS, mental health symptoms, and emotion dysregulation. Participants were in the polysubstance group if they reported using at least one other substance (e.g., cannabis, stimulants) in addition to alcohol in the past three months. Chi-square and t-tests examined differences between the two groups and multiple regression analyses examined correlates of risky drinking. RESULTS:...

Effectiveness and Safety of Biologic Therapy in Hispanic Vs Non-Hispanic Patients With Inflammatory Bowel Diseases: A CA-IBD Cohort Study

Fri, 5 Jan 2024 00:00:00 +0000

BACKGROUND & AIMS: There are limited data on outcomes of biologic therapy in Hispanic patients with inflammatory bowel diseases (IBDs). We compared risk of hospitalization, surgery, and serious infections in Hispanic vs non-Hispanic patients with IBD in a multicenter, electronic health record-based cohort of biologic-treated patients. METHODS: We identified adult patients with IBD who were new users of biologic agents (tumor necrosis factor α [TNF-α] antagonists, ustekinumab, vedolizumab) from 5 academic institutions in California between 2010 and 2017. We compared the risk of all-cause hospitalization, IBD-related surgery, and serious infections in Hispanic vs non-Hispanic patients using 1:4 propensity score matching and survival analysis. RESULTS: We compared 240 Hispanic patients (53% male; 45% with ulcerative colitis; 73% TNF-α antagonist-treated; 20% with prior biologic exposure) with 960 non-Hispanic patients (51% male; 44% with ulcerative colitis; 67% TNF-α antagonist-treated;...

Ultrasound diagnosis of malaria: examination of the spleen, liver, and optic nerve sheath diameter.

Sun, 24 Dec 2023 00:00:00 +0000

BACKGROUND: Over 90% of all cases of malaria worldwide occur in Africa. Current methods of diagnosis are time and labor intensive, and could lead to delayed treatment. METHODS: In this study we investigated the effectiveness of measurements of spleen, liver, and optic nerve sheath diameter (ONSD) in identifying patients with malaria or severe malaria through the use of hand-held ultrasound devices. We recruited 40 adult patients with malaria and 16 adult control subjects at two hospitals in Mwanza, Tanzania. Ultrasonographic diagnosis was compared with rapid antigen diagnostic test and peripheral blood smear as the gold standards. An receiver operating characteristic curve test was performed to determine the most optimal diagnostic threshold for malaria and severe malaria, using each of the measurements for liver size, spleen size, and ONSD. The thresholds were determined to be >12 cm for spleen length and >15.1 cm for liver length, whereas ONSD was not significant in this...

Point-of-Care Brain MRI: Preliminary Results from a Single-Center Retrospective Study.

Thu, 14 Dec 2023 00:00:00 +0000

Background Point-of-care (POC) MRI is a bedside imaging technology with fewer than five units in clinical use in the United States and a paucity of scientific studies on clinical applications. Purpose To evaluate the clinical and operational impacts of deploying POC MRI in emergency department (ED) and intensive care unit (ICU) patient settings for bedside neuroimaging, including the turnaround time. Materials and Methods In this preliminary retrospective study, all patients in the ED and ICU at a single academic medical center who underwent noncontrast brain MRI from January 2021 to June 2021 were investigated to determine the number of patients who underwent bedside POC MRI. Turnaround time, examination limitations, relevant findings, and potential CT and fixed MRI findings were recorded for patients who underwent POC MRI. Descriptive statistics were used to describe clinical variables. The Mann-Whitney U test was used to compare the turnaround time between POC MRI and...

Weighty Matters: A Real-World Comparison of the Handtevy and Broselow Methods of Prehospital Weight Estimation

Tue, 12 Dec 2023 00:00:00 +0000

INTRODUCTION: The majority of pediatric medications are dosed according to weight and therefore accurate weight assessment is essential. However, this can be difficult in the unpredictable and peripatetic prehospital care setting, and medication errors are common. The Handtevy method and the Broselow tape are two systems designed to guide Emergency Medical Services (EMS) providers in both pediatric patient weight estimation and medication dosing. The accuracy of the Handtevy method of weight estimation as practiced in the field by EMS has not been previously examined. STUDY OBJECTIVE: The primary objective of this study was to examine the field performance of the Handtevy method and the Broselow tape with respect to prehospital patient weight estimation. METHODS: This was a retrospective chart review of trauma and non-trauma patients transported by EMS to the emergency department (ED) of a quaternary care children's hospital from January 1, 2021 through June 30, 2021. Demographic...

9-1-1 Activations from Ambulatory Care Centers: A Sicker Pediatric Population

Tue, 12 Dec 2023 00:00:00 +0000

BACKGROUND: Pediatric patients transferred by Emergency Medical Services (EMS) from urgent care (UC) and office-based physician practices to the emergency department (ED) following activation of the 9-1-1 EMS system are an under-studied population with scarce literature regarding outcomes for these children. The objectives of this study were to describe this population, explore EMS level-of-care transport decisions, and examine ED outcomes. METHODS: This was a retrospective review of patients zero to <15 years of age transported by EMS from UC and office-based physician practices to the ED of two pediatric receiving centers from January 2017 through December 2019. Variables included reason for transfer, level of transport, EMS interventions and medications, ED medications/labs/imaging ordered in the first hour, ED procedures, ED disposition, and demographics. Data were analyzed with descriptive statistics, X test, point biserial correlation, two-sample z test,...

Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells: a case report

Thu, 7 Dec 2023 00:00:00 +0000

BackgroundUndifferentiated carcinomas of the pancreas with osteoclast-like giant cells (UCPOGC) are rare pancreatic neoplasms that account for less than 1% of all pancreatic malignancies. This case report of a 54-year-old male with metastatic UCPOGC adds to the existing literature and further ascertains the clinical and imaging features, treatment options, and prognosis of this rare entity.Case presentationWe present the detailed clinical course of a 54-year-old Asian male patient with UCPOGC, with focus on the relevant clinical features and imaging findings that are characteristic of this disease entity.ConclusionsUCPOGC is an extremely rare pancreatic tumor with a unique histopathology and clinical course. It is often difficult to distinguish UCPOGCs from other pancreatic tumors, such as traditional pancreatic ductal adenocarcinomas (PDAC), on imaging, and it therefore remains a pathological diagnosis. Surgery is generally regarded as the first-line treatment option, and the...

Suicide risk profiles and barriers to professional help-seeking among college students with elevated risk for suicide

Wed, 29 Nov 2023 00:00:00 +0000

Suicide is the second leading cause of death among college students, yet many students with elevated suicide risk do not seek professional help. This study identified suicide risk profiles among college students and examined these in relation to students' perceived barriers to professional help-seeking. Data were obtained from college students (n = 1689) identified to be at elevated risk for suicide based at four US universities. Latent class analysis was performed to determine risk profiles, followed by examinations of differences in help-seeking barriers by profile groupings. Results revealed three student groupings: (1) moderate internalizing and externalizing symptoms (with low alcohol misuse), (2) highest internalizing and externalizing symptoms (with highest social disconnection), and (3) lowest internalizing symptoms and low externalizing (with highest social connection and alcohol misuse). Group 1 included the youngest and most racially and sexually diverse students,...

The 2023 Model Core Content of Disaster Medicine

Thu, 9 Nov 2023 00:00:00 +0000

INTRODUCTION: Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners operate in situations where resources are not adequate, necessitating a modification in practice. While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States. STUDY OBJECTIVE: The objective of this work is to define the core curriculum for DM physician fellowships in the United States, drawing consensus among existing DM fellowship directors. METHODS: A panel of DM experts was created from the members of the Council of Disaster Medicine...

A qualitative study on user acceptance of a home-based stroke telerehabilitation system

Sun, 22 Oct 2023 00:00:00 +0000

Objective: This paper reports a qualitative study of a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education in the patient's home. The aims of the current report are to investigate patient perceived benefits of and barriers to using the telerehabilitation system at home.Methods: We used a qualitative study design that involved in-depth semi-structured interviews with 13 participants who were patients in the subacute phase after stroke and had completed a six-week intervention using the home-based telerehabilitation system. Thematic analysis was conducted to analyze the data.Results: Participants mostly reported positive experiences with the telerehabilitation system. Benefits included observed improvements in limb functions, cognitive abilities, and emotional well-being. They also perceived the system easy to use due to the engaging...

Underreporting of Alcohol Use in Trauma Patients: A Retrospective Analysis

Sun, 15 Oct 2023 00:00:00 +0000

BACKGROUND: This study assessed the inconsistencies between self-reported alcohol consumption and blood alcohol content (BAC) in trauma patients. We aimed to identify the incidence of positive BAC in trauma patients who reported a zero score on the Alcohol Use Disorders Identification Test (AUDIT). We also sought to identify characteristics of individuals who were likely to negate alcohol use, yet yielded a positive BAC, to improve our ability to provide alcohol screening and healthcare to these at-risk alcohol consumers. Methods: We conducted a retrospective study from 2010 to 2018 at a university-based, level-one trauma emergency department. We identified 2581 adult trauma patients who reported a zero score on the AUDIT from the trauma registry. We collected BAC, age, gender, race, education level, mechanism of injury, language and injury severity score (ISS) from patient charts, and used descriptive analyses and multivariate logistic regression to analyze the data. Results:...

A Mobile Health Application Using Geolocation for Behavioral Activity Tracking

Wed, 11 Oct 2023 00:00:00 +0000

The increasing popularity of mHealth presents an opportunity for collecting rich datasets using mobile phone applications (apps). Our health-monitoring mobile application uses motion detection to track an individual's physical activity and location. The data collected are used to improve health outcomes, such as reducing the risk of chronic diseases and promoting healthier lifestyles through analyzing physical activity patterns. Using smartphone motion detection sensors and GPS receivers, we implemented an energy-efficient tracking algorithm that captures user locations whenever they are in motion. To ensure security and efficiency in data collection and storage, encryption algorithms are used with serverless and scalable cloud storage design. The database schema is designed around Mobile Advertising ID (MAID) as a unique identifier for each device, allowing for accurate tracking and high data quality. Our application uses Google's Activity Recognition Application Programming...

Developing a Semantically Based Query Recommendation for an Electronic Medical Record Search Engine: Query Log Analysis and Design Implications

Wed, 4 Oct 2023 00:00:00 +0000

BACKGROUND: An effective and scalable information retrieval (IR) system plays a crucial role in enabling clinicians and researchers to harness the valuable information present in electronic health records. In a previous study, we developed a prototype medical IR system, which incorporated a semantically based query recommendation (SBQR) feature. The system was evaluated empirically and demonstrated high perceived performance by end users. To delve deeper into the factors contributing to this perceived performance, we conducted a follow-up study using query log analysis. OBJECTIVE: One of the primary challenges faced in IR is that users often have limited knowledge regarding their specific information needs. Consequently, an IR system, particularly its user interface, needs to be thoughtfully designed to assist users through the iterative process of refining their queries as they encounter relevant documents during their search. To address these challenges, we incorporated "query...

Electroencephalography Measures are Useful for Identifying Large Acute Ischemic Stroke in the Emergency Department

Wed, 20 Sep 2023 00:00:00 +0000

BACKGROUND: Early diagnosis of stroke optimizes reperfusion therapies, but behavioral measures have incomplete accuracy. Electroencephalogram (EEG) has high sensitivity for immediately detecting brain ischemia. This pilot study aimed to evaluate feasibility and utility of EEG for identifying patients with a large acute ischemic stroke during Emergency Department (ED) evaluation, as these data might be useful in the prehospital setting. METHODS: A 3-minute resting EEG was recorded using a dense-array (256-lead) system in patients with suspected acute stroke arriving at the ED of a US Comprehensive Stroke Center. RESULTS: An EEG was recorded in 24 subjects, 14 with acute cerebral ischemia (including 5 with large acute ischemic stroke) and 10 without acute cerebral ischemia. Median time from stroke onset to EEG was 6.6 hours; and from ED arrival to EEG, 1.9 hours. Delta band power (P = .004) and the alpha/delta frequency band ratio (P = .0006) each significantly distinguished patients...

Suicidality and Alcohol Use as Predictors of Future Suicidal Behavior in College Students

Tue, 19 Sep 2023 00:00:00 +0000

AIMS: There has been a marked increase in suicide fatalities among college-age students in recent years. Moreover, heavy alcohol use, a well-known risk factor for suicide, is present on most campuses. Yet, no prospective studies have examined alcohol use patterns among college students as predictors of suicidal behaviors. METHODS: Online of 40,335 students at four universities took place at the beginning of four academic years, 2015-2018. Of these, 2296 met criteria for an increased risk of suicidal behavior and completed 1- and/or 6-month follow-up evaluation(s). Baseline assessments included the Alcohol Use Disorders Identification Test to quantify alcohol consumption and resulting problems, and measures of depression, suicidal ideation and suicidal behavior. RESULTS: Suicide attempts during follow-up were reported by 35 (1.5%) of high-risk students. Regression analyses indicated that baseline severity of alcohol use consequences, but not amount of alcohol consumption, was associated...

Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers

Mon, 18 Sep 2023 00:00:00 +0000

OBJECTIVE: Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish "patient-centeredness" in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. METHODS AND MATERIALS: Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. RESULTS: The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers...

Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review

Mon, 18 Sep 2023 00:00:00 +0000

Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being...

Comparison of the bleeding cricothyrotomy model to SimMan for training students and residents emergency cricothyrotomy

Mon, 18 Sep 2023 00:00:00 +0000

INTRODUCTION: A cricothyroidotomy is an emergency procedure that few emergency medicine residents see or perform during their training. Therefore, there is a need for low cost, high fidelity models for training. In this study, we explore a new training model for cricothyroidotomies (the bleeding CRIC [cost-effective realistic interactive cricothyroidotomy]) to determine if this new task-trainer is non-inferior compared to the current standard of training. METHODS: Authors conducted a randomized control non-inferiority study. There were seventeen residents and medical students enrolled by convenience sample to partake in the study. The participants were randomized by block randomization to be taught how to perform a cricothyroidotomy on either the new task trainer or the current standard task trainer and then were asked to perform the procedure on a pig trachea model. Primary outcome measures were scores on a previously validated objective assessment tool and secondary outcomes...

Incorporating guidelines for use of mobile technologies in health research and practice

Sun, 17 Sep 2023 00:00:00 +0000

This commentary aims to create initial recommendations to guide researchers' decisions on the development and use of mobile technologies for public health research. We recommend that mobile technologies for public health research should be scalable and sustainable; draw on social, psychological and/or behavioral theoretical models; be able to be integrated with multiple communication devices; incorporate social network and/or geographic metrics and take a community-based participatory approach to development and implementation. All of these approaches are discussed.

Tehran cohort study (TeCS) on cardiovascular diseases, injury, and mental health: Design, methods, and recruitment data

Fri, 15 Sep 2023 00:00:00 +0000

Cardiovascular disease, mental health, and injury are among the top health issues globally. In Tehran Cohort Study, we aimed to determine the prevalence, incidence, and trend of cardiovascular diseases, psychiatric symptoms, injury, and risk factors in Tehran households. We enrolled 4215 households in the recruitment phase from March 2016 to March 2019. Demographic characteristics, past medical history, medications, and familial history of the participants were collected. Rose angina pectoris, general health Questionnaire-28 (GHQ-28), and injury questionnaires were completed. Fasting blood samples were collected to measure routine biochemistry and store samples in the biobank. Anthropometric and physiological measurements and electrocardiograms were performed. The participants are followed every three years for up to 12 years. In total, 8296 individuals participated in the cardiovascular section, 10247 completed the GHQ-28, and 4167 households completed the injury questionnaire....

Nicotine on the developing brain

Mon, 11 Sep 2023 00:00:00 +0000

Developmental periods such as gestation and adolescence have enhanced plasticity leaving the brain vulnerable to harmful effects from nicotine use. Proper brain maturation and circuit organization is critical for normal physiological and behavioral outcomes. Although cigarette smoking has declined in popularity, noncombustible nicotine products are readily used. The misperceived safety of these alternatives lead to widespread use among vulnerable populations such as pregnant women and adolescents. Nicotine exposure during these sensitive developmental windows is detrimental to cardiorespiratory function, learning and memory, executive function, and reward related circuitry. In this review, we will discuss clinical and preclinical evidence of the adverse alterations in the brain and behavior following nicotine exposure. Time-dependent nicotine-induced changes in reward related brain regions and drug reward behaviors will be discussed and highlight unique sensitivities within a...

Using a Linear Probe Ultrasound for the Detection of First-Trimester Pregnancies in the Emergency Department

Mon, 4 Sep 2023 00:00:00 +0000

Linear probe point-of-care ultrasound (LPUS) presents a less invasive alternative for identifying intrauterine pregnancies (IUPs) compared to usual practice (transabdominal (TAUS) or transvaginal (TVUS) ultrasound). TAUS and TVUS can be invasive or produce lower-resolution images than LPUS. The purpose of this study is to determine whether a linear probe alone can identify first-trimester IUPs. A convenience sample of 21 patients were enrolled at the University of California Irvine ED during a 7-month period. The inclusion criteria were English- or Spanish-speaking women (≥18 years) in their first trimester of pregnancy (≤12 weeks pregnant) with a body mass index (BMI) of <35. The exclusion criteria were psychiatric, incarcerated, or cognitively impaired patients. An ED physician performed LPUS and ordered a confirmatory ultrasound. The 21 patients enrolled had a mean age of 28.6 ± 6.60 years, BMI of 26.6 ± 5.03, and gestational age of 7.4 ± 2.69 weeks. Considering the 95%...

Supporting information retrieval from electronic health records: A report of University of Michigan’s nine-year experience in developing and using the Electronic Medical Record Search Engine (EMERSE)