Use of Electronic Health Records to Develop and Implement a Silent Best Practice Alert Notification System for Patient Recruitment in Clinical Research: Quality Improvement Initiative.

BACKGROUND: Participant recruitment, especially for frail, elderly, hospitalized patients, remains one of the greatest challenges for many research groups. Traditional recruitment methods such as chart reviews are often inefficient, low-yielding, time consuming, and expensive. Best Practice Alert (BPA) systems have previously been used to improve clinical care and inform provider decision making, but the system has not been widely used in the setting of clinical research. OBJECTIVE: The primary objective of this quality-improvement initiative was to develop, implement, and refine a silent Best Practice Alert (sBPA) system that could maximize recruitment efficiency. METHODS: The captured duration of the screening sessions for both methods combined with the allotted research coordinator hours in the Emerald-COPD (chronic obstructive pulmonary disease) study budget enabled research coordinators to estimate the cost-efficiency. RESULTS: Prior to implementation, the sBPA system underwent three primary stages of development. Ultimately, the final iteration produced a system that provided similar results as the manual Epic Reporting Workbench method of screening. A total of 559 potential participants who met the basic prescreen criteria were identified through the two screening methods. Of those, 418 potential participants were identified by both methods simultaneously, 99 were identified only by the Epic Reporting Workbench Method, and 42 were identified only by the sBPA method. Of those identified by the Epic Reporting Workbench, only 12 (of 99, 12.12%) were considered eligible. Of those identified by the sBPA method, 30 (of 42, 71.43%) were considered eligible. Using a side-by-side comparison of the sBPA and the traditional Epic Reporting Workbench method of screening, the sBPA screening method was shown to be approximately four times faster than our previous screening method and estimated a projected 442.5 hours saved over the duration of the study. Additionally, since implementation, the sBPA system identified the equivalent of three additional potential participants per week. CONCLUSIONS: Automation of the recruitment process allowed us to identify potential participants in real time and find more potential participants who meet basic eligibility criteria. sBPA screening is a considerably faster method that allows for more efficient use of resources. This innovative and instrumental functionality can be modified to the needs of other research studies aiming to use the electronic medical records system for participant recruitment.

Comparative performance of NEMS-S Surveys in latino food stores in the greater boston area

The dietary practices of diverse population groups, associated with the nutritional transition and the rapid demographic changes occurring globally require more attention to the food preferences of migrant groups such as Latinos living in the United States United States of America (US). This work aimed at the performance of an instrument utilized to measure availability of healthy food options in Latino stores located in the town of Somerville, state of Massachusetts. The methodology included the application of two versions: Guatemalan and US of the Nutrition Environment Measures Survey for Stores (NEMS-S), for the assessment of the availability of healthy food options in three Latino stores. Data were analyzed using descriptive statistics. The results indicated that foods sold in Latino stores were identified more successfully with the Guatemalan-NEMS-S than with the US NEMS-S. There was a general lack of healthy food options found when using the US survey, as well as a relatively narrow selection of fruits and vegetables. As conclusion, it was found that the US NEMS-S tended to identify a lower number of healthy food options, as compared to a larger number of similar options when a culturally-appropriate survey was used. These findings illustrate a manner in which a culture-specific instrument perform more appropriately than similar instruments adapted for other population groups, especially when the results are to be applied to support development of healthy food policies(AU)

Las prácticas alimentarias de diversos grupos de población, asociadas a la transición nutricional, y a los rápidos cambios demográficos que se producen a nivel mundial, exigen más atención a las preferencias alimentarias de grupos migrantes, como por ejemplo Latinos en los Estados Unidos de Norteamérica (EU). Este trabajo documenta los resultados de aplicar un instrumento para medir disponibilidad de alimentos saludables en tres tiendas latinas ubicadas en la ciudad de Somerville, estado de Massachusetts. La metodología utilizada incluyó la aplicación de dos versiones: guatemalteca y EU de la Encuesta para Medir Ambiente Nutricional en Tiendas (NEMS-S, siglas en inglés), para evaluar la disponibilidad de alimentos saludables. Los datos se analizaron con estadísticas descriptivas. Los resultados indicaron que los alimentos vendidos en las tiendas latinas fueron identificados con más acierto con el NEMS-S guatemalteco que con el NEMS-S de EU. Con este último instrumento, se obtuvo un número menor de opciones saludables y una selección limitada de frutas y de vegetales. Como conclusión, se encontró que el NEMS-S de EU identificaba un menor número de opciones de alimentos saludables, en comparación con el instrumento culturalmente apropiado. Estos hallazgos ilustran la importancia de utilizar instrumentos específicos para determinar disponibilidad de alimentos saludables, especialmente cuando los resultados se utilicen para apoyar el desarrollo de políticas alimentarias(AU)

Vitamin D status among indigenous Mayan (Kekchi) and Afro-Caribe (Garifuna) adolescents from Guatemala: a comparative description between two ethnic groups residing on the Rio Dulce at the Caribbean coast in Izabal Province, Guatemala.

OBJECTIVE: To assess vitamin D status and the influence of risk factors such as skin pigmentation and time spent outdoors on hypovitaminosis D among Guatemalan Kekchi and Garifuna adolescents. DESIGN: Cross-sectional study, with convenient sampling design. Blood samples, anthropometric and behavioural data were all collected during the dry season. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by RIA. SETTING: Communities of Rio Dulce and Livingston, Izabal Province, Caribbean coast of Guatemala, with latitude and longitude of 15°49'N and 88°45'W for Livingston and 15°46'N and 88°49'W for Rio Dulce, respectively. SUBJECTS: Eighty-six adolescents, divided evenly by sex and ethnicity, with mean age of 14 years. RESULTS: Mean (sd) 25(OH)D value was 27·8 (7·2) ng/ml for the total group, with 25·8 (5·9) and 29·8 (7·9) ng/ml, respectively, in Kekchis and Garifunas (P=0·01). Use of vitamin D supplementation, clothing practices and sun protection were not statistically different between groups. Skin area exposed on the day of data collection ranged from 20·0 % minimum to 49·4 % maximum, with mean (sd) exposure of 32·0 (8.5) %. With univariate regression analysis, age (P=0·034), sex (P=0·044), ethnicity (P=0·010), time spent outdoors (P=0·006) and percentage skin area exposed (P=0·001) were predictive. However, multivariate analysis indicated that only sex (P=0·034) and percentage skin area exposed (P=0·044) remained as predictors of 25(OH)D. CONCLUSIONS: Despite residing in an optimal geographic location for sunlight exposure, nearly 65 % of study adolescents were either insufficient or deficient in vitamin D. Correction and long-term prevention of this nutritional problem may be instrumental in avoiding adverse effects in adulthood attributed to low 25(OH)D during adolescence.