Using quality improvement approaches to increase emergency department provider engagement in research participant enrollment during COVID-19 and opioid overdose public health emergencies.

PURPOSE: We utilized quality improvement (QI) approaches to increase emergency department (ED) provider engagement with research participant enrollment during the opioid crisis and coronavirus disease (COVID-19) pandemic. The context of this work is the Evaluating Microdosing in the Emergency Department (EMED) study, a randomized trial offering buprenorphine/naloxone to ED patients through randomization to standard or microdosing induction. Engaging providers is crucial for participant recruitment to our study. Anticipating challenges sustaining long-term engagement after a 63% decline in provider referrals four months into enrollments, we applied Plan-Do-Study-Act (PDSA) cycles to develop and implement an engagement strategy to increase and sustain provider engagement by 50% from baseline within 9 months. METHODS: Our engagement strategy was centered on Coffee Carts rounds: 5-min study-related educational presentations for providers on shift; and a secondary initiative, a Suboxone Champions program, to engage interested providers as study-related peer educators. We used provider referrals to our team as a proxy for study engagement and report the percent change in mean weekly referrals across two PDSA cycles relative to our established referral baseline. RESULTS: A QI approach afforded real-time review of interventions based on research and provider priorities, increasing engagement via mean weekly provider referrals by 14.5% and 49% across two PDSA cycles relative to baseline, respectively. CONCLUSIONS: Our Coffee Carts and Suboxone Champions program are efficient, low-barrier, educational initiatives to convey study-related information to providers. This work supported our efforts to maximally engage providers, minimize burden, and provide life-saving buprenorphine/naloxone to patients at risk of fatal overdose.

RéSUMé: BUT: Nous avons utilisé des approches d'amélioration de la qualité (AQ) pour accroître l'engagement des fournisseurs des services d'urgence (SU) avec l'inscription des participants à la recherche pendant la crise des opioïdes et la pandémie de maladie à coronavirus (COVID-19). Le contexte de ce travail est l'étude Evaluating Microdosing in the Emergency Department (EMED), un essai randomisé offrant de la buprénorphine/naloxone aux patients aux urgences par randomisation à l'induction standard ou au microdosage. L'engagement des fournisseurs est crucial pour le recrutement des participants à notre étude. En anticipant les difficultés à maintenir un engagement à long terme après une baisse de 63 % des recommandations de fournisseurs quatre mois après les inscriptions, nous avons appliqué le Plan-Do-Study-Act (PDSA) cycles d'élaboration et de mise en œuvre d'une stratégie d'engagement visant à accroître et à maintenir l'engagement des fournisseurs de 50 % par rapport au niveau de référence dans les neuf mois. MéTHODES: Notre stratégie de mobilisation était axée sur les tournées de Coffee Carts : des présentations éducatives de cinq minutes sur l'étude pour les fournisseurs sur le quart de travail; et une initiative secondaire, un programme Suboxone Champions, pour mobiliser les fournisseurs intéressés en tant que pairs éducateurs liés à l'étude. Nous avons utilisé les recommandations des fournisseurs à notre équipe comme indicateur de la participation à l'étude et nous avons signalé le pourcentage de changement dans les recommandations hebdomadaires moyennes pour deux cycles PDSA par rapport à notre base de référence établie. RéSULTATS: Une approche d'AQ a permis d'examiner en temps réel les interventions en fonction des priorités de la recherche et des fournisseurs, ce qui a augmenté l'engagement par l'intermédiaire des recommandations hebdomadaires moyennes des fournisseurs de 14,5 % et de 49 % au cours de deux cycles de PDSA par rapport au niveau de référence, respectivement. CONCLUSION: Notre programme Coffee Carts and Suboxone Champions est une initiative éducative efficace et peu contraignante qui permet de transmettre aux fournisseurs des renseignements sur les études. Ce travail a appuyé nos efforts visant à mobiliser au maximum les fournisseurs, à réduire au minimum le fardeau et à fournir de la buprénorphine/naloxone vitale aux patients à risque de surdose mortelle.

Subjective Impact of Age-Related Hearing Loss Is Worse for Those Who Routinely Experience Boredom and Failures of Attention.

OBJECTIVES: Despite extensive evidence supporting the benefits of hearing treatments for individuals affected by hearing loss, many leave their hearing issues unaddressed. This underscores the need to better understand the individual factors influencing decision-making regarding hearing loss treatments. One consideration regarding the low uptake of treatment is the finding that the subjective impact of hearing loss is greater for some individuals than for others, yielding a significant discrepancy between subjective measures of hearing loss (e.g., self-report hearing-handicap scales) and objective audiometric assessments (e.g., audiograms). The current study seeks to elucidate some of the cognitive-affective factors that give rise to these individual differences in the subjective impact of hearing loss. Specifically, we hypothesized that a stronger trait tendency to experience boredom would be correlated with more intensely negative experiences of hearing-related issues, and that this relationship would be mediated by underlying attentional difficulties. METHODS: Through a partnership with hearing care clinics (Connect Hearing Canada), we recruited a large sample of older adults (n = 1840) through their network of hearing-care clinics. Audiometric thresholds provided an objective measure of hearing ability for each participant, while self-report questionnaires assessed individual differences in the subjective impact of hearing-related issues (hearing handicap), subjective strain experienced when listening (listening effort), tendency to experience boredom, tendency to experience difficulty maintaining task-focused attention (mind-wandering), and self-perceived level of cognitive functioning. RESULTS: The subjective impact of hearing loss-both in terms of hearing handicap and strain when listening-was found to be more intensely negative for those who are characteristically more susceptible to experiencing boredom, and this relationship was shown to be mediated by self-reported differences in the ability to maintain task-focused attention. This relationship between trait boredom proneness and the subjective impact of hearing-related issues was evident across all levels of objective hearing abilities. Moreover, there was no evidence that the subjective impact of hearing loss is worse for those who routinely experience boredom because of objectively-poorer hearing abilities in those individuals. CONCLUSIONS: A greater trait susceptibility to experiencing boredom was associated with a more aversive subjective experience of hearing loss, and this relationship is mediated by attentional difficulties. This is a novel discovery regarding the cognitive-affective factors that are linked to individual differences in the effect that hearing loss has on individuals' daily functioning. These results may be helpful for better understanding the determinants of hearing-rehabilitation decisions and how to improve the uptake of treatments for hearing loss. The observational nature of the current study restricts us from drawing any definitive conclusions about the casual directions among the factors being investigated. Further research is therefore needed to establish how individual differences in the characteristic tendency to experience boredom are related to attentional-control difficulties and the experience of hearing-related issues. More research is also required to determine how all of these factors may influence decisions regarding hearing-loss treatments.

European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology.

AIMS: To develop a set of quality indicators (QIs) for the evaluation of the care and outcomes for atherosclerotic cardiovascular disease (ASCVD) prevention. METHODS AND RESULTS: The Quality Indicator Committee of the European Society of Cardiology (ESC) formed the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with Task Force members of the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice and the European Association of Preventive Cardiology (EAPC). We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care for ASCVD prevention by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. In total, 17 main and 14 secondary QIs were selected across six domains of care for ASCVD prevention: (i) structural framework, (ii) risk assessment, (iii) care for people at risk for ASCVD, (iv) care for patients with established ASCVD, (v) patient education and experience, and (vi) outcomes. CONCLUSION: We present the 2021 ESC QIs for Cardiovascular Disease Prevention, which have been co-constructed with EAPC using the ESC methodology for QI development. These indicators are supported by evidence from the literature, underpinned by expert consensus and aligned with the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice to offer a mechanism for the evaluation of ASCVD prevention care and outcomes.

Screening for Lung Cancer: Communicating With Patients.

OBJECTIVE: The purposes of this article are to detail the experience of a single-center academic institution in applying the patient-centered approach to a lung cancer screening program and to examine how this approach can expand to other aspects of follow-up imaging of lung nodules. CONCLUSION: As the practice of patient-centered radiology gains attention, diagnostic radiologists are findings new ways to become more involved in patient care. A lung cancer screening program is one opportunity for radiologists to consult with and educate patients.

Integrating smoking cessation into lung cancer screening programs.

Early detection through low-dose computed tomographic screening for lung cancer and implementation of smoking cessation can reduce mortality related to lung cancer. While studies delineating the relationship between smoking cessation strategies and lung cancer screening programs remain sparse, we aim to review available data on their importance both individually and synergistically. Strategies and obstacles for implementation are also discussed.

Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer.

Obesity is a risk factor for the development of hormone receptor-positive breast cancer in postmenopausal women and has been associated with an increased risk of recurrence and reduced survival. In humans, obesity causes subclinical inflammation in visceral and subcutaneous adipose tissue, characterized by necrotic adipocytes surrounded by macrophages forming crown-like structures (CLS). Recently, we found increased numbers of CLS, activation of the NF-κB transcription factor, and elevated aromatase levels and activity in the mammary glands of obese mice. These preclinical findings raised the possibility that the obesity → inflammation axis is important for the development and progression of breast cancer. Here, our main objective was to determine if the findings in mouse models of obesity translated to women. Breast tissue was obtained from 30 women who underwent breast surgery. CLS of the breast (CLS-B) was found in nearly 50% (14 of 30) of patient samples. The severity of breast inflammation, defined as the CLS-B index, correlated with both body mass index (P < 0.001) and adipocyte size (P = 0.01). Increased NF-κB binding activity and elevated aromatase expression and activity were found in the inflamed breast tissue of overweight and obese women. Collectively, our results suggest that the obesity → inflammation → aromatase axis is present in the breast tissue of most overweight and obese women. The presence of CLS-B may be a biomarker of increased breast cancer risk or poor prognosis.