Areas Of Need Research Articles

Motivations for Pursuing Enhanced Skill Credentials in Family Medicine: A Study of the Certificates of Added Competence in Canada.

The College of Family of Physicians of Canada's Certificates of Added Competence (CACs) denote enhanced-skill family physicians who function beyond the scope of family practice or in specialized areas fundamental to family medicine practice. The credential provides recognition for skill development in areas of need and is intended to augment comprehensive care; however, there are concerns that it increases focused practice and decreases commitment to generalist care. To inform credentialing policies, we elucidated physician and trainee motivations for pursuing the CAC credential. We conducted secondary analyses of interview data collected during a multiple case study of the impacts of the CACs in Canada. We collected data from six cases, sampled to reflect variability in geography, patient population, and practice arrangement. The 48 participants included CAC holders, enhanced-skill family physicians, generalist family physicians, residents, specialists, and administrative staff. We subjected data to qualitative descriptive analysis, beginning with inductive code generation, and concluding in unconstrained deduction. Family physicians and trainees pursue the credential to meet community health care needs, limit or promote diversity in practice, secure perceived professional benefits, and/or validate their sense of expertise. Notably, family physicians face barriers to engaging in enhanced skill training once their practice is established. While the CACs can enhance community-adaptive comprehensive care, they can also incentivize migration away from generalist practice. Credentialing policies should support enhanced skill designations that respond directly to pervasive community needs.

Fertility and Pregnancy in Crohn's Disease.

The prevalence of inflammatory bowel disease is continuing to increase worldwide and is more commonly diagnosed in women of reproductive age. Individuals with Crohn's disease may have inaccurate perceptions regarding the rate of infertility, heritability, and the safety of taking therapies for Crohn's disease during pregnancy, all of which greatly affect their decisions surrounding family planning. Given this area of need for both patients and providers, in this article, we have included the latest evidence on the impact of Crohn's disease on fertility, heritability, pregnancy outcomes, and the safety of medications for Crohn's disease during pregnancy and lactation.

Investigating the relationship between mild traumatic brain injury and Alzheimer's disease and related dementias: a systematic review.

The objective of this systematic review is to synthesize the relevant literature published after 2016 to ascertain the current landscape of science that relates mild traumatic brain injury (mTBI) to the onset of Alzheimer's disease and related dementias (ADRD) and identify areas of need for future research. We conducted database searches and retrieved articles that were published after 2016 that utilized cognitive assessments to understand the relationship between mTBI and ADRD. We identified eight relevant articles in the review process, four of which presented a significant relationship between mTBI and disease or cognitive impairment outcomes. The studies included in this systematic review underscore the need for future research investigating a possible causal relationship between mTBI and ADRDs given the high prevalence of mTBI among brain injury patients and the lack of literature specifically addressing this issue. Future research should standardize the definitions of mTBI, AD, and ADRDs to create reliable and reproducible results that more comprehensively capture the nuances of this relationship.

The need for a personalized, comprehensive resource within the colorectal cancer community.

e24139 Background: Colorectal cancer is the third-most commonly diagnosed cancer and the second-leading cause of cancer death in men and women combined in the United States. In efforts to manage the disease, patients and caregivers turn to a variety of tools and resources for financial assistance, information dissemination, emotional and peer support, and treatment planning, among other critical issues and needs they face. The Colorectal Cancer Alliance (the Alliance) is committed to providing patients and caregivers with a resource solution that encompasses all potential areas of need. Methods: A survey aimed at understanding needs, barriers, and quality improvement opportunity was disseminated via the Alliance's Blue Hope Nation community for two weeks and by email. One hundred sixty-seven colorectal cancer patients and forty caregivers of colorectal cancer patients completed the survey. Results: Patients and caregiver respondents alike report reliance on external tools and resources to manage disease and support information. Of the support methods, patient respondents reported using social media (46.11%); notebooks, journals, and planners (45.41%); online articles (44.91%); the Blue Hope Nation Facebook group (41.32%); cancer discussion boards (35.33%); and spiritual or religious advice (29.94%). Caregiver respondents reported relying on friends and family (57.5%); the Blue Hope Nation Facebook group (47.5%); healthcare websites (47.5%); the Alliance website (42.5%); and spiritual or religious advisors (37.5%). To minimize diagnosis-related stressors, patients reported they look for financial assistance, local peer support and groups, and mental health help. To provide more efficient care and limit stress, the community suggested the need for financial help, communication and support from other patients and caregivers, and informational resources. Conclusions: These survey results are consistent with other published learnings about patient and caregiver reliance on support tools and highlights the myriad resources that patients and caregivers currently use for managing colorectal cancer. The saturation of the market has compelled the Colorectal Cancer Alliance to create a one-stop-shop, personalized resource with tools to organize and effortlessly share customized information treatment plans, and other support mechanisms. Such patient and caregiver-directed resources may enable a better care experience and potentially lead to better physical and mental health outcomes for patients and their caregivers.

Surveying the Landscape of Post-secondary Options and Support for Undocumented Students in the Pacific Northwest: A View From One State’s School Counselors

Now more than ever, supportive practices and policies are needed to bolster the opportunities, safety, and future of undocumented students. K-12 school counselors and educators who aim to support the college and career readiness of undocumented youth need to be well informed and prepared to adequately address requests for guidance by students and families. This article seeks to uncover the primary areas of need, support, and resources identified by school counselors in one Pacific Northwest state in order to optimize post-secondary options and success.

Are We Moving the Needle for Patients with TP53-Mutated Acute Myeloid Leukemia?

Simple SummaryTP53-mutated acute myeloid leukemia (AML) represents one of the most informative examples of adverse risk AML. As the currently available therapies have not translated to meaningful advances in the survival of these patients, a clinical trial should be the recommendation for all newly diagnosed patients. CD47/SIRPα axis and TIM-3 inhibition appear to be some of the more promising strategies, but other agents with novel mechanisms of action are in development. We review the pathobiology of TP53-mutated AML, the possible heterogeneity among patients with this disease and how some of the novel and emerging therapies may fit into the treatment landscape in the hopefully not-so-distant future.The currently available therapeutic options for patients with TP53-mutated acute myeloid leukemia (AML) are insufficient, as they translate to a median overall of only 6–9 months, and less than 10% of patients undergoing the most aggressive treatments, such as intensive induction therapy and allogeneic hematopoietic stem cell transplantation, will be cured. The lack of clear differences in outcomes with different treatments precludes the designation of a standard of care. Recently, there has been growing attention on this critical area of need by way of better understanding the biology of TP53 alterations and the disparities in outcomes among patients in this molecular subgroup, reflected in the development and testing of agents with novel mechanisms of action. Promising preclinical and efficacy data exist for therapies that are directed at the p53 protein rendered dysfunctional via mutation or that inhibit the CD47/SIRPα axis or other immune checkpoints such as TIM-3. In this review, we discuss recently attractive and emerging therapeutic agents, their preclinical rationale and the available clinical data as a monotherapy or in combination with the currently accepted backbones in frontline and relapsed/refractory settings for patients with TP53-mutated AML.

Nursing Faculty's Perceptions of Climate Change and Sustainability.

The aim of this research study was to investigate the perceptions of climate change and sustainability of faculty teaching in associate and baccalaureate degree nursing programs in South Carolina and their attitudes toward inclusion of relevant content into the nursing curriculum. Climate change is a topic that receives limited discussion in most nursing education curricula. This cross-sectional, descriptive study gathered data from 21 schools of nursing via an online survey consisting of demographic questions, the New Ecological Paradigm Scale, and the Sustainability Attitudes in Nursing Survey 2 and two questions regarding the current inclusion of content. Eighty-one percent of respondents did not include health implications of climate change in their teaching content; 67% did not include health implications of sustainability. Results provide preliminary evidence of gaps and areas of need for curricular content related to climate change and sustainability.

Unlocking sociocultural and community factors for the global adoption of genomic medicine

Advances in genomic sequencing and genetic testing are increasingly transforming the diagnosis and treatment of diseases—specifically, rare diseases. However, the application and benefit of such technologies remain inequitable globally. There is a clear and urgent need to provide genomic sequencing to people across the global population, including people living in under-resourced areas and/or underrepresented populations. Financial considerations are the most obvious barriers to the adoption of genomic medicine, yet there are many other factors that are not so obvious, such as geography, language, communication, and culture. Herein, we use the lens of rare diseases and focus on firstly, selected socio-cultural factors, and in particular stigma; and secondly, empowering community factors such as education, advocacy and connectivity amongst people living with rare diseases globally. These are critical areas of need and opportunity if genomic medicine is to achieve equitable and global adoption in the patient best-interest across low- middle- and high-income country health systems. Furthermore, we touch on specific child health aspects and how they can point towards opportunities to build on specific infrastructures.

Adult Growth Hormone Deficiency: Diagnostic and Treatment Journeys From the Patients' Perspective.

Adult growth hormone deficiency (AGHD) is a rare and serious condition associated with significant morbidity, including reduced quality of life, and is underdiagnosed and often missed in patients. Although the onset of AGHD can occur in either childhood or adulthood, adult-onset AGHD is more difficult to identify as it lacks the auxologic signs caused by GHD during childhood, includes symptoms that tend to be nonspecific, and lacks reliable, simple biomarker testing options. A panel of 9 patients with AGHD (3 with childhood onset; 6 with adult onset) was assembled to share their first-hand experiences, to help reveal important areas of need, increase health literacy, and to raise awareness about GHD among patients, caregivers, and healthcare practitioners. Interviews with patients yielded valuable insights from the patient perspective to supplement prior knowledge about AGHD symptomatology, biomarker testing, and treatment outcomes. Some patients described a burdensome and ineffective screening process that sometimes included many visits to different specialists, repeated rounds of biomarker testing, and, in some cases, excessive delays in AGHD diagnosis. All patients expressed frustration with insurance companies that often resist and/or delay treatment authorization and reimbursement and frequently require additional testing to verify the diagnosis, often leading to treatment gaps. These findings emphasize the necessity of more efficient identification and screening of patients with possible AGHD, better recognition by clinicians and insurance providers of the importance of sustained GH replacement therapy during adulthood, and better patient support for accessing and maintaining uninterrupted GH replacement therapy for patients with documented AGHD.

Mapping the PIK3CA-related overgrowth spectrum (PROS) patient and caregiver journey using a patient-centered approach

BackgroundPROS disorders are driven by somatic, gain-of-function mutations in PIK3CA that result in hyperactivation of the phosphatidylinositol-3-kinase (PI3K) signaling pathway. PROS encompasses a broad spectrum of overlapping phenotypes (including overgrowth and vascular malformations) that vary significantly in their severity; every case is unique, leading to different, complex experiences. Here, we aim to describe the PROS experience from the patients’ and caregivers’ points of view, from onset to diagnosis to treatment and support.ResultsThe PROS patient journey was developed using a literature review, an ethnography study, health care professional (HCP) research, and social listening. It was then validated with patients, caregivers, and patient advocates. Physician research included 94 PROS centers and other vascular anomaly centers throughout the United States and Europe. Ethnographic research included 24 patients, caregivers, and/or advocates; selected data from 223 patients were reviewed. Key priority areas of need were identified, along with barriers to and potential enablers of quality care. Visual mapping of the PROS patient and family journey was developed to identify key personal health and system issues, and opportunities for improvements throughout patients’ lifespans. Maps were also developed for 3 specific conditions: Klippel–Trénaunay syndrome (K–T); congenital lipomatous overgrowth, vascular malformations, epidermal nevi, scoliosis/skeletal and spinal anomalies (CLOVES) syndrome; and megalencephaly-capillary malformation syndrome (M-CM). Overall, most patients with PROS conditions and their families struggle with a long path to diagnosis, access to genetic testing, and finding qualified specialists. Following diagnosis, patients and families are frequently challenged with major medical events, comorbidities, unpredictability, frequent hospitalization, impact on school and work, the need for multidisciplinary care, unwanted attention, adverse impact on mental and emotional health, and financial pressures. Lack of effective pain management emerged as a substantial issue. Challenges and barriers to quality care shift throughout patients’ lifespans; transition from pediatric to adult care can be especially difficult.ConclusionsThis patient journey in PROS was created in collaboration with patients, caregivers, and advocates as key partners. This novel methodology, which could be applied elsewhere, can more accurately identify areas of unmet need, barriers to care, education topics, and assist HCPs to understand the patient and family perspective.

Using Appropriate Assessment to Plan Braille Literacy Instruction

To be effective teachers of literacy for students who read braille, we need to know what our students’ strengths and needs are as all these components come together in braille literacy. Using an appropriate assessment that addresses the skill sets involved in braille literacy is critical to putting together effective intervention packages for our students. The first author used the Kamei-Hannan and Ricci Reading Assessment (2015) and the Braille Reading Analysis Chart (Harley, et al., 1997) to determine areas of need for a student in grade 2 in a braille literacy program. Needs included: identifying ending sounds and naming final letters and sounds; basic decoding of short and long vowel sounds; recognizing sight words; and identifying letters. Specific miscue patterns in tactile perception (reversals) were identified. Information gathered from these assessments was used to develop a targeted intervention package and informed the development of a balanced literacy program for this student. Following a period of implementation, data showed evidence of overall improvement in braille literacy skills.

Data-Driven Food Desert Metric to Understand Access to Grocery Stores Using Chi-Square Automatic Interaction Detector Decision Tree Analysis

A food desert is a geographic area lacking spatial and socioeconomic access to healthy foods. Disparities in food access and availability hinder public health and individual wellbeing. Access to healthy food has been evaluated by many agencies and researches yet they do not comparably demarcate food deserts or identify vulnerable populations in methodical terms. Existing literature suggests a link between food deserts, income level, and vehicle ownership. This study evaluates the existing methods and proposes a novel data-driven method to identify food deserts in Baltimore, Maryland. This study evaluates responses from 573 respondents for an in-depth analysis of individual grocery store choice and travel decisions. Chi-square automatic interaction detector (CHAID) decision trees are used to develop a user-generated food desert metric. Income level is found to be a key indicator for food desert demarcation, more than vehicle ownership. Network distance was applied to develop the prioritization matrix for a food desert. This research provides a replicable method for determining food-insecure areas in a locality by aggregating individual data to identify such areas. Such a metric can aid policymakers to make investment decisions and to direct resources to areas of need.

Developing a profile of activities of daily living for bipolar disorder: a systematic review protocol and meta-analysis

IntroductionBipolar disorder (BD) is a severe mental health disorder that affects 2% of the adult population. Individuals with this disorder are at a higher risk for morbidity and functional difficulties....

\u201cWe need to build a better bridge\u201d: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth

BackgroundAdolescence and young adulthood is an important period for substance use initiation and related harms. In the context of the ongoing opioid crisis, the risks for youth (ages 16–29) who use opioids are particularly heightened. Despite recommendations to adopt a developmentally appropriate and comprehensive approach to reduce opioid-related harms among youth, data continue to show that youth are not adequately engaged in opioid treatments and encounter many barriers. The aim of this study is to identify youth-centered opportunities for improving opioid treatment services.MethodsThis paper reports multi-site qualitative findings from youth participating in the ‘Improving Treatment Together’ project, a community-based participatory project being conducted in British Columbia and Alberta, two western Canadian provinces that have been dramatically impacted by the opioid crisis. Qualitative data were collected during three workshops with youth who used opioids and accessed opioid treatment services in the prior 12 months. These workshops were conducted in three communities following the core elements of human-centered co-design. A multi-site qualitative analysis was conducted to identify within- and between-site themes surrounding youths’ needs for improving opioid treatment service experiences and outcomes.ResultsThree overarching needs themes were identified from across the communities. The first reflected youths’ difficulties finding and staying connected to opioid treatment services, with the overarching need theme suggesting opportunities to reduce organizational and systems-related barriers to care, such as waiting times and wider information about service availability. The second area of need was rooted in youths’ feelings of judgment when accessing services. Consequently, opportunities to increase respectful and empathic interactions were the overarching need. The final theme was more nuanced across communities and reflected opportunities for an individualized approach to opioid treatment services that consider youths’ unique basic safety, social, and health needs.ConclusionsThis study identifies fundamental directions for the operationalization and implementation of youth-centered opioid treatment services. These directions are contextualized in youths’ lived experiences accessing services in their local communities, with overarching themes from across sites strengthening their transferability to other settings.

Reading fluency intervention dosage: A novel meta-analysis and research synthesis

Reading fluency is a fundamental component of reading proficiency, and yet, it is a common area of need for students demonstrating reading difficulties. In response, reading fluency interventions have been researched and implemented relatively extensively, but how much intervention is needed to affect reading fluency growth is not clear. The purpose of this study was to meta-analyze and synthesize the research base regarding targeted reading fluency interventions for kindergarten through 12th grade students and to examine how intervention dosage is conceptualized and measured in these interventions. Thirty-three articles met the study inclusion criteria, and overall effects of reading fluency interventions were moderate (effect size = 0.46, 95% CI [0.23, 0.68], p < .001), with study design (group design ES = 0.41, single case design ES = 0.75) and study rigor moderating study effects (group design met standards ES = 0.57, group design did not meet standards ES = 0.34, single case design met standards ES = 0.79, single case design did not meet standards ES = 0.57). Most studies conceptualized and reported intervention dosage as the amount of time spent in intervention with intervention duration impacting total intervention growth. Implications for practice and research are discussed, particularly the need for additional research examining proximal measurement of intervention dosage in an effort to best understand how opportunities to practice impact reading fluency growth.

Getting Proactive with Police Proactivity: The Benefits of Computer-aided Dispatch for Directing Police Resources to Areas of Need

Abstract Sherman et al. [Sherman, L. W., Williams, S., Ariel, B., et al. (2014). ‘An Integrated Theory of Hot Spots Patrol Strategy Implementing Prevention by Scaling up and Feeding Back.’ Journal of Contemporary Criminal Justice30(2): 95–122.] argue that crime reductions associated with hot spot policing can be maximized by carefully managing the dosage of supplemental resources delivered. Fully achieving this goal in prior studies has been difficult due to resistance by officers, the use of atypical strategies for directing patrols to target locations, and insufficient attention to the measurement of treatment dosages. This has led to calls for process research examining the implementation of hot spot policing in law enforcement agencies. The current study represents one such effort. The computer-aided dispatch (CAD) system for a large US police department was pre-programmed with 16,200 supplemental community engagement patrols that were communicated to officers similar to emergency calls for service generated by the public. An interdisciplinary team comprised sworn officers, crime analysts, and academics designed and evaluated the intervention using an experimental design. The team found that the vast majority of patrols were delivered as scheduled (n = 12,965; 80.0%) and that planned dosage ratios between treatment conditions were achieved. Advantages of using CAD for proactive policing initiatives and benefits of police–academic partnerships are discussed.

Emerging Subspecialties in Neurology: A Career as a Clinical Trialist in Neurology.

The recent therapeutic advances in the field of neurology highlight the importance of ongoing clinical trials. However, while clinical research in neurology has remained relatively stable over the past 10 years, there has been an interval decrease in neuroscience applicants for NIH funding, which has raised concerns about the pipeline and future of clinical research in neurology. Those interested in such a career can begin by identifying a preclinical neuroscience advance that has yet to be translated into clinical trial work or a clinical area of need based on conversations with patients and families. Once such an area of interest is identified, seeking mentors either at one's own local institution or through networking at conferences is important in developing the necessary skills pertaining to clinical trial conduct and design and in gaining access to the relevant professional networks. There is also a myriad of training opportunities, such as the NINDS Clinical Trials Methodology Course, Masters of Science in Clinical Research, and certificate programs that offer formal training. Additional considerations for advancing in this career include exploring the potential for secondary publications using data available from previous clinical trials or serving as a subinvestigator. Challenges in pursuing such a career include the relatively low rate of positive outcomes compared with other fields and consistent salary support throughout one's career. Overall, a career as a clinical trialist in neurology is rewarding because one is able to participate in advancing the field and offer potentially new treatments to their patients.

One Stomatal Model to Rule Them All? Toward Improved Representation of Carbon and Water Exchange in Global Models

AbstractStomatal conductance schemes that optimize with respect to photosynthetic and hydraulic functions have been proposed to address biases in land‐surface model (LSM) simulations during drought. However, systematic evaluations of both optimality‐based and alternative empirical formulations for coupling carbon and water fluxes are lacking. Here, we embed 12 empirical and optimization approaches within a LSM framework. We use theoretical model experiments to explore parameter identifiability and understand how model behaviors differ in response to abiotic changes. We also evaluate the models against leaf‐level observations of gas‐exchange and hydraulic variables, from xeric to wet forest/woody species spanning a mean annual precipitation range of 361–3,286 mm yr−1. We find that models differ in how easily parameterized they are, due to: (a) poorly constrained optimality criteria (i.e., resulting in multiple solutions), (b) low influence parameters, (c) sensitivities to environmental drivers. In both the idealized experiments and compared to observations, sensitivities to variability in environmental drivers do not agree among models. Marked differences arise in sensitivities to soil moisture (soil water potential) and vapor pressure deficit. For example, stomatal closure rates at high vapor pressure deficit range between −45% and +70% of those observed. Although over half the new generation of stomatal schemes perform to a similar standard compared to observations of leaf‐gas exchange, two models do so through large biases in simulated leaf water potential (up to 11 MPa). Our results provide guidance for LSM development, by highlighting key areas in need for additional experimentation and theory, and by constraining currently viable stomatal hypotheses.

Diversity, Equity, and Inclusion Milestones: Creation of a Tool to Evaluate Graduate Medical Education Programs.

As the Accreditation Council for Graduate Medical Education (ACGME) began to ask programs to report their efforts surrounding diversity, equity, and inclusion (DEI), program directors felt ill prepared to evaluate their programs and measure change. To develop a tool that would allow graduate medical education (GME) programs to evaluate the current state of DEI within their residencies, identify areas of need, and track progress; to evaluate feasibility of using this assessment method within family medicine training programs; and to analyze and report pilot data from implementation of these milestones within family medicine residency programs. The Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed a tool for program DEI evaluation modeled after the ACGME Milestones. These milestones focus on DEI assessment in 5 key domains: Institution, Curriculum, Evaluation, Resident Personnel, and Faculty Personnel. After finalizing a draft, a pilot implementation of the milestones was conducted by a convenience sample of 10 AFMRD DHE Task Force members for their own programs. Scores varied widely across surveyed programs for all milestones. Highest average scores were seen for the Curriculum milestone (2.65) and the lowest for the Faculty Personnel milestone (2.0). Milestone assessments were completed within 10 to 40 minutes using various methods. The AFMRD DEI Milestones were developed for program assessment, goal setting, and tracking of progress related to DEI within residency programs. The pilot implementation showed these milestones were easily used by family medicine faculty members in diverse settings.

Impact of COVID-19 Pandemic on Daily Life, Physical Exercise, and General Health among Older People with Type 2 Diabetes: A Qualitative Interview Study.

The COVID-19 pandemic has resulted in significant alterations to and implications for the lives of millions of people, and especially for those with pre-existing medical conditions. The aim of this study was to explore the lived experience of older people with type 2 diabetes mellitus (T2DM) throughout the first 9 months of the pandemic, with emphasis on the habits of physical exercise. We conducted a qualitative study using semi-structured interviews. The data consist of telephone interviews of seventeen older people with T2DM (10 women and 7 men, aged 62–76 years). Using thematic analysis, five themes were generated: (1) an altered social and relational life; (2) changes in routine and attitude regarding physical activity behaviour; (3) home-related activities gained relevance; (4) health and well-being impact and management; and (5) thoughts about the post-pandemic period. The increase in the number of cases and the fear of becoming infected with COVID-19 limited the social (i.e., contact with family and/or friends) and functional (i.e., daily routine, the habit of exercising) lives of these people, reverberating negatively on their health and well-being. Feelings of isolation, loneliness, anxiety were common. The findings of this study help to better understand the impact of the pandemic and determine areas of need for future interventions. A multidisciplinary approach is necessary to provide support for older people with T2DM and tackle the negative effect of the pandemic, including the reduction in physical activity.