Publications

OBJECTIVE: Breast cancer over-screening is common in older women. Messaging about breast cancer screening cessation may reduce over-screening but the broader informational environment often emphasizes screening continuation. We aimed to examine the effect of receiving consistent messages about breast cancer screening cessation versus conflicting messages (i.e., receiving messages about screening cessation and screening continuation from different sources).

METHODS: In a two-wave survey experiment with 3809 women 65 + years from a U.S. population-based online panel, we randomized participants to a) no messages, b) consistent messages promoting screening cessation, or c) conflicting messages - a message promoting screening continuation followed by a message promoting screening cessation.

RESULTS: The conflicting message group had significantly lower support for screening cessation in a hypothetical older woman (mean 3.87 [SD 2.00] on 7-point scale, 95 % CI 3.76-3.97) compared with the consistent message group (mean 4.17 [SD 1.99], 95 % CI 4.08-4.28), but was still significantly higher than the control group (mean 2.68 [SD 1.87], 95 % CI 2.54-2.82, p's < 0.001). Message effects on self-screening intentions were similar. Participants reported low rates of confusion, distrust or ambivalence.

CONCLUSIONS: Messaging about screening cessation can significantly increase older women's support for screening cessation, with low rates of negative reactions, even if there are competing messages on continued screening.

PRACTICE IMPLICATIONS: Messaging about screening cessation can be incorporated into clinical discussions or used in conjunction with other interventions aimed at reducing over-screening.

BACKGROUND: Bedside whiteboards are ubiquitous fixtures in hospitalized patients' rooms and present unique, low-cost opportunities to improve patient care. Specifically, bedside whiteboards may enhance communication practices, safety standards, and patient education. Despite their commonality at the bedside, the direct impact of whiteboards on patient care remains unclear.

OBJECTIVE: To perform a scoping review of medical literature to synthesize available evidence and identify gaps regarding the impact of bedside whiteboards on patient communication, safety, and education.

ELIGIBILITY CRITERIA: Published articles evaluating the impact of physical, patient-facing whiteboards on patient communication, safety, and education for adult patients hospitalized on medical-surgical floors and intensive care units.

SOURCES OF EVIDENCE: MEDLINE via PubMed, Google Scholar, Embase, Web of Science, and CINAHL databases.

CHARTING METHODS: We performed a scoping review using Mak and Thomas' Steps for Conducting a Scoping Review and PRISMA-ScR guidelines. Two reviewers independently performed database searches on relevant publications that evaluated the impact of whiteboard-based interventions on communication practices, safety standards, and patient education.

RESULTS: Thirteen articles were included in the final analysis. Studies were conducted on general medicine-specific units (n = 9, 69%) or medicine-surgery inpatient units (n = 3, 23%). Twelve of the 13 studies evaluated patient communication metrics, including provider identification (n = 9), patient engagement in care plan (n = 6), patient-provider communication (n = 3), interprofessional communication (n = 1), and discharge date estimation (n = 4). Six of these studies showed a statistically significant improvement in some aspect of patient communication. Patient safety metrics and education efforts were rarely included in whiteboard-based interventions, with only 2 studies exploring each aspect, respectively.

CONCLUSIONS: Most studies focused on whiteboards to facilitate patient communication, with 4 studies showing 6 statistically significant improvements. Our scoping review highlights a paucity of research evaluating how whiteboard-based interventions could enhance patient safety and education, and future studies are necessary to explore this potential.

OBJECTIVE: Although the adverse effects of excessive alcohol consumption are well established, the association between light to moderate alcohol consumption (≤30 g ethanol per day) and risk of type 2 diabetes (T2D) remains controversial and holds substantial public health implications. We aimed to examine the association of total alcohol intake and drinking pattern with T2D among three cohorts, Nurses' Health Study (NHS), Nurses' Health Study II (NHSII), and Health Professionals Follow-up Study (HPFS).

RESEARCH DESIGN AND METHODS: Former regular drinkers were excluded from baseline nondrinkers. Hazard ratios (HRs) and 95% CIs were estimated by Cox models.

RESULTS: Over 3 decades of follow-up, 20,551 T2D cases were documented among 200,969 participants. Total alcohol intake was associated with a lower risk of T2D, either using nondrinkers or 0.1-4.9 g/day as the reference. The association was robust to extended latency periods and alternative modeling of exposure. Drinking frequency was associated with a lower T2D risk. For example, compared with drinking 1-2 days per week, the HRs (95% CIs) for drinking 5-6 days were 0.73 (0.65, 0.83), 0.73 (0.62, 0.86), and 0.76 (0.67, 0.86) in the NHS, NHSII, and HPFS cohorts, respectively. When modeled jointly, the lower risk of T2D among drinkers was primarily driven by the drinking frequency. The inverse association began at drinking 1-2 days per week in women and 3-4 days per week in men and was strongest for ≥5 days per week, regardless of drinking <10 g or ≥30 g per drinking day.

CONCLUSIONS: Light to moderate alcohol consumption, especially regular light drinking, was associated with a lower risk of T2D in both men and women.

OBJECTIVE: Neurosurgery is regarded as a meaningful career. However, there is no assessment of how many neurosurgeons hold this belief, factors that affect it, or the consequences that follow when neurosurgeons cannot practice in ways they find meaningful. We sought to quantify the neurosurgical experience of meaningful work, evaluate the impact of administrative burden, and relate meaningful work to physician attrition.

METHODS: An online survey investigating meaningful work, administrative burden, organizational commitment, and practice patterns was emailed to attending neurosurgeon members of the Congress of Neurological Surgeons.

RESULTS: 308 neurosurgeons completed the survey. 85.1% of neurosurgeons reported that they found their career to be meaningful; however, most also reported their administrative burden as excessive (59.4%). Over the past 10 years, 17.2% of neurosurgeons left a position due to excessive administrative burden. On multivariable analysis, increased burnout score correlated with increases in administrative hours outside of work (p = 0.0042), perception of excessive administrative burden (p = 0.0267), and willingness to leave a current position of employment (p = 0.0006). Rising administrative burden trended towards reduced experience of meaningful work (p = 0.062). A positive working relationship with their neurosurgical department enhanced meaningful work (p < 0.0017) and willingness to remain at place of employment (p = 0.0027).

CONCLUSION: The majority of neurosurgeons find neurosurgery to be a meaningful career. Critical to meaningful work is maintaining a good departmental working relationship and reducing administrative tasks. When neurosurgeons cannot practice their work meaningfully, they risk burnout. Organizations that do not invest in reducing their neurosurgical administrative burdens are at high risk for neurosurgeon attrition.

Circulating non-esterified fatty acids (NEFAs) have toxic effects on a variety of organs central to cardiometabolic disease and can cross the blood-brain barrier. Whether NEFAs associate with cognitive decline or dementia remains unknown. Circulating total NEFA levels were measured in 3242 participants without dementia among older adults of the Cardiovascular Health Study (CHS) and related to adjudicated dementia over 6 years (n = 456 cases) and annually assessed cognitive decline. For confirmation, we related circulating NEFAs to cognition assessed 10 years later among 4361 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). In CHS participants, each SD higher NEFA levels were associated with a hazard ratio (HR) for all-cause dementia of 1.11 (95 % CI: 1.01; 1.22). Baseline NEFA levels were also associated with more rapid decline in cognition over 6 years of follow-up. In MESA, circulating NEFA measurements were associated with lower cognitive scores measured 10 years later.'

BACKGROUND: Transitioning from hospital to home is fraught with anxiety and risk, as patients and family members assume responsibility for caring for themselves.

OBJECTIVES: We aimed to explore patients' experiences with reading their discharge summaries and the impact of having this information during the posthospitalization period. We focus on opportunities to address common concerns-such as medication changes, follow-up steps, and documentation errors.

METHODS: An email-based survey of hospitalized patients with portal accounts discharged to home was conducted between May 2022 and February 2023 at two academic health care centers in Boston, MA. We used qualitative and quantitative methods to analyze closed-ended and free-text survey responses. The primary outcomes were patient concerns about medications and the next steps.

RESULTS: Three hundred and ninety-two patients responded (hospital 1 = 321, response rate [RR] = 19.5%; hospital 2 = 71, RR = 4.9%). Patients reported positive effects of reading their discharge summary, including understanding the reason for hospitalization (66.9%) and next steps in managing their care (72.1%), and knowing how to take their medications (74%). Five percent reported a concern about taking a medication and 9.4% had a concern about next steps. In qualitative analysis of patient-reported concerns, the most commonly noted were related to explanations and next steps.

CONCLUSIONS: Rapidly spreading information transparency could transform how patients engage in care and communicate with clinicians. Patients and families report benefits from reading discharge summaries; however, over a quarter reported a concern. More work is needed in the inpatient arena to understand how to capitalize on data transparency in a way that benefits patients, families, clinicians, and organizations.

BACKGROUND: Clostridioides difficile infection (CDI) is a common and often nosocomial infection associated with increased mortality and morbidity. Antibiotic use is the most important modifiable risk factor, but many patients require empiric antibiotics. We estimated the increased risk of hospital-onset CDI with one daily dose-equivalent (DDE) of various empiric antibiotics compared to management without that daily dose-equivalent.

METHODS: Using a multicenter retrospective cohort of adults admitted between March 2, 2020 and February 11, 2021 for the treatment of SARS-CoV-2, we used a series of three-level logistic regression models to estimate the probability of receiving each of several antibiotics of interest. For each antibiotic, we then limited our data set to patient-days at intermediate probability of receipt and used augmented inverse-probability weighted models to estimate the average treatment effect of one daily dose-equivalent, compared to management without that daily dose-equivalent, on the probability of hospital-onset CDI.

RESULTS: In 24,406 patient-days at intermediate probability of receipt, parenteral vancomycin increased risk of hospital-onset CDI, with an average treatment effect of 0.0096 cases per daily dose-equivalent (95% CI: 0.0053-0.0138). In 38,003 patient-days at intermediate probability of receipt, cefepime also increased subsequent CDI risk, with an estimated effect of 0.0074 more cases per daily dose-equivalent (95% CI: 0.0022-0.0126).

CONCLUSIONS: Among common empiric antibiotics, parenteral vancomycin and cefepime appeared to increase risk of hospital-onset CDI. Causal inference observational study designs can be used to estimate patient-level harms of interventions such as empiric antimicrobials.

BACKGROUND: Cardiovascular disease (CVD) risk differs across Asian subgroups, possibly due to differences in hypertension burden. We characterized lifetime blood pressure (BP) trajectories for East and South Asian individuals and compared their associations with CVD risk.

METHODS: Among 148 872 UK Biobank participants with primary care utilization data, life course BP trajectories were fitted as a function of age by sex according to self-identified ethnicity. We determined associations of time-averaged young adulthood (18-39 years), middle age (40-64 years), and later life (≥65 years) systolic BP (SBP) and diastolic BP with incident atherosclerotic CVD risk.

RESULTS: The predicted SBP/diastolic BP (95% CI) at age 30 years was 108 (103-114)/68 (65-71) mm Hg for East Asian and 114 (110-118)/72 (71-73) mm Hg for South Asian individuals. By age 40, South Asian individuals were projected to reach an SBP of 130.0 mm Hg, whereas East Asian individuals reached the equivalent SBP by age 49 years. Among South Asian individuals, each SD increase in young adulthood SBP was associated with a higher atherosclerotic CVD risk with an odds ratio (95% CI) of 1.41 (1.12-1.75), but not among East Asians (Pinteraction=0.01). Midlife SBP was associated with peripheral artery disease among South Asian individuals (odds ratio, 2.08 [95% CI, 1.51-2.88]) and with ischemic stroke among East Asian individuals (odds ratio, 3.84 [95% CI, 1.08-5.07]). Later-life SBP was associated with myocardial infarction risk by 1.52 (1.15-1.92)-fold among South Asians and ischemic stroke by 2.50 (1.06-3.80)-fold among East Asian individuals.

CONCLUSIONS: East and South Asian individuals exhibit distinct BP trajectories that age-differentially associate with incident CVD. Disaggregating Asian subgroups may inform tailored hypertension screening and management.

[This corrects the article DOI: 10.1016/j.conctc.2022.101029.].