Publications

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: 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.].

PURPOSE OF THE REVIEW: Hypertension remains a major public health concern globally and in the United States with significant racial/ethnic disparities in prevalence, treatment, and control. Despite effective treatments, undiagnosed or uncontrolled hypertension persists, leading to an increased risk of cardiovascular disease and substantial healthcare costs. Addressing hypertension disparities requires a comprehensive approach, integrating clinical interventions with community-based strategies. This review examines the current landscape of clinic-and community-based interventions designed to improve hypertension management and reduce disparities.

RECENT FINDINGS: Clinic-based approaches highlighted include implementing evidence-based guidelines, using treatment algorithms, promoting self-management, integrating digital health technologies, and incorporating team-based care approaches. Community interventions discussed involve lifestyle modification programs, faith-based initiatives, trusted community spaces, culturally-tailored health education, engaging community health workers, and collaborative care models linking clinics and communities. This review stresses the importance of addressing SDoH, fostering community engagement, and delivering culturally competent care. Strengthening clinic-community linkages, evaluating long-term effectiveness and cost-effectiveness, leveraging technology and innovation, and addressing gaps in research for underrepresented groups are key priorities for advancing health equity in hypertension management.

SUMMARY: To effectively close the widening gap in hypertension disparities, collaborative multi-level efforts integrating clinical excellence and community empowerment are essential to mitigate the disproportionate burden of hypertension among racial/ethnic minority populations.

BACKGROUND: A healthier diet is associated with lower chronic disease burden, but the impact of neighbourhood food environments on disability and death in older adults is not known.

METHODS: In the Cardiovascular Health Study, a cohort study of adults aged 65+, we calculated study years until death (years of life (YOL)), study years without activities of daily living (ADL) difficulty (years of able life; YoAL) and percent of study years without ADL difficulty (compression of disability). Linear regression quantified associations of food establishments within 5 km of baseline home address (as a z-score) with each outcome, adjusted for sociodemographic characteristics. Sensitivity analyses considered adjustment for risk factors and comorbidities, multiple imputation, alternate neighbourhood definitions (1-km radial buffer, census tract) and restriction on residential stability.

RESULTS: We included 4298 participants followed for up to 26 years. All food retail establishments were associated with 6 months higher YoAL per SD in the main model (beta, 0.50 years; 95% CI 0.01, 0.98; p=0.046), with similar findings across sensitivity analyses except when restricting on residential stability. Supermarkets and produce markets were associated with compression of disability (beta, 2.31; 95% CI, 0.04, 4.57) and when using 1-km buffers with YOL (beta, 0.23 years; 95% CI 0.03, 0.43) and YoAL (beta, 0.21 years; 95% CI 0.01, 0.41). Non-supermarket food stores were associated with YoAL (beta, 0.67 years; 95% CI, 0.07, 1.27) and compression of disability (beta, 3.03; 95% CI 0.44, 5.62), but significance was not consistent across sensitivity analyses. Fast-food restaurants did not reach statistical significance in any model.

CONCLUSION: All food retail was associated with YOL without impairment. Neighbourhood food retail access and type may both have roles in extending YOL and years of able life among older adults, but the findings were sensitive to decisions made during measurement and modelling.