Depressive symptoms after surgical and medical management of OSA: a systematic review and meta-analysis.

Purpose: To evaluate the effect of CPAP and surgical alternatives for OSA on depression and compare the results of surgery to CPAP. ​METHODS: COCHRANE Library, CINAHL, PubMed, and Scopus databases were searched for English-language articles. Meta-analysis of continuous measures (mean), proportions (%), and mean difference (Δ) with 95% confidence interval was conducted for objective and subjective outcomes before and after treatment with CPAP or surgical interventions.

Development of the Dissemination and Implementation Science Collaborative (DISC): Opportunities to enhance implementation science capacity among researchers and practitioners in South Carolina.

This paper explores the development of the Dissemination and Implementation Science Collaborative (DISC) at the Medical University of South Carolina, established through the Clinical and Translational Science Award program. DISC aims to accelerate clinical and translational science by providing training, mentorship, and collaboration opportunities in dissemination and implementation (D&I) science. Through DISC, investigators, trainees, and community partners are equipped with the knowledge and skills to conduct D&I research and translate findings into practice, particularly in South Carolina's public health and healthcare landscape.

Telehealth Outreach Program for Child Traumatic Stress: Strategies for Long-Term Sustainability.

Background: There are high documented rates of exposure to traumatic events and mental health disorders among youths yet existing disparities in access to care for racial and ethnic minority youths and youths in rural communities. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based behavioral health therapy for children. The delivery of TF-CBT via telehealth can decrease access to care barriers.

Text And Telephone Screening And Referral Improved Detection And Treatment Of Maternal Mental Health Conditions.

Effective screening and referral practices for perinatal mental health disorders, perinatal substance use disorders (SUDs), and intimate partner violence are greatly needed to reduce maternal morbidity and mortality. We conducted a randomized controlled trial from January 2021 to April 2023 comparing outcomes between Listening to Women and Pregnant and Postpartum People (LTWP), a text- and telephone-based screening and referral program, and usual care in-person screening and referral within the perinatal care setting. Participants assigned to LTWP were three times more likely to be screened compared with those assigned to usual care.

Rural-Urban Differences in Mortality among Mechanically Ventilated Patients in Intensive and Intermediate Care.

Intermediate care (also termed "step-down" or "moderate care") has been proposed as a lower cost alternative to care for patients who may not clearly benefit from intensive care unit admission. Intermediate care units may be appealing to hospitals in financial crisis, including those in rural areas. Outcomes of patients receiving intermediate care are not widely described.

Pulmonologists' Perspectives on and Access to Palliative Care for Patients With Idiopathic Pulmonary Fibrosis in South Carolina.

Background: Idiopathic pulmonary fibrosis (IPF) is a serious illness with an unpredictable disease course and survival rates comparable with some cancers. Patients with IPF suffer considerable symptom burden, declining quality of life, and high health care resource utilization. Patients and caregivers report many unmet needs, including a desire for more education regarding diagnosis and assistance with navigating disease trajectory.

Development of an Implementation Science Telehealth Toolkit to Promote Research Capacity in Evaluation of Telehealth Programs.

Background: The field of telehealth is rapidly growing and expanding access to quality health care, although there have been varied implementation outcomes in telehealth modalities. Dissemination and implementation (D&I) research can provide a systematic approach to identifying barriers and facilitators to telehealth implementation processes and outcomes.

Methods: An interdisciplinary research and clinical team developed an implementation science telehealth toolkit to guide D&I evaluations of new and existing telehealth innovations.

Evaluation of a Telehealth-Enabled Pilot Program to Address Intensive Care Unit Health Care Worker Mental Health Distress.

Introduction: Health care workers (HCWs) are at heightened risk of adverse mental health events (AMHEs) and burnout with resultant impact on health care staffing, outcomes, and costs. We piloted a telehealth-enabled mental health screening and support platform among HCWs in the intensive care unit (ICU) setting at a tertiary care center.

Methods: A survey consisting of validated screening tools was electronically disseminated to a potential cohort of 178 ICU HCWs.

Diabetes Remote Monitoring Program Implementation: A Mixed Methods Analysis of Delivery Strategies, Barriers and Facilitators.

Background: Remote patient monitoring (RPM) is being increasingly utilized as a type of telemedicine modality to improve access to quality health care, although there are documented challenges with this type of innovation. The goals of this study were to characterize clinic delivery strategies for an RPM program and to examine barriers and facilitators to program implementation in a variety of community clinic settings.

Methods: Primary data were collected via individual and small group interviews and surveys of clinical staff from South Carolina primary care clinics participating in an RPM program for patients with diabetes mellitus type 2 in 2019.

Implementation of a women's reproductive behavioral health telemedicine program: a qualitative study of barriers and facilitators in obstetric and pediatric clinics.

Background: Perinatal Mood and Anxiety Disorders and Substance Use Disorders are common and result in significant morbidities and mortality. Despite evidence-based treatment availability, multiple barriers exist to care delivery. Because telemedicine offers opportunities to overcome these barriers, the objective of this study was to characterize barriers and facilitators to implementing a mental health and substance use disorder telemedicine program in community obstetric and pediatric clinics.

Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data.

Unlabelled: Emerging evidence suggests the potential importance of inspiratory driving pressure (DP) and respiratory system elastance (E) on outcomes among patients with the acute respiratory distress syndrome. Their association with outcomes among heterogeneous populations outside of a controlled clinical trial is underexplored. We used electronic health record (EHR) data to characterize the associations of DP and E with clinical outcomes in a real-world heterogenous population.

Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure.

Unlabelled: Existing recommendations for mechanical ventilation are based on studies that under-sampled or excluded obese and severely obese individuals.

Objective: To determine if driving pressure (DP) and total respiratory system elastance (E) differ among normal/overweight (body mass index [BMI] < 30 kg/m), obese, and severely obese ventilator-dependent respiratory failure (VDRF) patients and if there any associations with clinical outcomes.

Design Setting And Participants: Retrospective observational cohort study during 2016-2018 at two tertiary care academic medical centers using electronic health record data from the first 2 full days of mechanical ventilation.

Acceptability of a Serious Illness Conversation Guide to Black Americans: Results from a focus group and oncology pilot study.

Objectives: Serious illness conversations (SICs) can improve the experience and well-being of patients with advanced cancer. A structured Serious Illness Conversation Guide (SICG) has been shown to improve oncology patient outcomes but was developed and tested in a predominantly White population. To help address disparities in advanced cancer care, we aimed to assess the acceptability of the SICG among African Americans with advanced cancer and their clinicians.

A Non-Randomized Trial of In-Person Versus Text/Telephone Screening, Brief Intervention and Referral to Treatment for Pregnant and Postpartum Women.

Background: Systems of care that improve mental health and substance use disorder Screening, Brief Intervention and Referral to Treatment (SBIRT) for pregnant and postpartum women are needed.

Aims: The aim of this study is to determine if women receiving prenatal care from January 2020 to April 2021 are more likely to be screened, screen positive, be referred for treatment and attend treatment with technology facilitated SBIRT, compared to women receiving prenatal care and in-person SBIRT January 2017 to December 2019.

Materials & Methods: Technology facilitated SBIRT, designated Listening to Women (LTW), includes text message-based screening, phone-based brief intervention, and referral to treatment by a remote care coordinator.

Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Efficacy.

Background: Most smokers with chronic obstructive pulmonary disease (COPD) have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation, while also facilitating COPD screening, could help address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of this study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit (electronic visit) that could be delivered proactively to adult smokers at risk for COPD, who are treated within primary care.

A Pilot Study Examining Access to and Satisfaction with Maternal Mental Health and Substance Use Disorder Treatment via Telemedicine.

Mental health (MH) and substance use disorders (SUDs) are common during pregnancy and the postpartum year, and have a significant impact on maternal and child health. Most women do not receive treatment for these conditions due to barriers to care. Increasing access to these services via telemedicine is one potential solution to overcoming barriers, but it is unknown if this type of service is acceptable to women.

Clinician attitudes and concordance with self-assessed and actual intravenous fluid prescribing patterns: A single-institution evaluation of survey and electronic prescribing data.

Background: Recent studies suggest that balanced fluids improve inpatient outcomes compared to normal saline. The objective of this study was to obtain insights into clinicians' knowledge, attitudes and perceived prescribing practices concerning IV isotonic fluids and to analyze perceived prescribing in the context of actual prescribing.

Methods: This study, conducted at a single center (Medical University of South Carolina), included 1) a cross-sectional survey of physicians and advanced practice providers (APPs) (7/2019-8/2019) and 2) review electronic health record (EHR) claims data (2/2018-1/2019) to quantify the prescribing patterns of isotonic fluids.

Preventive Care Utilization by Patients Who Use Virtual Urgent Care.

The use of direct to patient (DTP) telemedicine for common acute conditions is widespread. It provides certain advantages over in-person visits, but has led to concerns about fragmentation of care. It is unknown whether use of DTP telemedicine decreases use of primary care services in a way that leads to missed preventive screenings and immunizations.

The Impact of Timing on Clinical and Economic Outcomes During Inter-ICU Transfer of Acute Respiratory Failure Patients: Time and Tide Wait for No One.

Unlabelled: Approximately one in 30 patients with acute respiratory failure (ARF) undergoes an inter-ICU transfer. Our objectives are to describe inter-ICU transfer patterns and evaluate the impact of timing of transfer on patient-centered outcomes.

Design: Retrospective, quasi-experimental study.

Not Home Alone: Leveraging Telehealth and Informatics to Create a Lean Model for COVID-19 Patient Home Care.

In response to the emerging COVID-19 public health emergency in March 2020, the Medical University of South Carolina rapidly implemented an analytics-enhanced remote patient monitoring (RPM) program with state-wide reach for SARS-CoV-2-positive patients. Patient-reported data and other analytics were used to prioritize the sickest patients for contact by RPM nurses, enabling a small cadre of RPM nurses, with the support of ambulatory providers and urgent care video visits, to oversee 1234 patients, many of whom were older, from underserved populations, or at high risk of serious complications. Care was escalated based on prespecified criteria to primary care provider or emergency department visit, with 89% of moderate- to high-risk patients treated solely at home.

Missing data methods for intensive care unit SOFA scores in electronic health records studies: results from a Monte Carlo simulation.

Missing data cause problems through decreasing sample size and the potential for introducing bias. We tested four missing data methods on the Sequential Organ Failure Assessment (SOFA) score, an intensive care research severity adjuster. Simulation study using 2015-2017 electronic health record data, where the complete dataset was sampled, missing SOFA score elements imposed and performance examined of four missing data methods - complete case analysis, median imputation, zero imputation (recommended by SOFA score creators) and multiple imputation (MI) - on the outcome of in-hospital mortality.

Development and implementation of a clinical decision support-based initiative to drive intravenous fluid prescribing.

Objective: Studies suggest superior outcomes with use of intravenous (IV) balanced fluids compared to normal saline (NS). However, significant fluid prescribing variability persists, highlighting the knowledge-to-practice gap. We sought to identify contributors to prescribing variation and utilize a clinical decision support system (CDSS) to increase institutional balanced fluid prescribing.

Enterprise Adoption of Telehealth: An Academic Medical Center's Experience Utilizing the Telehealth Service Implementation Model.

There are numerous challenges to developing and sustaining successful telehealth services and a paucity of guiding frameworks to inform telehealth strategy, design, and ongoing operations. The framework Telehealth Service Implementation Model (TSIM)™ was developed to provide a guiding telehealth framework that enables grassroots innovations and accounts for the many factors and domains necessary for successful telehealth service development, implementation, and sustainment. TSIM includes six phases: (1) Pipeline, (2) Strategy, (3) Development, (4) Implementation, (5) Operations, and (6) Continuous Quality Improvement.

Nurse Perspectives Regarding Implementation of an Asthma Monitoring Mobile Health Application in the School Setting.

School-based telehealth (SBTH) plays a valuable role in child asthma management, although nurses have concerns with caregiver engagement. Mobile technology (m-health) has potential to improve this engagement. We identified barriers and key desired features of an asthma m-health application as a supplement to an existing SBTH asthma program in rural settings.