Development of Secure Infrastructure for Advancing Generative AI Research in Healthcare at an Academic Medical Center.

The increasing interest in leveraging generative AI models in healthcare necessitates secure infrastructure at academic medical centers. Without an all-encompassing secure system, researchers may create their own insecure microprocesses, risking the exposure of protected health information (PHI) to the public internet or its inadvertent incorporation into AI model training. To address these challenges, our institution implemented a secure pathway to the Azure OpenAI Service using our own private OpenAI instance which we fully control to facilitate high-throughput, secure LLM queries.

A Randomized Controlled Trial of Brief Intervention by Interactive Voice Response.

Aims: To determine the effect of an Interactive Voice Response (IVR) brief intervention (BI) to reduce alcohol consumption among adults seeking primary care.

Methods: Patients (N = 1855) with unhealthy drinking were recruited from eight academic internal medicine and family medicine clinics and randomized to IVR-BI (n = 938) versus No IVR-BI control (n = 917). Daily alcohol consumption was assessed at baseline, 3- and 6-months using the Timeline Followback.

A Randomized Controlled Trial of IVR-Based Alcohol Brief Intervention to Promote Patient-Provider Communication in Primary Care.

Background: Brief interventions for unhealthy drinking in primary care settings are efficacious, but underutilized. Efforts to improve rates of brief intervention though provider education and office systems redesign have had limited impact. Our novel brief intervention uses interactive voice response (IVR) to provide information and advice directly to unhealthy drinkers before a physician office visit, with the goals of stimulating in-office dialogue about drinking and decreasing unhealthy drinking.

Feasibility of automated pre-screening for lifestyle and behavioral health risk factors in primary care.

Background: Screening of primary care patients for unhealthy behaviors and mental health issues is recommended by numerous governing bodies internationally, yet evidence suggests that provider-initiated screening is not routine practice. The objective of this study was to implement systematic pre-screening of primary care patients for common preventive health issues on a large scale.

Methods: Patients registered for non-acute visits to one of 40 primary care providers from eight clinics in an Academic Medical Center health care network in the United States from May, 2012 to May, 2014 were contacted one- to three-days prior to their visit.

An experimental test of assessment reactivity within a web-based brief alcohol intervention study for college students.

Objective: Web-based brief alcohol intervention (WBI) programs have efficacy in a wide range of college students and have been widely disseminated to universities to address heavy alcohol use. In the majority of efficacy studies, web-based research assessments were conducted before the intervention. Web-based research assessments may elicit reactivity, which could inflate estimates of WBI efficacy.

Recruiting 9126 Primary Care Patients by Telephone: Characteristics of Participants Reached on Landlines, Basic Cell Phones, and Smartphones.

In primary care, collecting information about patient health behaviors between appointments can be advantageous. Physicians and researchers who embrace phone-based technology may find valuable ways to monitor patient-reported outcome measures of health (PROM). However, the level of phone technology sophistication should be tailored to the phone use of the population of interest.

Brief Intervention for Heavy Drinking in Primary Care: Role of Patient Initiation.

Background: Alcohol brief intervention (BI) in primary care (PC) is effective, but remains underutilized despite multiple efforts to increase provider-initiated BI. An alternative approach to promote BI is to prompt patients to initiate alcohol-related discussions. Little is known about the role of patients in BI delivery.

Recruiting U.S. and Canadian college students via social media for participation in a web-based brief intervention study.

Objective: Recruiting young adults for health research is challenging. Social media provides wide access to potential research participants. We evaluated the feasibility of recruiting students via free message postings on Facebook and Twitter to participate in a web-based brief intervention study.

Efficacy of automated telephone continuing care following outpatient therapy for alcohol dependence.

Background: Relapse rates following cognitive behavioral therapy (CBT) for alcohol dependence are high. Continuing care programs can prolong therapeutic effects but are underutilized. Thus, there is need to explore options having greater accessibility.

Marijuana use and intoxication among daily users: an intensive longitudinal study.

Background: Most of the harm from marijuana use is experienced by daily users. Despite this, there has not been a detailed prospective description of daily marijuana use.

Methods: We recruited daily marijuana users (n=142) by internet ads, Craigslist, flyers, etc.

A test of the DSM-5 severity scale for alcohol use disorder.

Background: For the DSM-5-defined alcohol use disorder (AUD) diagnosis, a tri-categorized scale that designates mild, moderate, and severe AUD was selected over a fully dimensional scale to represent AUD severity. The purpose of this study was to test whether the DSM-5-defined AUD severity measure was as proficient a predictor of alcohol use following a brief intervention, compared to a fully dimensional scale.

Methods: Heavy drinking primary care patients (N=246) received a physician-delivered brief intervention (BI), and then reported daily alcohol consumption for six months using an Interactive Voice Response (IVR) system.

Natural history of attempts to stop smoking.

Introduction: This study provides a prospective fine-grain description of the incidence and pattern of intentions to quit, quit attempts, abstinence, and reduction in order to address several clinical questions about self-quitting.

Methods: A total of 152 smokers who planned to quit in the next 3 months called nightly for 12 weeks to an Interactive Voice Response system to report cigarettes/day, quit attempts, intentions to smoke or not in the next day, and so forth. No treatment was provided.

Individual patterns of alcohol use.

Aims: We present methodology to identify statistically distinct patterns of daily alcohol use and classify them into categories that could be further used in monitoring of transitions between patterns such as transitions from regular to problem use.

Data: The study analyzed individual patterns of adult alcohol consumption from two datasets containing short (<6 month) and long (up to 2years) daily records of drinking. These data were collected over the period between 1999 and 2003.

Comparison of categorical alcohol dependence versus a dimensional measure for predicting weekly alcohol use in heavy drinkers.

Background: The DSM specifies categorical criteria for psychiatric disorders. In contrast, a dimensional approach considers variability in symptom severity and can significantly improve statistical power. The current study tested whether a categorical, DSM-defined diagnosis of Alcohol Dependence (AD) was a better fit than a dimensional dependence measure for predicting change in alcohol consumption among heavy drinkers following a brief alcohol intervention (BI).

An evaluation of ventilator-associated pneumonia process measure sampling strategies in a surgical ICU.

Ventilator-associated pneumonia (VAP) is common, lethal, and expensive. Little is known about optimal strategies to evaluate process measures for VAP prevention. The authors conducted a prospective study of different sampling strategies for evaluating head of bed (HOB) elevation and oral care.

A daily process examination of the bidirectional relationship between craving and alcohol consumption as measured via interactive voice response.

Background: Craving is a central component to alcohol use disorders, although there are contradictory findings in the literature regarding the importance of craving in alcohol use. The study goal was to examine the bidirectional relationship between craving and alcohol consumption in heavy drinkers.

Methods: Participants received brief alcohol interventions from their primary care physicians and then were asked to make daily reports of craving and alcohol consumption to an interactive voice response (IVR) telephone system for 180 days.

Alcohol, moods and male-female differences: daily interactive voice response over 6 months.

Aims: The goal of this study was to better understand the predictive relationship in both directions between negative (anger, sadness) and positive (happiness) moods and alcohol consumption using daily process data among heavy drinkers.

Methods: Longitudinal daily reports of moods, alcohol use and other covariates such as level of stress were assessed over 180 days using interactive voice response telephone technology. Participants were heavy drinkers (majority meeting criteria for alcohol dependence at baseline) recruited through their primary care provider.

Monitoring daily affective symptoms and memory function using interactive voice response in outpatients receiving electroconvulsive therapy.

Objective: Recently, there has been a gradual shift from inpatient-only electroconvulsive therapy (ECT) toward outpatient administration. Potential advantages include convenience and reduced cost. But providers do not have the same opportunity to monitor treatment response and adverse effects as they do with inpatients.

Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement.

Aims: In HIV-infected individuals, heavy drinking compromises survival. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce drinking is unknown, alcohol-dependent patients may need greater intervention and resources are limited. Using interactive voice response (IVR) technology, HealthCall was designed to enhance MI via daily patient self-monitoring calls to an automated telephone system with personalized feedback.

The natural history of efforts to stop smoking: a prospective cohort study.

Background: In a prior study, we found changing tobacco use was more complex than previously thought, with users often transitioning between intending to quit and not intending to quit, and among typical use, abstinence, and reduction, on multiple occasions. The current study attempted to replicate those results.

Methods: A convenience sample of 40 tobacco smokers who intended to quit within the next 3 months called in nightly for 28 days to an interactive voice response system to report cigs/day and daily intentions to smoke or not for the next day.

Interactive voice response for relapse prevention following cognitive-behavioral therapy for alcohol use disorders: a pilot study.

Relapse after alcoholism treatment is high. Alcohol Therapeutic Interactive Voice Response (ATIVR) is an automated telephone program for posttreatment self-monitoring, skills practice, and feedback. This pilot study examined feasibility of ATIVR.

Predictive relationships between chronic pain and negative emotions: a 4-month daily process study using Therapeutic Interactive Voice Response (TIVR).

This article examines temporal relationships between negative emotions and pain in a cohort of 33 patients with chronic musculoskeletal pain enrolled in a telephone-based relapse prevention program (Therapeutic Interactive Voice Response [TIVR]), after 11 weeks of group cognitive behavioral therapy (CBT). Patients were asked to make daily reports to the TIVR system for 4 months after CBT. Patients' daily reports were analyzed with path analysis to examine temporal relationships between 3 emotion variables (anger, sadness, and stress) and 2 pain variables (pain and pain control).

Drinking and stress: an examination of sex and stressor differences using IVR-based daily data.

Background: Research on the relation of stress to alcohol consumption is inconsistent regarding the direction of effects, and this association has been shown to vary by sex and type of stress. We sought to build upon the stress-drinking literature by examining the direction of the stress-drinking association over time as well as sex and stressor differences using daily data.

Method: 246 heavy drinking adults (67% men) aged 21-82 reported daily stress levels and alcohol consumption over 180 days using Interactive Voice Response (IVR).

Automated screening for at-risk drinking in a primary care office using interactive voice response.

Objective: Screening for alcohol misuse in primary care settings is strongly recommended but grossly underused. Using interactive voice response (IVR), we developed an automated screening tool (IVR Screen) for identifying alcohol misuse in outpatient primary care offices and evaluated its use rate and acceptability for both patients and providers.

Method: Patients (N = 101) presenting to a primary care clinic for scheduled, nonemergent health care visits called the IVR Screen by using a dedicated telephone in the waiting room and answered five questions about their health.