Outcomes of Aural Rehabilitation Provided in Person or by Telehealth Among Deaf/Hard of Hearing Young Children with Cochlear Implants or Hearing Aids.

Cochlear implants and hearing aids may facilitate the development of listening and spoken language (LSL) in deaf/hard of hearing young children, but they require aural rehabilitation therapy-often unavailable outside urban areas-for optimal outcomes. This trial assessed the relative effectiveness of LSL therapy delivered either in person or by interactive video. The hypothesis was that telehealth service delivery would be noninferior to in-person therapy.

Patient Navigator Intervention to Improve Palliative Care Outcomes for Hispanic Patients With Serious Noncancer Illness: A Randomized Clinical Trial.

Importance: Disparities persist across the trajectory of serious illness, including at the end of life. Patient navigation has been shown to reduce disparities and improve outcomes for underserved populations.

Objective: To determine the effectiveness of a lay patient navigator intervention, Apoyo con Cariño, in improving palliative care outcomes among Hispanic patients.

Half-Bridge Silicon Strain Gauges with Arc-Shaped Piezoresistors.

Half-bridge silicon strain gauges are widely used in the fabrication of diaphragm-type high-pressure sensors, but in some applications, they suffer from low output sensitivity because of mounting position constraints. Through a special design and fabrication approach, a new half-bridge silicon strain gauge comprising one arc gauge responding to tangential strain and another linear gauge measuring radial strain was developed using Silicon-on-Glass (SiOG) substrate technology. The tangential gauge consists of grid patterns, such as the reciprocating arc of silicon piezoresistors on a thin glass substrate.

Reciprocating Arc Silicon Strain Gauges.

Currently, silicon-strain-gauge-based diaphragm pressure sensors use four single-gauge chips for high-output sensitivity. However, the four-single-gauge configuration increases the number of glass frit bonds and the number of aluminum wire bonds, reducing the long-term stability, reliability, and yield of the diaphragm pressure sensor. In this study, a new design of general-purpose silicon strain gauges was developed to improve the sensor output voltage while reducing the number of bonds.

Extracorporeal Membrane Oxygenation for Refractory Asthma Exacerbations With Respiratory Failure.

Background: Asthma exacerbations with respiratory failure (AERF) are associated with hospital mortality of 7% to 15%. Extracorporeal membrane oxygenation (ECMO) has been used as a salvage therapy for refractory AERF, but controlled studies showing its association with mortality have not been performed.

Research Question: Is treatment with ECMO associated with lower mortality in refractory AERF compared with standard care?

Study Design And Methods: This is a retrospective, epidemiologic, observational cohort study using a national, administrative data set from 2010 to 2020 that includes 25% of US hospitalizations.

Post-Acute Care Outcomes and Functional Status Changes of Adults with New Cancer Discharged to Skilled Nursing Facilities.

Objective: Older hospitalized adults with an existing diagnosis of cancer rarely receive cancer treatment after discharge to a skilled nursing facility (SNF). It is unclear to what degree these outcomes may be driven by cumulative effects of previous cancer treatment and their complications vs an absolute functional threshold from which it is not possible to return. We sought to understand post-acute care outcomes of adults newly diagnosed with cancer and explore functional improvement during their SNF stay.

Impact of Airline Secondhand Tobacco Smoke Exposure on Respiratory Health and Lung Function Decades After Exposure Cessation.

Background: Twenty-five percent to 45% of COPD is caused by exposures other than active smoking. Secondhand tobacco smoke (SHS) has been suggested as an independent cause of COPD, based on its association with increased respiratory symptoms and a small decrease in lung function, but its impact on respiratory health and lung function after exposure cessation has not been explored.

Research Question: What are the consequences of airline SHS exposure on respiratory health and lung function decades after cessation?

Study Design And Methods: We performed a cohort study involving flight attendants because of their exposure to SHS that stopped > 20 years ago.

Challenges Faced by Rural Primary Care Providers When Caring for COPD Patients in the Western United States.

Rationale: Rural chronic obstructive pulmonary disease (COPD) patients have worse outcomes and higher mortality compared with urban patients. Reasons for these disparities likely include challenges to delivery of care that have not been explored.

Objective: To determine challenges faced by rural primary care providers when caring for COPD patients.

Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease.

Background: Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring.

Methods: We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization.

Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization.

Background: After discharge from an acute care hospitalization, patients with cancer may choose to pursue rehabilitative care in a skilled nursing facility (SNF). The objective of this study was to examine receipt of anticancer therapy, death, readmission, and hospice use among patients with cancer who discharge to an SNF compared with those who are functionally able to discharge to home or home with home healthcare in the 6 months after an acute care hospitalization.

Methods: A population-based cohort study was conducted using the SEER-Medicare database of patients with stage II-IV colorectal, pancreatic, bladder, or lung cancer who had an acute care hospitalization between 2010 and 2013.

Accuracy of the Surprise Question on an Inpatient Oncology Service: A Multidisciplinary Perspective.

The surprise question (SQ), "Would you be surprised if your patient died within a year?", has been studied in the cancer population as a prognostic prompt. Studies have almost exclusively directed the SQ to physicians, whereas perspectives of nurses remain underevaluated. We asked the SQ for patients admitted to an inpatient medical oncology service to medical oncology, palliative care, and hospital medicine teams and bedside nurses.

Effect of Apoyo con Cariño (Support With Caring) Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latino Adults With Advanced Cancer: A Randomized Clinical Trial.

Importance: Strategies to increase access to palliative care, particularly for racial/ethnic minorities, must maximize primary palliative care and community-based models to meet the ever-growing need in a culturally sensitive and congruent manner.

Objective: To investigate if a culturally tailored patient navigator intervention can improve palliative care outcomes for Latino adults with advanced cancer.

Design, Setting, And Participants: The Apoyo con Cariño (Support With Caring) randomized clinical trial was conducted from July 2012 to March 2016.

Apoyo con Cariño (support with caring): RCT protocol to improve palliative care outcomes for Latinos with advanced medical illness.

Latinos are more likely to experience uncontrolled pain, and institutional death, and are less likely to engage in advance care planning. Efforts to increase access to palliative care must maximize primary palliative care and community based models to meet the ever-growing need in a culturally sensitive and congruent manner. Patient navigator interventions are community-based, culturally tailored models of care that have been successfully implemented to improve disease prevention, early diagnosis, and treatment.

Usefulness of the Surprise Question on an Inpatient Oncology Service.

Background: Prognostication of survival in patients with advanced cancer has been challenging and contributes to poor illness understanding. Prognostic disagreement occurs even among providers and is a less studied phenomenon.

Objective: We introduced the surprise question (SQ), "Would I be surprised if this patient died in the next 1 year, 6 months, and 1 month?," at multidisciplinary rounds to increase palliative care referrals through the introduction of this prognostic prompt.

Tobacco Use Among People Who Have Been in Prison: Relapse and Factors Associated with Trying to Quit.

Introduction: Tobacco use is common among people who have been in prison. The relationship between social stressors, risky health behaviours, and smoking cessation has not been studied in people recently released from prison. Studying this relationship could yield information that guides strategic and cost-effective tobacco cessation interventions for an under-resourced population.

Apoyo con Cariño: Strategies to Promote Recruiting, Enrolling, and Retaining Latinos in a Cancer Clinical Trial.

We present and describe tailored strategies to address known barriers to minority participation in clinical trial research. The strategies used allowed our team to engage communities and successfully recruit, enroll, and retain a diverse underserved population of Latinos with advanced cancer for this clinical trial. Participants were recruited from 3 urban and 7 rural sites.

Marijuana commercialization and adolescent substance treatment outcomes in Colorado.

Background And Objectives: In Colorado, marijuana was legalized for medical use in 2000, commercialized in 2009, and approved for recreational purposes in 2012. Little is known about the association between recent policy changes and adolescent substance treatment outcomes measured by urine drug screens (UDS). This study addressed this research gap.

Can Braden Score Predict Outcomes for Hospitalized Heart Failure Patients?

Background: Braden score is a routine assessment of pressure ulcer risk hypothesized to identify the frail phenotype.

Objectives: To investigate the predictive utility of the Braden score on outcomes of inpatients with heart failure (HF).

Design: Retrospective cohort study.

How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life.

Objectives: To compare healthcare use in the last months of life between physicians and nonphysicians in the United States.

Design: A retrospective observational cohort study.

Setting: United States.

Integrating Motivational Interviewing Into a Home Telehealth Program for Veterans With Posttraumatic Stress Disorder Who Smoke: A Randomized Controlled Trial.

Objective: We evaluated integrating a motivational interviewing (MI)-based smoking cessation curricula and MI counseling into a posttraumatic stress disorder (PTSD) home telehealth care management program to determine if smoking behaviors improved.

Method: We randomized 178 Veterans with PTSD to a 90-session MI-based home telehealth program or to usual care. Outcome measures included self-reported 24-hour quit attempts, seven-day point prevalence abstinence, progression along the stages of change, and mental health symptoms.

Hospital Readmission From Post-Acute Care Facilities: Risk Factors, Timing, and Outcomes.

Objectives: Hospital discharges to post-acute care (PAC) facilities have increased rapidly. This increase may lead to more hospital readmissions from PAC facilities, which are common and poorly understood. We sought to determine the risk factors and timing for hospital readmission from PAC facilities and evaluate the impact of readmission on patient outcomes.

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use.

Background: Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use.

Objective: We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients.

Patients' and Family Caregivers' Goals for Care During Transitions Out of the Hospital.

The aims of this study were to (a) describe the nature of patients' goals upon discharge from hospital, family caregivers' goals for their loved ones, and family caregivers' goals for themselves; (b) determine the degree of concordance with respect to the three elicited goals; (c) ascertain goal attainment across the three elicited goals; and (d) examine factors predictive of goal attainment. Our findings support the position that eliciting patient and family caregiver goals and promoting goal attainment may represent an important step toward promoting greater patient and family caregiver engagement in their care.

Enhancing the care transitions intervention protocol to better address the needs of family caregivers.

Background: Family caregivers play a central role in ensuring the execution of the discharge care plan.

Objective: To enhance an evidence-based model-the Care Transitions Intervention (CTI)-and to make it more responsive to the needs of family caregivers and determine its impact on a measure of activation.

Methods: Prospective cohort of 83 patient-family caregiver partnerships discharged from hospital.

Challenges of Providing End-of-Life Care for Homeless Veterans.

Objective: To describe challenges of caring for homeless veterans at end of life (EOL) as perceived by Veterans Affairs Medical Center (VAMC) homeless and EOL care staff.

Design: E-mail survey.

Setting/participants: Homelessness and EOL programs at VAMCs.