Modifiable Barriers and Facilitators for Breast Cancer Care: A Thematic Analysis of Patient and Provider Perspectives.

Introduction: We sought to examine patient and provider perspectives regarding modifiable contributors to breast cancer treatment and to assess perceptual alignment between these two groups.

Materials: Participants were women≥18 y with stage 0-IV breast cancer who received all oncologic care in a single health system and physicians and advanced practice providers who provided medical, radiation, or surgical oncology care for breast cancer. All completed ∼45-min semistructured interviews that were recorded and transcribed verbatim.

Cross-Sector Intervention Strategies to Target Childhood Food Insecurity in North Carolina.

Background: Childhood food insecurity increased considerably during the COVID-19 pandemic and is associated with compromised health. Health care systems are increasingly prioritizing food insecurity interventions to improve health, but it is unclear how health systems collaborate with other sectors that are addressing food insecurity. In this study, we aimed to evaluate existing collaborations and explore opportunities for further cross-sector engagement.

Effectiveness of COVID-19 treatment with nirmatrelvir-ritonavir or molnupiravir among U.S. Veterans: target trial emulation studies with one-month and six-month outcomes.

Background: Information about the effectiveness of oral antivirals in preventing short- and long-term COVID-19-related outcomes during the Omicron surge is limited. We sought to determine the effectiveness of nirmatrelvir-ritonavir and molnupiravir for the outpatient treatment of COVID-19.

Methods: We conducted three retrospective target trial emulation studies comparing matched patient cohorts who received nirmatrelvir-ritonavir versus no treatment, molnupiravir versus no treatment, and nirmatrelvir-ritonavir versus molnupiravir in the Veterans Health Administration (VHA).

Racial inequality in functional trajectories between Black and White U.S. veterans.

Background: Racial inequality in functional trajectories has been well documented in the U.S. civilian population but has not been explored among Veterans.

Mobilizing Domestic Funds for the HIV/AIDS Response in Nigeria: Estimating the Potential Contribution of the National Health Insurance Scheme.

Background: Amid the dwindling donor support for HIV in Nigeria, there is an urgent need for additional domestic HIV funding. This study estimates the required financial resources for people living with HIV (PLHIV) and the potential magnitude of domestic resources for HIV through the National Health Insurance Scheme (NHIS) and by prioritizing HIV within the health budget.

Methods: We estimated the resource needs for providing antiretroviral therapy (ART) to adults, children, and pregnant women living with HIV under 3 scenarios: current coverage rates, coverage rates based on historical trends, and a rapid scale-up situation.

Improving Care Coordination Between Veterans Health Administration Primary Care Teams and Community Home Health Aide Providers: A Qualitative Study.

Effective coordination between medical and long-term services is essential to high-quality primary care for older adults, but can be challenging. Our study assessed coordination and communication through semi-structured interviews with Veterans Health Administration (VHA) primary care clinicians ( = 9); VHA-contracted home health agencies ( = 6); and home health aides ( = 8) caring for veterans at an urban VHA medical center. Participants reported (1) establishing home health services is complex, requiring collaboration between many individuals and systems; (2) communication between medical teams and agencies is often reactive; (3) formal communication channels between medical teams and agencies are lacking; (4) aides are an important source of patient information; and (5) aides report important information, but rarely receive it.

A Survey of Research Participants' Privacy-Related Experiences and Willingness to Share Real-World Data with Researchers.

Background: Real-world data (RWD) privacy is an increasingly complex topic within the scope of personalized medicine, as it implicates several sources of data.

Objective: To assess how privacy-related experiences, when adjusted for age and education level, may shape adult research participants' willingness to share various sources of real-world data with researchers.

Methods: An electronic survey was conducted in April 2021 among adults (≥18 years of age) registered in ResearchMatch, a national health research registry.

Modifiable patient-reported factors associated with cancer-screening knowledge and participation in a community-based health assessment.

Background: We sought to identify modifiable factors associated with cancer screening in a community-based health assessment.

Methods: 24 organizations at 47 community events in central North Carolina distributed a 91-item survey from April-December 2017. Responses about (1) interest in disease prevention, (2) lifestyle choices (e.

The Aetion Coalition to Advance Real-World Evidence through Randomized Controlled Trial Emulation Initiative: Oncology.

Legislative and technological advancements over the past decade have given rise to the proliferation of healthcare data generated from routine clinical practice, often referred to as real-world data (RWD). These data have piqued the interest of healthcare stakeholders due to their potential utility in generating evidence to support clinical and regulatory decision making. In the oncology setting, studies leveraging RWD offer distinct advantages that are complementary to randomized controlled trials (RCTs).

The Impact of Hearing Loss and Its Treatment on Health-Related Quality of Life Utility: a Systematic Review with Meta-analysis.

Background: Hearing loss significantly impacts health-related quality of life (QoL), yet the effects of current treatments on QoL utility remain uncertain. Our objective was to describe the impact of untreated and treated hearing loss on QoL utility to inform hearing healthcare policy.

Methods: We searched databases for articles published through 02/01/2021.

Pharmacodynamic Biomarkers for Biosimilar Development and Approval: A Workshop Summary.

The US Food and Drug Administration (FDA) Biosimilars Guidance describes how biosimilars may be approved based on clinical pharmacokinetic and pharmacodynamic (PD) biomarker data, without comparative clinical studies with efficacy end points. This type of clinical development program, however, has only been implemented for a small number of FDA-approved biosimilar products over the last decade. To encourage the use of PD biomarkers in biosimilar development and approval, the Duke-Margolis Center for Health Policy collaborated with the FDA to host a two-day virtual public workshop entitled "Pharmacodynamic Biomarkers for Biosimilar Development and Approval" on September 20-21, 2021.

Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule.

Importance: Adult hearing screening is not routinely performed, and most individuals with hearing loss (HL) have never had their hearing tested as adults.

Objective: To project the monetary value of future research clarifying uncertainties around the optimal adult hearing screening schedule.

Design, Setting, And Participants: In this economic evaluation, a validated decision model of HL (DeciBHAL-US: Decision model of the Burden of Hearing loss Across the Lifespan) was used to simulate current detection and treatment of HL vs hearing screening schedules.

Early Adoption of Anti-SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022.

Importance: Older adults and individuals with medical comorbidities are at increased risk for severe COVID-19. Several pharmacotherapies demonstrated to reduce the risk of COVID-19-related hospitalization and death have been authorized for use.

Objective: To describe factors associated with receipt of outpatient COVID-19 pharmacotherapies in the Veterans Affairs (VA) health care system.

Advance directives among cognitively impaired persons who had an amyloid PET scan and their care partners: a mixed-methods study.

Background: Little research exists on the role of β-amyloid PET scans as part of Alzheimer's diagnostic tests and documentation of end-of-life preferences for persons with cognitive impairment. The study objectives were to examine the association of amyloid PET scan results (elevated vs. not elevated amyloid levels) and diagnostic category (mild cognitive impairment vs.

Adolescent and Young Adult Perspectives on Quality and Value in Health Care.

Objective: To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment.

Methods: A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment.

Practical Considerations and Recommendations for "a Revised Hippocratic Oath for the Era of Digital Health".

The Hippocratic Oath (the "Oath") is a longstanding body of ethical tenets that have undergone several amendments to accommodate changes and evolutions in the practice of medicine. In their recent perspective entitled, "A Revised Hippocratic Oath for the Era of Digital Health," Meskó and Spiegel offered proposed amendments to the Oath to address both challenges and needs that follow digital health implementation in clinical practice. In this commentary, we offer additional thoughts and considerations to Meskó and Spiegel's proposed amendments to accomplish two goals: (1) reflect on the shared goals and values of all digital health stakeholders and (2) drive home the focus on affirming patient choice, autonomy, and respect.

BMI Trends for Veterans Up to 10 Years After VA Enrollment Following Military Discharge.

Background: Obesity (body mass index [BMI]≥30kg/m) among US adults has tripled over the past 45 years, but it is unclear how this population-level weight change has occurred.

Objective: We sought to identify distinct long-term BMI trajectories and examined associations with demographic and clinical characteristics.

Design: The design was latent trajectory modeling over 10 years of a retrospective cohort.

Effectiveness of mRNA COVID-19 Vaccine Boosters Against Infection, Hospitalization, and Death: A Target Trial Emulation in the Omicron (B.1.1.529) Variant Era.

Background: The effectiveness of a third mRNA COVID-19 vaccine dose (booster dose) against the Omicron (B.1.1.

Standing Up For My Sister.

Integrating family caregivers into the health care team is particularly important for patients with intellectual disabilities.