Discussions of Cannabis Over Patient Portal Secure Messaging: Content Analysis.

Background: Patient portal secure messaging allows patients to describe health-related behaviors in ways that may not be sufficiently captured in standard electronic health record (EHR) documentation, but little is known about how cannabis is discussed on this platform.

Objective: This study aimed to identify patient and provider secure messages that discussed cannabis and contextualize these discussions over periods before and after its legalization for medical purposes in Pennsylvania.

Methods: We examined 382,982 secure messages sent by 15,340 patients and 6101 providers from an integrated health delivery system in Pennsylvania, United States, from January 2012 to June 2022.

Ethical considerations for respectful research participant payment processes.

Background: Researchers and research organizations acknowledge the importance of paying research participants but often overlook the process of providing participant payments as a locus for improving equity and inclusion in clinical research. In this conceptual paper, we argue that participants' lived experiences and social context should be recognized and respected when developing these processes.

Methods: We consider how participant payment processes that require specific payment types, delay the timing of payment, or require sharing sensitive information may impose barriers to equitable research.

Comparing models that integrate obstetric care and WIC on improved program enrollment during pregnancy: a protocol for a randomized controlled trial.

Background: Low-income, rural pregnant women are at disproportionate risk for adverse pregnancy outcomes as well as future cardiovascular risk. Currently, less than half of eligible women enroll in the Women, Infants, and Children's (WIC) Program. This study aims to evaluate whether integrating clinical care and social care may advance health equity and reduce health disparities by directly linking women receiving obstetric care to the Special Supplemental Nutrition Program for WIC and/or a Registered Dietitian/Nutritionist (RDN).

Multi-omic network analysis identifies dysregulated neurobiological pathways in opioid addiction.

Background: Opioid addiction is a worldwide public health crisis. In the United States, for example, opioids cause more drug overdose deaths than any other substance. Yet, opioid addiction treatments have limited efficacy, meaning that additional treatments are needed.

"Treatable not curable": trade-offs in the use of treatment-oriented language with patients who have incurable cancer.

Treatment-oriented language is used by physicians to convey to patients that treatment is available for their cancer (eg, "our usual treatment for this is…," "we can treat this," "your cancer is still treatable"). For patients who have incurable cancer, especially for patients with a poor prognosis or who are at the end of life, it is important to understand how physicians conceptualize and use this "everyday" clinical language. We conducted a qualitative interview study with a multidisciplinary group of physicians (n = 30) who may care for patients with cancer at different points in their clinical course, from diagnosis to end of life.

An emerging multi-omic understanding of the genetics of opioid addiction.

Opioid misuse, addiction, and associated overdose deaths remain global public health crises. Despite the tremendous need for pharmacological treatments, current options are limited in number, use, and effectiveness. Fundamental leaps forward in our understanding of the biology driving opioid addiction are needed to guide development of more effective medication-assisted therapies.

Development of the Better Research Interactions for Every Family (BRIEF) intervention to support recruitment for neonatal clinical trials: an intervention mapping guided approach.

Background: Recruitment for neonatal clinical trials can be particularly challenging. Low enrollment rates bias the research population and decrease generalizability of findings. We identified a critical need for an intervention to improve how researchers recruit for neonatal clinical trials.

Clinical Utility and Patient Compliance With Mobile Applications for Home-Based Rehabilitation Following Transforaminal Lumbar Interbody Fusion.

Study Design: Retrospective chart review.

Objectives: Transforaminal lumbar interbody fusion (TLIF) via open or minimally invasive (MI) techniques is commonly performed. Mobile applications for home-based therapy programs have grown in popularity.

"I'm completely off base here on what this child is capable of": A qualitative analysis of how medical ableism manifests in PICU clinicians' care of children with severe neurological impairment.

Background: Children with severe neurological impairment (SNI) are at heightened risk of experiencing medical ableism from clinicians in the pediatric intensive care unit (PICU), where barriers such as time scarcity and heavy workloads limit clinicians' ability to provide personalized care.

Objective: To examine medical ableism and strategies to support PICU clinicians in understanding the lives of children with SNI and their families.

Methods: This US-based, single-center, qualitative study included PICU clinicians identified by the parents/caregivers of a child with SNI.

Telemedicine in Advanced Kidney Disease and Kidney Transplant: A Qualitative Meta-Analysis of Studies of Patient Perspectives.

Rationale & Objective: While the use of telemedicine has increased dramatically across disciplines, patient perspectives on telemedicine related to chronic kidney disease are not well understood. We systematically reviewed qualitative studies on patients with chronic kidney disease as well as those with kidney transplant to better understand these patients' perspectives related to telemedicine.

Study Design: Qualitative meta-analysis.

Potential corporate uses of polygenic indexes: Starting a conversation about the associated ethics and policy issues.

Some commercial firms currently sell polygenic indexes (PGIs) to individual consumers, despite their relatively low predictive power. It might be tempting to assume that because the predictive power of many PGIs is so modest, other sorts of firms-such as those selling insurance and financial services-will not be interested in using PGIs for their own purposes. We argue to the contrary.

Fostering Students' Personal and Professional Growth: Responding to Error During the Internal Medicine Clerkship.

Objectives: Developing professionalism is critical to medical education; accordingly, professionalism curricula may be implemented longitudinally throughout undergraduate medical education. Here we share our experiences addressing student response to medical error as a component of professionalism education during the core clerkship year.

Methods: This pretest-posttest study reports medical students' knowledge regarding learning and growing in response to medical error.

Comparison of Clinical Decision Support Tools to Improve Pediatric Lipid Screening.

Objective: To test whether different clinical decision support tools increase clinician orders and patient completions relative to standard practice and each other.

Study Design: A pragmatic, patient-randomized clinical trial in the electronic health record was conducted between October 2019 and April 2020 at Geisinger Health System in Pennsylvania, with 4 arms: care gap-a passive listing recommending screening; alert-a panel promoting and enabling lipid screen orders; both; and a standard practice-no guideline-based notification-control arm. Data were analyzed for 13 346 9- to 11-year-old patients seen within Geisinger primary care, cardiology, urgent care, or nutrition clinics, or who had an endocrinology visit.

Declining but Pronounced State-Level Disparities in Prescription Opioid Distribution in the United States.

The United States (US) opioid epidemic is a persistent and pervasive public health emergency that claims the lives of over 80,000 Americans per year as of 2021. There have been sustained efforts to reverse this crisis over the past decade, including a number of measures designed to decrease the use of prescription opioids for the treatment of pain. This study analyzed the changes in federal production quotas for prescription opioids and the distribution of prescription opioids for pain and identified state-level differences between 2010 and 2019.

Perceptions and Attitudes Toward Genetic Counselors and Genetic Testing Among Certified Professional Midwives in Vermont: A Modified Grounded Theory Study.

Increasingly, pregnant people in the United States are choosing to give at birth at home, and certified professional midwives (CPMs) often attend these births. Care by midwives, including home birth midwives, has the potential to decrease unnecessary medical interventions and their associated health care costs, as well as to improve maternal satisfaction with care. However, lack of integration into the health care system affects the ability of CPMs to access standard medications and testing for their clients, including prenatal screening.

Community Engagement in Behavioral Medicine: A Scoping Review.

Background: Behavioral medicine has made key contributions toward improving health outcomes. Engaging community partners in research is critical to addressing persistent health inequities. The aim of this scoping review was to explore how researchers engaged community partners within the field of behavioral medicine research from 2005 to 2023.

Using Clinical Decision Intelligence Applications to Improve Pathways For Earlier Detection Of Underrecognized Cognitive Disorders.

Cost estimates for care for those with dementia and other cognitive impairments are rising globally, estimated to reach US $1 trillion by 2025. Lack of specialized personnel, infrastructure, diagnostic capabilities, and healthcare access impedes the timely identification of patients progressing to dementia, particularly in underserved populations. International healthcare infrastructure may be unable to handle existing cases in addition to a sudden increase due to undiagnosed cognitive impairment and dementia.

Designing implementation strategies to improve identification, cascade testing, and management of families with familial hypercholesterolemia: An intervention mapping approach.

Introduction: Familial hypercholesterolemia (FH) is a common inherited cholesterol disorder that, without early intervention, leads to premature cardiovascular disease. Multilevel strategies that target all components of FH care including identification, cascade testing, and management are needed to address gaps that exist in FH care. We utilized intervention mapping, a systematic implementation science approach, to identify and match strategies to existing barriers and develop programs to improve FH care.