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I Background: i Understanding SARS-CoV-2 vaccination among health care workers is important because they are at high risk for occupational exposure and may be convincing advocates for vaccination among their patients. Further work is needed to improve vaccination rates of health care system employees. Vaccination rates of health care system employees during the COVID-19 pandemic were less than ideal, particularly among certain groups at high risk for occupational exposure. [Extracted from the article]

Department of Motor Vehicles (DMV) facilities are assessed based on the proportion of patrons who consent to donate. To evaluate the individual characteristics that may influence donation consent, we analyzed the most recent transactions of 9,767,839 patrons of 203 Ohio DMVs between January 1, 2014 and November 17, 2018. Patron age, gender, donor designation, and DMV location were linked via patron zip codes with census tract data on race, ethnicity, income, and education. The Standardized Donor Designation Ratio (SDDR) (the observed number of donors at each DMV divided by the expected number of donors based on patron demographic characteristics) was calculated. Altogether 5,769,561 DMV patrons (59.1%) were designated as donors. Donor designation was independently associated with younger age, female gender, nonblack race, Hispanic ethnicity, and higher income. Across 203 DMVs, the percent donors ranged from 33% to 73%, and SDDRs ranged from 0.7 to 1.61. The correlation between the 2 measures demonstrated that 47% of the variation in SDDR was explained by percent donors. In conclusion, across DMVs there is substantial variation in organ donor designation rates. SDDRs that adjust for DMV patron characteristics may distinctly and more accurately describe individual DMV facility success in promoting organ donation. [ABSTRACT FROM AUTHOR]

The article discusses the study conducted on the prevalence of information copying by attendings and residents in intensive care progress notes. Progress notes of 135 patients generated between August 1, 2009 and December 31, 2009 are cited as the sources used. Residents are revealed to copy more frequently than attendings but attendings copied more information per note. Attendings' level of copying is presented to vary from 41 percent to 82 percent.

Background: The gap between the supply of organs available for transplantation and demand is growing, especially among ethnic groups. Objective: To evaluate the effect of a video designed to address concerns of ethnic groups about organ donation. Design: Cluster randomized, controlled trial. Randomization was performed by using a random-number table with centralized allocation concealment. Participants and investigators assessing outcomes were not blinded to group assignment. (ClinicalTrials.gov registration number: NCT00870506) Setting: Twelve branches of the Ohio Bureau of Motor Vehicles in northeastern Ohio. Participants: 952 participants aged 15 to 66 years. Intervention: Video (intervention; n = 443) or usual Bureau of Motor Vehicles license practices (control; n = 509). Measurements: The primary outcome was the proportion of participants who provided consent for organ donation on a newly acquired driver's license, learner's permit, or state identification card. Secondary outcomes included willingness to make a living kidney donation to a family member in need and personal beliefs about donation. Results: More participants who viewed the video consented to donate organs than control participants (84% vs. 72%; difference, 12 percentage points [95% CI, 6 to 17 percentage points]). The video was effective among black participants (76% vs. 54%; difference, 22 percentage points [CI, 9 to 35 percentage points]) and white participants (88% vs. 77%; difference, 11 percentage points [CI, 5 to 15 percentage points]). At the end of the trial, fewer intervention than control participants reported having insufficient information about organ donation (34% vs. 44%; difference, -10 percentage points [CI, -16 to -4 percentage points]), wanting to be buried with all of their organs (14% vs. 25%; difference, -11 percentage points [CI, -16 to -6 percentage points]), and having conflicts with organ donation (7% vs. 11%; difference, -4 percentage points [CI, -8 to -2 percentage points]). Limitation: How the observed increases in consent to donate organs might translate into a greater organ supply in the region is unclear. Conclusion: Exposure to a brief video addressing concerns that ethnic groups have about organ donation just before obtaining a license, permit, or identification card increased consent to donate organs among white and black participants. Primary Funding Source: National Institutes of Health and the Robert Wood Johnson Foundation. [ABSTRACT FROM AUTHOR]

The article assesses clinician-family communication with non-English-speaking family members. According to the authors, the amount of clinician speech as a proportion of total speech time was 42.7% in interpreted conferences and 60.5% in noninterpreted conferences. They suggest that families with non-English-speaking members may be at increased riks of receiving less information about their loved one's critical illness as well as less emotional support from their clinicians.

Community advisory boards (CABs) are increasingly recognized as a means of incorporating patient experience into clinical practice and research. The power of CABs is derived from engaging with community members as equals throughout the research process. Despite this, little is known of community member experience and views on best practices for running a CAB in a rare pulmonary disease. What are CAB members' views on the best practices for CAB formation and maintenance in a rare pulmonary disease? In August 2021, we formed the Cleveland Clinic Sarcoidosis Health Partners (CC-HP) as a CAB to direct research and clinic improvement initiatives at a quaternary sarcoidosis center. We collaboratively evaluated our process for formation and maintenance of the CC-HP with the patient members of the group. Through the series of reflection/debriefing discussions, CAB patient members developed a consensus account of salient obstacles and facilitators of forming and maintaining a CAB in a rare pulmonary disease. Clinician and community members of the CC-HP found published guidelines to be an effective tool for structuring formation of a CAB in a rare pulmonary disease. Facilitators included a dedicated coordinator, collaborative development of projects, and a focus on improving clinical care. Obstacles to CAB functioning were formal structure, focus on projects with academic merit but no immediate impact to patients, and overreliance on digital resources. By centering our evaluation of our CAB on community member experience, we were able to both identify facilitators and impediments to CAB as well as improve our own processes. [ABSTRACT FROM AUTHOR]

Background: The efficacy of video interventions to increase organ donation willingness remains unclear. Methods: Three‐arm web‐based randomized controlled trial involving 2261 students at 3 northeastern Ohio universities. Intervention students watched a live‐action (n = 755) or animated (n = 753) donation video. Control students (n = 753) viewed wellness information from the Centers for Disease Control and Prevention (CDC). The primary outcome was proportion of students who visited their state electronic donor registry to consent. The secondary outcome was intervention quality. Logistic regression assessed the effects of interventions on visiting the state registry to provide donation consent while controlling for baseline variables. Results: Students in the live‐action video arm visited their state registry more frequently than students in the CDC arm (OR = 1.86, 95% CI = 1.20‐2.88). There was no difference between students in the animated video and CDC arms (OR = 1.10, 95% CI = 0.69‐1.76). The quality of the live‐action video was rated lower than the animated video and the CDC text (75% ± 18, 84% ± 16, 80% ± 16, respectively; P < 0.001). Conclusion: Students who watched the live‐action video were more willing to visit their electronic donor registry to register as organ donors, but rated it lower in satisfaction. Future work should identify the most potent components of organ donation interventions. [ABSTRACT FROM AUTHOR]

In May, 24 per 10,000 White patients received nirmatrelvir prescriptions compared to 9 per 10,000 Black patients ( I p i <0.001) and 10 per 10,000 Hispanic patients ( I p i <0.001 when compared to White non-Hispanic patients). Oral nirmatrelvir has been shown to reduce the risk of progression to severe coronavirus disease 2019 (Covid-19) in high-risk, unvaccinated patients.[1] Reports from the manufacturer reveal a rapid increase in prescriptions months after approval, with as many as 80,000 patients treated in one week of April of 2022.[2] The drug may reduce racial and ethnic disparities as people of color are at a higher risk of complications from severe COVID-19 and are less likely to be vaccinated.[3] A study of nationwide dispensing data revealed lower dispenses in higher vulnerability zip codes, but the impact of race could not be evaluated.[4] We sought to determine whether nirmatrelvir prescriptions' rate differed along racial and ethnic lines by leveraging data from a large electronic health record (EHR) data aggregation collaborative. White, non-Hispanic patients made up 64% of the cohort, Black patients made up 13%, and Hispanic patients comprised 10%. [Extracted from the article]

There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care. [ABSTRACT FROM AUTHOR]

Despite having a higher prevalence and severity of obstructive sleep apnea (OSA), African Americans have lower adherence to continuous positive airway pressure (CPAP) compared to other groups. Information regarding challenges faced by African Americans prescribed CPAP are lacking. To determine the barriers and facilitators to optimal management of OSA with CPAP among African Americans and to understand the role bed partners may play. We conducted semi-structured in-depth interviews via video conferencing with African American patients of an urban safety-net health care system with OSA prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Verbatim transcripts were analyzed using the principles of thematic analysis. 15 patients (12 women) diagnosed with OSA and prescribed CPAP a mean 2.6 years prior along with 15 bed partners (3 women) were individually interviewed. Four themes emerged regarding impediments to CPAP use: 1) inadequate education and support, 2) CPAP maintenance and hygiene, 3) inconvenient design of CPAP interfaces, and 4) impediment to intimacy. Four themes emerged as facilitators to CPAP use: 1) provider and technical support, 2) properly fitted CPAP masks, 3) active support from partner and family, and 4) experiencing positive results from CPAP. African American patients with OSA and their bed partners identified several unique barriers and facilitators to CPAP use. Active involvement by bed partners was considered by both patients and partners as helpful in improving CPAP adherence. Interventions to improve OSA outcomes in this population should focus on patients and their bed partners. [ABSTRACT FROM AUTHOR]

Presents the medical case of a 53-year-old man who was admitted to a hospital with confusion and disorientation. Previous hospitalization for hypercalcemia due to the amount of calcium supplements he was taking for osteoporosis; Diagnosis of non-sercretory myeloma; Outcome of the case.

Smoking and OSA are widely prevalent and are associated with significant morbidity and mortality. It has been hypothesized that each of these conditions adversely affects the other, leading to increased comorbidity while altering the efficacy of existing therapies. However, while the association between smoking and OSA is plausible, the evidence is less than conclusive. Cigarette smoking may increase the severity of OSA through alterations in sleep architecture, upper airway neuromuscular function, arousal mechanisms, and upper airway inflammation. Conversely, some evidence links untreated OSA with smoking addiction. Smoking cessation should improve OSA, but the evidence to support this is also limited. This article reviews the current evidence linking both conditions and the efficacy of various treatments. Limitations of the current evidence and areas in need of future investigation are also addressed. [ABSTRACT FROM AUTHOR]

The article discusses several studies on the relationship between smoking and obstructive sleep apnea (OSA). Topics covered include the mechanisms that must be considered when determining how smoking may cause OSA including the changes in sleep architecture and the increased upper airway inflammation due to smoke inhalation, the effects of smoking cessation (SC) on OSA, and the evolution of aids for SC including electronic cigarettes and pharmacologic products like bupropion.

Spirometry is necessary to diagnose chronic obstructive pulmonary disease (COPD), yet a large proportion of patients are diagnosed and treated without having received testing. This study explored whether the effects of interventions using the electronic health record (EHR) to target patients diagnosed with COPD without confirmatory spirometry impacted the incidence rates of spirometry referrals and completions. This retrospective before and after study assessed the impact of provider-facing clinical decision support that identified patients who had a diagnosis of COPD but had not received spirometry. Spirometry referrals, completions, and results were ascertained 1.5 years prior to and 1.5 years after the interventions were initiated. Inhaler prescriptions by class were also tallied. There were 10,949 unique patients with a diagnosis of COPD who were eligible for inclusion. 4,895 patients (44.7%) were excluded because they had completed spirometry prior to the cohort start dates. The pre-intervention cohort consisted of 2,622 patients, while the post-intervention cohort had 3,392. Spirometry referral rates pre-intervention were 20.2% compared to 31.6% post-intervention (p < 0.001). Spirometry completion rates rose from 13.2% pre-intervention to 19.3% afterwards (p < 0.001). 61.7% (585 of 948) had no evidence of airflow obstruction. After excluding patients with a diagnosis of asthma, 25.8% (126 of 488) patients who had no evidence of airflow obstruction had prescriptions for long-acting bronchodilators or inhaled steroids. A concerted EHR intervention modestly increased spirometry referral and completion rates in patients with a diagnosis of COPD without prior spirometry and decreased misclassification of disease. [ABSTRACT FROM AUTHOR]

Background: Low organ donation rates remain a major barrier to organ transplantation.Objective: We aimed to determine the effect of a video and patient cueing on organ donation consent among patients meeting with their primary care provider.Design: This was a randomized controlled trial between February 2013 and May 2014.Setting: The waiting rooms of 18 primary care clinics of a medical system in Cuyahoga County, Ohio.Patients: The study included 915 patients over 15.5 years of age who had not previously consented to organ donation.Interventions: Just prior to their clinical encounter, intervention patients (n = 456) watched a 5-minute organ donation video on iPads and then choose a question regarding organ donation to ask their provider. Control patients (n = 459) visited their provider per usual routine.Main Measures: The primary outcome was the proportion of patients who consented for organ donation. Secondary outcomes included the proportion of patients who discussed organ donation with their provider and the proportion who were satisfied with the time spent with their provider during the clinical encounter.Key Results: Intervention patients were more likely than control patients to consent to donate organs (22 % vs. 15 %, OR 1.50, 95%CI 1.10-2.13). Intervention patients were also more likely to have donation discussions with their provider (77 % vs. 18 %, OR 15.1, 95%CI 11.1-20.6). Intervention and control patients were similarly satisfied with the time they spent with their provider (83 % vs. 86 %, OR 0.87, 95%CI 0.61-1.25).Limitation: How the observed increases in organ donation consent might translate into a greater organ supply is unclear.Conclusion: Watching a brief video regarding organ donation and being cued to ask a primary care provider a question about donation resulted in more organ donation discussions and an increase in organ donation consent. Satisfaction with the time spent during the clinical encounter was not affected.Trial Registration: clinicaltrials.gov Identifier: NCT01697137. [ABSTRACT FROM AUTHOR]

Background: The gap between the supply of organs available for transplantation and demand is growing, especially among ethnic groups.Objective: To evaluate the effect of a video designed to address concerns of ethnic groups about organ donation.Design: Cluster randomized, controlled trial. Randomization was performed by using a random-number table with centralized allocation concealment. Participants and investigators assessing outcomes were not blinded to group assignment. (ClinicalTrials.gov registration number: NCT00870506)Setting: Twelve branches of the Ohio Bureau of Motor Vehicles in northeastern Ohio.Participants: 952 participants aged 15 to 66 years.Intervention: Video (intervention; n = 443) or usual Bureau of Motor Vehicles license practices (control; n = 509).Measurements: The primary outcome was the proportion of participants who provided consent for organ donation on a newly acquired driver's license, learner's permit, or state identification card. Secondary outcomes included willingness to make a living kidney donation to a family member in need and personal beliefs about donation.Results: More participants who viewed the video consented to donate organs than control participants (84% vs. 72%; difference, 12 percentage points [95% CI, 6 to 17 percentage points]). The video was effective among black participants (76% vs. 54%; difference, 22 percentage points [CI, 9 to 35 percentage points]) and white participants (88% vs. 77%; difference, 11 percentage points [CI, 5 to 15 percentage points]). At the end of the trial, fewer intervention than control participants reported having insufficient information about organ donation (34% vs. 44%; difference, -10 percentage points [CI, -16 to -4 percentage points]), wanting to be buried with all of their organs (14% vs. 25%; difference, -11 percentage points [CI, -16 to -6 percentage points]), and having conflicts with organ donation (7% vs. 11%; difference, -4 percentage points [CI, -8 to -2 percentage points]).Limitation: How the observed increases in consent to donate organs might translate into a greater organ supply in the region is unclear.Conclusion: Exposure to a brief video addressing concerns that ethnic groups have about organ donation just before obtaining a license, permit, or identification card increased consent to donate organs among white and black participants.Primary Funding Source: National Institutes of Health and the Robert Wood Johnson Foundation. [ABSTRACT FROM AUTHOR]

Rationale: Many conferences in the ICU occur with the families of patients with limited English proficiency, requiring a medical interpreter. Despite the importance of medical interpretation, little is known about the alterations that occur and their effect on communication.Objectives: This study characterizes the types, prevalence, and potential effects of alterations in interpretation during ICU family conferences involving end-of-life discussions.Methods: We identified ICU family conferences in two hospitals in which a medical interpreter was used. Ten conferences were audiotaped; 9 physicians led these conferences, and 70 family members participated. Research interpreters different from those attending the conference translated the non-English language portions of the audiotaped conferences. We identified interpretation alterations, grouped them into four types, and categorized their potential effects on communication.Results: For each interpreted exchange between clinicians and family, there was a 55% chance that an alteration would occur. These alterations included additions, omissions, substitutions, and editorializations. Over three quarters of alterations were judged to have potentially clinically significant consequences on the goals of the conference. Of the potentially significant alterations, 93% were likely to have a negative effect on communication; the remainder, a positive effect. The alterations with potentially negative effects included interference with the transfer of information, reduced emotional support, and reduced rapport. Those with potential positive effects included improvements in conveying information and emotional support.Conclusions: Alterations in medical interpretation seem to occur frequently and often have the potential for negative consequences on the common goals of the family conference. Further studies examining and addressing these alterations may help clinicians and interpreters to improve communication with family members during ICU family conferences. [ABSTRACT FROM AUTHOR]