Article
Multidisciplinary Sciences
Peih-Ying Lu, Anna Shan Chun Hsu, Alexander Green, Jer-Chia Tsai
Summary: This study examines Taiwanese medical students' perceptions of their values and preparedness to care for LGBT patients. The results show that medical students have wide social acceptance and openness towards LGBT individuals, but they are unsure of how to communicate with LGBT patients. They also recognize the potential development of stigmatization and biases during their training, and acknowledge that gender stereotypes may negatively impact clinical reasoning. Furthermore, medical students consider themselves prepared to care for LGBT patients, but they lack relevant professional skills.
Article
Medicine, General & Internal
Jasmine Weiss, Lilanthi Balasuriya, Laura D. Cramer, Marcella Nunez-Smith, Inginia Genao, Rosana Gonzalez-Colaso, Ambrose H. Wong, Elizabeth A. Samuels, Darin Latimore, Dowin Boatright, Mona Sharifi
Summary: In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.
Article
Multidisciplinary Sciences
Izzy Gainsburg, Veronica Derricks, Cleveland Shields, Kevin Fiscella, Ronald Epstein, Veronica Yu, Jennifer Griggs
Summary: Disparities in medical treatment and health outcomes between Black and White Americans still exist. One reason is that physicians sometimes have implicit racial biases that favor White patients over Black patients. Therefore, patient activation can disrupt the effects of physicians' implicit bias and promote equitable health outcomes.
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
(2022)
Article
Pediatrics
Yarden S. Fraiman, Christine C. Cheston, Diana Morales, Kristen T. Leeman, Anne R. Hansen
Summary: Healthcare staff are aware of bias and its impact on their interactions with patients, families, and colleagues. They believe that implicit bias has a greater influence on their behaviors than explicit bias, and perceive themselves as having less bias than others. Staff have suggestions for approaches to mitigate the impact of bias.
PEDIATRIC RESEARCH
(2023)
Article
Geriatrics & Gerontology
Deepshikha Charan Ashana, Noah D'Arcangelo, Priscilla K. Gazarian, Avni Gupta, Stephen Perez, Amanda J. Reich, Jennifer Tjia, Scott D. Halpern, Joel S. Weissman, Keren Ladin
Summary: This study examines the barriers and facilitators to advance care planning (ACP) among clinicians. The findings show that most clinicians avoid discussing ACP with certain racial/ethnic groups, those with limited English fluency, and individuals with specific religious beliefs. The study suggests the need for interventions at the clinician and institutional levels to reduce disparities in ACP.
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES
(2022)
Article
Emergency Medicine
Mary E. McLean, Leigh E. McLean, Annie C. McLean-Holden, Linelle F. Campbell, Adriana M. Horner, Miriam L. Kulkarni, Laura D. Melville, Elizabeth A. Fernandez
Summary: This study found a high prevalence of interphysician implicit weight bias among physicians and highlighted the strong correlations between implicit, explicit, and professional biases. These results can guide implicit bias training for a more inclusive medical workplace and address potential disparities faced by physicians with obesity.
ACADEMIC EMERGENCY MEDICINE
(2021)
Review
Obstetrics & Gynecology
Tara K. Torres, Dana M. Chase, Ritu Salani, Heidi A. Hamann, Jeff Stone
Summary: Health disparities exist among patients with gynecologic cancers, with the greatest differences observed among racial, ethnic, and socioeconomic groups. Implicit biases in healthcare may unconsciously perpetuate bias towards racially and socioeconomically disadvantaged patients, leading to communication and medical judgment differences. This narrative review explores implicit bias in healthcare, specifically among oncology professionals, and identifies future research areas in gynecologic oncology.
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
(2022)
Article
Surgery
Denisse Cristina Porras Fimbres, Daniel P. Nussbaum, Paul J. Mosca
Summary: This study compared the time from admission to laparoscopic cholecystectomy for acute cholecystitis between non-Hispanic Black and non-Hispanic White patients. The findings showed that a higher percentage of Black patients experienced a time to surgery longer than 1 day compared to White patients. In the multivariable analysis, Black patients were found to be more likely than White patients to experience a time to surgery longer than 1 day, even after controlling for potential confounding factors.
AMERICAN JOURNAL OF SURGERY
(2023)
Article
Nursing
Mary A. Byrn, Elizabeth A. Buys, Mahasin Mujahid, Kristine Madsen
Summary: This study examined the differences in perinatal care based on the designated race of the birthing person within a large and diverse cohort of women. The results showed that there were few differences in perinatal care based on established guidelines, but disparities were evident in discretionary care.
BIRTH-ISSUES IN PERINATAL CARE
(2023)
Article
Medicine, General & Internal
Dowin Boatright, Nientara Anderson, Jung G. Kim, Eric S. Holmboe, William A. McDade, Tonya Fancher, Cary P. Gross, Sarwat Chaudhry, Mytien Nguyen, Max Jordan Nguemeni Tiako, Eve Colson, Yunshan Xu, Fangyong Li, James D. Dziura, Somnath Saha
Summary: This study examines the association between race and ethnicity and performance assessments among internal medicine residents. The results show that underrepresented in medicine and Asian residents received lower ratings on performance assessments compared to White residents during the first and second years of training, indicating the presence of racial bias in assessment.
Article
Medicine, General & Internal
Caitlin R. Ryus, Elizabeth A. Samuels, Ambrose H. Wong, Katherine A. Hill, Stephen Huot, Dowin Boatright
Summary: This study investigated the perceptions of SM medical students on the medical school learning environment and found that bisexual and gay or lesbian students had less favorable perceptions compared to heterosexual students. Moreover, the study suggested that the medical school environment might contribute to higher rates of burnout in SM students.
Article
Obstetrics & Gynecology
Fouad Atallah, Rebecca F. Hamm, Christina M. Davidson, C. Andrew Combs
Summary: The processes of diagnosis and management in healthcare are often influenced by cognitive biases, leading to medical errors. This article presents a framework of clinical thinking and decision-making, highlighting the potential biases that can occur. Examples of cognitive bias in obstetrics are reviewed, along with debiasing tools and strategies. The concept of a cognitive autopsy, which involves analyzing medical decision-making and the impact of cognitive biases, is promoted for reviewing adverse events. Future research on cognitive bias in obstetrics is suggested.
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
(2022)
Review
Nursing
Patricia S. Groves, Jacinda L. Bunch, Janice A. Sabin
Summary: Research on nurse bias and care disparities has become increasingly common in the past 38 years. Studies have found that nurse bias is associated with negative impacts on nursing care for patients with certain characteristics. However, there is still a lack of focus on interventions to address nurse bias and nursing care-related healthcare disparities.
JOURNAL OF CLINICAL NURSING
(2021)
Article
Allergy
Princess U. Ogbogu, Quinn Capers, Andrea J. Apter
Summary: The COVID-19 pandemic and movements for social and racial equality have highlighted disparities in American healthcare, which are influenced by social determinants of health, structural racism, and implicit bias. A four-pronged approach is proposed to address these inequities, including racial and ethnic inclusivity in research, diversity in training and practice, improved communication between clinicians and patients, and awareness of social determinants of health. Through these strategies, health disparities can be reduced.
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
(2021)
Article
Public, Environmental & Occupational Health
Max Jordan Nguemeni Tiako, Farah Rahman, Janice Sabin, Aba Black, Dowin Boatright, Inginia Genao
Summary: This study compared the effectiveness of a healthcare disparities module between internal medicine residents and public health graduate students. The results showed that the graduate students had greater knowledge gains compared to the residents. The study also highlighted knowledge gaps and growth opportunities for the residents in terms of health equity education.
FRONTIERS IN PUBLIC HEALTH
(2022)
Article
Health Care Sciences & Services
Wei Duan-Porter, David B. Nelson, Kristine E. Ensrud, Michele R. Spoont
Summary: This study using data from a national cohort of veterans in VA care found that greater limitations in physical functioning may act as barriers to initiating and retaining psychotherapy for individuals with PTSD, but had no significant effect on the initiation of medications.
BMC HEALTH SERVICES RESEARCH
(2021)
Article
Psychology, Clinical
Nina A. Sayer, Shannon Wiltsey-Stirman, Craig S. Rosen, Nancy C. Bernardy, Michele R. Spoont, Shannon M. Kehle-Forbes, Afsoon Eftekhari, Kathleen M. Chard, David B. Nelson
Summary: The study investigated whether VHA therapists have different levels of success in keeping PTSD patients engaged in evidence-based psychotherapies. Therapist effects were found to influence patient treatment experience and outcomes, with therapist skills and work environment contributing to variability in early dropout and adequate dose. Therapists in the highest retention decile were associated with higher odds of patients receiving an adequate dose compared to therapists in the lowest retention decile.
JOURNAL OF TRAUMATIC STRESS
(2022)
Article
Health Care Sciences & Services
Jasvinder A. Singh, David B. Nelson, Kristin L. Nichol
Summary: Changes in the mental health component were weakly associated with mortality outcomes, but not significantly correlated with hospitalization. Patient's current HRQOL generally provides meaningful information for predicting subsequent mortality and hospitalization.
JOURNAL OF CLINICAL EPIDEMIOLOGY
(2021)
Article
Psychology, Clinical
Michele Spoont, David Nelson, Shannon Kehle-Forbes, Laura Meis, Maureen Murdoch, Craig Rosen, Nina Sayer
Summary: The study evaluated variations in clinical outcomes across different racial and ethnic groups of veterans diagnosed with PTSD in VHA, finding disparities in PTSD and mental health quality of life outcomes for some racial and ethnic minority groups of veterans. However, in this study, improvements in PTSD symptoms and mental health quality of life were interrelated in complex ways across groups.
PSYCHOLOGICAL SERVICES
(2021)
Article
Medicine, Research & Experimental
Laura A. Meis, Shirley M. Glynn, Michele R. Spoont, Shannon M. Kehle-Forbes, David Nelson, Carl E. Isenhart, Afsoon Eftekhari, Princess E. Ackland, Erin B. Linden, Robert J. Orazem, Andrea Cutting, Emily M. Hagel Campbell, Millie C. Astin, Katherine E. Porter, Erin Smith, Christopher D. Chuick, Kristen E. Lamp, Tessa C. Vuper, Taylor A. Oakley, Lila B. Khan, Sally K. Keckeisen, Melissa A. Polusny
Summary: This paper describes a research method to evaluate whether family inclusion in Prolonged Exposure can improve treatment adherence for posttraumatic stress disorder. The results will provide important evidence for best practices in family involvement in trauma-focused treatments.
Article
Medicine, Research & Experimental
Shannon M. Kehle-Forbes, David Nelson, Sonya B. Norman, Paula P. Schnurr, M. Tracie Shea, Princess E. Ackland, Laura Meis, Kyle Possemato, Melissa A. Polusny, David Oslin, Jessica L. Hamblen, Tara Galovski, Marie Kenny, Nofisat Babajide, Hildi Hagedorn
Summary: This study aims to compare the effectiveness of trauma-focused therapy (TFT) and non-trauma-focused therapy (NTFT) for Veterans with PTSD and SUD. The study will examine the impact of varying SUD severity, type of substances used, and patient treatment preference.
CONTEMPORARY CLINICAL TRIALS
(2022)
Article
Medicine, Research & Experimental
Erin E. Krebs, William C. Becker, David Nelson, Beth M. DeRonne, Sean Nugent, Agnes C. Jensen, Erin C. Amundson, Jennifer K. Manuel, Brian Borsari, Allyson M. Kats, Karen H. Seal
Summary: The Veterans' Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study is a 12-month trial conducted at ten United States Veterans Affairs (VA) health care sites, aiming to test interventions to improve pain while reducing opioid use among VA patients. The study faced challenges from opioid prescribing trends and the COVID-19 pandemic but successfully recruited eligible patients. The results will provide limited evidence for interventions to improve pain and reduce opioid use.
CONTEMPORARY CLINICAL TRIALS
(2023)
Article
Clinical Neurology
Craig S. Rosen, Adam N. Kaplan, David B. Nelson, Heidi La Bash, Kathleen M. Chard, Afsoon Eftekhari, Shannon Kehle-Forbes, Shannon Wiltsey Stirman, Nina A. Sayer
Summary: This study assessed longitudinal changes in burnout among psychotherapists before and during the COVID-19 pandemic. It found that burnout prevalence increased during the pandemic and organizational support for evidence-based psychotherapies reduced burnout risk prior to the pandemic.
JOURNAL OF AFFECTIVE DISORDERS
(2023)
Article
Public, Environmental & Occupational Health
Shannon Wiltsey Stirman, Heidi La Bash, David Nelson, Robert Orazem, Abigail Klein, Nina A. Sayer
Summary: This paper describes the strategies used by the US Department of Veterans Affairs (VA) to understand adherence and modifications to evidence-based psychotherapies (EBPs) for Posttraumatic Stress Disorder (PTSD) using clinical documentation and administrative data. The study found that a combination of manual chart review and administrative data allowed for the identification of different types of modifications, and that therapists and patients contributed to the variance in modifications. However, scalable strategies are needed to document adaptations and modifications to EBPs in routine care.
FRONTIERS IN PUBLIC HEALTH
(2022)
Article
Medicine, General & Internal
Arianne K. Baldomero, Ken M. Kunisaki, Chris H. Wendt, Ann Bangerter, Susan J. Diem, Kristine E. Ensrud, David B. Nelson, Carrie Henning-Smith, Bradley A. Bart, Patrick Hammett, Hildi J. Hagedorn, R. Adams Dudley
Summary: This study used data from the National Veterans Health Administration and Medicare to assess the impact of drive time on the receipt of guideline-recommended screening, diagnosis, and treatment interventions. The study found that longer drive time was associated with lower rates of receiving recommended services.
Article
Mathematical & Computational Biology
Adam Kaplan, David Nelson
Summary: Missing outcomes are common in randomized controlled trials (RCTs) and can introduce bias in the analysis. We focus on binary outcomes that are possibly missing not at random. Anticipated response rates can be used to address these missing outcomes, especially when considering successful and unsuccessful treatment outcomes. We present Bayesian pattern-mixture models that incorporate information on response rates to analyze the relationship between a binary outcome and an intervention.
STATISTICS IN MEDICINE
(2023)
Article
Substance Abuse
Steven S. Fu, Dave Nelson, Tam Do, Diana J. Burgess, Christi A. Patten, Shu-Hong Zhu, Brian C. Martinson
Summary: This pilot study assessed the feasibility of two proactive outreach interventions to connect Vietnamese-speaking participants who smoke to the ASQ. The results showed that both proactive telephone outreach with interactive voice response (PRO-IVR) and proactive telephone outreach with a counselor trained in motivational interviewing (PRO-MI) were successful in promoting the initiation of smoking cessation treatment with the ASQ.
NICOTINE & TOBACCO RESEARCH
(2023)
Article
Respiratory System
Anne C. Melzer, Hildi Hagedorn, David Nelson, Adam Kaplan, Megan Campbell, Steven S. Fu
Summary: Despite overall increase in use, certain patient populations have persistently low technology use. This study examined access to, use of, and barriers surrounding information and communication technology (ICT) among patients with chronic obstructive pulmonary disease (COPD) who smoke, and evaluated associations between key predictors and electronic health (e-health) literacy. The findings indicate that many COPD patients face barriers to engagement with health promotion programs offered electronically, which may contribute to health disparities. Health promotion programs must address the low use of ICT and e-health literacy to ensure equitable access.
ANNALS OF THE AMERICAN THORACIC SOCIETY
(2023)
Article
Psychology, Clinical
Patrick J. Hammett, Harry A. Lando, Darin J. Erickson, Rachel Widome, Brent C. Taylor, David Nelson, Sandra J. Japuntich, Steven S. Fu
JOURNAL OF BEHAVIORAL MEDICINE
(2020)
Article
Psychology, Clinical
Helen Valenstein-Mah, Shannon Kehle-Forbe, David Nelson, Elisheva R. Danan, Dawne Vogt, Michele Spoont
PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY
(2019)