Journal of Clinical and Translational Science最新文献

Introduction: Rural cancer survivors have worse outcomes than their urban counterparts. To improve outcomes, it is essential that rural survivors participate in research, yet they are underrepresented in cancer research. The aim of this study was to assess urban-rural differences in participation in a cancer survivorship survey and differences in mode of participation (mail, online, or phone) by rurality and age.

Methods: We developed a survivorship needs assessment survey and invited cancer survivors to participate by mail, online, or phone. We compared participation between rural and urban invitees and examined differences in mode of participation by rurality and age.

Results: A quarter (25.47%) of invited rural patients and 27.84% of invited urban patients participated in the survivorship study. The probability of participation by urban survivors was approximately 1.09 times higher than for rural survivors (χ ²(1) = 4.31, p = 0.038). Rural survivors were more likely to participate by mail (average difference [Rural-Urban] = 9.64%, p < 0.001), while urban survivors were more likely to participate online (average difference [Urban-Rural] = 8.77%, p < 0.001). As participant age increased, the likelihood of survey participation by mail increased (1.16% per year of age, p < 0.001) while the probability of participating online decreased by 1.20% per year of age (p < 0.001).

Conclusion: To ensure equitable access to research for rural and older cancer survivors, researchers should design studies with a range of participation modes. Non-digital methods, such as mailed paper surveys, appear to promote participation among rural and older survivors.

Over the past decade, several multi-institutional research consortia have formed within the North American pediatric surgical community. In this article, we describe our experience with the creation and implementation of the Eastern Pediatric Surgery Network, a large and comprehensive research consortium designed to produce a wide array of high-quality clinical studies within our subspecialty. In 2020, a vision statement and rules of governance were established at thirteen academic pediatric surgery divisions in the eastern United States. The research consortium was organized based on four major pillars, namely legal ownership of aggregate data, horizontal leadership structure, mandatory participation in adopted studies, and a broad research portfolio that encompasses the full breath of the specialty. Over the past five years, the number of research projects has dramatically expanded over time and includes participation from 24 different medical centers. Despite a lack of dedicated sponsored extramural support for most projects, there have been 28 abstracts presented at national conferences and 12 manuscripts published in peer-reviewed journals. It is our hope that sharing our experience with creating this organization can help to inform others interested in establishing the academic infrastructure to engage in multi-institutional, evidence-based clinical research in other medical specialties and beyond.

Introduction: Scientific teams that are comprised of different types of researchers have higher research productivity, and there is a need for evidence-based methods to improve the biomedical research workforce. Building Up a Biomedical Research Workforce (Building Up) was a multi-center, cluster-randomized, unblinded controlled trial with one intervention arm and one control arm, conducted at 25 United States academic medical centers. The authors tested the hypothesis that participants from backgrounds underrepresented in science who are randomized to the intervention will have greater numbers of peer-reviewed publications and increased Psychological Capital, compared to the control group.

Methods: The study included a 10-month intervention period and follow-up assessments occurring one, two, and three years after the intervention began. The intervention arm received a 10-month intervention with monthly meetings, near-peer mentoring, networking opportunities, and grant- and scientific-writing coursework. Participants in the control arm experienced the usual forms of mentoring, networking, and coursework that their institutions provided.

Results: Of the 220 participants who completed the pre-intervention assessment (98% of all enrolled participants), 71% completed the post-intervention assessment at year 1, 60% at year 2, and 66% at year 3. Individuals in the intervention arm had significantly higher levels of self-efficacy, resilience, and optimism in the three years following the start of the intervention, compared to the control arm.

Discussion: This finding suggests that the Building Up intervention can increase participants' Psychological Capital.

The Duke Research Equity and Diversity Initiative (READI) was established in 2021 to engage Durham and surrounding communities in clinical research and build capacity to promote equitable access to research participation. Within READI, a voucher program was launched with the goals of increasing diverse participation in clinical research, improving community-partnered research, and enhancing community engagement. The vouchers leveraged a stand-alone, community-centered, outpatient research clinic, the Duke Research at Pickett (R@P) facility, which was originally opened to support COVID-19 trials. A formative evaluation of the voucher program was conducted with 3 voucher-awarded teams, READI personnel, and R@P staff. Data included 18 semi-structured interviews (n = 14) over two timepoints (Spring 2023, 2024). A rapid response analysis approach was used. Data indicate that READI voucher-awarded services were useful for voucher teams, with value for supporting community-engaged efforts, making research participation accessible, creating a community-centered and streamlined service facility, and personnel development benefits. Communication and flexibility of support services facilitated program implementation. Challenges occurred in service utilization logistics and incorporating community engagement into research support services. Ultimately, we find that a research support program with embedded community engagement support is feasible; this type of support can be integral in normalizing community-engaged research.

Introduction: Travel distance is a key barrier for patients to participate in clinical trials or receive cancer care. The National Cancer Institute (NCI) is a major funder of cancer research infrastructure through grant programs like the NCI Cancer Center (NCICC) and NCI Community Oncology Research Program (NCORP); however, the majority of US sites that care for people with cancer do not directly receive this funding.

Methods: Through geospatial analysis we examined patient distance to NCI-funded sites and evaluated demographic subgroups to identify potential disparities in access to research opportunities. We assessed whether new NCI support to previously unfunded sites could address identified barriers in access.

Results: NCI-funded sites tend to be in urban centers and are less accessible to low-income or rural patients. Nearly 17% of the US population over 35 years old would have to drive over 100 miles to obtain care at an NCI-funded site; only 1.6% would be beyond that distance when non-funded sites are added. For those below poverty level, the proportions are 20.2% and 1.9%, respectively. Several US regions, including the South and Appalachia, have particularly limited access to NCI-funded sites despite high cancer incidence, and much of the West and Great Plains are distant from any cancer facilities.

Conclusions: NCI could address travel distance as a major barrier to research participation by expanding the geographical footprint of its infrastructure funding using existing institutions in areas with identified gaps. Geospatial analysis at the census tract level is recommended and geospatial visualization can help identify strategic areas for interventions.

Background: Black or African Americans (AA) with Parkinson's disease (PD) are underrepresented in both care and research and experience significant health disparities. The existing literature provides limited guidance on how to enhance the engagement of AA individuals in PD care and research, particularly from the perspectives of AA patients, care partners, and healthcare providers. This project aimed to (1) describe the use of Community Engagement (CE) Studios as a community-engaged research approach to inform culturally appropriate and inclusive research and (2) examine factors influencing AA engagement in PD-related activities.

Methods: We conducted three CE Studios: one with AA with PD and care partners (N = 6), one with healthcare providers of AA with PD (N = 8), and one with AA with PD, care partners, and healthcare providers (N = 4).

Results: The CE Studios informed the design (e.g., cultural appropriateness) and conduct (e.g., accessibility) of the planned PD project, as well as identifying stakeholders to engage with, improving alignment between research and the AA community. We highlighted the importance of multifaceted factors, including environmental (e.g., segregation), biological (e.g., symptoms), sociocultural (e.g., not being invited), and behavioral (e.g., empowerment) domains, which influence AA engagement.

Conclusions: The CE Studios method is a feasible and useful approach for understanding the perspectives of AA in PD. It is possible to conduct an in-depth exploration of community perspectives by synthesizing comprehensive analyses and leveraging additional frameworks. These efforts include identifying barriers to engagement, recognizing locally relevant individuals, and refining PD-related care to enhance cultural appropriateness.

Background/objective: Point-of-care technologies (POCTs) have grown increasingly prevalent in clinical and at-home settings, offering various rapid diagnostic capabilities. This study presents findings from a nationwide survey conducted between November 2023 and January 2024, capturing clinician perceptions of POCTs.

Methods: The survey was distributed via email to healthcare professionals through academic and industry listservs and through LinkedIn posts. A total of 159 responses were analyzed.

Results: Core priorities, including accuracy, ease of use, and availability, remain consistently valued over the years. However, several perceived benefits, including continuous patient monitoring, diagnostic certainty, and patient management exhibited significant declines in agreement compared to previous years. Despite this, clinician perceptions of POCTs' abilities to enhance patient-provider communication remained stable. Evolving concerns may reflect heightened expectations and greater scrutiny as these technologies become commonplace. Agreement that POCTs may undermine clinical expertise increases, while concerns related to reimbursement and usability decline. Pilot questions related to artificial intelligence (AI) and machine learning (ML) indicated moderate openness to adopting AI-enhanced POCTs, particularly with tools offering novel clinical insights.

Conclusions: While POCTs continue to be an asset in clinical settings, the findings of this study suggest a shift in provider attitudes toward a more neutral standpoint. Limitations include a low response rate, self-selection, and missing demographic data from a subset of participants. Future surveys will further integrate AI/ML-related questions while prioritizing broader demographic and geographic reach.

Introduction: Community-acquired bacterial pneumonia (CABP) contributes significantly to mortality and healthcare costs worldwide. The use of guideline-concordant antibiotic therapy for CABP is associated with improved outcomes.

Methods: This was a retrospective cohort study of inpatients with CABP due to MRSA or P. aeruginosa in the All of Us database. The proportion of patients on guideline-concordant antibiotics or guideline-discordant antibiotics was compared within groups based upon patient age, sex, self-reported race, ethnicity, marital status, alcohol use, and tobacco use. Guideline concordance was determined using the 2019 IDSA/ATS CABP guidelines. Associations were further analyzed using multivariate logistic regression.

Results: A total of 336 patients with CABP due to MRSA (152) or P. aeruginosa (184) were included. Guideline-concordant antibiotic therapy was prescribed to 70% of CABP-MRSA patients and for 57% of CABP-P. aeruginosa patients. Independently predictive factors of guideline-concordant antibiotic prescribing for CABP-P. aeruginosa patients were Non-Hispanic Black (NHB) vs. Non-Hispanic White (NHW) race (odds ratio = 0.30, 95% confidence interval = 0.12 - 0.75).

Conclusion: In the All of Us database, the majority of CABP-MRSA and CABP-P. aeruginosa patients were prescribed guideline-concordant antibiotic therapy. Race was independently predictive of guideline-concordant antibiotic therapy for patients with CABP-P. aeruginosa, but not CABP-MRSA. NHB patients were less likely to receive guideline-concordant antibiotic therapy than NHW patients when treated for CABP-P. aeruginosa.