LAI Healthcare Research

Agenda: • Research Motivation and LAI Alignment • LAI Healthcare Research Pipeline • Overview of Research Projects • Final Comment

Do adolescents receive youth-friendly, person-centered contraceptive care at safety-net clinics in the U.S. South?: An examination of youths’ perspectives

Introduction: Improving the quality of contraceptive care that youth receive improves the patient-provider relationship, satisfaction with care, and contraceptive method use and continuation. In recent years, high-quality contraceptive care for youth has shifted away from tiered effectiveness counseling and toward youth-friendly, person-centered contraceptive counseling (YFPCCC). Rooted in the reproductive justice movement, YFPCCC requires that counseling encourages youth to say what matters to them in their contraceptive method, respects youth’s preferences in their contraceptive method, provides youth with the information necessary to make the best choice for them, and is respectful of youth’s choices. YFPCCC is especially important for minor youth and youth of color who have historically received biased care and for youth in the United States South where restrictive policies may prevent youth from receiving care. This study examined youths’ perspectives of YFPCCC at safety-net clinics in two states in the U.S. South. Methods: Between 2018 and 2022, a survey measuring patient perspectives of their contraceptive counseling was collected from youth (ages 16 to 24) who received care at federally qualified health centers (FQHCs) and health departments (HDs) in Alabama (AL) and South Carolina (SC). A total of 1,052 youth were included in the study (AL n=513 and SC n=539). Four survey items measuring the four components of person-centered counseling and two survey items measuring youth-friendliness (knowledgeable and trustworthy providers) were dichotomized into Yes/No responses and combined to create two new variables measuring PCCC and providers’ youth-friendliness. PCCC and youth friendliness were compared across clinic type, state, age, race/ethnicity, and insurance coverage using logistic regression. P-values less than 0.05 were considered significant. Results: Overall, 56% of youth in the study reported that they received all four components of PCCC and 71% reported that their providers were youth-friendly. Minor youth (ages 16 and 17) were 34% less likely than older youth (ages 20-24) to report receipt of PCCC (aOR 0.66, 95% confidence interval (CI) [0.45, 0.98]). Minor youth were also 39% less likely than older youth to report that their provider was youth-friendly (aOR 0.61, 95% CI [0.40, 0.93]). Non-Hispanic Black youth were 45% less likely than non-Hispanic White youth to report PCCC (aOR 0.55 95% CI [0.40, 0.70]). Similarly, non-Hispanic Black youth were 44% less likely than non-Hispanic White youth to report that their provider was youth-friendly (aOR 0.56 CI [0.41, 0.77]). Discussion: Providing contraceptive care that is both person-centered and youth-friendly is essential in improving the quality of care that youth receive. In this study, minors and non-Hispanic Black youth were the least likely to report that their care was both person-centered and youth-friendly. This gap in the quality of care that non-Hispanic Black youth receive may contribute to lower satisfaction with care which may contribute to lower contraceptive use rates and higher unintended teen birth rates for this group. Clinics can improve their ability to provide YFPCCC by ensuring providers are trained in youth-friendly and person-centered contraceptive care

[Study Protocol] Palliative long-term abdominal drains versus repeated drainage in individuals with untreatable ascites due to advanced cirrhosis: study protocol for a feasibility randomised controlled trial

Background: UK deaths due to chronic liver diseases such as cirrhosis have quadrupled over the last 40 years, making this condition now the third most common cause of premature death. Most patients with advanced cirrhosis (end–stage liver disease, [ESLD]) develop ascites. This is often managed with diuretics, but if refractory then the fluid is drained from the peritoneal cavity every 10-14 days by large volume paracentesis (LVP), a procedure requiring hospital admissions. As the life expectancy of patients with ESLD and refractory ascites (if ineligible for liver transplantation) is on average ≤ 6 months, frequent hospital visits are inappropriate from a palliative perspective. One alternative is long-term abdominal drains (LTAD), used successfully in patients whose ascites is due to malignancy. Although inserted in hospital, these drains allow ascites management outside of a hospital setting. LTAD have not been formally evaluated in patients with refractory ascites due to ESLD. Methods: Due to uncertainty about appropriate outcome measures and whether patients with ESLD would wish or be able to participate in a study, a feasibility randomised controlled trial (RCT) was designed. Patients were consulted on trial design. We plan to recruit 48 patients with refractory ascites and randomise them (1:1) to either a) LTAD or b) current standard of care (LVP) for 12 weeks. Outcomes of interest include acceptability of LTAD to patients, carers and healthcare professionals as well as recruitment and retention rates. Palliative care Outcome Scale (IPOS), the Short Form Liver Disease Quality of Life (SF-LDQOL), the EuroQol (EQ-5D) and carer (Zarit Burden Interview [ZBI-12]) reported outcomes will also be assessed. Preliminary data on cost effectiveness will be collected and patients and healthcare professionals will be interviewed about their experience of the trial with a view to identifying barriers to recruitment. Discussion: LTAD could potentially improve end-of-life care in patients with refractory ascites due to ESLD by improving symptom control, reducing hospital visits and enabling some self-management. Our trial is designed to see if such patients can be recruited, as well as informing the design of a subsequent definitive trial. Trial registration: ISRCTN30697116, date assigned: 07/10/201

Assessing the State of Comprehensive Medication Management in a Sample of Primary Care Clinics

OverviewComprehensive medication management (CMM) is an important tool to address medication-related morbidity and mortality and reduce health care costs. Medication therapy problems (MTPs) are a significant and costly barrier to improving patient outcomes1 and with more than half of all Americans taking at least one prescription drug,2 the need to manage and optimize patients’ medications is greater than ever. This report examines select practice and practitioner characteristics of the primary care clinics that participated in the research project, Enhancing Performance in Primary Care Medical Practice through Implementation of Comprehensive Medication Management. To be eligible to participate, sites had to have: established relationships with care team providers, a way of electronically identifying patients most in need of CMM, reporting processes in place for CMM data, read/write access in the electronic medical record, and an established CMM practice or a commitment to providing CMM. Because of these inclusion criteria, most participating clinics had CMM services in place for several years and were mature in their design and delivery of services. Site characteristics around the following areas were assessed: pharmacist and clinic demographics, delivery of pharmacy services, collaboration, billing and payment for CMM, and measuring CMM outcomes. The results of this report shed light on how CMM is being delivered in a sample of established CMM practices and therefore may provide benefit to those practitioners interested in building their own CMM practice.   Article Type: Original Researc

Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities : a systematic literature review

Objective: Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods: We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results: Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (n = 11), occupational therapy (n = 2), prosthetics (n = 1), exercise physiology (n = 1) and multidisciplinary (n = 4) services. The methodological quality varied (n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions: This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Host Iron Binding Proteins Acting as Niche Indicators for Neisseria meningitidis

Neisseria meningitidis requires iron, and in the absence of iron alters its gene expression to increase iron acquisition and to make the best use of the iron it has. During different stages of colonization and infection available iron sources differ, particularly the host iron-binding proteins haemoglobin, transferrin, and lactoferrin. This study compared the transcriptional responses of N. meningitidis, when grown in the presence of these iron donors and ferric iron, using microarrays

A haplotype map of allohexaploid wheat reveals distinct patterns of selection on homoeologous genomes

BACKGROUND: Bread wheat is an allopolyploid species with a large, highly repetitive genome. To investigate the impact of selection on variants distributed among homoeologous wheat genomes and to build a foundation for understanding genotype-phenotype relationships, we performed population-scale re-sequencing of a diverse panel of wheat lines. RESULTS: A sample of 62 diverse lines was re-sequenced using the whole exome capture and genotyping-by-sequencing approaches. We describe the allele frequency, functional significance, and chromosomal distribution of 1.57 million single nucleotide polymorphisms and 161,719 small indels. Our results suggest that duplicated homoeologous genes are under purifying selection. We find contrasting patterns of variation and inter-variant associations among wheat genomes; this, in addition to demographic factors, could be explained by differences in the effect of directional selection on duplicated homoeologs. Only a small fraction of the homoeologous regions harboring selected variants overlapped among the wheat genomes in any given wheat line. These selected regions are enriched for loci associated with agronomic traits detected in genome-wide association studies. CONCLUSIONS: Evidence suggests that directional selection in allopolyploids rarely acted on multiple parallel advantageous mutations across homoeologous regions, likely indicating that a fitness benefit could be obtained by a mutation at any one of the homoeologs. Additional advantageous variants in other homoelogs probably either contributed little benefit, or were unavailable in populations subjected to directional selection. We hypothesize that allopolyploidy may have increased the likelihood of beneficial allele recovery by broadening the set of possible selection targets