The Shared Health Appointments and Reciprocal Enhanced Support (SHARES) study: study protocol for a randomized trial

Abstract Background Diabetes shared medical appointments (SMAs) and reciprocal peer support programs have been found in efficacy trials to help adults with diabetes improve their self-management and achieve short-term gains in clinical and patient-centered outcomes. In order to translate this evidence to system-level interventions, there is a need for large-scale, pragmatic trials that examine the effectiveness, implementation, and costs of SMAs and reciprocal peer support across diverse settings. Methods The Shared Health Appointments and Reciprocal Enhanced Support (SHARES) study is a multisite, cluster randomized trial that is evaluating the effectiveness and implementation of SMAs with and without an additional reciprocal Peer-to-Peer (P2P) support program, when compared to usual care. The P2P program comprises periodic peer support group sessions and telephone contact between SMA participant pairs to promote more effective diabetes self-management. We will examine outcomes across three different treatment groups: (1) SMAs, (2) SMAs plus P2P, and (3) usual care. We will collect and analyze data over a 2.5-year implementation period at five geographically diverse Veterans Affairs (VA) health systems. The primary outcome is the relative change in hemoglobin A1c over time. Secondary outcomes are changes in systolic blood pressure, antihypertensive medication use, statin use, and insulin initiation over the study period. The unit of analysis is the individual, adjusted by the individual’s SMA group (the cluster). We will use mixed methods to rigorously evaluate processes and costs of implementing these programs in each of the clinic settings. Discussion We hypothesize that patients will experience improved outcomes immediately following participation in SMAs and that augmenting SMAs with reciprocal peer support will help to maintain these gains over time. The results of this study will be among the first to examine the effects of diabetes SMAs alone and in conjunction with P2P in a range of real-life clinical settings. In addition, the study will provide important information on contextual factors associated with successful program implementation. Trial registration ClinicalTrials.gov, ID: NCT02132676 . Registered on 21 August 2013.https://deepblue.lib.umich.edu/bitstream/2027.42/136794/1/13063_2017_Article_1959.pd

Impact of a Veterans Affairs Primary Care Collaboration to Provide Remote Team-Based Care and Telehealth Introductory Pharmacy Practice Experiences

Introduction: Developing remote team-based care and telehealth introductory pharmacy practice experiences (IPPEs) in primary care is desirable. The Department of Veterans Affairs (VA) endorses interdisciplinary teams to provide primary care services for Veterans and utilizes clinical dashboards to support population management. Pharmacy students, during IPPEs, can perform several patient care activities typically done by VA team members. Objective: The primary objective was to describe the economic impact of a collaboration between a VA health care system and a school of pharmacy to provide remote IPPEs. Methods: During Fall 2019, activities of second-year pharmacy students in a required VA population health IPPE were tracked. Select population management activities typically conducted by nurses, clinical pharmacy specialists (CPS), or primary care providers were assigned to pharmacy students. Students were granted remote access privileges to VA\u27s electronic health record (EHR) and precepted by VA CPS at the university. Students performed prescription drug monitoring program (PDMP) activities, reviewed outside medical records for laboratory results, ordered laboratory tests, conducted telephone pain assessments, and documented progress notes. The average time to complete each function and the average salary for the team member who typically completed the function was used to perform a cost-benefit analysis. Results: During the semester, 58 students spent 2 hours per week in the IPPE. Students wrote 2118 PDMP progress notes, ordered 1723 laboratory tests for provider signature and sent patients laboratory reminder letters, entered 171 outside laboratory results into VA\u27s EHR, and conducted 183 pain assessments. The semester cost of preceptor salaries was $13 937. Direct benefits to the health system included a salary savings of$24 388.56 to $31 402.03. The net benefit of$10 451.56 to $17 465 resulted in a 75% to 125% return on investment. Conclusion: Identifying practice-appropriate experiences for pharmacy students enabled active participation in remote team-based care and telehealth activities, facilitated primary care student experiences, and offered cost savings to the health care system

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

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Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field