The methodology of the Agile Nudge University.

Introduction: The Agile Nudge University is a National Institute on Aging-funded initiative to engineer a diverse, interdisciplinary network of scientists trained in Agile processes. Methods: Members of the network are trained and mentored in rapid, iterative, and adaptive problem-solving techniques to develop, implement, and disseminate evidence-based nudges capable of addressing health disparities and improving the care of people living with Alzheimer's disease and other related dementias (ADRD). Results: Each Agile Nudge University cohort completes a year-long online program, biweekly coaching and mentoring sessions, monthly group-based problem-solving sessions, and receives access to a five-day Bootcamp and the Agile Nudge Resource Library. Discussion: The Agile Nudge University is evaluated through participant feedback, competency surveys, and tracking of the funding, research awards, and promotions of participating scholars. The Agile Nudge University is compounding national innovation efforts in overcoming the gaps in the ADRD discovery-to-delivery translational cycle.

Agile Mentorship: A Longitudinal Exploratory Analysis.

Effective mentorship relationships increase mentee academic success and satisfaction. However, existing mentorship models are limited by miscommunication, undefined roles, and mismatched goals. The agile mentorship process aims to address these limitations by leveraging insights from agile science and the existing evidence on effective mentorship models to support effective mentoring relationships in healthcare environments. To illustrate the agile mentorship process and the growth of a mentored clinician-scientist (H.L., first author), we describe the model and share qualitative findings generated from the independent analysis of 18 months of mentee reflections. In two iterative cycles, reflections (n = 56) were analyzed using exploratory content and relational analysis. Coauthors C.S. and B.T. employed inductive and deductive coding approaches to explore the data using an ontological lens. We discuss and share quotes representing the identified four main themes. Identification of shortcomings, adaptive perspective, managing relationships, and personal growth. In addition, personal growth had three subthemes: Awareness, continual reflection, and toolkit development. In summary, the reflections of one mentee within the agile mentorship process illustrated the growth process which occurred within an effective mentorship relationship. The agile mentorship process is a scalable and sustainable framework that is adaptable to various career development processes. Further evaluation is needed to understand the longitudinal impact of the model on mentee performance and satisfaction.

Passive digital markers for Alzheimer's disease and other related dementias: A systematic evidence review.

BACKGROUND: The timely detection of Alzheimer's disease and other related dementias (ADRD) is suboptimal. Digital data already stored in electronic health records (EHR) offer opportunities for enhancing the timely detection of ADRD by facilitating the development of passive digital markers (PDMs). We conducted a systematic evidence review to identify studies that describe the development, performance, and validity of EHR-based PDMs for ADRD. METHODS: We searched the literature published from January 2000 to August 2022 and reviewed cross-sectional, retrospective, or prospective observational studies with a patient population of 18 years or older, published in English that collected and interpreted original data, included EHR as a source of digital data, and had the primary purpose of supporting ADRD care. We extracted relevant data from the included studies with guidance from the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist and used the US Preventive Services Task Force criteria to appraise each study. RESULTS: We included and appraised 19 studies. Four studies were considered to have a fair quality, and none was considered to have a good quality. The functionality of the PDMs varied from detecting mild cognitive impairment, Alzheimer's disease or ADRD, to forecasting stages of ADRD. Only seven studies used a valid reference diagnostic method. Nine PDMs used only structured EHR data, and five studies provided complete information on the race and ethnicity of its population. The number of features included in the PDMs ranges from 10 to 853, and the PMDs used a variety of statistical and machine learning algorithms with various time-at-risk windows. The area under the curve (AUC) for the PDMs varied from 0.67 to 0.97. CONCLUSION: Although we noted heterogeneity in the PDMs development and performance, there is evidence that these PDMs have the potential to detect ADRD at earlier stages.

Technology intervention to support caregiving for Alzheimer's disease (I-CARE): study protocol for a randomized controlled pilot trial.

BACKGROUND: Informal caregivers of patients with Alzheimer's disease and related dementias (ADRD) manage a complex spectrum of patient behavioral and psychological symptoms of dementia (BPSD). Mobile health information technologies have quickly become sources for modern social support and chronic disease management. These technologies can improve our understanding of how to care for patients with ADRD and their informal caregivers. A mobile telehealth intervention could help reduce caregiver burden and BPSD. METHODS: This is a pilot randomized controlled trial of 60 dyads of patients living with ADRD and their caregivers, to test the feasibility and estimate the potential effect of the Brain CareNotes (BCN) mobile telehealth system. Participants will be recruited from two health systems. Participants will be randomly assigned to either the BCN intervention arm or usual care comparator. Data will be collected at baseline, 3- and 6-month follow-up. The primary objectives of this trial are to assess feasibility outcomes: (a) recruitment rate, (b) data completion, (c) BCN usability, (d) BCN acceptance, and (e) BCN use and assessed either on an ongoing basis or at 3- and 6-month post-intervention. A secondary objective was to estimate the intervention's effects on caregiver burden and patient BPSD outcomes at 3 and 6 months, assessed by the Neuropsychiatric Inventory. DISCUSSION: The study will assess the intervention feasibility and potential effect size of the BCN telehealth system as a potentially scalable and lower-cost solution for addressing the ADRD public health crisis. TRIAL REGISTRATION: Clinical Trials. NCT03119259 . Registered on April 18, 2017.