Evaluating a Tobacco Treatment Program's Transition to Telehealth Using a Social Determinants of Health Lens.

INTRODUCTION: While strong associations exist between social determinants of health (SDOH), socioeconomic status, and smoking, these factors are not routinely assessed in tobacco treatment programs (TTP). This study addresses this gap by evaluating a composite metric of SDOH and a measure of access to care to determine program reach before and after the implementation of telehealth tobacco treatment delivery. AIMS AND METHODS: We examined inpatient data from a large TTP during two comparable time periods from April 1, 2019 to September 30, 2019 (pre-telehealth) and from April 1, 2020 to September 30, 2020 (telehealth). The populations were compared using point-of-care data, including 5-digit zip codes mapped to the CDC's Social Vulnerability Index (SVI) and driving distance (in 60-min increments) to the study hospital. Chi-square tests for homogeneity were performed for SVI and driving distance comparisons. RESULTS: While distance distributions were significantly different between the pre-telehealth and telehealth populations (χ 2 = 13.5 (df = 3, N = 3234), p = .004, no significant differences existed in the proportion of SVI categories between the two populations (χ 2 = 5.8 (df = 3, N = 3234), p = .12). In the telehealth population, patients with the highest SVI vulnerability had the greatest proportions living >1 h from the hospital. CONCLUSIONS: This study offers a novel evaluation of tobacco treatment in relation to an SDOH metric (SVI) and care access (distance to the hospital) for inpatient populations. Patient reach, including to those with high vulnerabilities, remained consistent in a transition to telehealth. These methods can inform future reach and engagement of patients who use tobacco products, including patients with high vulnerability or who reside at greater distances from treatment programs. IMPLICATIONS: This study provides the first analysis of inpatient tobacco use treatment (TUT) transition to telehealth delivery of care during the COVID-19 pandemic using the CDC's SVI metric and patient distance to the hospital. The transition resulted in consistent reach to patients at the highest vulnerability. These findings can inform efforts to evaluate SDOH measures and improve reach, engagement, and research on telehealth delivery of inpatient TUT.

An Analysis of Inpatient Tobacco Use Treatment Transition to Telehealth.

INTRODUCTION: During the COVID-19 pandemic, many tobacco users increased their tobacco use, and calls to quitlines decreased. Among inpatients, the pandemic also necessitated a rapid transition of intensive tobacco use counseling to telehealth counseling. No data exist comparing the outcomes of telehealth inpatient counseling with in-person (pre-telehealth) counseling. AIMS AND METHODS: We examined inpatient data from a large tobacco treatment program (TTP) during two comparable time periods 04/01/2019-09/30/2019 (pre-telehealth) and 04/01/2020-09/30/2020 (telehealth). The pre-telehealth and telehealth populations were compared using Pearson's chi-square test for homogeneity on each populations' patient, visit, and medication acceptance characteristics. Reach to "current tobacco users" was analyzed using TTP flowsheet and electronic health record (EHR) data in relation to aggregate EHR data in the data warehouse. RESULTS: Mean monthly tobacco treatment inpatient counseling and outreach visits increased 38.9% in the telehealth period (M = 376, SD = 36.7) compared with the pre-telehealth period (M = 271, SD = 50.0) (t(10) = 3.8, p = .004). Reach significantly increased from 32.8% to 65.9% among all "current tobacco users" admitted, including 31.8% to 66.6% in races at higher risk for COVID-19 severe disease. Pearson's chi-square tests for homogeneity showed significant differences in the pre-telehealth and telehealth population distributions for age, visit type, ethnicity, and medication acceptance. CONCLUSIONS: This study offers the first understanding of characteristics of patients, visits, and medication acceptances in pre-telehealth and telehealth tobacco use treatment for inpatient populations. Larger reach and counseling were identified in the telehealth population. This study's findings on inpatient tobacco use treatment can inform future reach and engagement of large numbers of patients who use tobacco products. IMPLICATIONS: This study provides the first analysis of inpatient tobacco use treatment transition to telehealth delivery of care during the COVID-19 pandemic. The transition resulted in increases in reach and cessation counseling. These findings can inform efforts to improve reach, engagement, and research on telehealth delivery of inpatient tobacco use treatment.

Designing More Effective Cigar Warnings: An Experiment Among Adult Cigar Smokers.

INTRODUCTION: Little systematic evidence exists about the effectiveness of cigar warnings. This study examined the perceived message effectiveness (PME) of warning statements about different health consequences caused by cigars. PME is a validated self-report scale of how effectively a health message discourages smoking. AIMS AND METHODS: We conducted an online study from April to May 2020 with adults in the United States who used cigars in the past 30 days (n = 777). Participants were randomly assigned to view and rate PME (three items, range 1-5) for seven out of 37 text warning statements about different health consequences from cigar use. Linear mixed effects models evaluated the most effective warning characteristics (eg, type of health consequence), controlling for repeated measures and participant demographics. RESULTS: Analyses showed that health consequences about the cardiovascular system (B = 0.38), mouth (B = 0.40), other digestive (B = 0.45), respiratory system (B = 0.36), and early death (B = 0.36) were associated with higher PME scores than reproductive health consequences (all p values <.001). Similar results were found for these health consequences compared with addiction (all p values p < .001). We also observed that awareness of the health consequence was associated with higher PME scores (B = 0.19, p < .001) and length of the warning message (number of characters) was associated with lower PME scores (B = -0.007, p = .03). No differences were observed between cancer and noncancer health consequences (p = .27) or health consequences that used plain language versus medical jargon (p = .94). CONCLUSIONS: Our study provides new evidence about the perceived effectiveness of different cigar health warning statements and identifies features that may strengthen statements. IMPLICATIONS: Our study with cigar smokers from across the United States provides much-needed evidence concerning the perceived effectiveness of different cigar health warning statements and features that may strengthen such statements. Mandated cigar warnings in the United States could be strengthened by including health consequences that were perceived as more effective in our study (eg, early death), using health consequences that participants were aware of, and using short warning statements.

Methodological quality of systematic reviews comprising clinical practice guidelines for cardiovascular risk assessment and management for noncardiac surgery.

BACKGROUND: Cardiac assessment in noncardiac surgery clinical practice guidelines should be supported by the highest-quality evidence such as that offered by systematic reviews. Currently, the methodological and reporting quality of these studies remains unknown. METHODS: We used PubMed to search for all clinical practice guidelines related to perioperative cardiovascular patients undergoing noncardiac surgery from 2010 to 2021. The included clinical practice guidelines were analysed for all systematic reviews and meta-analyses. The primary objective of this study was to determine reporting and methodological quality using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2) instruments. Our secondary objective was to compare systematic reviews conducted by the Cochrane Collaboration with non-Cochrane studies. RESULTS: Three clinical practice guidelines were included in our study. Within these, 78 systematic reviews were included. PRISMA completion ranged from 34.8% to 100.0% with a mean of 76.9%. AMSTAR-2 completion ranged from 15.6% to 96.9% with a mean of 58.0%. Fifty-four systematic reviews underpinned a clinical practice guidelines recommendation, of which 25 were rated 'critically low' by AMSTAR-2 appraisal. Cochrane systematic reviews typically performed better than non-Cochrane studies, but were a minority of the included studies (10/78). CONCLUSION: We found deficiencies in several key areas regarding the methodological and reporting qualities of systematic reviews included in cardiac assessment in noncardiac surgery clinical practice guidelines. As these clinical practice guidelines are instrumental to clinical decision-making and patient care in cardiac assessment in noncardiac surgery, we advocate for improved reporting quality among systematic reviews cited as supportive evidence for these recommendations.

Analysis of the Five Unimolecular Reaction Pathways of CD2ClCHFCl with Emphasis on CD2Cl(F)C: and CD2Cl(Cl)C: Formed by 1,1-HCl and 1,1-HF Elimination.

The five unimolecular HX and DX (X = F, Cl) elimination pathways of CD2ClCHFCl* were examined using a chemical activation technique; the molecules were generated with 92 kcal mol-1 of vibrational energy in a room-temperature bath gas by a combination of CD2Cl and CHFCl radicals. The total unimolecular rate constant was 9.7 × 107 s-1, and branching fractions for each channel were 0.52 (2,1-DCl), 0.29 (1,1-HCl), 0.10 (2,1-DF), 0.07 (1,1-HF), and 0.02 (1,2-HCl). Comparison of the individual experimental rate constants to calculated statistical rate constants gave threshold energies for each process as 63, 72, 66, 73, and 70 kcal mol-1, listed in the same order as the branching fractions. The 1,1-HCl and 1,1-HF reactions gave carbenes, CD2Cl(F)C: and CD2Cl(Cl)C:, respectively, as products, which have hydrogen-bonded complexes with HCl or HF in the exit channel of the potential energy surface. These carbenes have energy in excess of the threshold energy for D atom migration to give CDCl═CDF and CDCl═CDCl, and the subsequent cis-trans isomerization rates of the dihaloethenes can provide information about energy disposal by the 1,1-HX elimination reactions. Electronic structure calculations provide information for transition states of CD2ClCHFCl and hydrogen-bonded complexes of carbenes with HF and HCl. In addition, D atom migration in both free carbenes and in complexes formed by the carbene hydrogen bonding to HCl or HF is explored.

The Unimolecular Reactions of CF3CHF2 Studied by Chemical Activation: Assignment of Rate Constants and Threshold Energies to the 1,2-H Atom Transfer, 1,1-HF and 1,2-HF Elimination Reactions, and the Dependence of Threshold Energies on the Number of F-Atom Substituents in the Fluoroethane Molecules.

The recombination of CF3 and CHF2 radicals in a room-temperature bath gas was used to prepare vibrationally excited CF3CHF2* molecules with 101 kcal mol-1 of vibrational energy. The subsequent 1,2-H atom transfer and 1,1-HF and 1,2-HF elimination reactions were observed as a function of bath gas pressure by following the CHF3, CF3(F)C: and C2F4 product concentrations by gas chromatography using a mass spectrometer as the detector. The singlet CF3(F)C: concentration was measured by trapping the carbene with trans-2-butene. The experimental rate constants are 3.6 × 104, 4.7 × 104, and 1.1 × 104 s-1 for the 1,2-H atom transfer and 1,1-HF and 1,2-HF elimination reactions, respectively. These experimental rate constants were matched to statistical RRKM calculated rate constants to assign threshold energies (E0) of 88 ± 2, 88 ± 2, and 87 ± 2 kcal mol-1 to the three reactions. Pentafluoroethane is the only fluoroethane that has a competitive H atom transfer decomposition reaction, and it is the only example with 1,1-HF elimination being more important than 1,2-HF elimination. The trend of increasing threshold energies for both 1,1-HF and 1,2-HF processes with the number of F atoms in the fluoroethane molecule is summarized and investigated with electronic-structure calculations. Examination of the intrinsic reaction coordinate associated with the 1,1-HF elimination reaction found an adduct between CF3(F)C: and HF in the exit channel with a dissociation energy of ∼5 kcal mol-1. Hydrogen-bonded complexes between HF and the H atom migration transition state of CH3(F)C: and the F atom migration transition state of CF3(F)C: also were found by the calculations. The role that these carbene-HF complexes could play in 1,1-HF elimination reactions is discussed.

Reinvestigation of the Unimolecular Reactions of CHF2CHF2: Identification of the 1,1-HF Elimination Component from Addition of :CFCHF2 to trans-2-Butene.

The recombination of ·CHF2 radicals in a room-temperature bath gas was used to generate CHF2CHF2* (where * indicates vibrational excitation) molecules with 96 kcal mol-1 of vibrational energy. The CHF2CHF2* molecules decompose by four-centered 1,2-HF elimination and by three-centered 1,1-HF elimination reactions to give HF and either CHF═CF2 or :CFCHF2, respectively. The 1,1-HF component was identified by trapping the :CFCHF2 carbene with trans-2-butene that forms 1-fluoro-1-difluoromethyl-2,3-dimethylcyclopropane. The total rate constant for the decomposition of CHF2CHF2* was 6.0 × 105 s-1, and the rate constant for the 1,1-HF pathway forming the carbene, as measured by the 1-fluoro-1-difluoromethyl-2,3-dimethylcyclopropane yield, was 1.4 × 105 s-1. On the basis of matching the experimental rate constants to calculated statistical rate constants, the threshold energies for the four-centered and three-centered reactions are 78 and ≤85 kcal mol-1, respectively.

Chemical Activation Study of the Unimolecular Reactions of CD3CD2CHCl2 and CHCl2CHCl2 with Analysis of the 1,1-HCl Elimination Pathway.

Chemically activated C2D5CHCl2 molecules were generated with 88 kcal mol-1 of vibrational energy by the recombination of C2D5 and CHCl2 radicals in a room temperature bath gas. The competing 2,1-DCl and 1,1-HCl unimolecular reactions were identified by the observation of the CD3CD═CHCl and CD3CD═CDCl products. The initial CD3CD2C-Cl carbene product from 1,1-HCl elimination rearranges to CD3CD═CDCl under the conditions of the experiments. The experimental rate constants were 2.7 × 107 and 0.47 × 107 s-1 for 2,1-DCl and 1,1-HCl elimination reactions, respectively, which corresponds to branching fractions of 0.84 and 0.16. The experimental rate constants were compared to calculated statistical rate constants to assign threshold energies of 54 and ≈66 kcal mol-1 for the 1,2-DCl and 1,1-HCl reactions, respectively. The statistical rate constants were obtained from models developed from electronic-structure calculations for the molecule and its transition states. The rate constant (5.3 × 107 s-1) for the unimolecular decomposition of CHCl2CHCl2 molecules formed with 82 kcal mol-1 of vibrational energy by the recombination of CHCl2 radicals also is reported. On the basis of the magnitude of the calculated rate constant, 1,1-HCl elimination must contribute less than 15% to the reaction; 1,2-HCl elimination is the major reaction and the threshold energy is 59 kcal mol-1. Calculations also were done to analyze previously published rate constants for chemically activated CD2ClCHCl2 molecules with 86 kcal mol-1 of energy to obtain a better overall description of the nature of the 1,1-HCl pathway for 1,1-dichloroalkanes. The interplay of the threshold energies for the 2,1-HCl and 1,1-HCl reactions and the available energy determines the product branching fractions for individual molecules. The unusual nature of the transition state for 1,1-HCl elimination is discussed.

A cross-sectional analysis of reporting guideline and clinical trial registration policies in nephrology journals.

OBJECTIVE: To determine the extent to which nephrology journals recommend and require reporting guideline adherence and clinical trial registration. BACKGROUND: Despite a rising disease burden, research published on chronic kidney disease (CKD) and the field of nephrology has failed to keep pace and is limited. To improve the quality of research in the field of nephrology, reporting guidelines have been developed to minimize such deficits in research quality. However, the extent to which nephrology journals require and use reporting guidelines in addition to clinical trial registration is unknown. METHODS: Sixty-two Nephrology journals were selected through the 2021 Scopus CiteScore tool. Each journal's Instructions for Authors was assessed to determine endorsement of study design-specific reporting guidelines or clinical trial registration. Researchers used R (version 4.2.1) and RStudio to create data summaries of descriptive statistics for nephrology journal reporting guidelines. RESULTS: Clinical trial registration was required by 52% (32/62) of nephrology journals within our sample. The reporting guideline for clinical trials, CONSORT, was required by 17.74% (11/62) of journals. The EQUATOR Network was mentioned by 46.77% (29/62) of journals, while 9.67% (6/62) failed to mention the ICMJE. The reporting guideline for systematic review, PRISMA, was only required by 12.90% (8/62) of journals. When contacting journal editors, 9.67% (6/62) responded and 4.83% (3/62) provided clarifying information. CONCLUSIONS: Reporting guidelines and clinical trial registration are suboptimally required and recommended by nephrology journals. Their adoption may decrease bias and increase research quality. Thus, nephrology journals should consider a more complete endorsement of these safeguards.

Family medicine journals' endorsement of reporting guidelines and clinical trial registration: a cross-sectional analysis.

BACKGROUND: Family medicine, vital for patient care but underfunded, prompts an evaluation of how family medicine journals endorse, require, and advocate for reporting guidelines (RGs), clinical trial, and systematic review registration. AIM: Assess endorsement and requirement of RGs, and the stance on clinical trial and systematic review registration in family medicine journals, impacting research quality and transparency. DESIGN & SETTING: A cross-sectional analysis of 43 "Family Practice" journals, identified through the 2021 Scopus CiteScore. Editors-in-Chief were contacted to confirm article types. Data extracted from "instructions to authors" pages focused on RG recommendations, requirements, and trial registration. METHOD: To ensure confidentiality and prevent bias, authors independently extracted data on RG utilisation, adherence, and clinical trial registration provide a overview of research standards. RESULTS: Of 43 journals, the most recommended guidelines were CONSORT (69%), PRISMA (58%), and STROBE (60%). The most required were PRISMA (16%) and CONSORT (11%). Clinical trial registration was recommended or required by 67% of journals. Additionally, 40 out of the 43 (93%) journals cited at least one reporting guideline in their instructions to authors. CONCLUSION: Family medicine journals exhibit varied endorsement and requirement patterns for RGs and clinical trial registration. While guidelines like CONSORT, PRISMA, and STROBE are acknowledged, caution is needed in presuming a direct link to enhanced research quality. A nuanced approach, promoting diverse reporting guidelines and rigorous study registration, is essential for elevating transparency and advancing research standards in family medicine.

The evaluation of reporting of patient-reported outcomes in MDD: A meta-epidemiological study of clinical trials.

Major depressive disorder (MDD) is a multifaceted disease that profoundly affects quality of life. Patient reported outcomes (PROs) are used in randomized controlled trials (RCTs) to better understand patient perspectives on interventions. Therefore, we sought to assess the completeness of reporting PROs in RCTs addressing MDD. We identified RCTs evaluating MDD containing a PRO measure published between 2016 and 2020 from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Inclusion of studies was performed in duplicate. The completion of reporting of RCTs was assessed using the Consolidated Standards of Reporting Trials (CONSORT-PRO) adaptation. Bivariate regression analyses were used to evaluate reporting completeness and trial characteristics. A total of 49 RCTs were included in our analysis, with a mean CONSORT-PRO completion score of 56.7% (SD = 17.3).Our findings show a significant association with completeness of reporting and the following: secondary PRO trials were less completely reported as compared to primary PRO trials (t = -3.19, p = .003); studies with a follow-up period between six months and year were more completely reported as compared to three months or less (6 months to a year, t = 2.34, p = .024); and increased trial sample size was associated with more completeness of reporting (t = 3.17, p = .003). As compared to brain stimulation, the intervention types classified as combination, other, and psychotherapy had greater completeness of reporting (combination, t = 2.35, p = .024; other, t = 3.13, p = .003; psychotherapy, t = 3.41, p = .001). There were no other significant findings. Our study found the completeness of PRO reporting to be inconsistent in RCTs regarding MDD. Moreover, we advocate for the need to establish a core outcome set relevant to the management of adults diagnosed with MDD and facilitate training on the application of PRO data.