Diversity in the pediatric research workforce: a scoping review of the literature.

The purpose of this scoping review is to determine trends in racial and ethnic representation, identify barriers and facilitators to greater diversity, and assess strategies and interventions to advance diversity among those in the pediatric research workforce in the U.S. We conducted a scoping review of PubMed supplemented with the authors' personal library of papers published from January 1, 2010, to December 31, 2021. To be eligible, papers had to provide original data, be published in English, report information from a U.S. healthcare institution, and report on outcomes of interest relevant to the child health field. The diversity of faculty has modestly increased over the past decade but reflects a worsening representation compared to overall population trends. This slow increase reflects a loss of diverse faculty and has been referred to as a "leaky pipeline." Strategies to plug the "leaky pipeline" include greater investments in pipeline programs, implementation of holistic review and implicit bias training, development of mentoring and faculty programs targeted to diverse faculty and trainees, alleviation of burdensome administrative tasks, and creation of more inclusive institutional environments. Modest improvements in the racial and ethnic diversity of the pediatric research workforce were identified. However, this reflects worsening overall representation given changing U.S. population demographics. IMPACT: Racial and ethnic diversity in the pediatric research workforce has shown modest increases but worsening overall representation. This review identified barriers and facilitators at the intrapersonal, interpersonal, and institutional levels that impact BIPOC trainees and faculty career advancement. Strategies to improve the pathway for BIPOC individuals include greater investments in pipeline and educational programs, implementation of holistic review admissions and bias training, institution of mentoring and sponsorship, alleviation of burdensome administrative responsibilities, and creation of inclusive institutional climates. Future studies should rigorously test the effects of interventions and strategies designed to improve diversity in the pediatric research workforce.

Physiological and Perceptual Responses to High-Intensity Circuit Training using Body Weight as Resistance: Are There Sex-Specific Differences?

High-intensity circuit training (HICT) using body weight as resistance is a popular fitness trend and an ideal exercise modality in terms of functionality and economy. Given the popularity of HICT, evidence suggests that sex may elicit unique physiological and perceptual responses to this mode of exercise and there is a need for further work in this area. The purpose of this study was to examine physiological and perceptual responses of females and males to HICT using body weight resistance exercise. Forty-five participants (23 females and 22 males) completed baseline testing and a 15-minute HICT exercise bout wearing a portable metabolic analyzer. %VO2max, %HRmax, and RER were monitored during exercise and analyzed at 3 different 5-minute time segments during the HICT (beginning, middle, end). RPE was assessed half-way through the circuit (7.5), immediately upon cessation of exercise (15), and 15-minutes post-exercise (Session RPE). There was a significant (p<0.01) time effect on %VO2max, %HRmax, RER, and RPE. At all three time points, %VO2max was significantly (p<0.02) higher among females compared to males. RER values were significantly (p=0.02) higher among females during the last 5-minute segment (i.e. the end) of the exercise bout. However there were no differences in %HRmax (p>0.20). Males reported a higher RPE immediately post-exercise compared to females (p=0.01). Taken together, these data suggest that there are distinct, sex-specific physiological and perceptual responses to HICT; thus, sex-specific exercise prescription considerations are warranted.

Using Lean to Enhance Heart Failure Patient Identification Processes and Increase Core Measure Scores.

BACKGROUND: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction. LOCAL PROBLEM: Heart failure core measure (CM) scores at our medical center were lower than the national average, and methods for capturing the appropriate documentation on HF patients to ensure CM compliance were not clear. METHODS: An interdisciplinary team determined barriers to increasing CM scores, gathered baseline data, and identified gaps in the existing process. INTERVENTIONS: The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a HF diagnosis, and developed a patient appointment section before discharge in the electronic medical record. RESULTS: There was a decrease in readmissions within 30 days of implementation from 12% to 8%, and HF CM compliance score increased from 88% to 100%. The percentage of HF patients not identified during hospitalization decreased from 17% to 0%. Heart failure patients discharged with a 7-day follow-up appointment increased from 88% to 98%. CONCLUSION: Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and CMs were achieved.

A 3-State Analysis of Black-White Disparities in Diabetes Hospitalizations Among Medicaid Beneficiaries.

INTRODUCTION: Although diabetes is one of the leading chronic disease in the country, efforts in primary care and patient self-care management could prevent most of the diabetes-related hospitalizations and produce cost savings and improvements in quality of life. We used information from Medicaid beneficiaries in 3 states to predict racial differences in diabetes hospitalizations and demonstrate how they vary across states. METHODS: We conducted a cross-sectional study to examine differences between black and white patients with diabetes hospitalizations. Information was obtained from the Medicaid Analytic eXtract files. We used multiple logistic regression models to assess the significance of the differences. RESULTS: Analysis included 10 073 adult Medicaid recipients from the states of Mississippi (51%), Georgia (35%), and Michigan (14%). Blacks were more likely to experience longer hospital stays in Georgia (odds ratio [OR] = 1.040; 95% confidence interval [CI]: 1.03-1.06) and Mississippi (OR = 1.048; 95% CI: 1.03-1.07). A majority of patients in both groups were likely to be discharged to their homes for self-care. Black patients had lower odds of repeated stays in Georgia (OR = 0.670; 95% CI: 0.54-0.84), but higher odds in Michigan (OR = 1.580; 95% CI: 1.12-2.24). Similar differences occurred when patients were matched by age and sex. Blacks had lower odds of qualifying for dual Medicare-Medicaid enrollment benefit in Georgia and Mississippi. CONCLUSION: Racial differences in diabetes-related hospitalizations reflect possible inefficiencies in the process of care. Identification of race-specific factors for hospitalizations and implementation of primary care strategies that support effective self-management skills would aid in reducing diabetes hospitalizations and related disparities.

Use of Six Sigma for eliminating missed opportunities for prevention services.

Delivery of primary care preventative services can be significantly increased utilizing Six Sigma methods. Missed preventative service opportunities were compared in the study clinic with the community clinic in the same practice. The study clinic had 100% preventative services, compared with only 16.3% in the community clinic. Preventative services can be enhanced to Six Sigma quality when the nurse executive and medical staff agree on a single standard of nursing care executed via standing orders.

A community-based oral health self-care intervention for Hispanic families.

OBJECTIVES: A community-based intervention is described that targets oral health self-care practices among Hispanic children in the United States and is being tested in an ongoing trial. Descriptive results of baseline oral health variables are presented. METHODS: As of January 2013, 284 Hispanic children of ages 5-7 enrolled in the Healthy Families Study in Nashville, TN, USA. Families are randomized to one of two culturally appropriate interventions. RESULTS: At baseline, 69.6 % of children brushed at least twice daily, and 40.6 % brushed before bed daily. One-third of parents did not know if their children's toothpaste contained fluoride. CONCLUSIONS: This intervention fills the need for community-based interventions to improve oral health self-care practices that are culturally appropriate in Hispanic families.

Using a participatory research process to address disproportionate Hispanic cancer burden.

Community-based participatory research (CBPR) offers great potential for increasing the impact of research on reducing cancer health disparities. This article reports how the Community Outreach Core (COC) of the Meharry-Vanderbilt-Tennessee State University (TSU) Cancer Partnership has collaborated with community partners to develop and implement CBPR. The COC, Progreso Community Center, and Nashville Latino Health Coalition jointly developed and conducted the 2007 Hispanic Health in Nashville Survey as a participatory needs assessment to guide planning for subsequent CBPR projects and community health initiatives. Trained community and student interviewers surveyed 500 Hispanic adults in the Nashville area, using a convenience sampling method. In light of the survey results, NLHC decided to focus in the area of cancer on the primary prevention of cervical cancer. The survey led to a subsequent formative CBPR research project to develop an intervention, then to funding of a CBPR pilot intervention study to test the intervention.

Predictors of new screening for African American men participating in a prostate cancer educational program.

BACKGROUND: African American (AA) men continue to have a greater than twofold risk of dying from prostate cancer compared to Whites. METHODS: This community-based intervention study employed a quasi-experimental, delayed-control (cross-over) design with randomization at the church-level (N = 345 AA men). RESULTS: Logistic regression analyses revealed that the level of knowledge (b = .61, P < .05, Exp (B) = 1.84), the perception of risk (b = 2.99, P < .01, Exp (B) = 19.95), and having insurance (b = 3.20, P < .01, Exp (B) = 24.65) significantly increased the odds of participants who needed screening getting screened during study. DISCUSSION: This study demonstrated the need for education, community involvement, and increased access to encourage minority men to obtain needed health screenings.

A church-based program on prostate cancer screening for African American men: reducing health disparities.

INTRODUCTION: African American men have a significantly higher incidence of prostate cancer, are diagnosed at younger ages and more advanced stages, and have higher mortality rates from prostate cancer than do White men. METHODS: This community-based intervention study employed a quasiexperimental delayed-control (crossover) design with randomization at the church level. Forty-five African American churches were randomly assigned to two study groups: early intervention and delayed intervention. A convenience sample of 430 African American male volunteers (ages 40-70) was enrolled through the churches, and 350 men remained in the study through wave 3. The intervention was a culturally tailored group educational program, which included a video and a question-and-answer session with an African American physician. RESULTS: Within each group, knowledge, perceived threat, and screening prevalence all increased significantly. However, the magnitude of increases was similar, so the groups did not differ significantly at wave 2. Knowledge at wave 2 was associated with greater odds of having a digital rectal exam by wave 3 only for the early-intervention group. The early-intervention group was two times more likely to have talked to a physician about prostate cancer screening by wave 3. CONCLUSIONS: The findings suggest that the delayed-intervention group did not function as a pure control and may have unintentionally received a partial intervention. This finding demonstrated that a low-cost prostate cancer awareness campaign within a church may be enough to affect prostate cancer knowledge, attitudes, and behaviors among African American men. Further research should examine the church-specific intervention elements, cultural appropriateness of the messages, and whether group sessions provide additional effect.

EPSDT preventive services in a low-income pediatric population: impact of a nursing protocol.

Medicaid mandates coverage of clinical preventive services for children under the Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT). This article assesses the usefulness of a nursing protocol for delivering comprehensive EPSDT services to pediatric patients during any primary care visit. Secondary data from a recent controlled trial were analyzed. An intervention group received the clinical protocol (n = 514 children in a low-income pediatric clinic), whereas data from a "usual care" comparison group were obtained from medical records (n = 115 children). The nursing protocol included 52 items corresponding to EPSDT services and was administered by a prevention nurse. In the intervention group, 11 605 out of 11 607 (approximately 100.0%) EPSDT service needs were initiated, as compared to 21.2% (572 out of 2695) in the comparison group (P < .001). The study demonstrates the feasibility of using a nursing protocol to integrate EPSDT clinical preventive services into pediatric visits.