A Case Series Study Assessing an Equity-Focused Implementation of Self-Monitoring Blood Pressure Programs Using Telehealth.

CONTEXT: Self-monitoring blood pressure (SMBP) programs are an evidence-based hypertension management intervention facilitated through telehealth. SMBP programs can provide a continuum of care beyond a clinical setting by facilitating hypertension management at home; however, equitable access to SMBP is a concern. OBJECTIVES: To evaluate the implementation of telehealth SMBP programs using an equity lens in 5 federally qualified health centers (FQHCs) in Massachusetts (MA). DESIGN: A prospective case series study. SETTING: Five FQHCs. PARTICIPANTS: The MA Department of Public Health (MDPH) selected 5 FQHCs to implement SMBP programs using telehealth. FQHCs were selected if their patient population experiences inequities due to social determinants of health and has higher rates of cardiovascular disease. Each of the 5 FQHCs reported data on patients enrolled in their SMBP programs totaling 241 patients examined in this study. INTERVENTION: SMBP programs implemented through telehealth. MAIN OUTCOME MEASURE: Systolic blood pressure and diastolic blood pressure. RESULTS: Approximately 53.5% of SMBP participants experienced a decrease in blood pressure. The average blood pressure decreased from 146/87 to 136/81 mm Hg. Among all patients across the 5 FQHCs, the average blood pressure decreased by 10.06/5.34 mm Hg (P < .001). Blood pressure improved in all racial, ethnic, and language subgroups. CONCLUSIONS: Five MA FQHCs successfully implemented equitable telehealth SMBP programs. SMBP participants enrolled in the programs demonstrated notable improvements in their blood pressure at the conclusion of the program. A flexible, pragmatic study design that was adjusted to meet unique patient needs; engaging nonphysician team members, particularly community health workers; adapting health information technology; and partnerships with community-based organizations were critical facilitators to program success.

Crimean-Congo haemorrhagic fever during the COVID-19 pandemic in Africa: Efforts, recommendations and challenges at hand.

Since the beginning of the COVID-19 pandemic, millions have suffered globally and as a result, attention and resources for other diseases, such as Crimean-Congo Haemorrhagic Fever (CCHF), has declined. Despite a significantly lower incidence rate compared to COVID-19, CCHF has a considerably higher mortality rate at approximately 30%. Both diseases share symptoms such as headache, fever, nausea and vomiting, fatigue, sore throat, however they have different modes of transmission, mortality rates, and incubation periods. Public health professionals have faced several challenges when attempting to prevent and control the spread of both diseases and despite their differences, many of the prevention methods remain the same. These include increasing public awareness regarding avoiding contact with infected individuals and animals, training healthcare professionals in emergency and preparedness for disease outbreaks and increasing the investment in medical supplies and treatment to control the spread of both diseases.

Racial and Ethnic Disparities in Primary Open-Angle Glaucoma Clinical Trials: A Systematic Review and Meta-analysis.

Importance: The disease burden for primary open-angle glaucoma (POAG) is highest among racial/ethnic minority groups, particularly Black individuals. The prevalence of POAG worldwide is projected to increase from 52.7 million in 2020 to 79.8 million in 2040, a 51.4% increase attributed mainly to Asian and African individuals. Given this increase, key stakeholders need to pay particular attention to creating a diverse study population in POAG clinical trials. Objective: To assess the prevalence of racial/ethnic minorities in POAG clinical research trials compared with White individuals. Data Sources: This meta-analysis consisted of publicly available POAG clinical trials using ClinicalTrials.gov, PubMed, and Drugs@FDA from 1994 to 2019. Study Selection: Randomized clinical trials that reported on interventions for POAG and included demographic subgroups including sex and race/ethnicity. Data Extraction and Synthesis: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2 independent reviewers extracted study-level data for a random-effects meta-analysis. A third person served as the tiebreaker on study selection. Microsoft Excel 2016 (Microsoft Corporation) and SAS, version 9.4 (SAS Institute) were used for data collection and analyses. Main Outcomes and Measures: The primary outcomes were the prevalence of each demographic subgroup (White, Black, Hispanic/Latino, other race/ethnicity groups, and female or male) in each trial according to the trial start year, study region, and study sponsor. Participation rates are expressed as percentages. Results: A total of 105 clinical trials were included in the meta-analysis, including 33 428 POAG clinical trial participants (18 404 women [55.1%]). Overall, 70.7% were White patients, 16.8% were Black patients, 3.4% were Hispanic/Latino patients, and 9.1% were individuals of other races/ethnicities, including Asian, Native Hawaiian or Pacific Islander, American Indian or Alaska Native, and unreported as defined by the US Census. The mean (SD) numbers of participants by race/ethnicity were 236.5 (208.2) for White, 58.4 (70.0) for Black, 29.9 (71.1) for Hispanic/Latino, and 31.1 (94.3) for other race/ethnicity. According to the test for heterogeneity using the Cochrane Risk of Bias tool, the I2 statistic was 98%, indicating high heterogeneity of outcomes in the included trials. A multiple linear regression analysis was performed to assess any trend and significance between participation by Black individuals and the year the study started, the region in which the study took place, and the study sponsor. There was no significant increase of Black participant enrollment from 1994 to 2019 (r2 = 0.11; P = .17) and no significant association between Black participant enrollment and clinical trial region (r2 = 0.16; P = .50), but there was a significant association between Black participant enrollment and study sponsor (r2 = 0.94; P = .03). Conclusions and Relevance: This meta-analysis found that compared with White individuals, individuals from racial/ethnic minority groups had a very low participation rate in POAG clinical trials despite having a higher prevalence among the disease population. Despite measures to increase clinical trial diversity, there has not been a significant increase in clinical trial participation among Black individuals, the group most affected by this disease; this disparity in POAG clinical trial representation can raise questions about the true safety and efficacy of approved medical interventions for this disease and should prompt further research on how to increase POAG clinical trial diversity.

Birley Place: a virtual community for the delivery of health and social care education.

Virtual simulation can provide high-quality learning experiences through innovative and engaging activities while also overcoming some of the constraints associated with physical simulation. We developed a virtual community, called Birley Place, to facilitate simulation-based learning activities. Adopting a novel approach, we modelled the virtual community on the large metropolitan city in which our institution is based. Publicly available health and population data were used to ensure that the homes, businesses and services in the community were representative of distinct socioeconomic areas of our city. The residents of the virtual community were also matched with the real-world areas based on health and lifestyle data. Our virtual community is used to facilitate learning activities across our health and social care degree programmes. In this article, we summarise how we developed Birley Place, before providing one example of how it is used to facilitate the delivery of a large-scale interprofessional education project. Birley Place is an innovative tool for delivering online and virtual simulation. The use of this virtual community facilitates learners' understanding of the connection between settings and health status.

The theatre of high-fidelity simulation education.

High-fidelity simulation is a useful mechanism to aid progression, development and skill acquisition in nurse education. However, nurse lecturers are daunted by sophisticated simulation technology. This paper presents a new method of introducing human patient simulation to students and educators, whilst seeking to demystify the roles, responsibilities and underpinning pedagogy. The analogy of simulation as theatre outlines the concepts of the theatre and stage (simulation laboratory); the play itself (Simulated Clinical Experience, SCE); the actors (nursing students); audience (peer review panel); director (session facilitator); and the production team (technical coordinators). Performing in front of people in a safe environment, repeated practice and taking on a new role teaches students to act, think and be like a nurse. This in turn supports student learning and enhances self confidence.