"They don't care to study it": Trust, race, and health care experiences among patient-caregiver dyads with multiple myeloma.

BACKGROUND: Medical mistrust, rooted in unethical research, is a barrier to cancer-related health care for Black/African American (AA) persons. Understanding trust, mistrust, and health care experiences is crucial, especially in multiple myeloma (MM), which disproportionately burdens Black/AA persons in incidence and survival. STUDY PURPOSE: This study qualitatively examines the experiences of Black/AA and White dyads (patient with MM and adult caregiver) to gain insights into these phenomena. METHODS: From November 2021 to April 2022, we recruited 21 dyads from the UNC Lineberger Comprehensive Cancer Center. Participants completed a sociodemographic survey and a 60-90 min semi-structured interview. We used ATLAS.ti v9 for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk Inc). RESULTS: We interviewed 21 racially concordant dyads (11 Black/AA, 10 White) with mean patient ages of 70 (Black/AA) and 72 (White) at enrollment. Both Black/AA and White caregivers had a mean enrollment age of 68. The mean duration from MM diagnosis to enrollment for all patients was 5.5 years. Four key themes emerged: (1) knowledge and trust, (2) heightened emotions and discomfort, (3) differing mental constructs of health care experiences, and (4) mitigating mistrust, which varied by self-identified race. Black/AA participants had greater knowledge of historical events like the U.S. Public Health Service Untreated Syphilis Study at Tuskegee and carried the emotional burden longer. They also emphasized self-learning and self-guided research about MM for informed medical decision-making. Both Black/AA and White dyads emphasized the pivotal role of patient-provider relationships and effective communication in fostering trust and addressing concerns. CONCLUSION: Our study offers contextual insights into the enduring challenges of medical mistrust, particularly within the Black/AA community, and its implications for patients and caregivers accessing and receiving MM-related care. Future studies should leverage these insights to guide the development of multilevel interventions addressing medical mistrust within the Black/AA community.

Identifying factors influencing orthodontic residency program selection.

PURPOSE: The desirability of Orthodontic Residency remains high today relative to the past 30 years. This investigation seeks to re-assess factors influencing Orthodontic Residency program selection amidst contemporary challenges and changes, including increasing student debt, reduced residency stipends, and shifting practice models. METHODS: This mixed-methods study consisted of interviews (qualitative) and surveys (quantitative). Fifteen final-year dental students and first-year orthodontic residents were interviewed one-on-one following a topic guide and then transcripts were analyzed using MAXQDA2022 to identify values, factors, and influences related to program selection and ranking. Qualitative findings and previous studies provided the basis for a survey distributed to residency applicants in 2020-22. Data were analyzed with bivariate and descriptive statistics with stratification by debt group. RESULTS: Interviews (N = 15) elevated the importance of location, interview experience, program cost, and clinical education. Surveys (N = 239) identified the most desirable factors for program selection: satisfied residents, strong clinical training with multiple techniques, good interview impressions, low cost, high patient numbers, a strong reputation, and good clinical facilities with new technology. Less desirable factors include programs that are hospital-based, certificate-only, research-intensive, and require considerable after-hours work. CONCLUSIONS: Clinical education and interview experiences are key for residency selection, consistent with prior studies, though program cost has grown in importance. Findings can help guide orthodontic programs in recruiting applicants and suggest a need to limit educational costs.

Preferred physical characteristics of lidocaine thin film for women with vestibulodynia.

Introduction: Vestibulodynia (VBD) is the most common cause of sexual pain in the United States, affecting up to 15% of reproductive-aged women during their lifetime with limited treatment options. The purpose of this study was to describe ideal physical characteristics of a vulvar film designed for insertional sexual pain in sexually active women with VBD. Methods: Twenty women were recruited to participant in one of six, semi-structured 60-minute focus group discussions regarding treatment options for VBD. Heterosexual women, aged 18-51 years old with a diagnosis of vulvodynia, vestibulodynia or insertional dyspareunia fit the inclusion criteria. Those who reported no episodes of vaginal intercourse in the prior 18 months were excluded. A new vulvar film technology loaded with 50 mg of 5% lidocaine was introduced to the group. Participants took part in focus groups on a rolling basis depending on availability. Focus group discussions were audio-recorded and transcribed verbatim. Two study investigators coded the transcripts using inductive coding and merged their respective projects to resolve disagreements. We analyzed data related to each code to develop code clusters and higher-level primary topics regarding device preferences. Data related to each of these primary topics was analyzed to assess the range of participant attitudes and preferences and to identify patterns within each primary topic. Results: One hundred and sixteen women were recruited, and twenty women were enrolled. The mean age for the participants was 33.3 years. Most women were educated with at least some college (93%), White (78.6%), married (75%), and had income greater than $100,000 (50%). Analysis of the focus group discussions identified five common topics addressed by participants: desired loaded medication, film size, film shape, film flexibility, and ease and accuracy of use. Concerns across topics included comfort, sexual spontaneity, and efficacy. Interest in loading the device with other acceptable medications or combination with lidocaine was independently noted in 2/6 (33%) of the focus groups. Discussion: Mucoadhesive vulvar thin films may be an acceptable drug delivery system for insertional sexual pain for women with VBD.

More than medications: a patient-centered assessment of Parkinson's disease care needs during hospitalization.

Background: Parkinson's disease (PD) increases the risk of hospitalization and complications while in the hospital. Patient-centered care emphasizes active participation of patients in decision-making and has been found to improve satisfaction with care. Engaging in discussion and capturing hospitalization experience of a person with PD (PwP) and their family care partner (CP) is a critical step toward the development of quality improvement initiatives tailored to the unique hospitalization needs of PD population. Objectives: This qualitative study aimed to identify the challenges and opportunities for PD patient-centered care in hospital setting. Methods: Focus groups were held with PwPs and CPs to capture first-hand perspectives and generate consensus themes on PD care during hospitalization. A semi-structured guide for focus group discussions included questions about inpatient experiences and interactions with the health system and the clinical team. The data were analyzed using inductive thematic analysis. Results: A total of 12 PwPs and 13 CPs participated in seven focus groups. Participants were 52% female and 28% non-white; 84% discussed unplanned hospitalizations. This paper focuses on two specific categories that emerged from the data analysis. The first category explored the impact of PD diagnosis on the hospital experience, specifically during planned and unplanned hospitalizations. The second category delves into the unique needs of PwPs and CPs during hospitalization, which included the importance of proper PD medication management, the need for improved hospital ambulation protocols, and the creation of disability informed hospital environment specific for PD. Conclusion: PD diagnosis impacts the care experience, regardless of the reason for hospitalization. While provision of PD medications was a challenge during hospitalization, participants also desired flexibility in ambulation protocols and an environment that accommodated their disability. These findings highlight the importance of integrating the perspectives of PwPs and CPs when targeting patient-centered interventions to improve hospital experiences and outcomes.

"A lot to manage and still have some kind of a life": How multiple myeloma impacts the function and quality-of-life of Black-White patient-caregiver dyads.

BACKGROUND: Multiple myeloma (MM) is an incurable debilitating blood cancer associated with the lowest health related quality of life (HRQoL) of all cancers. With nearly 88% of adults aged ≥55 years at diagnosis, age-associated physical losses, comorbidities, and social factors contribute to worsening HRQoL. This qualitative study assessed dyadic (patient-informal caregiver) perspectives on the factors contributing to HRQoL in MM survivors. METHODS: We recruited 21 dyads from the UNC-Chapel Hill Lineberger Comprehensive Cancer between 11/2021 and 04/2022. Participants completed a single dyadic semistructured interview capturing broad perspectives on MM. We used ATLAS. ti v 9 for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk, Inc.). This iterative approach allowed the exploration and identification of themes within and across transcripts. RESULTS: The mean age at enrollment was 71 years (median: 71, range: 57-90) for patients and 68 years (median 67, range: 37-88) for caregivers. All dyads were racially concordant (11 Black/AA and 10 White). However, we aggregated the findings due to no consistent racial differences. Six themes related to (1) physical burden, (2) treatment challenges, (3) losses of independence, (4) caregiver burden, (5) patient and caregiver perseverance, and (6) adjustment to a new normal were identified. Dyads also experienced MM together, resulting in patients and caregivers experiencing changes in their ability to engage in physical and social activities, which further contributed to poor HRQoL. Patients' increased need for social support led to shifts in the caregiver roles, resulting in caregivers feeling burdened by their responsibilities. All dyads acknowledged the need for perseverance and adaptability to a new normal with MM. CONCLUSION: The functional, psychosocial, and HRQoL of older patients with MM and their caregivers remain impacted ≥6 months after a new diagnosis highlighting clinical and research opportunities to focus on preserving or improving the health of dyads living with MM.

Evaluating video-based lectures on YouTube for dental education.

PURPOSE/OBJECTIVES: Multimedia presentations and online platforms are used in dental education. Though studies indicate the benefits of video-based lectures (VBLs), data regarding user reception and optimal video features in dental education are limited, particularly on Web 2.0 platforms like YouTube. Given increasing technology integration and remote learning, dental educators need evidence to guide implementation of YouTube videos as a freely available resource. The purpose of this study is to determine video metrics, viewership and format efficacy for dental education videos. METHODS: First, a cross-sectional survey was conducted of viewers (N = 683) of the Mental Dental educational videos on YouTube. Analytics were evaluated for 677 200 viewers to assess audience demographics, retention and optimal video length. Second, a randomized crossover study was conducted of dental students (N = 101) who watched VBLs in either slideshow or pencast formats and were tested on content learning to compare format efficacy. RESULTS: Most viewers of Mental Dental videos were dental students (44.2%) and professionals (37.8%) who would likely recommend the platform to a friend or colleague (Net Promoter Score = 82.1). Audience retention declined steadily at 1.34% per minute, independent of video length. Quiz performance did not differ between slideshow and pencast videos, with students having a slight preference for slideshows (P = 0.049). CONCLUSIONS: Dental students and professionals use VBLs and are likely to recommend them to friends and colleagues. There is no optimal video length to maximize audience retention and lecture format (slideshow vs. pencast) does not significantly impact content learning. Results can guide implementation of VBLs in dental curricula.

Treatment decision conversations, symptoms, and functional status in older adults with advanced cancer: An exploratory study utilizing mixed methods.

INTRODUCTION: Adults 65 years of age or older with metastatic cancer face complicated treatment decisions. Few studies have explored the process with oncology clinicians during clinic encounters. Our exploratory study evaluated whether symptom burden or functional status impacted treatment decision conversations between older adults, caregivers, and oncology clinicians in a single National Cancer Institute within the Mountain West region. MATERIALS AND METHODS: We conducted an observational, convergent mixed methods longitudinal study between November 2019 and January 2021; participants were followed for six months. The MD Anderson Symptom Inventory (MDASI) and Katz Index of Independence in Activities of Daily Living (ADL) were administered prior to clinical encounter. Ambulatory clinic encounters were audio recorded, transcribed, and analyzed. Nineteen older adults with a metastatic cancer diagnosis or a relapsed refractory hematologic malignancy were approached to achieve a sample of fifteen participants. The main outcome of interest was the number and quality of treatment decision making conversations, defined broadly and encompassing any interaction between the participant and oncology provider that involved (a) an issue or concern (e.g., symptoms, quality of life) brought up by anyone in the room during the clinical encounter, (b) a clinician addressing the concern, or (c) the patient or caregiver making a decision that involved a discussion of their goals or treatment preferences. RESULTS: Nine men and six women with a mean age of 71.3 years (6.6; standard deviation [SD]) were enrolled, and four died while on study. Participants were followed from one to ten visits (mean 4.5; SD 2.8) over one to six months. Of the 67 analyzed encounters, seven encounter conversations (10%) were identified as involving any type of treatment decision discussion. The seven treatment decision conversations occurred with five participants, all male (although female participants made up 40% of the sample), and 63% of participants who reported severe symptoms on the MDASI were female. Severe symptoms or functional status did not impact treatment conversations. DISCUSSION: Our results suggest that older adults with incurable cancer and their oncology clinicians do not spontaneously engage in an assessment of costs and benefits to the patient, even in the setting of palliative treatment and significant symptom burden.

Patient Perspectives on Performance of a Smartphone App for Atrial FibrillationSelf-Management.

Introduction: AF self-care requires patients to perform daily self-monitoring for symptoms, practice decision making to address symptom changes, and adhere to prescribed medication, diet, physical activity, and follow-up care. Technology can facilitate these critical self-care behaviors and ultimately improve patient outcomes. We assessed atrial fibrillation (AF) patients' experiences with a smartphone application (app) for AF self-management. Methods: A focus group with 9 AF patients and app users was conducted and analyzed using qualitative research methods. The focus group was recorded, transcribed, and coded using a priori and inductive coding strategies. Participant responses for each code were synthesized to identify primary themes. Results: We identified four superordinate themes from patients' experiences: (1) disconnect between tool and its intended use; (2) app as acknowledged tool for adherence; (3) knowledge as empowerment; (3) motives: self-interest vs supporting research. Results from this qualitative study underscore the need to clarify the app's intended use and to better accommodate patients with different AF experiences. The disconnect between a tool and its intended use can generate frustration for users. Discussion: The study reinforces that participants not only see how the app is a tool for adherence; they also see knowledge they gain via the app as empowering, suggesting a correlation between app use and self-efficacy.

Lived experience of loneliness in psychosis: A qualitative approach.

BACKGROUND: Loneliness impedes recovery from mental illness. Despite increased interest in loneliness in psychosis, qualitative methods are underused in clinical research on this topic. AIMS: We used qualitative interviews to explore loneliness among persons with schizophrenia spectrum disorders (SSDs). We examined which aspects of living with psychosis were associated with the experience of loneliness, including symptomatology, social relationships, and disruptions in school/work. METHODS: Sixteen participants diagnosed with SSDs engaged in semi-structured, qualitative interviews about loneliness. Participants commented on current activities and social relationships, including their perceptions of the quantity, quality and types of relationships. Important demographic and clinical information was acquired through communication with participants and/or through medical record review. Thematic analysis was used to examine interview content. RESULTS: Our analyses revealed four key topic areas and several sub-themes related to loneliness across participants, including aspects of the physical environment (e.g. financial limitations), social context (e.g. lacking a romantic partner), and psychological functioning (e.g. psychotic/symptoms) that impact lonely feelings. Participants commented on coping strategies to manage loneliness and provided suggestions for possible interventions. CONCLUSIONS: Persons diagnosed with SSDs report significant and impactful feelings of loneliness. This study highlights the need for novel and effective treatments targeting loneliness in this population.

Understanding technology adoption by orthodontists: A quantitative study.

INTRODUCTION: Digital scanning, treatment planning, 3-dimensional imaging, and printing are changing the practice of orthodontics. These tools are adopted with the hope that treatment becomes more predictable, efficient, and effective while reducing adverse outcomes. Digital tools are impacting care, but knowledge of nationwide adoption trends and motivators is incomplete. METHODS: We aimed to identify adoption decision-makers, information sources, incentives, and barriers through the first nationwide survey of American Association of Orthodontics members on their technology adoption habits, needs, and outcomes. Data were assessed using descriptive and bivariate analyses. The survey was developed from a comprehensive qualitative interview phase as part of a mixed methodology study. RESULTS: Responses (n = 343) revealed orthodontists make adoption decisions on the basis of advice from other dentists and company representatives while rarely consulting staff or research literature. Continuing education and meetings are most effective at disseminating information to practicing doctors, whereas journals generate less impact. Key adoption incentives include added capabilities, practice efficiency, ease of implementation, and performance, whereas cost is the main barrier to purchase. Early adopters with larger practices charge higher fees than other adopters to support the costs of technologies. Treatment outcome is not a primary adoption incentive for specific technologies. CONCLUSIONS: Orthodontists positively perceive the influence of intraoral scanning, cone-beam computed tomography imaging, 3-dimensional printing, computer-aided design-computer-aided manufacturing archwires, and clear aligner therapy on their practice and patient care. The orthodontic technological transformation is underway, and knowledge of adoption can guide our transition into modern practice, in which digital tools are effective adjuncts to the specialists' expertise.

Identifying factors that impact general dentists' referrals to orthodontists.

INTRODUCTION: Referrals from general dentists are a significant source of orthodontic patients, but our knowledge of factors guiding referral decisions predates recent marketplace trends of direct-to-consumer products and broad digitization. To provide orthodontists with current, nationwide data on referral values and communication preferences, a mixed-methods study was conducted. METHODS: Semistructured interviews were conducted with practicing general dentists (n = 23), and interviews were analyzed to identify factors important to communication and referrals. Qualitative data provided the foundation to develop and pretest a survey distributed nationally to American Dental Association general dentists through email (n = 373). Survey results were evaluated using bivariate and descriptive statistics. RESULTS: Although 42% of general dentists provide orthodontics, of those, 68% report insufficient orthodontic training in dental school, and 61% have increased orthodontic care in recent years. General dentists refer to orthodontists for complex cases and growing patients, with the orthodontist's perceived skill and proximity to the patient being important for choosing a specific orthodontic practice. Phone (70%) and email (61%) are the most used interoffice communication methods, with email (40%) and then phone (30%) being the most preferred. The most important aspects of a working relationship were patient satisfaction and final occlusal outcome, whereas the best way to boost referrals was through improving communication. CONCLUSIONS: Excellent care and patient satisfaction remain primary motivators for referrals from generalists to orthodontists. An improved orthodontic curriculum is needed for general dentists. Good communication with dentists is critical for growing referral streams and enhancing patient care.

Educational debt and the gender gap: Understanding factors influencing orthodontists' career decisions.

INTRODUCTION: Orthodontic residents face challenges unparalleled to their predecessors, including competitive marketplaces, rising debt burdens, and changing demographics that have contributed to the shift in initial career choice from owner to employee. We aim to understand factors important to orthodontists at different career stages and the impact on job satisfaction through a sequential mixed methodology study. METHODS: Semistructured interviews were conducted with 25 orthodontic residents and practitioners. A survey was developed from qualitative findings that explored career decision-making of orthodontic residents and practicing orthodontists, with descriptive and bivariate statistical analyses (n = 343 orthodontists and 185 residents). RESULTS: Graduating orthodontic residents are choosing employment over ownership as their initial job, prioritizing high income to offset the educational debt. The majority of residents report thinking about their debt very often to all of the time and find it very to extremely stressful. Current residents have long-term goals of ownership, whereas practicing doctors of both genders became owners at equal frequencies. However, on average, women earn $119,000 less per year and report being the primary family caretaker more often than men. CONCLUSIONS: Excellent patient care, work-life balance, and sufficient income are the most important drivers for career choices and job satisfaction for orthodontists of all ages. Despite debt, most residents and working orthodontists report a high level of job satisfaction and would recommend the field of orthodontics to others.

Lived experiences of subjective binge eating: An inductive thematic analysis.

OBJECTIVE: Growing evidence suggests that subjective binge eating (SBE; loss of control eating involving subjectively, but not objectively, large quantities of food) is clinically concerning even though it is not currently considered a diagnostic criterion for eating disorders. However, the lived experience of SBEs has not been examined in a systematic, and data-driven way. METHOD: The current study used a qualitative, inductive interview approach to further define SBEs as described by individuals who experience them. Participants (N = 14; 11 cisgender women, Mage  = 35.29, 12 White/non-Latinx) reported SBEs that occurred at least twice per week over the prior 3 months. We completed semi-structured qualitative phone interviews with participants regarding their most recent SBE and objective binge-eating episode (OBE) if applicable, as well as broader experiences and attitudes regarding non-binge eating. RESULTS: Inductive, reflexive, thematic coding yielded descriptive and interpretive codes regarding SBEs. Main themes regarding SBE experience included: (a) SBEs Occur Across Contexts and Food Types, (b) SBEs Are Contrasts to General Over-Control, (c) SBEs Are Distress- and Disconnection-Inducing, Not Relieving, (d) SBEs Are Responses to Hunger and Restriction, and (e) SBEs Can Be "Echoes" of OBEs. DISCUSSION: The current study explored the lived experiences of those who report SBEs and provides an important foundation for hypothesis generation for future research on and clinical interventions for SBEs.

Understanding Patients' Decisions to Obtain Unplanned, High-Resource Health Care After Colorectal Surgery.

Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview participants from a prospective cohort of adult CRS patients. Thirteen (72%) participants had an unplanned postdischarge health care visit. Participant decision-making was classified by methodology (algorithmic, guided, or impulsive), preexisting rationale, and emotional response to perceived health care needs. Participants voiced clear mental algorithms about when to visit an ED. In addition, participants identified facilitators and barriers to optimal health care use. They also identified tangible targets for health care utilization reduction efforts, such as improved care coordination with streamlined discharge instructions and improved communication with the surgical team. Efforts should be directed at improving postdischarge communication and care coordination to reduce CRS patients' high-resource health care utilization.

Influences on dentists' adoption of nonsurgical caries management techniques: A qualitative study.

BACKGROUND: Nonsurgical caries management techniques (NSCMT) offer a simple, conservative approach to treating caries. Despite evidence supporting and potential advantages of NSCMT, dentists can be reluctant to adopt these techniques. To better understand this phenomenon, the authors interviewed dentists who primarily treat children regarding their thoughts, attitudes, and adoption of 3 NSCMT. METHODS: The 3 NSCMT were fluoride varnish, silver diamine fluoride, and Hall stainless steel crowns. The authors interviewed dentists in North Carolina whose practices were restricted mostly to children. A nonprobabilistic maximum-variation design was used in the sampling. Using a semistructured interview guide, the authors recorded the interviews digitally and analyzed them thematically. The authors stratified the analysis according to years of practice, geographic location, and type of practice. Reporting was based on emerging and recurring themes and insightful quotes. RESULTS: Factors most likely to promote the adoption of NSCMT were related to clinical practice, family preference, patient safety, and provider philosophy. Barriers to adoption included previous practitioner negative experiences using the techniques, high-risk caries population, and perceived likelihood of negative outcomes. Characteristics of the practice environment, patient population, communication with families, and financial considerations were influential in the clinician's determination as to whether to use these techniques. CONCLUSIONS: These findings provide valuable insight into practitioners' influences, motivations, and clinical decision making in the adoption and use of management and treatment approaches for carious lesions in the pediatric population. PRACTICE IMPLICATIONS: The primary factors and barriers identified in this study are possible targets for education and quality improvement programs aimed at increasing NSCMT use.

Surgical patient values frame and modify the impact of risk factors for non-routine postdischarge care: A mixed-methods study.

BACKGROUND: Adult colorectal surgery patients continue to have high rates of readmissions, despite known risk factors for non-routine postdischarge care (emergency department (ED) visit or rehospitalization) and countless interventions to address these. It is unclear how the difficult-to-quantify patient perspective frames and modifies the impact of these quantifiable risk factors. STUDY DESIGN: We identified consecutive adult inpatient colorectal surgery patients from 2017 to 2018. This mixed methods study merged data from electronic health records and in-depth patient interviews. RESULTS: We enrolled 258 participants, surveyed 167, and interviewed 18. Depressive symptoms represent one of many risk factors confirmed to increase non-routine healthcare utilization (RR 1.85, 95% CI 1.02-3.37), though the patient perspective explained why these symptoms seemed to greatly impact some patients more than others. Additionally, consistent with patient report, patients with non-routine postdischarge care (26%) were less likely to report communication with their surgical team (80% vs 97%, p < 0.001). CONCLUSION: Patient perspectives add depth and understanding of the impact of risk factors on non-routine post-discharge care. This expanded knowledge explains why one patient is more likely to visit an ED close to home whereas another patient might prefer to visit their surgeon's clinic directly. Effective strategies to reduce unplanned postdischarge care should be tailored.

Community-University Partnership Characteristics for Translation: Evidence From CDC's Prevention Research Centers.

Background: The Centers for Disease Control and Prevention's Prevention Research Centers (PRC) Program supports community engagement and partnerships to translate health evidence into practice. Translation is dependent on the quality of partnerships. However, questions remain about the necessary characteristics to develop and maintain translation partnerships. Aim: To identify the characteristics that influence community-university partnerships and examine alignment with the Knowledge to Action (K2A) Framework. Methods: Final Progress Reports (N = 37) from PRCs funded from September 2009 to September 2014 were reviewed in 2016-2017 to determine eligibility. Eligible PRCs included those that translated an innovation following the applied research phase (2009-2014) of the PRC award (n = 12). The PRCs and the adopters (i.e., community organizations) were recruited and participated in qualitative interviews in 2017. Results: Ten PRCs (83.3% response rate) and four adopters participated. Twelve codes (i.e., elements) were found that impacted partnerships along the translation continuum (e.g., adequate communication, technical assistance). Each element aligned with the K2A Framework at multiple steps within the translation phase. The intersection between the element and step in the translation phase is termed a "characteristic." Using interview data, fifty-two unique partnership characteristics for translation were found. Discussion and Conclusion: The results suggest multiple characteristics that impact translation partnerships. The inclusion of these partnership characteristics in policies and practices that seek to move practice-based or research-based evidence into widespread use may impact the receptivity by partners and evidence uptake by communities. Using the K2A Framework to assess translation partnerships was helpful and could be considered in process evaluations to inform translation partnership improvement.

Understanding technology adoption by orthodontists: A qualitative study.

INTRODUCTION: Orthodontics is evolving with advances in 3D imaging, additive fabrication, digital scanning, and treatment planning. With digital tools, orthodontic treatment may become more predictable, efficient, and effective while reducing side-effects. These technologies are affecting patient care, but knowledge of their adoption patterns and influence is incomplete. We aimed to identify adoption decision makers, information sources, perspectives, incentives, and barriers. METHODS: Twenty-four privately practicing orthodontists were interviewed in a semistructured format following a topic guide. Interview transcripts were analyzed to identify factors in technology adoption and its perceived influence on practice. Thematic patterns were established through iterative systematic analysis, and qualitative validity was ensured with researcher triangulation. RESULTS: Qualitative interviews revealed that orthodontists make purchasing decisions independently from staff, after consulting other dentists and company representatives. Meetings, residency training, and continuing education courses are influential information sources, whereas research literature is not. Early and middle adopters are integrating digital imaging, planning, and fabrication technologies into practice and view enhanced ease of use, capabilities, performance, and procedural efficiency as primary incentives to adoption. Improving outcomes and patient comfort are not frequently cited as incentives, and all interviewees view cost as the largest barrier. Orthodontists positively perceive the influence of technology on their practices, but are concerned that further innovation and direct-to-consumer products will cause loss of market share. CONCLUSIONS: CAD/CAM appliances, 3D imaging, and digital treatment planning are viewed as future standards of care and are increasingly being incorporated into the orthodontic office. Understanding the technology adoption process can guide innovation to improve treatment and ease the transition into a digital workflow.

Understanding antagonism and synergism: A qualitative assessment of weight management in youth with Type 1 diabetes mellitus.

AIMS: No current clinical guidelines focus on weight management in youth with type 1 diabetes mellitus (T1DM). Our aim was to characterize the patient-perceived experience and barriers to weight management in youth with T1DM. METHODS: Participants were recruited from the University of North Carolina (n = 16, 56% female, 60% White, 50% insulin pump users, mean age 14.8 years, mean HbA1c 8.5% (69 mmol/mol)) and the University of Colorado (n = 18, 50% female, 80% white, 53% pump users, mean age 15.3 years, mean HbA1c 9.3% (78 mmol/mol)). Focus groups were stratified by sex and weight status (BMI cutoff = 25). Discussions were guided by a standardized set of questions, audio-taped, transcribed, and analyzed thematically using inductive qualitative methods. RESULTS: Youth with T1DM expressed four interrelated themes of antagonism between type 1 diabetes and weight management: dysregulated appetite, disruption of blood glucose levels associated with changing diet/exercise, hypoglycemia as a barrier to weight loss, and the overwhelming nature of dual management of weight and glycemic control, and two interrelated themes of synergism: improvement in shared, underlying heath behaviors and exercise as a tool for weight and glycemic control. Variation in emphasis of specific thematic elements was greatest across sex. Youth identified five major components of a weight management program for T1DM: intensified glucose management, healthy diet with known carbohydrate content, exercise, individualization and flexibility, and psychosocial and peer support. CONCLUSIONS: There is critical need for personalized, T1DM-specific weight recommendations to overcome disease-specific barriers to weight management in the context of T1DM.

Telephone Follow-Up for Older Adults Discharged to Home from the Emergency Department: A Pragmatic Randomized Controlled Trial.

BACKGROUND/OBJECTIVES: Telephone calls after discharge from the emergency department (ED) are increasingly used to reduce 30-day rates of return or readmission, but their effectiveness is not established. The objective was to determine whether a scripted telephone intervention by registered nurses from a hospital-based call center would decrease 30-day rates of return to the ED or hospital or of death. DESIGN: Randomized, controlled trial from 2013 to 2016. SETTING: Large, academic medical center in the southeast United States. PARTICIPANTS: Individuals aged 65 and older discharged from the ED were enrolled and randomized into intervention and control groups (N = 2,000). INTERVENTION: Intervention included a telephone call from a nurse using a scripted questionnaire to identify obstacles to elements of successful care transitions: medication acquisition, postdischarge instructions, and obtaining physician follow-up. Control subjects received a satisfaction survey only. MEASUREMENTS: Primary outcome was return to the ED, hospitalization, or death within 30 days of discharge from the ED. RESULTS: Rate of return to the ED or hospital or death within 30 days was 15.5% (95% confidence interval (CI) = 13.2-17.8%) in the intervention group and 15.2% (95% CI = 12.9-17.5%) in the control group (P = .86). Death was uncommon (intervention group, 0; control group, 5 (0.51%), 95% CI = 0.06-0.96%); 12.2% of intervention subjects (95% CI = 10.1-14.3%) and 12.5% of control subjects (95% CI = 10.4-14.6%) returned to the ED, and 9% of intervention subjects (95% CI = 7.2-10.8%) and 7.4% of control subjects (95% CI = 5.8-9.0%) were hospitalized within 30 days. CONCLUSION: A scripted telephone call from a trained nurse to an older adult after discharge from the ED did not reduce ED or hospital return rates or death within 30 days. Clinicaltrials.gov identifier: NCT01893931z.