Reliant Medical Group

BackgroundSchool masking mandates were widely adopted as a pandemic control measure, however, limited data are available regarding their effectiveness as a strategy for reducing burden of disease in the surrounding community.ObjectiveTo evaluate the impact of school masking policy de-adoption (mask-lifting) on SARS-CoV-2 incidence rates, hospitalizations, and deaths in the surrounding community.MethodsDesign: Retrospective observational study with an event study design, a difference-in-difference method; a target trial emulation (TTE) framework was applied as a secondary analysis. Cohort creation: Data collected from 9/2021 to 6/2022 on SARS-CoV-2 cases, hospitalizations, deaths and vaccination rates were combined with district-level masking policy data. Analysis: In the event study, the impact of masking policy de-adoption on SARS-CoV-2 cases per 100,000 county residents stratified by age during the 8-week period following the policy change was estimated. Effects on hospitalization and deaths per 1,000,000 residents were secondarily estimated. In a secondary analysis, a target trial emulation framework was applied to estimate average treatment effects.ResultsN = 3,970 districts composed of 53,453 schools were included in the cohort. In the event study, no consistent trends for COVID-19 case rates were identified for the whole cohort or for any age group. For the whole cohort, there was a statistically significant increase found 6–8 weeks following the policy change (maximum increase, 1.91 hospitalizations per 1,000,000 county residents); increases in hospitalizations were also found in the stratified analysis for all age groups, although absolute impacts were small. An increase in deaths was found during the period from 4 to 7 weeks following the policy change (maximum increase 0.62 deaths per 1,000,000 residents). In the stratified analysis, small increases in death rates were seen in 50–69 year olds (range, 0.088–1.49) and >70 year olds (range, 0.23–2.58) but not in younger groups. In the TTE framework, cases, hospitalizations, and deaths were similar in control and intervention counties.ConclusionThis study evaluating the impact of lifting of mask mandates in schools, analyzed in two ways, was consistent results ranging from no impact to a small but statistically significant impact of the policy change on SARS-CoV-2 case and severe outcomes rates in the surrounding community. Findings can be used to inform future pandemic policy responses for elementary and secondary schools.

Despite various attempts to improve patient-clinician communication, there has been limited head-to-head comparison of these efforts. To assess whether clinician coaching (mobile application or in-person) is more effective than reminder posters in examination rooms and whether mobile app use is noninferior to in-person coaching. A cluster randomized clinical trial with 3 arms. A total of 21 primary care clinics participated in 3 health systems in the US; participants were patients and primary care clinicians with clinic visits between August 28, 2019, and December 31, 2021. Data were analyzed from August 4, 2022, to November 10, 2024. Data analysis was based on intention to treat. In-person coaching of clinicians with standardized patient instructor training (high-touch), mobile application-based coaching (high-tech), and posters placed in examination rooms encouraging shared decision-making (AskShareKnow [ASK]). Before visits, patients in the high-touch and high-tech groups were prompted to inform their clinicians of the most important matter for discussion using online check-in. The primary outcome was a patient engagement measure (CollaboRATE) of patient perceptions of communication and shared decision-making during the visit. Difference-in-differences mixed-effect regression with random intercepts for primary care clinician were used for analyses. Secondary outcomes included the net promoter score (patient's likelihood of recommending this clinician to others) and patient's confidence in managing their health. Participants included 4852 patients with a median age of 54 years (IQR, 39-66 years); 63.6% were women. A total of 114 clinicians (median age range, 40-59 years; 48 were women [42.1%]) participated. The 3 interventions did not differ significantly in probability of CollaboRATE top score (marginal difference, high-tech vs ASK, -0.021; 95% CI, -0.073 to 0.030; high-touch vs ASK, -0.018, 95% CI, -0.069 to 0.033; high-tech vs high-touch, -0.003, 95% CI, -0.057 to 0.052; P = .14). Patients in the high-tech group were less likely to recommend their clinician to others than patients in the high-touch group (difference in marginal probability, -0.056; 95% CI, -0.118 to 0.019; P = .04). After 3 months, patients in the high-tech group had a significantly lower score than patients in the high-touch group (mean difference, -0.176; 95% CI, -0.341 to -0.011; P = .04) in confidence in managing their health. This cluster randomized clinical trial found no evidence of intervention effects, although there were differences across systems. Some secondary outcomes suggested positive effect of clinicians receiving in-person coaching. Alternative outcome measures of patient engagement may be needed. ClinicalTrials.gov Identifier: NCT03385512.

Objective There is a pervasive underrepresentation of researchers and clinicians from diverse backgrounds in psychology. This is the first study to focus on diversity gaps in Psychotherapy Research. We examine a gap in the representation of research from low-income countries and summarize barriers and solutions to increase diversity in the field. Method We examined trends in submission, acceptance, and rejection rates of all submissions (n = 7183) from 75 countries, representing eight geographical regions to Psychotherapy Research, between 28 April 2005 and 22 June 2023. Results Most submissions were from Europe and North America, with the fewest from Africa and Asia/Northeast Asia. High-income countries had significantly more submissions than low-income countries, with gaps increasing over time. North America and Europe had the highest acceptance rates and Africa and Asia/Southeast Asia had the lowest rates. Conclusion Psychotherapy Research is one of the most internationally representative journals in the field. Yet, we found underrepresentation of non-western countries. There is a need to increase the representation of research participants and researchers from non-western countries through direct initiatives and investments in research and researchers from underrepresented backgrounds.

Unintentional pediatric ingestions of substances can lead to serious and even fatal consequences in children1 and raises concern for supervisory neglect. Supervisory neglect occurs when a caregiver's supervisory decisions or behaviors place a child in their care at significant risk for physical, emotional or psychological harm.2 A caregiver who is taking prescription medication or who uses recreational or therapeutic substances, such as cannabis, must protect children in their care from accessing these potentially harmful drugs. Studies have demonstrated that unintentional cannabis ingestions by children has increased in states that have legalized medical and recreational cannabis.3 Given the changing laws surrounding cannabis in Rhode Island, this study aims to provide a conceptual framework to diagnose, manage and understand supervisory neglect when children present to care with a cannabis ingestion. Additionally, this paper provides guidance for providers to help prevent unintentional cannabis ingestions.

BackgroundDespite the growing prevalence of depression and anxiety among adolescents, fewer than half access appropriate mental health care. Single-session interventions (SSIs) for depression and anxiety offered in primary care are a promising approach to bridging the treatment gap.ObjectiveWe aimed to implement a clinical workflow for primary care and behavioral health providers to refer patients aged 13 to 17 years with mild to moderate depression and anxiety symptoms to Project YES (Youth Empowerment and Support), an open-access SSI platform, in a large group medical practice with an integrated behavioral health department.MethodsPediatric primary care and integrated behavioral health providers will be educated on the benefits of Project YES for adolescent anxiety and depression and trained in a workflow integrated within the electronic health record system, Epic, to refer patients during well-child visits and pediatric behavioral health visits. Patients with mild to moderate internalizing symptoms based on the 17-item Pediatric Symptom Checklist or youth Pediatric Symptom Checklist will be invited to try an SSI through Project YES. We will examine provider uptake and perceptions of acceptability, feasibility, and appropriateness over time.ResultsThe rollout will take place between November 2022 and May 2023, when outcomes will be evaluated. Data analysis and manuscript writing are anticipated to be completed during the summer of 2023.ConclusionsSSIs such as those available through Project YES have the potential to provide low-cost, evidence-based mental health treatment to adolescents with mild to moderate depression and anxiety. If deemed feasible and acceptable, providing SSIs in primary care settings could significantly improve access to mental health care without taxing pediatric primary care and behavioral health providers.International Registered Report Identifier (IRRID)DERR1-10.2196/45666

COVID-19 vaccines are widely available, but uptake is suboptimal. To develop strategies to increase vaccination rates, we sought to (1) characterize adults initially hesitant to be vaccinated for COVID-19 who later received the vaccine and (2) identify factors associated with their vaccination decision. In January 2021, we conducted an online survey of US adults via Prolific that assessed vaccination intent, COVID-19-related knowledge and attitudes, and demographic characteristics. In May 2021, we recontacted respondents to assess vaccination status and factors influencing their vaccination decision. We used χ2 statistics and t tests to examine associations between respondents' vaccination status and their characteristics, knowledge, and attitudes. We analyzed reasons for vaccination using thematic analysis. Of 756 initially vaccine-hesitant respondents, 529 (70.0%) completed the follow-up survey. Nearly half of those initially not sure about vaccination (47.3%, 112 of 237) were vaccinated at follow-up, while 21.2% (62 of 292) of those initially planning not to be vaccinated were vaccinated at follow-up. Of those initially not sure, higher educational attainment, greater knowledge of COVID-19, and a doctor's recommendation were associated with vaccination. Of those initially intending not to be vaccinated, male sex, Democratic political affiliation, receipt of an influenza shot within 5 years, being more worried about COVID-19, and having greater COVID-19 knowledge were associated with increased likelihood of being vaccinated. Of 167 respondents who gave reasons for vaccination, protecting oneself and others (59.9%), practical issues (29.9%), social influences (17.4%), and vaccine safety (13.8%) were the main reasons. Providing information on the protective value of vaccination, implementing rules that make remaining unvaccinated burdensome, making vaccination easy, and providing social support may influence vaccine-hesitant adults to accept vaccination.

Monoclonal gammopathy of undetermined significance (MGUS) is the precursor of multiple myeloma. This qualitative study described patient (n = 14) experiences and healthcare providers' (n = 8) opinions and practices concerning care for patients with MGUS in the US. Semi-structured, in-depth interviews were analyzed using thematic analysis. We identified six overarching themes related to the care pathway for patients with MGUS: (1) Process of MGUS diagnosis, (2) Providers' explanations, (3) Patients' understanding, (4) Impact of the diagnosis, (5) Follow-up/management, and (6) Factors influencing healthcare utilization. Patients demonstrated a basic understanding of MGUS. However, some patients felt anxiety around the diagnosis, which may affect other aspects of their lives. Non-hematologist providers report having less MGUS-specific knowledge. Older age, high-risk MGUS, and insurance coverage/healthcare costs influenced healthcare utilization. Patients with MGUS may have difficulty processing this premalignant diagnosis. Non-hematologist providers may have gaps in knowledge around specific care for patients with MGUS.