BACKGROUND:Patients in emergency departments (EDs) often face barriers to care, including complex operations, long waits, and limited communication from care teams. These factors contribute to dissatisfaction and may increase rates of leaving before treatment is complete. Automated text messaging (SMS) may improve transparency by providing real-time updates and answering common patient questions about comfort and visit milestones. This pilot study evaluated the feasibility of implementing a fully automated SMS program and describes key aspects of its design and implementation. METHODS:SMS content and triggering logic were developed through informal patient interviews and iterative input from a multidisciplinary team, including physicians, nurses, registration staff, and patient experience administrators. Messages were mapped to electronic health record (EHR) events and triggered automatically without staff intervention. Following deployment, a convenience sample of English-speaking, adult patients at a single urban academic ED were offered enrollment over a 15-month period. Enrolled patients received an optional, anonymous post-visit survey. Data on enrollment and survey results were summarized descriptively. RESULTS:Thirteen automated messages were implemented. Between July 2023 and October 2024, 4,100 of 42,915 eligible patients enrolled (9.6%). Among enrollees, 185 completed the post-visit survey (4.5%). Of respondents, 89.7% reported wanting text messages during their ED visit. The most frequently selected desired topic was "updates on what tests/procedures are still pending" (65.4%). CONCLUSIONS:A fully automated ED SMS communication program was technically feasible and was viewed favorably by survey respondents. Future work should evaluate strategies to increase enrollment and engagement, assess implementation in other settings, and examine the impact of automated messaging on patient experience.
Meniscal tearing is one of the most common knee in- juries. Meniscus tears seldom heal, making partial meniscectomy the primary surgical option for patients seeking quick relief. Unfortunately, removal of meniscal tissue impedes loadbearing in the knee, which can lead to accelerated post-traumatic osteoarthritis. It is hypothesized that implementing stem/progenitor cells in the treatment of orthopedic soft-tissue injuries may improve the rate of healing. This article discusses the progress made by our research group in the Department of Orthopedics at Brown University Health, with funding and logistical support from Advance RI-CTR, to develop a novel cell-based strategy for stimulating meniscal fibrocartilage healing. We detail the clinical need that fueled (and continues to fuel) our research efforts, our justification for cell selection, and our published studies that have tested the efficacy of this approach using both in vitro and in vivo models of meniscal injury.
The Networks and Causal Inference for Public Health Research (NCIPHER) Lab at the University of Rhode Island (URI) was established in 2018, with an initial pilot project supported by Advance Rhode Island Clinical Translational Research (RI-CTR), to develop methodological and computational approaches for evaluating interventions in real-world settings where individuals are connected in ways that impact their health. Leveraging bioinformatics and high-performance computing resources through Advance RI-CTR, we integrate empirical and simulation methods to estimate causal intervention effects (i.e., change in an outcome caused by a specific intervention) beyond treated individuals, including spillover through social and healthcare networks and clusters. Our work demonstrates that accounting for spillover improves understanding of the effectiveness of HIV and opioid use disorder (OUD) interventions. In the Transmission Reduction Intervention Project Athens, Greece, participants not exposed themselves to community alerts about HIV risk, with 50% of their immediate contacts exposed, reported three fewer unsafe injection behaviors (per 100 participants), compared to those who had 20% of their contacts exposed (95% CI: -7, 0). We also found 26 fewer reports (per 100 persons) at six months under individual treatment with medication for opioid use disorder with 60% of other individuals in the network treated, compared to no treatment with 20% of others treated (95% CI: -38, -13). Understanding effects in networks can improve translation from intervention delivery to population-level impact, supporting evidence-based policy.
Chronic myeloid leukemia (CML) can rarely present with extreme thrombocytosis as the initial manifestation, a phenotype that can mimic essential thrombocythemia, leading to delayed diagnosis. We describe the case of a 54-year-old woman who was evaluated by outpatient hematology for isolated thrombocytosis with normal iron studies and leukocyte counts. Molecular testing confirmed BCR::ABL1 fusion, consistent with chronic phase CML. She was started on hydroxyurea, but her platelet count continued to rise, requiring hospitalization for close monitoring, where she was initiated on dasatinib, a tyrosine kinase inhibitor (TKI). As her platelets peaked above 4,000 × 109/L (Reference Range [RR]: 150-450 × 109/L), given the high risk of both thrombotic and bleeding complications, she underwent plateletpheresis, which effectively reduced counts before TKI therapy could achieve disease control. This case highlights the importance of considering the diagnosis of CML in patients with isolated thrombocytosis, particularly in women, and emphasizes the role of plateletpheresis as a potential preventive bridge until TKI therapy takes effect.
OBJECTIVES:To evaluate the impact of a Rhode Island (RI) Latent Tuberculosis Infection (TB Infection) Extension of Community Healthcare Outcomes (ECHO) telementoring program on primary care clinicians' self- reported learning and performance. METHODS:Utilizing an exploratory, sequential, mixed- methods design, we first conducted 24 qualitative interviews with RI primary care clinicians and nurses to identify TB infection management gaps. These findings informed the curriculum for a six-session RI TB Infection ECHO course launched in 2021. Participant learning and performance were evaluated using pre- and post-course-structured questionnaires and follow-up qualitative interviews. RESULTS:Qualitative analysis revealed that participating clinicians felt comfortable with TB infection screening but lacked confidence in treatment initiation and selection. Following the ECHO course, participants demonstrated significant increases in self-reported confidence across the majority of TB infection practice areas (P<0.05). Notably, 75% of post-survey respondents reported making specific practice changes, such as adopting shorter treatment regimens and improving newer test interpretation. CONCLUSIONS:The mentored research award was instrumental in the establishment of the first Project ECHO hub at The Warren Alpert Medical School of Brown University. By achieving Level 5 (Performance) on Moore's Educational Framework through documented practice change, the program demonstrated that tele- mentoring can effectively democratize specialized TB infection knowledge. This framework has since scaled to a regional TB infection ECHO program.
Advance Rhode Island Clinical and Translational Research (Advance RI-CTR) is a statewide consortium funded by the Institutional Development Award (IDeA) Program of the National Institute of General Medical Sciences. Over the past decade, it has strengthened Rhode Island's clinical and translational research ecosystem. Led by Brown University in partnership with Brown University Health, Care New England, the Providence VA Medical Center, and the University of Rhode Island, the consortium provides infrastructure, pilot funding, workforce development, and community-engaged resources aligned with state health priorities. Guided by environmental assessment and sustained community input, Advance RI-CTR prioritizes chronic disease and aging, behavioral and mental health, and maternal and child health, with crosscutting emphases on substance use disorder, social determinants of health, and healthcare delivery. Through five integrated cores, the program supports investigators statewide. Major accomplishments include establishing a practice- based research network, expanding informatics capacity, strengthening implementation science, enhancing workforce training, and increasing competitiveness for extramural funding. The program demonstrates strong return on investment and measurable statewide impact.
In this article, we present the case of a 78-year-old man with a history of coronary artery disease status post- coronary artery bypass grafting and mild cognitive impairment (previously treated with donepezil and memantine) who was transferred for consideration of exchange transfusion in the setting of high-grade babesiosis parasitemia complicated by disseminated Lyme disease, acute kidney injury, and acute hemolytic anemia. Using this case, we highlight an atypical presentation of the growing burden of tickborne disease in older adults. We review the epidemiology of Lyme disease and babesiosis in aging populations, outline the diagnostic criteria and management considerations for disseminated Lyme disease and severe babesiosis, and discuss clinical factors unique to older patients, including delayed recognition, baseline cognitive impairment, and increased risk of severe complications. This report adds to the expanding literature emphasizing the distinctive presentation and management challenges of increasingly prevalent tickborne infections in older adults.
A lack of proper medical interpretation has been shown to worsen quality of care, patient outcomes, and patient satisfaction. This study aimed to describe how faculty and residents communicate with patients who prefer a language other than English across inpatient and outpatient settings at an academic children's hospital, as well as describe the barriers to interpretation. A survey of pediatric faculty and residents was conducted to assess interpreter use and barriers to use within this hospital. Seventy faculty and 21 residents responded. Providers and trainees across a variety of settings reported high positive attitudes toward interpreters and high use of interpreters to perform most job tasks. Most providers in all groups (75-95%) reported interpreter availability as a barrier. These findings highlight the need for increased access to interpreters in all settings to ensure proper communication with patients and families.
OBJECTIVE:Alzheimer's disease and related dementias (ADRD) pose a growing public health challenge, with 45% of cases attributable to 14 modifiable risk factors. Midlife represents a critical window for prevention. Hispanic/Latino adults face disproportionate ADRD risk, compounded by health inequities such as limited healthcare access and higher prevalence of cardiovascular and metabolic conditions. In Rhode Island, where 17.6% of residents identify as Hispanic/Latino, culturally tailored interventions are urgently needed. This study aims to inform the cultural adaptation of the TEACH intervention (Tailored Education for Aging and Cognitive Health), an evidence-based, multidomain behavioral intervention designed to reduce ADRD risk through lifestyle modification, to ensure its cultural relevance for Hispanic/ Latino adults. DESIGN AND METHODS:The research team will follow the Cultural Adaptation Process (CAP) model to guide the adaptation of the TEACH intervention, emphasizing linguistic and cultural relevance for Hispanic/Latino adults in southern New England by incorporating the views and perspectives of key stakeholders. We will conduct semi-structured qualitative interviews with bilingual stakeholders (N=6-8) and Hispanic/Latino adults aged 40-69 (N=10-12) recruited from clinical and community settings. Interviews will explore brain health beliefs, perceived intervention needs, barriers, and cultural values. Qualitative data will be analyzed using framework matrix and applied thematic analysis approaches to identify adaptation priorities across language, content, and delivery. RESULTS:This project was funded in September 2023. Data collection began in 2024, and analysis is projected to be completed in 2026. CONCLUSIONS:Findings will guide cultural adaptation of the TEACH intervention using the CAP model. This work addresses a critical gap in ADRD prevention for U.S. Hispanic/Latino populations and lays the foundation for a future randomized controlled trial to evaluate efficacy of the adapted intervention.
INTRODUCTION:Socioeconomic and environmental factors play a significant role in shaping an individual's overall health. Despite longstanding recommendations to integrate cultural competency and multidisciplinary training, health equity remains underemphasized in US medical schools. The Emergency Medicine (EM) clerkship is ideal to address this gap, given the diverse Emergency Department (ED) patient population. METHODS:A health equity curriculum was integrated into clerkship simulations. Using the AAMC Core Entrustable Professional Activities (EPA), a score was assigned between 1-4 based on a scaled evaluation of students' ability to incorporate responses appropriate to age, gender, race, religion, disabilities, and/or sexual orientation into patient encounters. Beginning and end- of-rotation simulation were compared pre- and post- implementation using t-tests. Students were surveyed regarding experiences at the end of the rotation. RESULTS:Mean scores were similar pre-implementation (2.48 vs 2.46; not significant). Post-implementation mean scores increased from 2.5 to 3.3 (p<0.01). Baseline scores were similar pre- and post-implementation, while end-of-rotation scores improved (p<0.01). Fifty-six students participated in the health equity curriculum; evaluations were sent to all students with an 87.5% response rate; 83.7% agreed or strongly agreed it helped build knowledge, 85.7% agreed or strongly agreed it improved patient care skills, and 89.8% agreed or strongly agreed that topics were relevant to future clinical practice. CONCLUSION:Incorporating a focused health equity curriculum into EM clerkship simulations is feasible, impactful, well-received by students, and improved EPA scores. The curriculum equips learners with tools that can be applied to real-world patient care, which may enhance the physician-patient experience.
INTRODUCTION:Mothers, especially those with marginalized identities, often struggle to meet physical activity (PA) guidelines. We examined feasibility, acceptability, and preliminary efficacy of Moms on the Move (MOMs), a community-based PA promotion intervention targeting Hispanic and Black mothers delivered in partnership with a youth sports organization in Providence, RI. METHODS:Feasibility targets centered around enrollment (i.e., n>30 participants), retention (i.e., >80% of participants through follow-up), and assessment (i.e., collection of PA data from >80% of participants at multiple timepoints), while acceptability targets centered around participant satisfaction (i.e., >80% of participants being satisfied with the intervention). For preliminary efficacy, we assessed weekly minutes of moderate-to- vigorous intensity PA (MVPA) via 7-Day PA Recall (PAR) at baseline, intervention end (8 weeks), and follow-up (12 weeks), and examined within-person changes in MVPA over time using paired T-tests. Stratified analysis was used to examine differences between participants who were already meeting the national guideline of >150 minutes of MVPA per week at baseline and those who were not. RESULTS:We met recruitment (n=35) and retention (94%) targets but only collected PA data at multiple timepoints from 21 participants (64%). Most participants (94%) were satisfied with the intervention, all (100%) said they learned from the program, and all (100%) said they would recommend participation to a friend. Participants who were not meeting the MVPA guideline at baseline (n=12) reported an increase in MVPA at both intervention end (mean change: 110.27 minutes, Cohen's d: 0.89) and follow-up (mean change: 82.09 minutes, Cohen's d: 0.76). CONCLUSIONS:Findings around recruitment, retention, and participant satisfaction were promising, though assessing MVPA via the PAR, which requires a semi-structured interview, proved challenging. Nonetheless, the findings, which also showed that insufficiently active mothers had significantly higher levels of MVPA at intervention end and follow-up, support testing MOMs in a fully powered, randomized controlled trial.
OBJECTIVES:Pre-hospital emergency care depends on reliable infrastructure. On December 11, 2023, the westbound span of the Washington Bridge connecting eastern and western Rhode Island (RI) closed emergently due to structural issues. This study examines the impact of sudden infrastructure failure on Emergency Medical Services (EMS) transport in RI. METHODS:This retrospective observational study used a Rhode Island Department of Health dataset of 911 EMS calls from December 11, 2023 to December 11, 2024. Response-to-scene time, scene-to-destination time, and hospital destination for six months preceding bridge closure, the four days of full closure, and six months after the closure were compared, with additional comparison for the municipalities most likely to use this bridge (the "East Bay"). RESULTS:911-call volume and distribution did not significantly change. Statewide mean response-to-scene times increased from 4.64 min (SD 3.16) pre-closure to 4.88 min (SD 3.14) (p<.001) following full closure, while scene-to-destination times decreased from 10.57 min (SD 6.84) to 10.04 min (SD 6.64) (p<.001). No significant statewide differences were observed during the full- closure period. The East Bay, however, saw significantly increased scene-to-destination times during full closure and post-closure (17.00 min, SE=6.59; and 15.97 min, SE=7.04, compared to 14.97 min, SE=6.75 pre-closure, p<.001). Response-to-scene times in the East Bay did not significantly change. East Bay EMS decreased the use of general adult hospitals requiring travel over this bridge without significant difference in transport to specialty hospitals. CONCLUSIONS:This study demonstrates that major infrastructure failures significantly affect ambulance transport times and destination patterns, highlighting the need to understand infrastructure vulnerability in emergency planning.
BACKGROUND:Simultaneous rupture of multiple major tendons is exceedingly rare and is typically associated with high-energy trauma or underlying systemic disease. This report describes the management and outcome of an unusual low-energy, three-tendon rupture involving the quadriceps, patellar, and triceps tendons in a professional bodybuilder. CASE:A 36-year-old male professional bodybuilder presented after slipping on ice with acute loss of bilateral knee extension and right elbow extension. Physical examination and imaging confirmed complete rupture of the left quadriceps tendon, right patellar tendon, and right triceps tendon. The patient underwent single-stage surgical repair of all three tendons, utilizing transosseous fixation for both knee tendons and a suture anchor construct for the triceps tendon, followed by a tailored rehabilitation protocol. Functional and radiographic outcomes were assessed over one year. At one year, the left quadriceps and right triceps demonstrated a full range of motion and strength, allowing the patient to return to work without limitation. Imaging of the right patellar tendon demonstrated proximal tendon discontinuity and patella alta, consistent with repair failure. Despite this, the patient maintained 5/5 quadriceps strength, intact straight leg raise, and reported no limitations in daily activities, likely due to compensatory stabilization from an intact retinaculum. Revision surgery was recommended but deferred. CONCLUSION:This case demonstrates that simultaneous multi-tendon rupture can occur after low-energy trauma in the absence of identifiable systemic disease. Early clinical suspicion supported by imaging and coordinated surgical and rehabilitative management can yield meaningful functional recovery, even in the presence of radiographic failure. LEVEL OF EVIDENCE:IV.
Vitamin D plays a vital role in numerous physiological processes, including immune function, cardiovascular health, and bone maintenance. The adequacy of its status has been strongly associated with morbidity and mortality across diverse populations, particularly among individuals with chronic kidney disease (CKD). Given the kidneys' critical role in vitamin D metabolism and homeostasis, deficiency is highly prevalent in this population and has been linked to adverse outcomes and poor survival. In this review, we provide a comprehensive overview of vitamin D, its sources, metabolism, physiological actions, and clinical management of its deficiency or insufficiency, with a specific focus on patients with CKD.
