Taren Swindle

The science of deimplementation—reducing harmful or ineffective practices—has focused almost exclusively on clinical prescribing, with no studi

Background: The reflection spectroscopy (RS)-based skin carotenoid score (SCS) has been validated to assess carotenoid intake. However, associations between the SCS and individual dietary carotenoid species have been inconsistently reported in the previous literature. This study examined the utility of using a carotenoid screener along with RS to assess individual dietary carotenoid species intake among U.S. adults. Methods: Adults (N = 280) from eight U.S. sites completed a 44-item carotenoid intake screener to estimate total and individual dietary carotenoid intake (α-carotene, β-carotene, β-cryptoxanthin, lutein + zeaxanthin, and lycopene) over the past 7 days. Each participant’s SCS was measured using two Veggie Meter^® devices. Spearman’s Rank correlation tests and linear mixed models with a random intercept for site were conducted. Results: Mean (± Standard Deviations) carotenoid intake ranged from 21,226.8 ± 9914.1 to 28,863.5 ± 22,462.2 µg/day, and mean SCS ranged from 229.2 ± 72.3 to 325.6 ± 94.1 across the eight sites. Participants’ SCS was significantly associated with self-reported total carotenoids (mg)/week (r_s = 0.2 and B = 0.11; p < 0.01) and with all individual carotenoids (r_s ranged from 0.15 to 0.23, p < 0.01; B ranged from 0.11 to 21.1, p < 0.01), except lycopene. Conclusions: Our findings suggest that combining the carotenoid intake screener with RS may offer a practical approach for assessing individual carotenoid species intake in adults.

Introduction: The impact of guideline-directed medical therapy (GDMT) has not fully translated to decreases in the disproportionate rates of hospitalization and lengths of stay in African Americans with congestive heart failure (CHF). GDMT is optimized by registered nurses (RNs) and their use of clinical information. Yet, there are no instruments for measuring the influence of clinical information use and nursing care. The study assessed an instrument’s ability to measure the influence of RN performance of social, technical, and socio-technical care tasks on length of stay in the CHF hospitalizations of African Americans. Methods: A sample of 200 RNs, who cared for 5060 African Americans with 14,123 heart failure hospitalizations, were surveyed. Descriptive statistics, Cronbach’s alpha, and a generalized linear regression assessed the instrument’s reliability and predictive validity. Results: The Cronbach’s alpha was 0.95 (95% CI: 0.94–0.96). The corrected item-total correlations for the 22 items ranged from 0.44 to 0.80. For an increase of one to four points per item in a RN’s performance, the estimated reductions in the patient’s length of stay were 3.34% (6.11,0.5), 6.58% (11.84,1), 9.70% (17.22,1.49), and 12.72% (22.28,1.99), respectively ( P = 0.004). Conclusions: Increases in a RN’s performance of social, technical, and socio-technical care tasks were significantly associated with clinically meaningful decreases in their patients’ length of stay. The instrument has strong potential for addressing the disproportionate impact of CHF by measuring and tailoring interventions to optimize nursing care and the use of clinical information in the provision and receipt of GDMT.

Background: Adaptive implementation strategies tailor support to setting needs rather than applying a uniform approach. These strategies improve efficiency and fit, yet practical guidance on identifying decision points and tailoring variables is limited. This study collected end-user and partner input to specify decision points and tailoring variables for an adaptive implementation strategy. Methods: This study focused on the evidence-based nutrition program, Together, We Inspire Smart Eating (WISE). End users and implementation partners with prior experience in WISE were recruited in two states to participate in semi-structured interviews or focus groups designed to elicit feedback to specify an adaptive implementation strategy for WISE. Results: Qualitative input supported three crucial decisions for an adaptive implementation strategy: (1) low-intensity support, the starting point for all sites, will include leadership commitments, local champions, an implementation blueprint, classroom reminders, and task-focused facilitation at the site level; (2) assessment of response to low-intensity support will occur in October (Month 3) of the school year; and (3) sites not responding by Month 3 will receive holistic facilitation and tailored educational materials at the teacher level. Participants emphasized the universal need for facilitation at all sites, with struggling sites requiring more. They also identified tailoring variables: sites with fewer than 60% of classrooms achieving fidelity would require high-intensity support. Conclusions: This study illustrates a process for using feedback from end users and partners to define key elements of an adaptive implementation strategy. Our approach holds significant potential to specify strategies for scaling health-related evidence.

Background: The African American population is disproportionately impacted by congestive heart failure (CHF). The impact includes a hospitalization rate that is 2.5 times higher and a hospital stay that is, on average, a quarter of a day longer compared with Caucasians. Notably, nursing care has been associated with nearly a 30% decrease in hospitalizations and readmissions. Previous studies have demonstrated that registered nurses (RNs), working in conjunction with electronic health record systems to conduct care tasks, may optimize length of stay in African Americans with CHF. Objective: This study aimed to identify the needs of RNs who performed sociotechnical tasks, the perceived importance of these sociotechnical tasks, and the perceived performance of these tasks by RNs, in relation to the length of stay of their African American patients with CHF. Methods: The study used an observational, cross-sectional survey design in RNs who were randomly selected from a total population of 3498 RNs who provided care to 22,703 African American patients with CHF within 113,543 heart failure hospitalizations between January 1, 2015, and January 1, 2024. The RNs were retrospectively stratified into 2 groups based on EHR data: those whose African American patients had a mean length of stay of 10 days or less (Group A) and those whose mean length of stay was greater than 10 days (Group B). Descriptive statistics, Cohen d , and a 2-sided unpaired t test were used to analyze the data. Results: The total sample of 200 RNs responded to the survey (100% survey completion rate). Group A (100 RNs) reported the least important task as drawing conclusions about how to use the EHR to care for African American patients (mean 4.66, SD 1.82). The least important task in Group B (100 RNs) was reading published research on African American patients (mean 4.88, SD 1.70). Group A reported performing best in caring for African American patients (mean 5.61, SD 1.44). Group B reported performing best at caring for all patients (mean 5.86, SD 1.04). A total of 17 significant sociotechnical needs were identified among groups. In total, 2 sociotechnical needs were unique to group B: caring for patients (ie, the full scope of social and technological processes in nursing care; Cohen d =0.32, 95% CI 0.04-0.59; P =.04) and working with information related to a patient’s CHF in the EHR (eg, laboratory results, discharge summaries, or radiographic images) to care for the patient (Cohen d =0.33, 95% CI 0.05-0.61; P =.03). Conclusions: Lengths of patient stay may be reduced by identifying and addressing sociotechnical needs through targeted training, nursing care interventions, and RN-led risk stratification guidelines for working with EHRs to reduce lengths of stay in those who are disproportionately impacted by CHF.

Background: Master protocols leverage a common trial infrastructure for launching multiple sub-studies. Translational research aims to progress scientific discoveries toward public health impact, which depends on establishing an intervention’s efficacy, effectiveness in real-world conditions, and successful strategies for implementation. While master protocols have been designed to improve the efficiency of clinical trials as sub-studies addressing a particular disease, their application with effectiveness-implementation hybrid studies is yet to be explored. The aim of this study was to develop recommendations for adapting mater protocol methods for effectiveness-implementation research. Methods: A method of consultation with translational research networks was undertaken between January and December 2024. Consideration was given to the requirements for service providers to engage in translational research, and how master protocols could support effectiveness-implementation hybrid sub-studies. The underlying rationale for potential adaptations is provided with reference to implementation frameworks, discussion of advantages and disadvantages, and summary recommendations. Results: Recommendations are proposed on establishing common trial infrastructure, aims and hypotheses, data collection, control groups, adaptive elements, and eligibility criteria. By leveraging cross-sectoral partnerships, co-producing research and dissemination, and incorporating adaptive elements, master protocols may offer a promising approach for accelerating progress along the translational research pipeline. Conclusions: The adaptation of master protocols for hybrid sub-studies could enable evidence-based interventions to be more effectively implemented in routine care settings. The feasibility of master protocols for effectiveness-implementation research is yet to be tested, and further development in this area is needed to trial the proposed methodology.

This article describes the Implementation Science (IS) Scholars Program at the University of Arkansas for Medical Sciences (UAMS). The program’s goal is to translate knowledge, approaches, and methods from IS to front-line clinicians in an academic medical center, thereby supporting its goals as a learning health system and promoting a dynamic workforce of IS-informed change leaders. Initiated in 2020, the program is relatively unique in that it attempts to translate concepts and knowledge from IS to clinicians to improve their skills as implementers and change agents. The program is supported by the Translational Research Institute, the UAMS’ awardee of the Clinical and Translational Science Award Program. The two-year program provides 20% salary coverage, bespoke didactics, and close mentoring on a Scholar-initiated project to improve care in their clinical context. The program has trained four cohorts of Scholars over the program’s initial five years. We describe the program, our evaluation of it thus far, and future plans. The program has contributed to numerous healthcare improvements and served as a gateway to future implementation and other research activities among some Scholars.