Christopher Donald Stave

Family navigation (FN) has emerged as a promising intervention for reducing barriers and addressing social and economic inequities in autism service delivery. Little is known regarding the implementation and effectiveness of FN for children with autism. The aims of this scoping review are to: (1) summarize the breadth, quantity, and characteristics of the existing literature on FN for children diagnosed with autism; (2) describe the models and outcomes of FN for this population; and (3) identify knowledge gaps and provide directions for future research. Authors used Arksey and O'Malley's methodological framework for scoping reviews. Searches were conducted in PubMed, CINAHL, Embase, Social Services Abstracts, and Web of Science, resulting in identification of 308 papers. Two independent raters completed title/abstract and full-text screenings. Data was extracted using a researcher-developed tool. Results synthesis involved content and construct analysis and descriptive numerical summaries. 17 publications met inclusion criteria. Among these, seven studies evaluated FN models delivered by professional or peer navigators. Three studies investigated FN tools. The remaining seven papers included five qualitative and two mixed methods studies that provided valuable insights on improving FN programs. Overall, studies on FN models reported positive impacts on family activation and well-being, knowledge, and service access and utilization. None addressed improvements in child developmental status or behavioral profiles. FN is a promising intervention for improving family outcomes and increasing service access and utilization. Further research is needed to establish best practices, identify child- and family-centered outcome metrics, and promote scalability and sustainability.

Background: Precision medicine, sometimes referred to as personalized medicine, is rapidly changing the possibilities for how people will engage health care in the near future. As technology to support precision medicine exponentially develops, there is an urgent need to proactively improve our understanding of precision medicine and pose important research questions (RQs) related to its inclusion in the education and training of future emergency physicians.Methods: A seven‐step process was employed to develop a research agenda exploring the intersection of precision and emergency medicine education/training. A literature search of articles about precision medicine was conducted first, which informed the creation of future four scenarios in which trainees and practicing physicians regularly discuss and incorporate precision medicine tools into their discussions and work. Based on these futurist narratives, potential education RQs were generated by an expert panel. A total of 59 initial questions were subsequently categorized and refined to a priority list through a nominal group voting method. The top/priority questions were presented at the 2023 SAEM Consensus Conference on Precision Medicine, Austin, Texas, for further input.Results: Eight high‐value education RQs were developed, reflecting a holistic view of the challenges and opportunities for precision medicine education in the knowledge, skills, and attitudes relevant to emergency medicine. These questions contend with topics such as most effective pedagogical methods; intended resulting outcomes and behaviors; the generational differences between practicing emergency physicians, educators, and future trainees; and the desires and expectations of patients.Conclusions: Emergency medicine and emergency physicians must be prepared to understand precision medicine and incorporate this information into their “toolbox” of thinking, problem solving, and communication with patients and colleagues. This research agenda on how best to educate future emergency physicians in the use of personalized data to provide optimal health care is the focus of this article.

Importance Studies of brain imaging and movements during REM sleep indicate basal ganglia involvement in pediatric acute-onset neuropsychiatric syndrome (PANS). Characterizing neurological findings commonly present in patients with PANS could improve diagnostic accuracy. Objective To determine the prevalence of neurological soft signs which may reflect basal ganglia dysfunction (NSS-BG) in youth presenting with PANS and whether clinical characteristics of PANS correlate with NSS-BG. Design, Setting, and Participants: 135 new patients who were evaluated at the Stanford Children’s Immune Behavioral Health Clinic between November 1, 2014 and March 1, 2020 and met strict PANS criteria were retrospectively reviewed for study inclusion. 16 patients were excluded because they had no neurological exam within the first three visits and within three months of clinical presentation. Main Outcomes and Measures The following NSS-BG were recorded from medical record review: 1) glabellar tap reflex, 2) tongue movements, 3) milkmaid’s grip, 4) choreiform movements, 5) spooning, and 6) overflow movements. We included data from prospectively collected symptoms and impairment scales. Results The study included 119 patients: mean age at PANS onset was 8.2 years, mean age at initial presentation was 10.4 years, 55.5% were male, and 73.9% were non-Hispanic White. At least one NSS-BG was observed in 95/119 patients (79.8%). Patients had 2.1 NSS-BG on average. Patients with 4 or more NSS-BG had higher scores of global impairment (p=0.052) and more symptoms (p=0.008) than patients with 0 NSS-BG. There was no significant difference in age at visit or reported caregiver burden. On Poisson and linear regression, the number of NSS-BG was associated with global impairment (2.857, 95% CI: 0.092-5.622, p=0.045) and the number of symptoms (1.049, 95% CI: 1.018-1.082, p=0.002), but not age or duration of PANS at presentation. Conclusions and Relevance We found a high prevalence of NSS-BG in patients with PANS and an association between NSS-BG and disease severity that is not attributable to younger age. PANS may have a unique NSS-BG profile, suggesting that targeted neurological exams may support PANS diagnosis. Question Do patients with pediatric acute-onset neuropsychiatric syndrome present with neurological soft signs reflective of basal ganglia dysfunction, and are these examination findings associated with disease severity? Findings In this cohort study of 119 patients with pediatric acute-onset neuropsychiatric syndrome, most patients presented with at least one neurological soft sign pertaining to the basal ganglia. The number of signs was associated with global impairment and the number of PANS symptoms. These findings are consistent with basal ganglia pathology in pediatric acute-onset neuropsychiatric syndrome. Meaning Targeted neurological exams may help support the diagnosis of pediatric acute-onset neuropsychiatric syndrome.

Introduction: As interest in medicine grows, admissions committees must review an increasingly competitive pool of medical school and residency candidates. Nearly all admissions committees have moved towards a holistic review, which considers an applicant's experiences and attributes in addition to academic metrics. As such, identifying nonacademic predictors of success in medicine is necessary. Parallels between skills necessary to succeed in athletics and in medicine have been drawn, including teamwork, discipline and resiliency. This systematic review synthesises the current literature to evaluate the relationship between participation in athletics and performance in medicine. Methods: The authors searched five databases to conduct a systematic review following PRISMA guidelines. Included studies assessed medical students, residents or attending physicians in the United States or Canada and used prior athletic participation as a predictor or explanatory variable. The review examined associations between prior athletic participation and outcomes in medical school, residency and/or as an attending physician. Results: Eighteen studies evaluating medical students (78%), residents (28%) or attending physicians (6%) met inclusion criteria for this systematic review. Twelve (67%) studies specifically assessed participants based on skill level, and five (28%) studies specifically assessed participants based on type of athletic participation (team versus individual). Sixteen studies (89%) found that former athletes performed significantly better than their counterparts (p < 0.05). These studies found significant associations between prior athletic participation and better outcomes in multiple performance indicators, including exam scores, faculty ratings, surgical errors and burnout. Conclusions: Current literature, although limited, suggests that prior participation in athletics may be a predictor of success in medical school and residency. This was demonstrated through objective scoring methods, such as USMLE, and subjective outcomes, such as faculty ratings and burnout. Specifically, multiple studies indicate that former athletes demonstrated increased surgical skill proficiency and decreased burnout as medical students and residents.

Vulnerable populations face significant challenges in getting the healthcare they need. A growing body of implementation science literature has examined factors, including facilitators and barriers, relevant to accessing healthcare in these populations. The purpose of this scoping review was to identify themes relevant for improving implementation of healthcare practices and programs for vulnerable populations. This scoping review relied on the methodological framework set forth by Arksey and O’Malley, and the Consolidated Framework for Implementation Research (CFIR) to evaluate and structure our findings. A framework analytic approach was used to code studies. Of the five CFIR Domains, the Inner Setting and Outer Setting were the most frequently examined in the 81 studies included. Themes that were pertinent to each domain are as follows—Inner Setting: organizational culture, leadership engagement, and integration of the intervention; Outer Setting: networks, external policies, and patients’ needs and resources; Characteristics of the Individual: knowledge and beliefs about the intervention, self-efficacy, as well as stigma (i.e., other attributes); Intervention Characteristics: complexities with staffing, cost, and adaptations; and Process: staff and patient engagement, planning, and ongoing reflection and evaluation. Key themes, including barriers and facilitators, are highlighted here as relevant to implementation of practices for vulnerable populations. These findings can inform tailoring of implementation strategies and health policies for vulnerable populations, thereby supporting more equitable healthcare. People with certain physical or mental health conditions and/or socioeconomic challenges can experience poor health outcomes (herein referred to as vulnerable populations). A growing body of research has focused on the evaluation of implementation of practices and programs among vulnerable populations; however, little work has summarized the factors that impact successful implementation. This scoping review takes advantage of a structured framework, the Consolidated Framework for Implementation Research, to organize relevant implementation factors from implementation studies among vulnerable populations into one of five categories: inner setting, outer setting, intervention characteristics, characteristics of the individual, and process. Overall, findings showed that engagement in the intervention must occur at all levels of the organization with careful planning and evaluation. Successful implementation requires facilitating a supportive culture, belief in the intervention, and self-efficacy from the providers and patients. Stigma, patient needs, and practical issues of staffing and cost for the intervention are common barriers to be addressed. Findings from this review provide guidance for future implementation efforts among vulnerable populations and inform health policies to support more equitable health care.

The COVID-19 pandemic has brought substantial attention to the systems used to communicate biomedical research. In particular, the need to rapidly and credibly communicate research findings has led many stakeholders to encourage researchers to adopt open science practices such as posting preprints and sharing data. To examine the degree to which this has led to the adoption of such practices, we examined the “openness” of a sample of 539 published papers describing the results of randomized controlled trials testing interventions to prevent or treat COVID-19. The majority (56%) of the papers in this sample were free to read at the time of our investigation and 23.56% were preceded by preprints. However, there is no guarantee that the papers without an open license will be available without a subscription in the future, and only 49.61% of the preprints we identified were linked to the subsequent peer-reviewed version. Of the 331 papers in our sample with statements identifying if (and how) related datasets were available, only a paucity indicated that data was available in a repository that facilitates rapid verification and reuse. Our results demonstrate that, while progress has been made, there is still a significant mismatch between aspiration and the practice of open science in an important area of the COVID-19 literature. Open Materials We are committed to making the details of our research process as open as possible. The data and code that underlie our analyses are archived and published through the Dryad Data Repository (https://doi.org/10.5061/dryad.mkkwh7137). Documentation and instructions for manuscript screening and data extraction are available on Protocols.io (https://dx.doi.org/10.17504/protocols.io.x54v9jx7zg3e/v1). Author contributions are outlined in Supplementary Table 1.