Current Funded College of Nursing Research Projects

Principal Investigator Title (click each link for more info) Sponsor / Type
Bryant, Debbie Chatman Grace Impact Developmental Health Services Program of Berkeley County Coastal Community Foundation of SC/Volvo Grant Fund
Chandler, Jessica Patient Centered Health Technology Medication Adherence Program for African American Hypertensives NIH/NHLBI
Cormack, Carrie Palliative Care Certificate The David R. Clare and Margaret C. Clare Foundation
 
Davidson, Tatiana M
Elder Abuse Assessment Training and MentalHealth Services Program S.C. Office of the Attorney General/Dept. of Crime Victim Assistance Grants
Expanding the Reach of a Novel Mental Health Service for Traumatic Injury Patients Duke Endowment
Web-based Resource to Assist Behavioral Health Providers Work Within Fire Service Organizations Dept. of Homeland Security/Federal emergency Management Agency (FEMA)
Durham, Catherine (Cathy) O. Behavioral Health Workforce Education and Training (BHWET) Program
Health Resources and Services Administration (HRSA)
The Choose Well Initiative
The New Morning Foundation
Fowler, Terry Leveraging an Interprofessional Diabetes Telehealth Service to Optimize Outcomes in High Risk Underserved Patients Duke Endowment
 
 
Kelechi, Teresa J
A Social Genomics Model to Explore Loneliness and Systemic Inflammation in an Older Adult Population with Chronic Venous Leg Ulcers NIH/NINR
Predictive Chronic Wound Monitor for Healing Assessment via Intelligent Sensor Fusion Clemson University and Medical University of South Carolina Artificial Intelligence Pilot Project Initiative
Technology Enhanced Self-Management Interventions for Fatigue and Pain: The Symptoms Self-Management Center
NINR/P20
Technology Enhanced Self-Management Interventions for Fatigue and Pain: The Symptoms Self-Management Center (Supplement) NIH/NINR
Kelechi, Teresa J.
Qanungo, Suparna
Mealtime Partnership for People with Dementia in Respite Centers & at Home NIH/NINR
Kozachik, Sharon Advanced Nursing Education Workforce (ANEW) Program Health Resources and Services Administration (HRSA)
Enhanced Screening, Brief Intervention, & Referral (SBIRT) Training through Multi-Modal Medication Assisted Treatment Instruction Duke Endowment
Mueller, Martina A Randomized Controlled Trial of Electroconvulsive Therapy versus Usual Care for the Acute Management of Severe Agitation in Alzheimer's Dementia (ECT-AD) Sub. McClean Hospital/NIH/NIA
Muzzy, Wendy Peer Social Support During in Vivo Exposure for PTSD: A Program to Address Dropout from Prolonged Exposure US Army/USAMRAA
The Efficacy of 90-Minute vs. 60-Minute Sessions of Prolonged Exposure for PTSD: A Randomized Controlled Trial in Active Duty Military Personnel Sub University of Pennsylvania/Dept. of the Army
Newman, Susan Nurse Faculty Loan Program HRSA
PHOENIX: Development of a Spinal Cord Injury Peer-Supported Self-Management Intervention
Dept. of Health and Human Services (DHHS)/Administration for Community Living
Phillips, Shannon SMYLS: A Self-Management Program for Youth Living with Sickle Cell Disease NIH/NINR - K23
Qanungo, Suparna Implementation of Home-Based Palliative Care in Limited Resource Settings NIH/NCI
Riding, Leigh A Scalable mHealth Resource to Facilitate Behavioral and Emotional Recovery after Pediatric Traumatic Injury
NIH/ Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
 
Ruggiero, Kenneth J.
Bounce Back Now: A Low-Cost Intervention to Facilitate Post-Disaster Recovery NIH/NIMH - R01
Improving Quality of Care in Child Mental Health Service Settings NIH/NIMH
Stecker, Tracy CBT by Phone to Promote Use of Alcohol Related Care and Reduce Drinking Sub. University of Rochester/NIH/NIAAA
Wagner, Janelle Fostering Medication Adherence in Children with Epilepsy using mHealth Technology
Sub. Cincinnati Children’s Hospital Medical Center/NIH/NINR 

Grace Impact Developmental Health Services Program of Berkeley County

Sponsor/Type: Coastal Community Foundation of South Carolina/Volvo Grants Fund
Project Period: 09/01/2019 - 07/31/2021 
Debbie Chatman Bryant, DNP, RN, FAAN

Abstract:

Berkeley County is home to an estimated 219,000 residents and is designated as medically underserved, representing a shortage of primary care providers (2,900:1). Over 20% of Berkeley County residents are uninsured and 12.8% of residents live in poverty. Residents of Berkeley County, especially those that are poor and uninsured, are affected disproportionately by poor health as a result of uneven distribution of resources or social determinants of health (SDOH). SDOH factors such as low literacy, poor housing, low household incomes, the inability to exercise, lack of transportation, and proximity to medical services affect one’s ability to live, work, and access healthcare. These factors contribute to higher rates of chronic disease (diabetes, hypertension). The average commute to access healthcare for residents is 28 minutes. Increased access to primary care is key for management of chronic diseases and improved health outcomes. To increase access to quality primary care in Berkeley County, MUSC's College of Nursing (CON), Grace Impact Development Center (GIDC) and East Cooper Community Outreach (ECCO) in partnership with the South Carolina Telehealth Alliance (SCTA) and Volvo’s Operation Fund, propose establishing a community safety-net primary care clinic in Berkeley County. The clinic will expand on the partnership and success of a primary care clinic established in 2013 by CON and ECCO. The proposed clinic will utilize remote patient monitoring (telehealth) to create a primary care medical home thereby increasing access and reducing SDOH burdens. In the initial year, nurse practitioners (NPs) will staff the clinic quarterly, providing upwards of 192 patient encounters. The site will provide students with hands-on training for primary care delivery systems and experiences in SDOH. Funding will support infrastructure and resources including staff, equipment (remote monitoring glucometers, lancets, and blood pressure monitors), supplies, and high-speed Wi-Fi.

For more information contact Dr. Bryant at bryantdc@musc.edu

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Patient Centered Health Technology Medication Adherence Program for African American Hypertensives

Sponsor/Type: NIH/NHLBI
Project Period: 07/10/2017- 04/30/2021
Jessica Chandler, PhD.

Project Summary/Abstract:

Efforts to improve medication non-adherence (MNA) and blood pressure (BP) control in patients with essential hypertension (EH) have met with limited success. Innovative approaches are needed that are acceptable, sustainable, efficacious, and easily disseminated. There have been no randomized controlled trials (RCTs) evaluating the application of theory-driven, patient centered, mobile health (mHealth) technology programs among African Americans with MNA and uncontrolled EH. The proposed research will test and refine the Smart phone Medication Adherence Stops Hypertension (SMASH) program. SMASH includes multi-level components: 1) automated reminders from an electronic medication tray; 2) tailored text message/voice mail motivational feedback and reinforcement guided by self-determination theory and based upon adherence to daily medication and BP monitoring and 3) automated summary reports and direct alerts to providers. A 6-month, 2-arm (SMASH vs. enhanced Standard Care [SC]) efficacy RCT will be conducted in 192 African Americans (21-59 years old) with MNA and uncontrolled EH. Evaluations will occur at baseline, months 3 and 6, and post-trial follow-ups at months 12 and 18. Specific aims are to test the hypotheses that, compared to the enhanced SC cohort, the SMASH cohort will demonstrate significantly improved and sustained changes in:

  1. Primary Outcome Variables: a)  Medication adherence: percent with electronic monitor-derived adherence scores greater than 0.90; b) BP control: percent meeting JNC8 guidelines for BP control (resting BP less than 140 / 90 mmHg.)
  2. Secondary Outcome Variables: a) percent reaching and sustaining 24-hr ambulatory BP less than 130 / 80 mmHg and b) provider adherence to JNC8 guidelines as measured by timing of medication changes c) patient changes in Self-Determination Theory constructs (e.g., competence and autonomous regulation.)
  3. Exploratory Outcome Variable of cost effectiveness. After final follow-up evaluations, focus groups with random sample of SMASH subjects (n = 30) and healthcare providers (n =~ 12) will assess key user reactions including acceptability, usability, salience and aids/barriers to sustainability. Data from RCT and focus groups will be triangulated to further refine and optimize SMASH and prepare for a multi-site effectiveness RCT. Our long-term objective is to reduce premature mortality among African Americans by developing effective and sustainable mHealth secondary prevention self-management programs for medication adherence and bio-function monitoring (e.g., BP) related to their chronic diseases.

For more information contact Dr. Chandler at chandlje@musc.edu

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Palliative Care Certificate

Sponsor/Type: The David R. Clare and Margaret C. Clare Foundation
Project Period: 09/09/2019 – 09/02/2021
Carrie Cormack, DNP, APRN, CPNP-PC, CHPPN

Project Description:

1) Purpose and goals. MUSC CON will develop a post-Master of Science in Nursing to Doctorate of Nursing Practice (DNP) palliative care track and post-graduate certificate. The National Hospice and Palliative Care Organization (NHPCO) defines palliative care as “patient and family-centered care that optimizes quality of life…and occurs throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs…to facilitate patient…choice” (NHPCO, 2018). Advanced practice registered nurses (APRN) trained in palliative care could fill an important gap in access to evidence-based, high quality care. Nurse Practitioners (NPs) provide holistic, person-centered care, advocate and seek patient goals for care (AACN, 2018a; AANP, 2019) and this correlates perfectly with palliative care (Fennimore, et al., 2018). NPs are licensed to diagnose and treat health conditions with an added emphasis on disease prevention and health management using a comprehensive approach (AANP, 2019).

Research has demonstrated that implementing palliative care early leads to a reduction in costly and preventable hospitalizations, readmission, and emergency department visits (Meier, 2011). It is important to note that hospice care is part of the palliative care continuum. Hospice care specifically addresses the end of life needs whereas palliative care stresses quality of life for the patient and family living with a serious and life-limiting disease from time of diagnosis throughout the trajectory (Meier, 2011). With the aging population living longer and the number of serious illnesses on the rise, the demand for health care services including lifespan palliative care, is expected to rise to an unprecedented high in South Carolina (see below). These changing demographics creates an important need for trained healthcare providers, such as APRNs trained specifically in palliative care with a post-graduate certificates or post-MSN DNP degree, who have the specialized knowledge and skills in providing palliative care, for both adults and children. Unfortunately, it is also well-recognized that there is not a sufficient cohort of trained palliative care healthcare providers to meet those diagnosed with life-limiting illnesses or conditions. The World Health Organization identifies a number of pediatric and adult diseases which benefit from palliative care:

Pediatric - cancer, cardiovascular diseases, cirrhosis of the liver, congenital anomalies, blood and immune disorders, HIV/AIDS, meningitis, kidney diseases, neurological diseases, and neonatal conditions.

Adult - Alzheimer’s and other dementias, cancer, cardiovascular diseases, cirrhosis of the liver, chronic obstructive pulmonary diseases, diabetes, HIV/AIDS, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, and drug-resistant tuberculosis.

The treatment and care a child or adult needs can affect a parent’s or family’s ability to continue working, care for other children and critical relationships (e.g. marriage). Palliative care interventions address these issues and lead to improved quality of life for the child and family.

For more information contact Dr. Cormack at cormackc@musc.edu

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Elder Abuse Assessment Training and Mental Health Services Program

Sponsor/Type: S.C. Office of the Attorney General/Dept. of Crime Victim Assistance Grants
Project Period: 10/01/2020 – 09/30/2021
Tatiana M. Davidson, PhD

Project Description:

Problem Summary:
1. Health care personnel and other professionals such as professional caregivers (CNAs, PCAs) etc., are in a pivotal position to help victims of elder mistreatment because they see virtually every adult over age 60 each year. However, they frequently fail to do so because they are not trained to consistently recognize, assess, and refer to services and

2. Evidence-based counseling services are not readily available, particularly to rural elder abuse victims. We still remain the only specialized evidence-based mental health services program for victims of elder abuse in South Carolina.

Solution:
Training Component: We have implemented since October 2015 a low-cost, easily disseminated and highly sustainable elder abuse identification, intervention, and referral training program designed for
(a) health care professionals already in practice,
(b) healthcare professional students in training in academic settings.

Specifically, we have trained since October 2015 more than 4000 healthcare providers in the tri-county area of Charleston. As an added incentive to engage providers into training we worked extensively in the curriculum and updated in the past year its contents, by working closely with our Continuing Education Office and Web-based educational system “MyQuest” to offer the program in both in person and online versions. In addition, we are offering CME/CE credits which are a tremendous incentive and validation to the training we are offering. Every two years a few must be paid to continue offering the CME/CE credits. We have added this component to our budget. The advantages offered by this our multiple: First, our comprehensive revision have created a version online that can be paced according to the providers available time and needs. The in person though still kept brief, goes a little bit further into addressing specific questions to the providers on site.
Whether in person or online, this training program has been designed in a way that its main components are easily integrated into (a) existing practice sites, particularly those serving low income and minority populations, where risk of elder mistreatment is greatest. In addition, these training protocols are amenable to being delivered to (b) nursing, medical, and physician assistant students as part of their classroom instruction. Finally, for dissemination purposes and incorporation of these methods of evaluation and referral of older adults at risk into the culture of each practice, we propose to train nurse practitioners, residents and junior level healthcare providers to deliver these elder abuse training programs to other health care personnel in their clinical settings.

Components of the Training Program:
Components of the training program are tailored considering provider’s location and serving populations particularly if those are minority or rural groups, and characteristics of the clinics in terms of budgetary and time constraints. In this way we determine feasibility and applicability of the screenings and referral systems. Overall, the components are established based on goals to achieve which are:
• Identification of the signs, symptoms, risk factors, perpetrator characteristics, and mental health outcomes of elder abuse.
• Assessing an older adult with evidence-based validated screening tools such as the Elder Abuse Suspicion Index (EASI).

For more information contact Dr. Davidson at davidst@musc.edu

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Expanding the Reach of a Novel Mental Health Service for Traumatic Injury Patients

Sponsor/Type: Duke Endowment
Project Period: 06/01/2017 – 05/31/2021
Tatiana M. Davidson, PhD

Abstract:

Our primary aim is to implement Trauma/Telehealth Resilience and Recovery Program (TRRP) in three partnering Level I-II trauma centers in South Carolina. TRRP activities include provision of in-hospital education after traumatic injury (Step 1), enrollment in our text-message service to monitor emotional recovery (Step 2), 30-day telephone mental health screen (Step 3), and provision of mental health treatment or referral (Step 4). We will initiate this process with each center by working closely with hospital leadership (i.e., trauma medical director, trauma program manager) and key personnel (e.g., social workers) to determine the optimal approach toward implementing TRRP and identify, record, and address barriers to integration. Most of this planning will focus on optimal procedures supporting the initial brief (i.e., 10 min) educational encounter because all other levels of our service will be provided via various forms of technology. We will document barriers and solutions to implementation at each site to inform future dissemination initiatives.

One full-time coordinator will be hired at each Center to provide TRRP services using funds from The Duke Endowment and MUSC Health Center for Telehealth. Coordinators will complete a 2-week intensive training in TRRP operations at MUSC. Training will include orientation to program goals and procedures, guided reading and discussion, and hands-on supervised experience in the first (in-hospital education) and third (telephone mental health screen) step of TRRP. MUSC staff will provide all support for the second (text messaging) and fourth (mental health treatment) steps of TRRP. Best practice treatment will be offered directly or by referral based, in part, on our capacity and patient preference. We will continue to provide oversight to coordinators throughout the award period and will travel to each site on a quarterly basis to work with hospital leadership and provide booster training. Site coordinators will maintain daily contact with the MUSC team to support program operations.

For more information contact Dr. Davidson at davidst@musc.edu

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Web-based resource to assist behavioral health providers work within fire service organizations

Sponsor/Type: Dept. of Homeland Security/Federal emergency Management Agency (FEMA)
Project Period: 08/22/2018 – 09/17/2021
Tatiana M. Davidson, PhD.

Abstract:

Most fire departments rely on contracted employee assistance programs (EAPs) to fulfill their behavioral health obligations. Some function well but many are seen by departments and firefighters as marginally helpful at best. This project joins resources of the MUSC Center for Firefighter Behavioral Health (CFFBH), the Employee Assistance Professionals Association (EAPA), and a number of fire service collaborators to (a) establish consensus baseline competencies needed to work with fire departments and firefighters, (b) build on proven and successful elements of existing CFFBH projects to deliver effective and accessible preparation for EAP providers, (c) provide a recognizable certification for providers prepared to effectively engage fire service organizations and personnel, and (d) create a registry for departments and firefighters to locate certified providers in their area prepared to effectively serve their unique organizational and behavioral health needs.

For more information contact Dr. Davidson at davidst@musc.edu

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Behavioral Health Workforce Education and Training (BHWET) Program

Sponsor/Type: Health Resources and Services Administration (HRSA)
Project Period: 09/30/2017 – 08/31/2021
Catherine (Cathy) O. Durham, DNP, APRN, FNP-C

Abstract:

This application requests funds to support innovative interdisciplinary academic-practice partnerships to prepare psychiatric mental health nurse practitioner (PMHNP) students in the MSN and DNP at MUSC CON for the professional track. The purpose of this project is to expand lifespan behavioral health workforce through increased longitudinal placements and provide interprofessional training in collaborative practice for students, faculty, and preceptors (field placement supervisors). The BHWET project will provide stipends to PMHNP students who commit to completing their field placement and plan to pursue employment in rural, vulnerable, and/or medically underserved areas (MUA). MUSC CON opened a PMHNP BSN to MSN/DNP program in Fall 2016 and enrolled 11 PMHNP students and 10 new students will be matriculating for Fall 2017. The CON graduated 68 primary care nurse practitioner students during 07/01/16-06/30/17. 100% of graduates from the previous year (07/01/2015 – 06/30/2016) are employed in rural, underserved and public health practice settings with 51% being classified as a HPSAs and 91% as a MUAs. Thus, demonstrating our historical support of these populations. We are requesting special funding consideration based upon the CON’s significant contribution to meeting the needs of the rural and underserved in SC.

The Goals/Objectives for the BHWET grant include:

  1. Provide stipend support to eligible PMHNP students completing final field placement.
  2. Expand community partnerships to increase longitudinal field placements while developing recruitment strategies with AHEC to increase employment for PMHNP students post-graduation in rural, vulnerable, and /or medically underserved areas.
  3. Implement and provide interprofessional collaborative practice training to CON students, faculty and preceptors using enhanced didactic and experiential activities integrating behavioral health and team-based care to increase competencies.
  4. Communicate with other BHWET Program grant recipients to share successes and problem solve any challenges or barriers to ensure optimal program outcomes as part of ongoing quality improvement and evaluation.

Processes and evaluation for the BHWET program will occur as follows:

Objective 1: PMHNP students will be eligible to apply in the final year of full-time or final two years for part-time study. A rubric will be used to rank and fund the top students. Priority points will be awarded to disadvantaged and/or diverse students, and students who live or have clinical rotations in rural areas, MUAs or HPSAs. Students must remain in good standing each semester. All BHWET students will sign a commitment letter (Attachment 8) each funded year. Longitudinal data collected includes post-graduation position placement.

Objective 2: Innovative community partnerships will be expanded.

Objective 3: Didactic and experiential training using the Interprofessional Core Competencies will occur with students, faculty and preceptors.

Objective 4: As part of ongoing project quality improvement, we commit to participating in email, blog and/or HRSA interactive phone conferences to ensure best program outcomes. An annual performance report and final report will be submitted as required.

For more information contact Dr. Durham at durhamc@musc.edu

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The Choose Well Initiative

Sponsor/Type:The New Morning Foundation
Project Period: 01/01/2017 – 12/31/2020
Catherine (Cathy) O. Durham, DNP, APRN, FNP-C

Abstract:

Choose Well is a statewide initiative of the New Morning Foundation, whose goal is to substantially and measurablyreduce unintended pregnancy among women and teens in South Carolina over a 4-year period (2017-2020). This collective impact initiative will involve a wide range of partners, including state agencies and coalitions, health care services, schools and colleges of nursing and medicine, and community-based and community-serving organizations, whose individual and collaborative work will result in better access to highly effective contraceptive methods and a decrease in unintended pregnancy.

For more information contact Dr. Durham at durhamc@musc.edu

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Leveraging an Interprofessional Diabetes Telehealth Service to Optimize Outcomes in High Risk Underserved Patients

Sponsor/Type: Duke Endowment
Project Period: 01/01/2020 – 12/31/2022
Terri Fowler DNP, APRN, FNP-C

Project Summary/Abstract:

Federally Qualified Health Centers (FQHCs) serve underserved communities with complex medical needs. Health disparities in this population demonstrate disproportionally high rates of diabetes-related morbidity and mortality, both of which are preventable with access to expert interprofessional (IP) teams. Unfortunately, the FQHCs that serve these patients often lack such teams. For example, at Fetter Healthcare Network (FHCN), 30% of patients are diagnosed with DM; 63% of these patients are uncontrolled and 32% are markedly uncontrolled (A1C less than 9%), but these patients have limited access to expert-led diabetes care teams such as those in academic health centers. The lack of access increases health disparities and poor health outcomes experienced by underserved populations. Health inequities, minority groups, and persons with lower socioeconomic status have 2-4 times higher rates of diabetes related hospitalizations, amputations, renal disease and death. With Health Resources and Services Administration funding, a pilot telehealth pharmacotherapy program was established at FHCN with MUSC collaboration in 2016 and demonstrated success in integrating the infrastructure and processes for providing telehealth-based care in a FQHC. In 2018, the pharmacotherapy program completed 721 visits across seven FHCN sites with a median A1C decrease of 1.6% per patient. Pharmacotherapy management is one aspect of diabetes; however, diabetes is a complex disease with many issues such as concurrent comorbidities, primary and secondary disease prevention and life-style modifications. The American Diabetes Association and American Association of Clinical Endocrinologists support the use of diabetes management with an expert IP care team. This project will build on the success of the pharmacotherapy program and provide a comprehensive expert IP team approach to diabetes management by leveraging the telehealth model to reach multiple FQHC sites, rather than having to deploy separate teams at each site, thereby meeting patients and providers “where they are at” to improve health outcomes.

For more information contact Dr. Fowler at fowlerte@musc.edu

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A Social Genomics Model to Explore Loneliness and Systemic Inflammation in an Older Adult Population with Chronic Venous Leg Ulcers

Sponsor/Type: NIH/NINR
Project Period: 09/09/2020 – 07/31/2022
Teresa J. Kelechi RN, PhD, FAAN

Project Summary/Abstract:

This application seeks to advance social genomics research by exploring psychosocial stressors, symptoms and biomarkers in a chronic wound population. The most common type of chronic wound is a venous leg ulcer (CVLU), which accounts for 70-80% of the 6.5 million wounds currently being treated in the U.S. at health care costs approaching $25 billion. One of the most common psychosocial stressors is loneliness, which affects 68% of individuals with CVLUs, negatively influencing social relationships and reducing quality of life. Unfortunately, psychosocial stressors are rarely assessed or managed during clinical encounters, and may play a predominant role in the chronic, non-healing state. Loneliness has been linked to systemic inflammation through various molecular pathways such as the upregulation of inflammatory genes. Inflammation is also a well-established biological pathway associated with poor healing suggesting inflammation is a common molecular mechanism that underlies both loneliness and poor wound healing. However, the confluence of loneliness and inflammation in a wound population has not been elucidated. Thus, we hypothesize that substantially heightened inflammation is a common molecular mechanism with a distinct profile that underlies both loneliness and poor wound healing in a chronic wound population compared to a wound population without loneliness. In this application, using a social genomics framework guided by the psychoneuroimmunology (PNI) paradigm and the conserved transcriptional response to adversity (CTRA) model, the aims of our prospective observational longitudinal study are to: examine whether psychosocial stressors (i.e., social isolation, social support) and symptoms (i.e., fatigue, pain, depression, anxiety, sleep disturbance, reduced QOL) differ between lonely (L+) and non-lonely (L-) patients with CVLUs using well-validated questionnaires; characterize a biomarker (chemotaxic factors, growth factors, vascular damage and immune regulators) profile common to L+ and CLVU using well-established RNA sequencing and PCR methods for whole blood samples; and, explore whether age and sex/psychological stressors and symptoms indicate potential moderation/mediation of the effect of loneliness on the biomarker profile, over a 3-month study period, collecting data at 3 time points during wound care. We will also explore demographic and other variables such as age (60 – 74, ≥75 years), sex, chronic illnesses, cognition, health status, functional activity, stigma, nutritional status, length of time to heal (healing trajectory), and wound treatment type across the 3 time points. The long-term objective of this research to better understand molecular mechanisms common to loneliness and inflammation towards development of a biopsychosocial prognostic indicator of healing potential in persons with chronic wounds.

For more information contact Dr. Kelechi at kelechtj@musc.edu

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Predictive Chronic Wound Monitor for Healing Assessment via Intelligent Sensor Fusion

Sponsor/Type: Clemson University and Medical University of South Carolina Artificial Intelligence Pilot Project Initiative
Project Period: 05/15/2020 – 05/14/2021
Teresa J. Kelechi RN, PhD, FAAN 

Project Summary/Abstract:

Chronic wounds present a significant clinical challenge and economic burden (more than $20 billion annually) to the US healthcare system. These wounds are characterized by chronic inflammation and the failure of wounds to close properly. Additionally, multispecies infection exacerbates these wounds and lead to negative clinical outcomes such as amputation. Most patients suffering from these wounds present with comorbidities such as obesity, diabetes mellitus, neuropathy, and vascular disease that further impair the healing process. Approximately 90% of patients with chronic wounds are treated in outpatient clinics and through home healthcare services. Treatment strategies include cleaning, debridement, wound dressing application, negative pressure wound therapy (NPWT, wound vac), casting, orthotic footwear to enable offloading, and antibiotic treatment in the case of infection. Given the nature of these wounds and the patient population, healing can be a long process in which it is critical for patients to be adherent to instructions from their healthcare provider. Adherence becomes more important as clinical and home health care visits become less frequent; thus there exists a critical need to provide patients and healthcare providers with real-time feedback on wound healing between visits to maximize effectiveness of the limited clinical interactions and to improve patient awareness toward proactive adherence in the healing of their wounds.The proposed project will use a machine learning-based approach to build a classification model that connects clinical wound assessment (i.e. visual inspection via wound imaging) with wearable sensor data. The combination of these two wound assessment techniques will give a holistic picture of the progression toward wound healing. This project will employ a convolutional neural network (CNN) to extract critical features from wound images taken with WoundVision, a highly sensitive infrared system currently used in our wound studies. These features will then be arranged into a vector that will serve as a ‘pseudo-sensor’ that can be fused with wearable sensor data to determine the relationship between the two assessment methods. The wearable sensor used in this study is a nonwoven poly-l-lactide nanofiber mat functionalized with wound healing-specific antibodies for specific quantification of vascular endothelia growth factor (VEGF), tissue necrosis factor (TNFα), and transforming growth factor (TGF-β1). The nanofiber mat is screen printed with Carbon nanotube-based conductive ink to create an interdigitated electrode array. A 1 V pk-pk sine wave between 200 Hz – 2000 Hz is then applied across this electrode array to generate an electric field which can be monitored for changes in impedance based on adhesion of target biomolecules. The monitoring of the concentration of these target molecules over time comprises the signal from the wearable sensor and can be combined with image data to characterize wound state, both inside and outside the clinic.

For more information contact Dr. Kelechi at kelechtj@musc.edu

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Technology Enhanced Self-Management Interventions for Fatigue and Pain: The Symptoms Self-Management Center

Sponsor/Type: NINR/P20
Project Period: 08/01/2016 – 04/30/2021
Teresa J. Kelechi RN, PhD, FAAN

Abstract:

The overall goal of the Symptoms Self-Management Center is to build a critical mass of research thematically focused on targeting symptoms of fatigue and pain through complementary, synergistic research activities. Toward this end, the National Institute on Nursing Research-funded (NINR-P20) Symptom Self-Management Center (SSMC) at the College of Nursing, Medical University of South Carolina, provides the infrastructure and context for nurse scientists who will: IDENTIFY groups of patients, who are at risk for chronic disease symptom exacerbation in the areas of fatigue and pain through cutting edge biomedical informatics DEVELOP effective, scalable and sustainable technology enhanced self-management interventions that are accessible to these patients through iterative, patient-centered design approaches; and EVALUATE these in real world community settings through established community partnerships interventions. In other words, the SSMC will deliver novel self-management interventions where they are needed, to whom they are needed, when they are needed. Thus, the SSMC Specific Goals are:

Strengthen the infrastructure within which emerging investigators in self-management interventions can collaborate with biomedical informaticists to use predictive analytic strategies to identify patients suffering from symptoms of fatigue and pain, across a variety of disorders in the early stages of symptom development.

Provide instrumental support for junior and experienced investigators to collaborate with ehealth, mhealth, and web health design experts from the MUSC Technology Applications for Health Lifestyles (TACHL) health-technology center to iteratively design patient centered, technology enhanced self and self/family management interventions.

Build upon the existing community based infrastructure that facilitates enhanced access to and relationships with community partners to develop ecologically valid, natural community laboratories that would otherwise not be feasible to create in the short time frame of pilot projects.

For more information contact Dr. Kelechi at kelechtj@musc.edu

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Technology Enhanced Self-Management Interventions for Fatigue and Pain: The Symptoms Self-Management Center (Supplement)

Sponsor/Type: NIH/NINR
Project Period: 07/15/2020 – 04/30/2021
Teresa J. Kelechi RN, PhD, FAAN

Project Summary/Abstract:

The goal of this study within the supplement is to test the feasibility of a self-managed (SM), electronic/mobile Health (e/mHealth) yoga intervention for reducing stress symptoms (burden) in older caregivers (CG) of people with Alzheimer’s Disease and related dementia’s (PWD). CG burden can exacerbate a myriad of physical and psychosocial comorbidities in CGs as well as PWD neuropsychiatric symptoms. These effects may be further amplified in older CG with underlying health concerns or those who are not able to access programs for effective management of their own medical or self-care needs. Low-impact physical activities such as gentle Yoga (GY) have shown positive effects on mood and symptoms of pain and fatigue in older community dwellers, and digital e/mHealth platforms have a great deal of potential to overcome financial and medical barriers for the delivery SM stress interventions across demographic boundaries. In this study, we will examine the feasibility of a 12-week e/mHealth gentle yoga+yogic breathing (GYYB) intervention for alleviating symptoms of burden in aging CG of PWD (Aim 1); measure initial changes in stress and QoL indicators in CG and PWD (post- vs. pre-intervention) to inform an adequately-powered, future efficacy trial (Aim 2), and; establish a Dyadic Analysis Training Program for MUSC faculty within the College of Nursing and P20 Symptom Self-Management Center (SSMC) to support future research evaluating the influence of care-recipient interactions on health outcomes (Aim 3). Feasibility will be assessed using the RE-AIM framework, and will include measures such as recruitment, adherence, treatment satisfaction, attrition, and feedback for intervention refinement. Data related to CG physical function, fatigue, depression, social isolation, loneliness, relationship quality, burden, and stress biomarkers, as well as PWD and CG QoL, will be collected via daily electronic practice logs and interviews at study beginning and end. Older (> 55 yrs. old) male and female CG (N=20) of PWD regularly attending respite care (RCC) programs will be recruited from an existing study population (R01 NR016466) participating in CG-RCC mealtime partnerships for improved PWD nutritional outcomes. The HIPAA-compliant GYYB intervention will employ ‘tablets’ that allow CG to practice GYYB at home by following along with recorded lessons. CG will initially be trained on the use of the tablet and proper GYYB practices by the study coordinator (in-home), with weekly follow up (Skype/phone) for the duration of the study. This investigation is ideally aligned with the aims of the parent SSMC (P20 NR016575) that are focused on providing infrastructure and community-based resources for design and ecologically-valid testing of SM interventions for individuals with chronic conditions.

For more information contact Dr. Kelechi at kelechtj@musc.edu

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Mealtime Partnerships for People with Dementia in Respite Centers & at Home

Sponsor/Type: NIH/NINR
Project Period: 09/01/2017 – 06/30/2021
Teresa J. Kelechi, PhD, RN, GCNS-BC, CWCN and Suparna Qanungo, PhD

Abstract:

The goal of this study is to test the efficacy of a mealtime intervention (Partners at Meals) in respite care centers (RCCs) that provide a social model of care for people with dementia living in the community and support for their caregivers. Largely staffed by long-time volunteers, these centers support caregivers’ ability to maintain their loved one in the home. Outcomes include improvements in: a) quality of life (QOL) and nutritional outcomes for people with dementia (PWD) and QOL outcomes for family caregivers (CGs); b) self-efficacy training outcomes for assessing and managing meals for the CGs and the RCC volunteers; and c) sustainability outcomes as determined by directors of the RCCs. Two large RCCs with a total of 5 sites of care in suburban and rural areas of SC will be the sites of this project; and 60 PWDs and 60 CGs will be recruited for this cluster-randomized trial, as well as potentially 60 staff and volunteers. Caregiving for PWDs is increasingly occurring in the community by persons who are often not prepared to assume this responsibility. Fortunately, RCCs evolved as a vital community-based resource that provide socialization, meaningful activities, respite for caregivers and at least one meal daily. Mealtime is a particular problem for PWDs because as this life-limiting disease progresses, they lose the functional ability to manage meals and display a variety of challenging behaviors all of which will eventually affect their ability to consume adequate calories and continue the social aspects of meals that connect them to others. A HIPAA-compliant telehealth system using simple ‘tablets’ will allow CGs to capture behaviors and environmental aspects of meals in the home at the time behaviors occur so that plans of care can be tailored to PWD needs. Using a train-the-trainer model, volunteers will be taught to assess the environment (Place), the interactions between the PWD and others (People), and the actions of the PWD (Person). They will then train the CGs to make those observations so they can tailor and change mealtimes in the home – the telehealth component supports this. Thus this project could be used in the community as a model for behavior modification for other dysfunctional behaviors in the home. This study proposes to examine the following aims: (Primary) Compared to participants in ‘enhanced usual care’ sites, PWD participants in the intervention sites will demonstrate improvement in nutritional status and dysfunctional behaviors, and QOL; (Secondary) a) CGs will report improve QOL and self-efficacy for managing meals, and decreased depression and burden; c) RCC volunteers will report improved self-efficacy for training and management of feeding issues; and d) Directors will report satisfaction with the program and willingness to continue the program post-funding. Additionally, hospitalizations and discharges related to nutrition-related issues among PWDs will be collected for future work.

For more information contact Dr. Kelechi kelechtj@musc.edu or Dr. Qanungo at qanungo@musc.edu

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Advanced Nursing Education Workforce (ANEW) Program

Sponsor/Type: Health Resources and Services Administration (HRSA)
Project Period: 07/01/2017 – 06/30/2023
Sharon L. Kozachik, MSN, PhD, RN, FAAN

Abstract:

This application requests $2.5 million to support innovative academic-practice partnerships to prepare primary care APRN students in the MUSC CON DNP program. The purpose is to increase the longitudinal clinical immersive training experiences with rural and/or underserved populations for selected primary care (PC) APRN students, implement a clinical preceptor orientation and support program, and facilitate post-graduate employment and follow-up in rural and HPSA and/or MUA in four nurse practitioner roles: AGNP, FNP, PMHNP, and PNP. The ANEW project will provide traineeships to 16-18 students who commit to at least two years of primary care work in a rural and HPSA and/or MUA. CON graduated 55 APRN students during 07/01/17-06/30/18; 100% are employed in rural, underserved and public health settings, and 84% are employed in HPSAs and 53% in MUAs (Table 1). Since 2010, CON has funded a total of 136 students who received AENT (n=81), ANEE (n=30) and ANEW (n=25) HRSA grants. Currently, 100% of their practice sites are in underserved and public health settings of which 76% are in HPSAs, 82% in MUAs and 24% in rural areas. We are requesting special funding consideration based upon the CON’s significant contribution to meeting the needs of the rural and underserved in SC.

The objectives for the ANEW grant include:

Establish or enhance at least 1 innovative academic/clinical partnership between 1 or more schools of nursing and 1 or more clinical practice partners;
Provide longitudinal immersive clinical training experiences for APRN students in community-based settings, including providing support through traineeships;
Recruit, train, develop, support, and evaluate preceptors as program partners to enhance community-based clinical and didactic nursing education;
Connect APRN graduates with resources to assist employment in rural and underserved areas;
Follow up on graduates’ careers to determine retention in nursing practice and in rural/underserved communities for at least 1-year after graduation.
Processes and evaluation for the ANEW program will occur as follows:

Objective 1. CON will continue to partner with SC AHEC for clinical placements for APRN students and support students’ participation in AHEC’s Institute for Primary Care, promoting interprofessional development and AHEC’s Scholars program. We are establishing a new partnership with MUSC Family Medicine Clinic and an innovative partnership with Francis Marion University Graduate Nursing Program to disseminate our online APRN telehealth curriculum.

Objective 2: Full-time APRN students at any program point and part-time students in the last year will be eligible to apply. A rubric will rank the top students. Priority points will be awarded to disadvantaged and/or diverse students, and students who live in or have clinical rotations in rural areas, MUAs or HPSAs. Students will be tracked and registered each semester. Support during training includes enhanced curriculum experiences in palliative care, substance abuse, and telehealth. Students will sign a commitment letter (see Workplan & Budget Justification) each funded semester. Longitudinal data to be collected includes post-graduation position placement. An annual performance report and final report will be submitted as required.

Objective 3: The online clinical preceptor orientation will be implemented in fall 2019 after pilot testing in spring 2019. The program will be housed on the AHEC website. Preceptors will earn a certificate upon completion; they are also invited to events for faculty at CON, the annual faculty telehealth conference, and CON’s online SBIRT/Opioid training modules at no cost.

Objective 4: We will disseminate a recruitment program we developed with AHEC for NP/PA/medical students to encourage post-graduation primary care employment in rural, MUA and HPSA areas. Students will also be oriented to the HRSA Healthcare Workforce Connector to assist with finding employment.

Objective 5: Student Services maintains communication with CON graduates and distributes the annual Alumni Survey to ascertain employment location and measures such as committee work, presentations/publications, and evaluation of skills used and/or needed in practice. CON will obtain graduates’ NPI numbers to track employment.

For more information contact Dr. Kozachik at kozachik@musc.edu

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Enhanced Screening, Brief Intervention, & Referral (SBIRT) Training through Multi-Modal Medication Assisted Treatment Instruction

Sponsor/Type: Duke Endowment
Project Period: 01/01/2018 – 06/30/2021
Sharon L. Kozachik, MSN, PhD, RN, FAAN

Abstract:

Problem or opportunity addressed. Addiction problems are outpacing healthcare providers’ abilities to treat them. This is due, in large part, to deficits in healthcare provider education and training programs on primary care-based addiction intervention. 21.6 million Americans have a substance use problem and less than 20% receive treatment, but most present to primary care at some time during their addiction. Failure to offer screening and treatment during these visits represents a missed opportunity. SBIRT is ranked as the third highest prevention priority for adults based on preventable disease burden and cost-effectiveness. With Substance Abuse and Mental Health Services Administration funding, the MUSC Training Team (TT) has fully integrated SBIRT training into the Colleges of Medicine and Nursing curricula, and trained MUSC faculty and community preceptors. Since October 2015, over 950 MUSC students, faculty and community preceptors have been trained in SBIRT. Student feedback via evaluations and focus groups has been excellent. The next step is to address the opioid epidemic which takes more than 30,000 lives/year in the US. Evidence based MAT is a combination of medication and behavioral therapies effective in substance use disorder (SUD) treatment requiring specialized training. With few providers currently prepared to provide MAT services (e.g., there are ONLY TWO in SC), the 2016 Comprehensive Addiction and Recovery Act (CARA) provided for waivers that would allow physicians, nurse practitioners (NPs) and physician assistants (PAs) to become certified MAT practitioners and increase MAT patient load. This content is lacking in the MUSC healthcare provider education. The MUSC TT is fully integrated and is perfectly poised to distribute this critical knowledge and skills to the current and future health care providers who will serve SC and the country.

Population served. Within the first year of the project, the curriculum will be enhanced to include opioid crisis content (prevention, MAT, overdose reversal medications, and other recovery support services/resources) and will target medical and nursing students who will be future providers, as well as their faculty and preceptors. The project will expand in Year 2 to other colleges to include PAs and Dental students, as well as state-wide training to MD providers registered nurses, advanced practice nurses, and PAs. Implementation of the evidence-based training program will decrease disparities in access to care, improve health outcomes for the active and at-risk SUD population, and encourage primary care providers to seek further education and certification as MAT certified providers.

Program design and goals/objectives. The purpose of this project is to produce and build the current healthcare workforce to provide culturally competent care to the active and at-risk SUD population, including opioid users. The trainers will attend a SAMHSA-supported MAT train-the-trainer program and utilize SAMHSA materials to assemble asynchronous (i.e., at trainee convenience) online and live trainings. Year 1: Staff training and curriculum development will occur; the training program will be piloted with a pilot cohort, of 50 medical students, 50 nursing students, 10 faculty, and 10 preceptors. Year 2: The program will be introduced to other colleges, with180 medical students, 250 nursing students, 40 PA students, 50 Dental students, 50 faculty and 50 preceptors will be trained. Year 3: 180 medical students, 250 nursing students, 40 PA students, 50 Dental students, 50 faculty, 50 preceptors and 100 health professionals throughout SC will be trained. It is imperative to include faculty and community preceptors in training to institute the “train the trainer model” to ensure faculty and preceptors practice this critical public health intervention, role model to students, and understand the role of MAT.

For more information contact Dr. Kozachik at kozachik@musc.edu

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A Randomized Controlled Trial of Electroconvulsive Therapy versus Usual Care for the Acute Management of Severe Agitation in Alzheimer's Dementia (ECT-AD)

Sponsor/Type: Sub. McClean Hospital/NIH/NIA
Project Period: 09/30/2018 – 05/31/2023
Martina Mueller, PhD

Abstract:

Alzheimer's dementia (AD), the most prevalent neurodegenerative disease of aging, affects cognition, emotion, and behavior. Agitation is a common behavioral syndrome that frequently emerges during middle to late stage AD and is characterized by psychomotor hyperactivity, aggression, irritability, yelling, resistance to care, and insomnia. The untoward consequences of agitation and related behavioral disturbances are considerable and include impaired quality of life, accelerated cognitive decline, heightened risk of institutionalization, and increased morbidity and mortality. Agitation also increases caregiver burden, including stress and deleterious health consequences. However, despite the damaging impact of agitation on the patient and caregiver, current treatments have only modest efficacy. Behavior management strategies are widely employed, but effective only in mild cases. Antipsychotics, the most commonly used class of medication for agitation and psychosis in dementia, have demonstrated mixed results in controlled studies and are associated with elevated morbidity and mortality. Thus, there is a clear need for improved interventions, particularly for severe agitation in AD. Electroconvulsive Therapy (ECT) is a safe and effective intervention for severe mood disorders in later life, including depression complicated by psychosis, mania or catatonia. Concerns regarding adverse cognitive effects of ECT, however, have limited ECT's clinical use in treating dementia with agitation. Both retrospective and prospective studies conducted by our group support the safety and efficacy of ECT in patients with AD and severe agitation. ECT, therefore, may represent an effective treatment of severe agitation in AD. We propose a five-site, randomized, single-blind, controlled clinical trial to determine the safety and efficacy of ECT plus usual care compared with Simulated ECT (S-ECT) plus usual care in 200 hospitalized individuals with moderate to severe stage AD, probable Alzheimer's type (based on NIA-AA criteria), complicated by severe agitation.

Subjects will be randomized to either (1) ECT for three weeks (up to 9 ECT treatments) plus usual care (UC), defined as standard behavioral therapy and pharmacotherapy or (2) Simulated ECT (S-ECT) plus UC. Primary efficacy will be measured with the Cohen-Mansfield Agitation Inventory (CMAI). Safety parameters include daily assessment of delirium (Confusion Assessment Method, CAM), cognition (Severe Impairment Battery, SIB-8) and serious adverse events. A 12-week follow-up includes monthly assessments to explore stability of agitation reduction.

For more information contact Mrs. Mueller at muellerm@musc.edu

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Peer Social Support During In Vivo Exposure for PTSD: A Program to Address Dropout from Prolonged Exposure

Sponsor/Type: US Army/USAMRAA
Project Period: 03/15/2018 – 03/14/2022
Wendy Muzzy, MRA, MLIS

Abstract:

Background: Post-traumatic Stress Disorder (PTSD) is a significant problem for Veterans and Active Duty personnel. Although effective treatments for PTSD exist (e.g., Prolonged Exposure, PE; Cognitive Processing Therapy; CPT) and have, at great expense, been widely disseminated by VA and DoD, over of those 30% who start treatment subsequently drop out prior to completion.
In our first preliminary study we addressed published survey data from Veterans indicating that dropout was related to logistical barriers such as travel time, cost, and stigma associated with care from mental health settings, and so overcame these barriers by delivering treatment via home based telehealth. However, dropout remained virtually unchanged. Veterans in our study who dropped out of treatment, including that delivered via home based telehealth, were interviewed and a majority responded that they would (a) consider returning to treatment and (b) would be more likely to complete treatment if a peer who had themselves successfully completed treatment were available to help them with exposure homework.

In keeping with this feedback, our second preliminary study examined the feasibility of using peers to (a) encourage Veterans who had dropped out of PE to return to treatment and (b) offer support during in vivo (real world) exposure therapy homework assignments (e.g., as they would during ‘gym workouts’). Preliminary findings indicate that such an approach is feasible, and potentially effective, in that over 50% of dropouts from PE agreed to return to treatment and 30% of these actually did so immediately.

Objective: We propose to evaluate whether the opportunity to receive social support duringin vivo exposure therapy homework from Veterans who themselves have successfully competed PE (i.e., the therapeutic equivalent of an exposure therapy ‘workout buddy’) is effective in reversing dropout and improving PTSD outcomes; and, secondarily, to determine whether this program is particularly helpful for those receiving PE via telemedicine.

Study Design: We will use a between group, randomized controlled repeated measures design comparing PE+Exposure Workout Buddy vs. Supportive Counseling (the standard treatment referral option for PE dropouts) to evaluate the ‘PE+Exposure Workout buddy’ adjunctive therapy component in terms of its ability to increase likelihood that veterans will (a) return to and complete treatment & (b) evince reduced PTSD Symptomatology at post, 3&6 month followup.

Specific Aims: Aim 1: To determine relative differences in treatment dose obtained, measuredin terms of the number of sessions completed upon return to treatment, in response to ‘PE+ Exposure Therapy Workout Buddy’ vs. ‘Supportive Counseling’ in individuals who have previously dropped out of evidence based treatment for PTSD. Aim 2: To determine differential effectiveness, measured in terms of therapeutic gains over time on measures of PTSD symptomatology, of ‘PE+ Exposure Workout Buddy’ with therapy dropouts in (i.e., ‘treatment outcome’). Exploratory Aim 3. To determine the presence of an initial signal of differential dose and effectiveness of ‘PE+ Exposure Therapy Workout Buddy’ when delivered in traditional in person (face to face) vs. telemedicine formats.

Hypotheses: Hypothesis1: Treatment ‘dose’, measured in terms of number of sessions completed post randomization, will be greater for participants in the PE+ Exposure Workout Buddy condition compared to the Supportive Counseling condition. Hypothesis 2: Treatment ‘outcome’, measured in terms of PTSD symptom reduction scores, will be significantly more improved for participants in the PE+ Exposure Workout Buddy relative to Supportive Counseling condition at each assessment point (post treatment, 3 month and 6 month followup).

Relevance: Military: If the present intervention, which builds upon the teamwork and leadership skills implicit in military training, is effective in retaining individuals in treatment who otherwise would drop out, then we may well be able to dramatically address the high dropout rate from our most effective class of interventions, and thus significantly enhance our ability to sustain force strength.Civilian: Findings from this study will potentially provide direction to reducing the high dropout rate from evidenced based treatment for PTSD among rape victims, accident victims, victims of natural disaster, and victims of terrorist acts. As such, the public impact of this project’s findings are potentially enormous. 

For more information contact Mrs. Muzzy at muzzy@musc.edu

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The Efficacy of 90-Minute vs. 60-Minute Sessions of Prolonged Exposure for PTSD: A Randomized Controlled Trial in Active Duty Military Personnel

Sponsor/Type: Sub. University of Pennsylvania (PENN)/US Army/USAMRAA
Project Period: 10/17/2017 – 03/30/2021
Wendy Muzzy, MRA, MLIS

Abstract:

PTSD among active military personnel has devastating effects on multiple aspects of functioning, making it imperative to increase access to evidence-based treatments for military personnel. Prolonged Exposure (PE) is the most available evidence-based treatment, but the standard 90-minute PE session format constitutes a significant barrier to its implementation in military settings, which typically use 60-minute appointment sessions. Thus, reducing PE sessions from 90 minutes to 60 minutes would remove a major barrier to the adoption of PE in the military. The proposed study is a 2-group, prospective, randomized, controlled, non-inferiority trial, comparing 60 vs. 90-minute PE sessions. This trial will consent 200 active duty military personnel with PTSD with the intent to randomize 160 equally into one of the two treatment arms.

The main aims of this study are:

  1. To investigate the efficacy and efficiency (i.e., rate of improvement) of 60 vs. 90-minute PE sessions (including 20 vs. 40-minute imaginal exposures, respectively)
  2. To compare pre-/post- psychophysiological markers of treatment response 
  3. To test mechanisms of PE by investigating the associations between objective (i.e., psychophysiological) and subjective (i.e., self-report ) measures of extinction-related arousal, changes in cognitions, and clinical outcomes.

The results of this study will inform dissemination efforts of evidence-based treatment in the military as well as in the public sector. Identifying mechanisms of therapeutic change will answer important theoretical questions about how PE works, in order to refine and improve PE to better meet the needs of afflicted service members.

For more information contact Mrs. Muzzy at muzzy@musc.edu

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Nurse Faculty Loan Program

Sponsor/Type: HRSA
Project Period: 07/01/2013 – 06/30/2021
Susan D Newman RN, PhD, CRRN

Abstract:

This application is a funding priority request for financial loan support for students enrolled in a Doctor of Philosophy in Nursing (PhD) degree program and the post-Master’s Doctorate of Nursing Practice Program (DNP) at the College of Nursing (CON), Medical University of South Carolina (MUSC) with a career goal to serve as nurse faculty upon graduation. The CON DNP program is fully accredited by the Commission of Collegiate Nursing Education (CCNE) through June 30, 2026, and all MUSC programs were reaccredited by the Southern Association of Colleges and Schools Commission on Colleges (SACs) through 2027 (Attachment 1).

The objectives for this program are as follows:

Increase the number of graduate doctoral students in the post MSN-DNP, BSN-PhD and MSN-PhD programs who are prepared to become qualified nurse faculty upon program completion by ensuring:

All students who received NFLP funding complete the three educational courses needed for national certification as a nurse educator.

Students who previously completed the three educational courses and are not certified as nurse educators with at least one year of teaching experience are offered the mentored teaching course to gain doctoral level teaching experience.

Processes and evaluation for the program will occur as follows:
Recruitment and student orientation. Following receipt of funds from HRSA, an e-mail and CON electronic newsletter outlining the purpose, criteria and eligibility of the NFLP program is sent out to all PhD and post-MSN DNP students (July). Students are informed how the loan works, and required completion of the service agreement as full-time nursing faculty at an accredited school of nursing. Students then apply by completing a three-page application that includes a statement of commitment to complete the three required nurse educator courses prior to graduation. Students understand a new plan of study will be developed to reflect the change. Previous students will be given priority for funding. New applicants meeting criteria for the loan and completing an entrance interview will be considered on a first come first serve basis, with priority given to those from diverse or disadvantaged backgrounds. Students will be notified (August) and receive information about cancellation provisions, loan default and complete paperwork.

Program requirements and monitoring. Once awarded NFLP loan funding, students’ plans of study will be rewritten with specific educator courses required and signed (August). The Office of Academics will track and register the students each semester with loan funding provided at that time (Fall 2019; Spring and Summer 2020). Students in the program will be asked to re-sign their commitment letters each funded academic year.

Program completion, reports and post-graduation follow-up. Students will be followed at the end of each semester to ensure successful completion of the courses. Five students are scheduled to graduate from the 2018-19 NFLP funding period, and 5 from the 2019-20 funding period. Longitudinal data will include collection of teaching program level for each NFLP graduate completed by the coordinators of the DNP and PhD programs at 4-months post-graduation followed by annually for four years. Bi-annual reports for HRSA will be completed and submitted, (January and July) as required, by the Executive Associate Dean of Academics.

For more information contact Dr. Newman at newmansu@musc.edu

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PHOENIX: Development of a Spinal Cord Injury Peer-Supported Self-Management Intervention

Sponsor/Type: Dept. of Health and Human Services (DHHS)/Administration for Community Living
Project Period: 09/30/2017 – 09/30/2021
Susan D. Newman, PhD, RN, CRRN

Project Abstract:

The goal of this 2-phase, 3-year proposal is to develop and pilot test, in partnership with the South Carolina Spinal Cord Injury (SCI) Association, a SCI Peer Navigator intervention for implementation across South Carolina, integrating online and telehealth platforms. Our Peer-supported Health Outreach, Education, aNd Information eXchange (PHOENIX) intervention, which builds on our pilot Peer Navigator study, is specifically designed to promote self-management after SCI. The broad goals of PHOENIX are to improve participants’ community participation and quality of life (QOL) and decrease subjective impact and occurrence of secondary conditions and rehospitalization after SCI. During Phase 1, we will complete translation of our existing in-person SCI Peer Navigation program for online and telehealth delivery.

Key objectives of Phase 1 include:

  1. Integration of mobile technology to improve access and reach of PHOENIX
  2. Development of additional multimedia online educational content.

During Phase 2, we will conduct a randomized waitlisted pilot trial to identify potential logistical and methodological issues of both intervention implementation and study procedures in preparation for conducting a future full scale, randomized controlled trial.

Key objectives of Phase 2 include:

  1. Evaluation of feasibility, acceptability, and fidelity of intervention implementation and study design and procedures
  2. Obtaining estimates of variability of relevant outcome measures.

The expected outcomes are that PHOENIX will be feasible and acceptable to participants and stakeholders, and we will observe increased levels of community participation and QOL, and decreased subjective impact and incidence of medically serious secondary conditions and rehospitalizations. The expected products are Peer Navigator training and PHOENIX curriculum housed in the online iTunes U platform. 

For more information contact Dr. Newman at newmansu@musc.edu

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SMYLS: A Self-Management Program for Youth Living with Sickle Cell Disease

Sponsor/Type: NIH/NINR - K23
Project Period: 04/18/2019 – 03/31/2022
Shannon Phillips, PhD, RN

Abstract:

The long-term objectives of this K23: Mentored Patient-Oriented Research Career Development Award are to develop the candidate, Dr. Shannon Phillips, into an independent investigator and prepare her to lead large, rigorously designed, randomized clinical trials with the goal of improving symptoms self-management in children, adolescents, and young adults with sickle cell disease (SCD) and their families. Individuals with SCD often live with burdensome symptoms, such as acute and chronic pain and fatigue. Further, as children with SCD transition into adolescence and adulthood, comorbidities and rates of healthcare utilization increase. Scalable self-management interventions that promote preventive care and reduce comorbidities are critical to improving symptom and self-management, quality of life, and healthcare utilization, consistent with the mission of the National Institutes for Nursing Research. The proposed career development plan was developed with Dr. Teresa Kelechi, primary mentor, and the candidate’s mentorship team of experts in communication, technology, statistics and chronic conditions in special populations.

The plan builds on the candidate’s previous clinical nursing, educational, and research experience to accomplish the following training-specific aims:

  1. Develop expertise in designinginterventions to facilitate symptom and self-management;
  2. Attain skills and knowledge to conduct rigorous, randomized clinical trials;
  3. Enhance knowledge of applying mHealth strategies to reach special populations;
  4. Further develop skills as a scholar, including developing and sustaining collaborative, interdisciplinary relationships
  5. Develop a sustainable program of research with funding as an independent nurse scientist.

Goals will be accomplished through the following training methods: one-on-one, hands-on experience with mentors; participation in local and national conferences, workshops, and institutes; and formal coursework. Outcomes of training will include published manuscripts relevant to the application topic, presentations at local and national conferences, and an NIH R01 submission. The candidate will apply skills obtained during training to the conduct of a pilot study to assess the feasibility of an mHealth intervention for facilitating self-management behaviors in adolescents with SCD. Estimates of variability for measures of transition readiness, physical and psychological symptoms, healthcare utilization, and quality of life will also be obtained. A key focus of the intervention will be on patient-provider communication effectiveness pertaining to self-management development. Training activities and research will take place at a research-intensive institution with extensive resources devoted to early career investigators, including those offered via the CTSA, such as the Technology Applications Center for Healthful Lifestyles and the Special Populations Program. At the conclusion of this award, the candidate will have strong pilot feasibility data and necessary training to be well-positioned to pursue career goals including NIH-funding and a research trajectory in symptoms self-management.

For more information contact Dr. Phillips at phillipss@musc.edu

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Implementation of Home-Based Palliative Care in Limited Resource Settings

Sponsor/Type: NIH/NCI
Project Period: 08/01/2020 – 07/31/2022
Suparna Qanungo, PhD

Product Summary/Abstract:

The extremely limited use of palliative care in low resource settings exacerbates suffering in patients with life-limiting illnesses such as cancer. This is particularly a problem for patients living in rural areas where barriers to care are even more pronounced. These barriers include factors such as distance from a cancer center, lack of healthcare providers in rural communities, restrictive morphine access policies, lack of transportation and treatment costs. For these reasons, most patients living in rural communities never receive palliative care or even basic pain management. In recognition of the urgent need for palliative care in limited resource settings, the World Health Organization released the Palliative Care Toolkit as a resource that community members can use to deliver palliative care in their own communities. The toolkit provides evidence-based educational materials to manage the physical, emotional and practical challenges of life-threatening illnesses, along with data collection instruments to assess and manage patient needs. We will carry out a pragmatic clinical trial to evaluate implementation of a novel Pal-Care intervention that will leverage community health workers to facilitate the delivery of basic palliative care using the Palliative Care Toolkit. The study will be conducted at the Tata Medical Center in Kolkata India, among their patients who reside in the 24 Parganas region outside of Kolkata, India. With randomization at the patient level, there will be an intervention group which will receive home-based palliative care services from a community health worker trained in palliative care and a control group which will receive standard cancer-center based palliative care services. Two specific aims will be evaluated within the study. Aim 1 will be to evaluate implementation of the home-based palliative care intervention within the context of the RE-AIM Framework domains (e.g. Reach, Effectiveness, Adoption, Implementation and Maintenance). To evaluate this aim, we will triangulate data from multiple data sources, including pre-post surveys to evaluate the community health worker training, palliative care logs completed by navigators while delivering care, meeting minutes and post-intervention interviews with cancer center stakeholders (clinical team, health workers and patients/caregivers). Aim 2 will be to evaluate outcomes of this intervention to determine its relative effects compared to a standard control group on diverse patient endpoints, including palliative care needs, symptom burden, quality of life and experience with care.

For more information contact Dr. Qanungo at qanungo@musc.edu

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A Scalable mHealth Resource to Facilitate Behavioral and Emotional Recovery after Pediatric Traumatic Injury

Sponsor/Type: NIH/ Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Project Period: 07/15/2020 – 06/03/2025
Leigh Ridings, PhD

Project Summary/Abstract:

Pediatric traumatic injury (PTI) is a public health priority, with nearly 300,000 children incurring injuries so severe that they require hospitalization each year. PTI is associated with annual individual and societal costs of $87 billion and elevates risk for posttraumatic stress, depression, and other health risk consequences that affect quality of life, physical recovery, emotional and behavioral outcomes, family roles and routines, and academic functioning. Follow-up care for affected children and caregivers is critical to support behavioral and emotional recovery, but few trauma centers provide these services and established, scalable models of care are lacking. Cost-effective, sustainable interventions are needed to reduce barriers to care and reach families that need it most. Pilot data collected by the candidate suggest that a technology-enhanced model of care is appealing to caregivers and has high potential to address service barriers by providing real-time assistance to help caregivers manage their own distress and their children’s behavioral and emotional recovery. The candidate proposes to develop and systematically evaluate CAARE (Caregivers’ Aid to Accelerate Recovery after pediatric Emergencies), an intervention informed by our ongoing clinical initiatives together with results of qualitative semi-structured interviews with caregivers of young children after PTI. CAARE will consist of education, self-monitoring, and coping resources.

Specific aims include:

  1. Finalize the CAARE model and research protocol with ~15 caregivers after PTI;
  2. Pilot test CAARE via an open trial (n=60)
  3. Assess CAARE implementation feasibility with families (n~20), trauma center directors (n~15), and program managers (n~15)

The research environment, facilities, and resources at MUSC are ideally suited for mentored career development in child traumatic stress research.

Dovetailing with the research aims, K23 training objectives are to:

  1. Develop proficiency in clinical trial design, implementation, and evaluation
  2. Eenhance proficiency in the use of iterative-design technology-based solutions
  3. Develop expertise in implementation science
  4. Enhance statistical training in clinical trials, longitudinal analyses, and qualitative data analysis
  5. Expand skills in scientific communication, including grant writing, presentations, and publications

Mentorship and consultation from experts in pediatric trauma, health technology solutions, implementation science, and advanced statistics will ensure training goals are met. The candidate’s long-term career goal is to establish a research portfolio that develops, rigorously tests, and scales innovative, cost-efficient, evidence-based health technology resources to improve access and quality of care for trauma-impacted families in real-world settings. These research and training goals directly correspond with priorities detailed in NICHD’s Pediatric Trauma and Critical Illness Branch, and will allow the candidate to become an internationally recognized leader in child and family trauma prevention and treatment research. The training proposed herein is designed to develop expertise in this area, represents a clear progression from prior training, and would not be possible without this K23.

For more information contact Dr. Ridings at ridingle@musc.edu

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Bounce Back Now: A Low-Cost Intervention to Facilitate Post-Disaster Recovery

Sponsor/Type: NIH/NIMH - R01
Project Period: 08/01/2015 – 06/30/2021
Ken Ruggiero, PhD

Abstract:

Disasters confront individuals with a wide range of stressors, including threat of death or injury, loss of loved ones, limited access to basic needs, and financial strain due to property damage or disruptions in employment. Many survivors are resilient or recover rapidly, but a significant minority develops behavioral health problems such as posttraumatic stress disorder and depression. Some efficacious treatments exist for these mental health problems, but many disaster survivors encounter barriers to receipt of services (e.g., stigma, time commitment, cost, scheduling, transportation). The availability of brief, effective, free, and highly accessible interventions to facilitate personal and community resilience and rapid and sustained recovery is potentially of tremendous value to disaster-affected communities and disaster response agencies. We propose to evaluate Bounce Back Now (BBN),a novel, scalable, and highly sustainable technology-based intervention. BBN will be accessible via any device that is connected to the internet, such as a computer, smartphone, or tablet; it will be optimized for mobile devices to ensure that it is highly accessible and user friendly.

The intervention consists of three major components:

  1. A symptom/activity tracking component designed to facilitate self-monitoring in the acute post-disaster phase;
  2. A brief self-help intervention component that aims to accelerate mental health recovery relative to PTSD and mood symptoms; and
  3. A provider assistance component that will connect survivors to a national Disaster Distress Helpline.

Our research has supported the feasibility of the first two components of BBN, and the initial efficacy of the brief intervention component of BBN. The Disaster Distress Helpline is a national service administered by the Substance Abuse and Mental Health Services Administration that provides crisis counseling and local referrals to mental health providers. We will recruit 5,000 disaster survivors to test the intervention: 2,500 will be randomly assigned to the BBN condition, the other 2,500 to an enhanced usual care comparison condition. We will also examine the cost effectiveness of the BBN intervention relative to enhanced usual care. A secondary research aim centers on the exploration of triage-level risk factors that are associated with mental health recovery, use of BBN, and service utilization. The American Red Cross and the Office of the Assistant Secretary for Preparedness and Response have partnered with us on this proposal and will assist us with participant recruitment and collection of data relating to triage-level risk factors. We will conduct this research using an innovative phased-funding approach that will ensure that we are prepared to initiate research in the immediate aftermath of a triggering disaster incident. This study will significantly improve the evidence base around technology-based disaster mental health intervention.

For more information contact Dr. Ruggiero at ruggierk@musc.edu

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Improving Quality of Care in Child Mental Health Service Settings

Sponsor/Type: NIH/NIMH
Project Period: 08/01/2017 – 05/31/2021
Ken Ruggiero, PhD

Abstract:

Assuring children access to the highest quality mental health care is a top national priority. Yet, quality of care continues to be highly variable in traditional service settings. Novel, scalable solutions are needed to address modifiable quality-of-care indicators in sustainable ways. To this end, provider fidelity and children’s engagement are key correlates of clinical outcome and practical targets for intervention. There is tremendous opportunity to address both through technology. Studies in child education show that interactive games, touch-screen learning, and demonstration videos enhance engagement, knowledge, motivation, and learning. These benefits also may extend to the therapeutic context, where strategic integration of technology-based activities may enhance children’s learning, strengthen the therapeutic alliance, and keep providers on protocol. We are in the final stages of an NIMH R34 in which we piloted a patient- and provider-informed tablet-based toolkit designed to facilitate delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – a treatment that was selected because it addresses a wide range of symptoms using techniques shared by other treatments for emotional and behavioral disorders. The tablet-based toolkit consists of numerous components (e.g., videos, interactive games, drawing applications) that are designed to facilitate provider-patient interactions in a way that enhances children’s engagement and supports adherence to the treatment model. The tablet-based toolkit was very well received by children, caregivers, and providers in our pilot work. Moreover, all benchmarks for feasibility outlined in our NIMH R34 application were met or exceeded. We now propose to conduct a hybrid effectiveness-implementation trial to examine the extent to which the tablet intervention may improve fidelity, engagement, and children’s mental health outcomes. We will conduct a randomized controlled trial with 120 mental health providers and 360 families in partnership with dozens of clinics in the Carolinas and Florida. Providers will be assigned randomly to tablet-facilitated vs. standard TF-CBT. Youth aged 8-16 years with clinically elevated symptoms of PTSD will be recruited. Baseline and 3-, 6-, 9-, and 12-month post-baseline assessments will be conducted by independent, blind evaluators. Sessions will be video recorded for observational coding of engagement and fidelity by independent raters blind to study hypotheses. We will also examine costs and conduct semi-structured interviews with families, providers, supervisors, and agency leaders to inform future dissemination and implementation initiatives. Technology-based resources that are scalable, easy to use, and designed for efficient integration into everyday practice may have sustained national impact. The return on investment of these initiatives will ultimately rest on their potential to improve the spread of best-practice treatments and the quality with which they are delivered to the children who need them.

For more information contact Dr. Ruggiero at ruggierk@musc.edu

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CBT by Phone to Promote Use of Alcohol Related Care and Reduce Drinking

Sponsor: Sub. University of Rochester/NIH/NIAAA
Project Period: 09/01/2018 – 08/31/2022
Tracy Stecker, PhD

Abstract:

Numerous evidence-based treatments for alcohol use disorder (AUD) have been developed, and research shows that individuals who obtain alcohol specialty care have improved drinking outcomes and are more likely to recover, yet a small percentage of individuals with AUD obtain treatment. Use of Screening, Brief Intervention, and Referral to Treatment (SBIRT) interventions is a potential strategy to increase treatment seeking, yet there is little evidence that these interventions increase participation in alcohol-related care and a lack of evidence that such care serves as a mechanism for improved drinking outcomes. The current randomized controlled trial (RCT) of a one session intervention delivered by telephone seeks to address these gaps in evidence. The specific aims are to show that research volunteers ages 18 and older with AUD who are assigned to the intervention compared to an information control condition are more likely to initiate alcohol specialty care (aim 1), have decreased frequency of alcohol use (as measured by percent days abstinent) and intensity of alcohol use (as measured by drinks per drinking day) (aim 2), and that treatment engagement serves as a mediator of the improved drinking outcomes (aim 3). Innovations include the use of an SBIRT intervention based on the theory of planned behavior and cognitive behavioral treatment principles and that the intervention was developed for phone administration from the onset and was explicitly designed to promote treatment engagement. The project is in response to PA-15-299, Alcohol Use Disorders: Behavioral Treatment, Services, and Recovery Research. It builds on a smaller efficacy trial that showed that the intervention leads to increased engagement in alcohol-related care (Stecker et al., 2012) and extends that study in several ways including through the use of a priori tests to determine efficacy of the intervention to improve drinking outcomes and that treatment engagement serves as a mediator of the improved outcomes.

For more information about this trial contact Dr. Stecker at stecker@musc.edu.

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Fostering Medication Adherence in Children with Epilepsy using mHealth Technology

Sponsor/Type: Sub. Cincinnati Children’s Hospital Medical Center/NIH/NINR
Project Period: 08/01/2018 – 05/31/2023
Janelle L. Wagner, PhD

Project Summary/Abstract:

Non-adherence to antiepileptic drugs (AEDs) is a common problem (i.e., 58% of patients have some level of non-adherence) for young children with newly diagnosed epilepsy, with potentially devastating consequences. AED non-adherence is associated with a 3-fold increased risk of seizures, poor quality of life, inaccurate clinical decision-making, and higher health care utilization and costs. One of the primary barriers to adherence is forgetting, which may be particularly amenable to mHealth (mobile technology in healthcare) interventions. Despite the critical need to develop and implement interventions to improve adherence, there are few family- based interventions for young children with epilepsy and their families, with the exception of the PI's pilot and existing R01 trial. Although highly promising, this intervention requires six in-person sessions, which can be impossible for families who lack routine access to tertiary specialty care due to time, financial, or transportation constraints. Thus, unmet medical and psychosocial needs of the underserved pediatric epilepsy population are perpetuated and compounded by limited access to this state of the art care. Our overall goal is to test a mHealth adherence intervention that is easily accessible using a stepped up care model based on individual needs. This stepped up care model will conserve patient, family, and provider time, costs and resources. The aim of this multi-site R01 is to conduct a two-stage, sequential, multiple assignment, randomized trial (SMART) to evaluate the effectiveness of mHealth intervention strategies for improving AED adherence in caregivers of young children with epilepsy. A two-month baseline period will be followed by two stages. In Stage 1 (3-months long), non-adherent caregivers (less than 95%) will be randomized to a mHealth education module and automated digital reminders (control) or the mHealth education module, automated digital reminders, and individualized adherence feedback based on real-time adherence monitoring (treatment) to address the primary barrier of forgetting. At the beginning of Stage 2 (two months long), caregivers randomized to treatment who do not achieve adherence greater than 95% (response) by the end of Stage 1 will be re-randomized to either continued individualized adherence feedback or individualized adherence feedback augmented with two mHealth problem-solving modules (translated from the PIs existing RCTs) with a therapist. Thus, there are three intervention strategies embedded in this SMART: #1 control, #2 treatment, and #3 problem-solving augmented treatment if nonresponsive at three months. The primary outcome is electronically-monitored adherence and secondary outcomes include seizure severity/frequency, quality of life, and healthcare utilization. If the aims of the project are achieved, this study would have a large impact on pediatric epilepsy, with the potential to change clinical practice for treating non-adherence. The SMART design would allow us to identify patients who are most likely to respond to interventions and step up care with more time- and resource-intensive interventions (i.e., problem-solving with a therapist via the web), when necessary.

For more information contact Dr. Wagner at wagnerjl@musc.edu

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