Beau Abar’s research while affiliated with University of Rochester and other places

Background Patients with cancer frequently visit the emergency department (ED) and are at high risk for hospitalization due to severe illness from cancer progression or treatment side effects. With an aging population and rising cancer incidence rates worldwide, it is crucial to understand how EDs and other acute care venues manage oncologic emergencies. Insights from other nations and health systems may inform resources necessary for optimal ED management and novel care delivery pathways. We described clinical management of oncologic emergencies and their contribution to ED visits and hospitalizations worldwide. Methods We performed a systematic review of peer-reviewed original research studies published in the English language between January 1st, 2003, to December 31st, 2022, garnered from PubMed, Web of Science, and EMBASE. We included all studies investigating adult (≥ 18 years) cancer patients with emergency visits. We examined chief complaints or predictors of ED use that explicitly defined oncologic emergencies. Results The search strategy yielded 49 articles addressing cancer-related emergency visits. Most publications reported single-site studies (n = 34/49), with approximately even distribution across clinical settings- ED (n = 22/49) and acute care hospital/ICU (n = 27/49). The number of patient observations varied widely among the published studies (range: 9 – 87,555 patients), with most studies not specifying the cancer type (n = 33/49), stage (n = 41/49), or treatment type (n = 36/49). Most studies (n = 31/49) examined patients aged ≥ 60 years. Infection was the most common oncologic emergency documented (n = 22/49), followed by pain (n = 20/49), dyspnea (n = 19/49), and gastrointestinal (GI) symptoms (n = 17/49). Interventions within the ED or hospital ranged from pharmacological management with opioids (n = 11/49), antibiotics (n = 9/49), corticosteroids (n = 5/49), and invasive procedures (e.g., palliative stenting; n = 13/49) or surgical interventions (n = 2/49). Conclusion Limited research specifically addresses oncologic emergencies despite the international prevalence of ED presentations among cancer patients. Patients with cancer presenting to the ED appear to have a variety of complaints which could result from their cancers and thus may require tailored diagnostic and intervention pathways to provide optimal acute care. Further acute geriatric oncology research may clarify the optimal management strategies to improve the outcomes for this vulnerable patient population.

Background Cervical cancer (CC) is preventable. CC screening decreases CC mortality. Emergency department (ED) patients are at disproportionately high risk for nonadherence with CC screening recommendations. The ED, therefore, is a target‐rich environment for interventions to promote CC screening. Methods We conducted a randomized clinical trial to test and compare the efficacies of (1) basic referral for CC screening and (2) basic referral plus a text messaging intervention, grounded in behavioral change theory, to promote uptake of CC screening among ED patients. Participants aged 21–65, identified as in need of CC screening, were randomized to study arms and followed up at 150 days to assess interval CC screening uptake (primary outcome) and analyze methods‐related moderators of intervention effects. Participants were recruited from a large, urban ED and a small, rural ED within the same health care system. Intervention arms were compared to historical controls. Results A total of 4035 patients were surveyed, with 1089 identified as requiring CC screening and subsequently randomized. Upon 150‐day follow‐up, 20% of individuals in the basic referral arm and 23% of individuals in the basic referral plus text messaging arm had obtained screening. Screening uptake in the historical control group was found to be 10% over a 150‐day period. The overall difference between prospective arms was not significant ( p = 0.219). However, moderation analysis found that women ≥40 years old demonstrated greater uptake of screening after the higher intensity intervention compared to the lower ( p = 0.032). The differences in screening uptake between both interventions, individually and combined, when compared to controls was significant ( p ≤ 0.001). Conclusions This study demonstrates that both of the evaluated low‐intensity ED‐based interventions significantly increase subsequent CC screening uptake compared to historical controls. The higher intensity intervention significantly increased screening uptake compared to the lower intensity intervention among women ≥40 years old.

Background Enrolling heart failure (HF) patients in clinical studies is challenging. Emergency department (ED) may use students as research associates programs, such as the University of Rochester Medical Center (URMC) ED Research Associate (EDRA) program, to screen and consent patients for clinical studies. This manuscript examines the effectiveness of the URMC EDRA program in consenting HF patients into a clinical study. Methods The URMC EDRA program recruited and consented HF patients presenting at URMC's ED. Research associates in the EDRA program identified potential patients based on age (>18 years) and chief complaints indicative of HF. After identifying potential patients, a thorough chart review was conducted, and any uncertainties were discussed with the patient and treating provider before patients were consented into the study. Descriptive statistics were used to assess the program's effectiveness. Results Over one fiscal year, the URMC EDRA program screened 1669 unique patients, of whom 118 (7.1 %) were consented. Consented patients tended to be younger (65 ± 12 years) than those who refused consent (70 ± 14 years) (p = 0.007). Of the 1551 patients not consented, 1021 (65.8 %) were deemed ineligible. Compared to a full time research associate, the URMC EDRA program was cheaper and more productive. Conclusion The URMC EDRA program was highly effective in screening and consenting HF patients, successfully consenting 118 patients (14 per month). This is a significant achievement, especially given the study's strict inclusion and exclusion criteria. Compared to other studies and a full time research associate, the URMC EDRA program demonstrated remarkable productivity.

Background Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. Emergency departments (ED) represent a promising setting to address preventive health measures like CRC screening. Objectives The current study adapted an existing cervical cancer screening intervention for use in catalysing CRC screening. We evaluated feasibility of identification, provided preliminary effect size estimates and documented participant acceptability. Methods This study was funded by the University of Rochester (ClinicalTrials.gov # NCT05004376 ). We enrolled ED patients, 45–75 years old, in the Greater Rochester, NY region into a randomised controlled pilot from January to May 2022. Patients were excluded if non-English speaking, lacking a cell phone or had a history of CRC, colorectal resection, inflammatory bowel disease or abdominal radiation. Participants were surveyed to determine adherence with recommended CRC screening guidelines. Patients found non-adherent were randomised to receive (1) recommendation for CRC screening only or (2) recommendation and a text-based intervention aimed at generating intention and motivation to get screened. Patients were blind to allocation at enrolment. The primary outcome was patient CRC screening or scheduling. Results 1438 patients were approached, with 609 found ineligible, 576 declining participation and 253 enrolled. A randomised sample of 114 non-adherent patients were split evenly between the control and intervention arms. Among participants with follow-up data ( n control =38, n intervention =36), intervention participants had a 2%–3% higher rate of scheduling or receiving screening (7%–27% relative improvement). When using the complete sample (n=114) and conservatively assuming no screening for those lost to follow-up, differences in screening across arms were mildly decreased (0%–2% absolute difference). Acceptability of CRC intervention was high, and participants offered formative feedback. Conclusion The piloted text message intervention through the ED shows potential promise for catalysing CRC screening. Subsequent replication in a fully powered trial is needed.

Repetitive head hits (RHHs) in sports and military settings are increasingly recognized as a risk factor for adverse neurological outcomes, but they are not currently tracked. Blood-based biomarkers of concussion have recently been shown to increase after nonconcussive RHHs during a single sporting contest, raising the possibility that they could be used in real time to monitor the brain's early response to repeated asymptomatic head hits. To test this hypothesis, we measured GFAP in serum immediately before (T0), immediately after (T1) and 45 min (T2) after a single collegiate football game in 30 athletes. Glial fibrillary acidic protein (GFAP) changes were correlated with three measures of head impact exposure (number of hits, total linear acceleration, and total rotational acceleration captured by helmet impact sensors) and to changes in brain white matter (WM) integrity, estimated by regional changes in fractional anisotropy (FA) and mean diffusivity (MD) on diffusion tensor imaging from 24 h before (T1) to 48 h after (T3) the game. To account for the potentially confounding effects of physical exertion on GFAP, correlations were adjusted for kilocalories of energy expended during the game measured by wearable body sensors. All 30 participants were male with a mean age of 19.5 ± 1.2 years. No participant had a concussion during the index game. We observed a significant increase in GFAP from T0 to T1 (mean 79.69 vs. 91.95 pg/mL, p = 0.008) and from T0 to T2 (mean 79.69 vs. 99.21 pg/mL, p < 0.001). WM integrity decreased in multiple WM regions but was statistically significant in the right fornix (mean % FA change -1.43, 95% confidence interval [CI]: -2.20, -0.66). T0 to T2 increases in GFAP correlated with reduced FA in the left fornix, right fornix, and right medical meniscus and with increased MD in the right fornix (r-values ranged from 0.59 to 0.61). Adjustment for exertion had minimal effect on these correlations. GFAP changes did not correlate to head hit exposure, but after adjustment for exertion, T0 to T2 increases correlated with all three hit metrics (r-values ranged from 0.69 to 0.74). Thus, acute elevations in GFAP after a single collegiate football game of RHHs correlated with in-game head hit exposure and with reduced WM integrity 2 days later. These results suggest that GFAP may be a biologically relevant indicator of the brain's early response to RHHs during a single sporting event. Developing tools to measure the neurological response to RHHs on an individual level has the potential to provide insight into the heterogeneity in adverse outcomes after RHH exposure and for developing effective and personalized countermeasures. Owing to the small sample size, these findings should be considered preliminary; validation in a larger, independent cohort is necessary.

Objective Alcohol use disorder (AUD) is among the most prevalent substance use disorders in the USA. Despite availability of effective interventions, treatment initiation and engagement remain low. Existing interventions target motivation and practical barriers to accessing treatment among individuals established within treatment systems. In contrast, Cognitive Behavioral Therapy for Treatment-Seeking (CBT-TS) aims to elicit and modify treatment-seeking beliefs to increase treatment-seeking behaviors among treatment-naïve samples. We aim to understand which beliefs were endorsed by those who did/did not initiate treatment, including changes in number of drinking days. Method We examined treatment seeking beliefs elicited during CBT-TS among community-based adults with moderate–severe AUD with no treatment history. In this study, we discuss which beliefs were modifiable (i.e. those discussed during the intervention among individuals who subsequently attended treatment and may be associated with treatment-seeking behaviors). Results Of the 194 participants who received the intervention, 16 categories of beliefs were endorsed. Of the 38 participants (19.6%) who attended treatment, the most frequently endorsed belief was ‘Not wanting specific types of substance use treatment or supports’ (50%), a belief that may inhibit treatment seeking. The idea ‘Treatment is positive’ (47%) was also frequently cited, a belief that may facilitate treatment seeking. Conclusions This study describes the beliefs that were more frequently endorsed among adults with moderate–severe, but untreated AUD who reported attending treatment following CBT-TS. Findings point to the potential of discussing and modifying treatment-seeking beliefs among treatment-naïve adults with severe AUD to increase treatment-seeking behaviors.