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Article ; Online: Developing a clinical research infrastructure embedded in an academic medicine center that equitably supports future clinician scientists.

Holsti, Maija / Keenan, Heather T / Kadish, Howard A / Sapiro, Heather K / Giardino, Angelo P / Osborn, Katharine A / Cline, Kristen L / Byington, Carrie L

Clinical and translational science

2023 Volume 16, Issue 9, Page(s) 1547–1553

Abstract: Clinical research in academic medical centers can be difficult to conduct and meet enrollment goals. Students under-represented in medicine (URiM) are also under-represented in academic leadership positions and as physician-scientists but are critical to ...

Abstract	Clinical research in academic medical centers can be difficult to conduct and meet enrollment goals. Students under-represented in medicine (URiM) are also under-represented in academic leadership positions and as physician-scientists but are critical to help solve health disparities. Barriers in pursuing medicine as a career may be high for URiM students, therefore it is important to create pre-medicine opportunities accessible to all students interested in healthcare careers. We describe an undergraduate clinical research platform, the Academic Associate (AcA) program, embedded in the medical system that supports clinical research for academic physician scientists and provides students equitable access to experiences and mentoring opportunities. Students have the opportunity of completing a Pediatric Clinical Research Minor (PCRM) degree. This program satisfies many pre-medicine opportunities for undergraduate students, including those URiM, and allows access to physician mentors and unique educational experiences for graduate school or employment. Since 2009, 820 students participated in the AcA program (17.5% URiM) and 235 students (18% URiM) completed the PCRM. Of the 820 students, 126 (10% URiM) students matriculated to medical school, 128 (11%URiM) to graduate school, and 85 (16.5% URiM) gained employment in biomedical research fields. Students in our program supported 57 publications and were top-enrollers for several multicentered studies. The AcA program is cost-effective and achieves a high level of success enrolling patients into clinical research. Additionally, the AcA program provides equitable access for students URiM to physician mentorship, pre-medical experiences, and an avenue to early immersion in academic medicine.
MeSH term(s)	Humans ; Child ; Career Choice ; Mentors ; Biomedical Research ; Academic Medical Centers ; Physicians ; Students, Medical
Language	English
Publishing date	2023-06-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2433157-0
ISSN	1752-8062 ; 1752-8054
ISSN (online)	1752-8062
ISSN	1752-8054
DOI	10.1111/cts.13565
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Social Needs Screening During Pediatric Emergency Department Visits: Disparities in Unmet Social Needs.

Tedford, Natalie J / Keating, Elizabeth M / Ou, Zhining / Holsti, Maija / Wallace, Andrea S / Robison, Jeff A

Academic pediatrics

2022 Volume 22, Issue 8, Page(s) 1318–1327

Abstract: Objective: To determine the prevalence of unmet social needs (USN) in a pediatric emergency department (PED) patient population and examine disparities in USN by self-selected language and patient demographics.: Methods: We surveyed a convenience ... ...

Abstract	Objective: To determine the prevalence of unmet social needs (USN) in a pediatric emergency department (PED) patient population and examine disparities in USN by self-selected language and patient demographics. Methods: We surveyed a convenience sample of English- and Spanish-speaking caregivers of patients <18-years-old presenting to a free-standing children's hospital in Salt Lake City, Utah. In the caregiver's self-selected language, the pediatric version of the Screener for Intensifying Community Referrals for Health (p-SINCERE) assessed patient demographics and 10 areas of social needs. The primary outcome was presence of USN. Descriptive statistics compared 1) self-selected languages and 2) absence versus presence of USN. Patient and caregiver-level risk factors associated with USN were identified using multivariable logistic regression. Results: Of the 10,156 patients seen in our PED from 04/01/2021 to 08/03/2021, there were 9922 eligible, 5357 approached, and 3987 enrolled caregivers. Of the 3987 caregivers enrolled, self-selected language was English for 3662 (91.8%) and Spanish for 325 (8.2%). There were 1680 enrolled caregivers with ≥1 USN, representing 39.7% of English-speaking and 70.2% of Spanish-speaking caregivers (P < .001). The odds of having ≥1 USN was more than 2 times higher in Spanish-speakers than in English-speakers after adjustment. Conclusions: USN are common for families presenting for care to a PED, especially among Spanish-speaking caregivers. Furthermore, this study demonstrates disparities in limited English proficiency, race and ethnicity, and child insurance status. These findings support the practicality of utilizing the PED as an access point to initiate social need screening and referrals to address social determinants of health and health disparities.
MeSH term(s)	Adolescent ; Child ; Humans ; Caregivers ; Emergency Service, Hospital ; Hispanic or Latino ; Language ; Mass Screening ; Pediatric Emergency Medicine ; Health Services Needs and Demand ; Needs Assessment ; Social Determinants of Health
Language	English
Publishing date	2022-05-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2483385-X
ISSN	1876-2867 ; 1876-2859
ISSN (online)	1876-2867
ISSN	1876-2859
DOI	10.1016/j.acap.2022.05.002
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Article ; Online: Health Care Provider Bias in Estimating the Health Literacy of Caregivers in a Pediatric Emergency Department.

Dorsey, Bridget F / Cook, Lawrence J / Katz, Adam D / Sapiro, Heather K / Kadish, Howard A / Holsti, Maija

Pediatric emergency care

2023 Volume 39, Issue 12, Page(s) e80–e85

Abstract: Background: Health literacy is a growing concern because of its effects on communication and health outcomes. One aspect of this communication is the ability of the health care provider to estimate the health literacy of a patient or their caregiver. ... ...

Abstract	Background: Health literacy is a growing concern because of its effects on communication and health outcomes. One aspect of this communication is the ability of the health care provider to estimate the health literacy of a patient or their caregiver. The objectives of this study are to quantify misestimation of caregiver health literacy by providers and identify potential descriptive or demographic factors that might be related to those misestimations. Methods: Providers were asked to perceive descriptive factors and estimate the health literacy of caregivers in a pediatric Emergency Department. Then, the health literacy of the caregiver was tested using the Short Assessment of Health Literacy, and cross-tabulated with provider estimates. Results: Providers correctly estimated the health literacy of the caregivers 60% of the time, and misestimates were often underestimates (27.7%) rather than overestimates (12.3%). Providers overestimated the health literacy of 24.1% of fathers and only 9.8% of mothers (P = 0.012). They correctly estimated the health literacy of 63.9% of English-speaking caregivers compared with 30.6% of Spanish-speaking caregivers, and underestimated the health literacy of 50% of Spanish-speaking caregivers and 24.8% of English-speaking caregivers (P < 0.001). Providers correctly estimated the health literacy of 34.4% of racially and ethnically diverse caregivers compared with 71.5% of White/non-Hispanic caregivers. They underestimated the health literacy of 52.1% of these racially and ethnically diverse caregivers and 16.8% of White/non-Hispanic caregivers (P < 0.001). Conclusions: Providers often overestimate and underestimate the health literacy of parents in the pediatric emergency department. Misestimates are related to race, caregiver role, and language spoken by the caregiver. When providers misestimate health literacy, they may use words or phrases that are above or below the health literacy level of the caregiver. These results suggest a need for further health literacy research and interventions in provider education and clinical practice.
MeSH term(s)	Child ; Female ; Humans ; Caregivers ; Health Literacy ; Health Personnel ; Communication ; Emergency Service, Hospital
Language	English
Publishing date	2023-11-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	632588-9
ISSN	1535-1815 ; 0749-5161
ISSN (online)	1535-1815
ISSN	0749-5161
DOI	10.1097/PEC.0000000000003076
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Article ; Online: Public support for and concerns regarding pediatric dose optimization for seizures in emergency medical services: An exception from informed consent (EFIC) trial.

Ward, Caleb E / Adelgais, Kathleen M / Holsti, Maija / Jacobsen, Kammy K / Simon, Harold K / Morris, Claudia R / Gonzalez, Victor M / Lerner, Gonzalo / Ghaffari, Kimia / VanBuren, John M / Lerner, E Brooke / Shah, Manish I

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2024

Abstract: Background: Federal regulations allow exception from informed consent (EFIC) to study emergent conditions when obtaining prospective consent is not feasible. Little is known about public views on including children in EFIC studies. The Pediatric Dose ... ...

Abstract	Background: Federal regulations allow exception from informed consent (EFIC) to study emergent conditions when obtaining prospective consent is not feasible. Little is known about public views on including children in EFIC studies. The Pediatric Dose Optimization for Seizures in EMS (PediDOSE) trial implements age-based, standardized midazolam dosing for pediatric seizures. The primary objective of this study was to determine public support for and concerns about the PediDOSE EFIC trial. The secondary objective was to assess how support for PediDOSE varied by demographics. Methods: We conducted a mixed-methods study in 20 U.S. communities. Participants reviewed information about PediDOSE before completing an online survey. Descriptive data were generated. Univariable and multivariable logistic regression analysis identified factors associated with support for PediDOSE. Reviewers identified themes from free-text response data regarding participant concerns. Results: Of 2450 respondents, 79% were parents/guardians, and 20% had a child with previous seizures. A total of 96% of respondents supported PediDOSE being conducted, and 70% approved of children being enrolled without prior consent. Non-Hispanic Black respondents were less likely than non-Hispanic White respondents to support PediDOSE with an adjusted odds ratio (aOR) of 0.57 (95% CI 0.42-0.75). Health care providers were more likely to support PediDOSE, with strongest support among prehospital emergency medicine clinicians (aOR 5.82, 95% CI 3.19-10.62). Age, gender, parental status, and level of education were not associated with support of PediDOSE. Common concerns about PediDOSE included adverse effects, legal and ethical concerns about enrolling without consent, and potential racial bias. Conclusions: In communities where this study will occur, most respondents supported PediDOSE being conducted with EFIC and most approved of children being enrolled without prior consent. Support was lowest among non-Hispanic Black respondents and highest among health care providers. Further research is needed to determine optimal ways to address the concerns of specific racial and ethnic groups when conducting EFIC trials.
Language	English
Publishing date	2024-03-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14884
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Article: Communication Gaps Between Providers and Caregivers of Patients in a Pediatric Emergency Department.

Dorsey, Bridget F / Kamimura, Akiko / Cook, Lawrence J / Kadish, Howard A / Cook, Heather K / Kang, Ashley / Nguyen, Jacqueline B T / Holsti, Maija

Journal of patient experience

2022 Volume 9, Page(s) 23743735221112223

Abstract: Communication gaps between the healthcare team and caregivers of pediatric patients can result in negative consequences. This study aims to identify specific words and phrases used in a pediatric emergency department (ED) that are unclear or confusing to ...

Abstract	Communication gaps between the healthcare team and caregivers of pediatric patients can result in negative consequences. This study aims to identify specific words and phrases used in a pediatric emergency department (ED) that are unclear or confusing to caregivers. Research assistants at the Primary Children's Hospital recorded caregivers' responses to the question, "
Language	English
Publishing date	2022-07-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2857285-3
ISSN	2374-3743 ; 2374-3735
ISSN (online)	2374-3743
ISSN	2374-3735
DOI	10.1177/23743735221112223
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Article: Cultural identity central to Native American persistence in science.

Chow-Garcia, Nizhoni / Lee, Naomi / Svihla, Vanessa / Sohn, Claira / Willie, Scott / Holsti, Maija / Wandinger-Ness, Angela

Cultural studies of science education

2022 Volume 17, Issue 2, Page(s) 557–588

Abstract: Native Americans are the least represented population in science fields. In recent years, undergraduate and graduate level summer research programs that aimed to increase the number of Native Americans in science have made some progress. As new programs ... ...

Abstract	Native Americans are the least represented population in science fields. In recent years, undergraduate and graduate level summer research programs that aimed to increase the number of Native Americans in science have made some progress. As new programs are designed, key characteristics that address science self-efficacy and science identity and provide supports for Native American students' commitment to a scientific career should be considered. In this study, we used sequential mixed methods to investigate the potential of culturally tailored internship programs on Native American persistence in science. We analyzed surveys (
Language	English
Publishing date	2022-01-29
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2237680-X
ISSN	1871-1510 ; 1871-1502
ISSN (online)	1871-1510
ISSN	1871-1502
DOI	10.1007/s11422-021-10071-7
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Article ; Online: Communication Gaps Between Providers and Caregivers of Patients in a Pediatric Emergency Department

Bridget F. Dorsey BS / Akiko Kamimura PhD, MSW, MA / Lawrence J. Cook PhD / Howard A. Kadish MD, MBA / Heather K. Cook BA / Ashley Kang BS / Jacqueline B.T. Nguyen / Maija Holsti MD, MPH

Journal of Patient Experience, Vol

2022 Volume 9

Abstract	Communication gaps between the healthcare team and caregivers of pediatric patients can result in negative consequences. This study aims to identify specific words and phrases used in a pediatric emergency department (ED) that are unclear or confusing to caregivers. Research assistants at the Primary Children’s Hospital recorded caregivers’ responses to the question, “ What words or phrases have been used during this visit that are unclear or don’t make sense to you?” Across all steps in the care process, 62 of 220 participants (28.2%) reported unclear words and phrases used by the healthcare team. Responses recorded after the discharge step had the highest proportion of communication problems, followed by the initial evaluation and then the update step ( χ 2 [2, N = 220] = 6.30, P = .043). Themes among responses included ED logistics, signs/symptoms, the diagnostic process, treatment/procedures, general confusion, and language barriers. These results provide feedback to pediatric emergency medicine providers about potential communication gaps and point to a need for further efforts to train providers in the practice of high-quality communication.
Keywords	Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	SAGE Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Impact of an Offline Pain Management Protocol on Prehospital Provider Self-Efficacy: A Randomized Trial.

Jaeger, April / Dudley, Nanette / Holsti, Maija / Sheng, Xiaoming / Gurley, Kristin Lauria / Adelgais, Kathleen

Pediatric emergency care

2017 Volume 33, Issue 6, Page(s) 388–395

Abstract: Background: Pain in children is inadequately treated in the prehospital setting despite the reported recognition by prehospital providers (PHPs) of pain treatment as an important part of patient care. The impact of pediatric pain management protocol ( ... ...

Abstract	Background: Pain in children is inadequately treated in the prehospital setting despite the reported recognition by prehospital providers (PHPs) of pain treatment as an important part of patient care. The impact of pediatric pain management protocol (PPP) implementation on PHP self-efficacy (SE), a measure congruent with performance, is unknown. Objective: The aim of this study was to evaluate the impact of PPP implementation and pain management education on PHP SE. Methods: This was a prospective study evaluating the change in PHP SE after a PPP was implemented. Prehospital providers were randomized to 3 groups: protocol introduction alone, protocol introduction with education, and protocol introduction with education and a 3-month interim review. Prehospital provider SE was assessed for pain management given 3 age-based scenarios. Self-efficacy was measured with a tool that uses a ranked ordinal scale ranging from "certain I cannot do it" (0) to "completely certain I can do it" (100) for 10 pain management actions: pain assessment (3), medication administration (4), dosing (1), and reassessment (2). An averaged composite score (0-100) was calculated for each of the 3 age groups (adult, child, toddler). Paired-sample t tests compared post-PPP and 13-month scores to pre-PPP scores. Results: Of 264 PHPs who completed initial surveys, 142 PHPs completed 13-month surveys. Ninety-three (65%) received education with protocol review, and 49 (35%) had protocol review only. Self-efficacy scores increased over the study period, most notably for pain assessment. This increase persisted at 13 months for child (6.6 [95% confidence interval {CI}, 1.4-11.8]) and toddler pain assessment (22.3 [95% CI, 16.4-28.3]). Composite SE scores increased immediately for all age groups (adult, 3.1 [95% CI, 1.3-4.9]; child, 6.1 [95% CI, 3.8-8.5]; toddler, 12.0 [95% CI, 9.5-14.5]) and persisted at 13 months for the toddler group alone (7.0 [95% CI, 4.3-9.7]). There was no difference between groups who received protocol review alone compared with those with education or education plus a 3-month interim review. Conclusions: After a pain management protocol was introduced, SE scores among PHPs increased immediately and remained elevated for some individual actions involved in pain management, most notably pain assessment. Prehospital provider pain assessment SE scores declined 13 months after protocol introduction for adults, but remained elevated compared with baseline for the pediatric age groups.
Language	English
Publishing date	2017-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	632588-9
ISSN	1535-1815 ; 0749-5161
ISSN (online)	1535-1815
ISSN	0749-5161
DOI	10.1097/PEC.0000000000000657
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Article ; Online: Increasing diversity of the biomedical workforce through community engagement: The University of Utah Native American Summer Research Internship.

Holsti, Maija / Hawkins, Sam / Bloom, Kim / White, Richard / Clark, Edward B / Byington, Carrie L

Clinical and translational science

2015 Volume 8, Issue 2, Page(s) 87–90

MeSH term(s)	Biomedical Research/education ; Biomedical Research/manpower ; Career Choice ; Cultural Diversity ; Education, Graduate ; Humans ; Indians, North American/ethnology ; Mentors ; Personnel Selection ; Program Development ; Universities ; Utah
Language	English
Publishing date	2015-04
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2433157-0
ISSN	1752-8062 ; 1752-8054
ISSN (online)	1752-8062
ISSN	1752-8054
DOI	10.1111/cts.12258
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Article ; Online: Seizure Treatment in Children Transported to Tertiary Care: Recommendation Adherence and Outcomes.

Siefkes, Heather M / Holsti, Maija / Morita, Denise / Cook, Lawrence J / Bratton, Susan

Pediatrics

2016 Volume 138, Issue 6

Abstract: Background and objectives: Convulsive seizures account for 15% of pediatric air transports. We evaluated seizure treatment received in community hospital emergency departments among transported patients for adherence to recommended management.: ... ...

Abstract	Background and objectives: Convulsive seizures account for 15% of pediatric air transports. We evaluated seizure treatment received in community hospital emergency departments among transported patients for adherence to recommended management. Methods: This study was a retrospective cohort study of children transported for an acute seizure to a tertiary pediatric hospital from 2010 to 2013. Seizure treatment was evaluated for adherence to recommended management. The primary outcome was intubation. Results: Among 126 events, 61% did not receive recommended acute treatment. The most common deviation from recommended care was administration of >2 benzodiazepine doses. Lack of adherence to recommended care was associated with a greater than twofold increased risk of intubation (relative risk 2.4; 95% confidence interval, 1.4-4.13) and 1.5-fold increased risk of admission to the ICU (relative risk 1.65; 95% confidence interval, 1.24-2.16). Duration of ventilation was commonly <24 hours (87%) for patients who did or did not receive recommended acute seizure care. Among events treated initially with a benzodiazepine, only 32% received a recommended weight-based dosage, and underdosing was most common. Conclusions: Adherence to evidence-based recommended acute seizure treatment during initial care of pediatric patients using medical air transportation was poor. Intubation was more common when patients did not receive recommended acute seizure care. Educational efforts with a sustained quality focus should be directed to increase adherence to appropriate pediatric seizure treatment of children in community emergency departments.
MeSH term(s)	Anticonvulsants/therapeutic use ; Child ; Child, Preschool ; Cohort Studies ; Emergency Medical Services ; Female ; Guideline Adherence/statistics & numerical data ; Humans ; Infant ; Intubation, Intratracheal/statistics & numerical data ; Male ; Retrospective Studies ; Seizures/therapy ; Tertiary Healthcare ; Transportation of Patients
Chemical Substances	Anticonvulsants
Language	English
Publishing date	2016-11-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2016-1527
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