The Family Adaptation study, ancillary to the Single Ventricle Reconstruction Trial, examined the prevalence of anxiety and its associations with stress, psychosocial factors, and quality of life measures in parents of infants who underwent the Norwood procedure.

Two hundred and fifteen parents (143 mothers and 72 fathers) of 146 infants completed state anxiety (State Anxiety Inventory), stress, psychosocial, and quality of life measures post-Norwood, post-Stage II, and at a final visit (median child age: 14 months).

A substantial proportion of parents reported severe anxiety symptoms following the Norwood surgery, with 61% of mothers and 43% of fathers affected, decreasing over time to 46% and 33% by the final visit, respectively. Mothers’ average STAI-S scores were significantly higher than fathers’ post-Norwood (47.7 ± 13.2 versus 43.5 ± 11.8, p = 0.03), declining to 42.1 ± 13.0 versus 39.0 ± 9.6 (p = 0.14) at the final visit. Stress related to parenting a child with a serious illness was a stronger and more consistent predictor of mothers’ anxiety over time (highest R2 = 0.49 for emotional distress), whereas insufficient coping and fewer protective factors were greater and more consistent predictors for fathers (highest R2 = 0.40 for mastery and health). Quality of life was a consistent predictor of state anxiety for both mothers and fathers.

Anxiety is elevated in parents of infants who underwent the Norwood procedure and is influenced by a complex interplay of stress, psychosocial factors, and quality of life. Addressing these factors is crucial for improving parents’ mental health, which in turn promotes the well-being of the entire family.

Guideline development handbooks outline the methodology that authoring organizations use to create public health and clinical practice guidelines (CPGs). We created an Equity Assessment Tool (EquAT) for guideline development handbooks to identify areas of improvement and foster conversations.

Sequential phases lead to tool development and face/content validation in this mixed-methods study. In phase 1, we reviewed the literature to generate a list of “essential elements” or tasks that are part of guideline development methodology, mapped “essential elements” with relevant equity concepts, and drafted our tool for use in reviewing guideline development handbooks. In phase 2, we surveyed experts for feedback on “essential elements” and explicit language for assessing equity within the tool and refined items. We piloted and finalized the tool based on feedback.

We identified 18 essential elements within five domains of guideline development and created a draft EquAT. Twenty of 25 invited experts responded to the online survey for feedback on the tool. Most experts provided limited feedback, and the most common suggestion was adding clarifying language to the existing tool criteria for assessing equity. Ten experts participated in pilot testing the revised tool. We found a diversity of scores, and potential reasons might be due to the complexity of the tool, differences in equity frameworks, and a variety of expertise. We incorporated their feedback and finalized the tool.

We developed and validated the EquAT, a tool to foster discussion among assessors about the extent of health equity considerations in guideline development handbooks.

From 2023–2024, the Maryland Statewide Prevention & Reduction Collaborative (SPARC) led an intervention targeting broad-spectrum antibiotic use for sepsis, aiming to identify the factors that influence the success of collaborative quality improvement (QI) programs.

Evaluation of a state collaborative run QI intervention.

Acute-care facilities in Maryland.

Participating sites developed and implemented sepsis-focused interventions with SPARC support, including tailored guidance and bimonthly office hours. Following the implementation of site-level interventions, sites participated in a mixed-methods assessment guided by the RE-AIM framework including brief qualitative interviews and a 6-month follow-up.

Eight hospitals implemented multi-component, multi-disciplinary sepsis-focused interventions. Facilities involved staff from up to six departments in the implementation of interventions. All sites noted the effectiveness of SPARC in supporting sites’ intervention activities, as well as the effectiveness of the site’s interventions in creating change. Sites identified barriers impacting the implementation of their interventions including lack of resources, administrative red-tape, and challenges changing culture. Facilitators included leadership support, having a structured intervention plan, and opportunities for peer-to-peer learning. Most sites were positive about SPARC’s role identifying interventions and support, utilized information from SPARC as part of their interventions, and found it useful to hear how other institutions implement antibiotic stewardship. Six months post-assessment, all sites were continuing intervention activities.

This evaluation highlights how statewide QI collaboratives can be effective in promoting hospital-based antibiotic stewardship. Sites identified several facilitators and challenges that contributed to intervention implementation and highlighted the contributions of the SPARC team.

Researchers have traditionally engaged Community Advisory Boards (CABs) to meaningfully involve community members in the research process. However, CABs are often formed only after a grant is funded, leading to criticisms of functioning merely as “ethical approvers.” For substance use researchers, the inclusion of people with living experience (PWLE; current experience with drug use) across all stages of research is especially important as they have historically been the experts in the needs of their community.

In response to this need for community engagement in research, the University of Kentucky, in partnership with a local recovery community center (RCC; Voices of Hope), established the Survivors Union of the Bluegrass (SUB). The SUB is a stand-alone CAB (i.e., not tied to any particular research study) comprised of PWLE. Biannually, the SUB leadership team conducts quality improvement process evaluation focus groups with SUB members.

The SUB has held 33 monthly meetings with 52 university substance use research teams, all unanimously approved by members to attend. Members identified benefits to participating in the SUB, felt researchers treated them as experts, and supported other institutions establishing similar boards. Members also described feelings of belonging and empowerment, and valued being viewed as experts.

To our knowledge, the SUB is one of the first CABs comprised of PWLE housed at a university that is not tied to a specific study or project. The SUB’s high retention rate and member feedback demonstrate the benefit of meaningfully involving PWLE throughout the research process.

This study investigates the impact of patent ductus arteriosus (PDA) status and treatment response on myocardial adaptation in preterm infants by comparing serial echocardiographic trajectories across three groups: high-risk infants with treatment success, high-risk infants with treatment failure, and low-risk infants not requiring treatment.

In this prospective cohort study, preterm infants born < 29 weeks’ gestation were stratified using the EL-Khuffash PDA Severity Score and subsequent response to medical therapy. Echocardiographic assessments were performed at three timepoints: day 2, 2 weeks, and 36 weeks corrected gestational age. A range of structural and functional parameters was analysed.

Of 184 included infants, 58 were high risk with treatment success, 52 were high risk with treatment failure, and 74 were low risk. High-risk infants with treatment failure had persistent myocardial and haemodynamic alterations, including higher left ventricular wall thickness and lower coeliac artery velocities at follow-up. Treatment success was associated with improvements in strain metrics, systemic perfusion, and structural indices. Low-risk infants demonstrated spontaneous PDA closure and overall stable haemodynamics. Distinct differences in the evolution of myocardial trajectories between groups were apparent between day 2 and week 2 echocardiograms.

Serial echocardiographic assessments highlight the dynamic impact of PDA treatment response on myocardial adaptation. Persistent ductal patency despite treatment is associated with sustained structural and functional changes. Early definitive ductal closure may promote haemodynamic stability and mitigate maladaptive remodelling in a subgroup of high-risk infants.