Clinical Assistant Professor, Medicine - Primary Care and Population Health
Section Chief, Nursing Research Section, Primary Care and Population Health, Medicine, Stanford School of Medicine (2023 - Present)
Co-Chair, Health Equity: MGT, Stanford Health Care (2023 - Present)
Co-Chair, Health Equity Council, Stanford Health Care (2022 - Present)
A Safety and Efficacy Study Evaluating CTX130 in Subjects With Relapsed or Refractory T or B Cell Malignancies (COBALT-LYM)
This is a single-arm, open-label, multicenter, Phase 1 study evaluating the safety and efficacy of CTX130 in subjects with relapsed or refractory T or B cell malignancies.
Phase 1/2a Study of SQ3370 in Patients With Advanced Solid Tumors
The purpose of this study is to evaluate the safety, tolerability, and preliminary activity of SQ3370 in patients with advanced solid tumors.
Convalescent Plasma in Outpatients With COVID-19
The overarching goal of this project is to confirm or refute the role of passive immunization as a safe and efficacious therapy in preventing the progression from mild to severe/critical COVID-19 illness and to understand the immunologic kinetics of anti-SARS-CoV-2 antibodies after passive immunization.The primary objective is to determine the efficacy and safety of a single dose of convalescent plasma (CP) for preventing the progression from mild to severe COVID-19 illness. The secondary objective is to characterize the immunologic response to CP administration. This study will enroll adults presenting to the emergency department (ED) with mild, symptomatic, laboratory-confirmed COVID-19 illness, who are at high risk for progression to severe/critical illness, but who are clinically stable for outpatient management at randomization.
Stanford is currently not accepting patients for this trial.
Characteristics, methodological, and reporting quality of scoping reviews published in nursing journals: A systematic review.
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing
INTRODUCTION: Given the diversity of the scope for inquiry and methodologies used in nursing research, the synthesis of primary research may not be as straightforward as conducting a meta-analysis or systematic review on clinical trials. Scoping reviews offer an option to nursing academics for inquiries involving a range of applications and interpretations. Given the continual advances in evidence-based research, it is, therefore, crucial for nursing to constantly substantiate its research capabilities and uphold standards in its research inquiry. Accordingly, an updated overview would be timely to characterize scoping reviews in the nursing literature. Hence this review aimed to examine the characteristics of scoping reviews published in nursing journals and evaluate the methodological and reporting quality of the scoping reviews.DESIGN: A systematic review.METHODS: A comprehensive search of three electronic databases (PubMed, CINAHL, and Embase) were conducted. Scoping reviews published in English on or before December 31, 2020 were included, with the criterion that their publication had been in nursing journals indexed in the Journal Citation Reports (2020 Science Edition) of the Web of Science. Two reviewers independently screened the titles and abstracts for eligibility. A standardized data extraction form was used for data collection, and a 29-item checklist was developed to assess the methodological and reporting quality of the scoping reviews. The methodological and reporting quality was assessed independently by four reviewers and subsequently counter-checked by another two reviewers. Descriptive statistics were used to characterize the included papers, and narrative synthesis was undertaken to explain the results.RESULTS: This review included 422 papers from 88 nursing journals. They were published between 2008 and 2021 (median year 2019). Only 15 (3.5%) reviews reported accessible protocols, and 63 (15.0%) presented data on their critical appraisal of the included sources of evidence. Poor reporting of the selection of sources of evidence and data extraction was also identified. Overall, the 422 included reviews had complied with 20 (median [range: 9-27]) of the 29 items on the checklist.CONCLUSIONS: Scoping reviews have garnered wider acceptance in nursing research, of which the scopes and methodologies exhibit much diversity. Our systematic review has provided insights into existing scoping reviews published in nursing journals through our characterization of them and appraisal of their methodological and reporting quality. However, our findings underline several areas needing improvement: the lack of transparency, the absence of critical appraisal, non-compliance to established checklists, and inconsistencies in the data processing.CLINICAL RELEVANCE: Appraising included sources of evidence and maintaining transparency in the conduct and reporting of scoping reviews increases the practical utility of scoping reviews.
View details for DOI 10.1111/jnu.12861
View details for PubMedID 36494752
Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming.
International journal of environmental research and public health
2022; 19 (19)
(1) Background: African American women breast cancer survivors face unique experiences that impact their quality of life as they transition beyond treatments. Experiences may be complicated by living at the intersection of systemically oppressed identities, including gender, race, social class, and cancer-related disability. Using the Black Feminist Thought (BFT) framework and the PEN-3 cultural model, this qualitative study sought to: (a) understand African American women breast cancer survivors' lived experiences; (b) examine how the multiple intersecting factors of race, gender, social class/socioeconomic status, and cancer-related disability impact their quality of life; and (c) inform future health promotion programming that is culturally relevant to AAWBCS to improve their quality of life. (2) Methods: Seven focus groups were conducted with 30 African American breast cancer survivors in a Midwestern metropolitan region. Focus groups were audiotaped and transcribed verbatim. Framework analyses were conducted to identify themes with NVivo qualitative analysis software. (3) Results: Four themes emerged: (a) caregiving roles provide both support and challenges for survivors, (b) the "strong Black woman" is inherent in survivor experiences, (c) intersectionality impacts survivorship, and (d) African American women resist oppression through culturally specific supports and advocacy. (4) Conclusions: The intervention point of entry should be at the peer support group level and centered on family and provide community-based support and services. Future research should move upstream to address social determinants of health, including racism, sexism, and ableism; there is a critical need to discuss how structural racism affects health care and develop interventions to address racial discrimination and racial bias in health care.
View details for DOI 10.3390/ijerph191912807
View details for PubMedID 36232105
Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: An Observational Study Using a Real-Time Locating System.
Journal of medical Internet research
BACKGROUND: The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments is of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization.OBJECTIVE: To evaluate changes in nursing workflow relative to pre-pandemic levels using real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit.METHODS: In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. Existing RTLS captured nurse movement during 1 pre- and 5 post-pandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level.RESULTS: Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P's<0.0001). Frequency of encounters decreased (difference-in-differences range: -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range: 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units compared to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (p's>0.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (standard deviation = 13.6) each.CONCLUSIONS: RTLS movement data suggests total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, frequency of nurse-patient in-person encounters decreased and duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to pre-pandemic periods. The simultaneous adoption of telehealth suggests virtual care was a complement to, rather than a replacement for, in-person care. Study limitations, however, preclude our ability to draw a causal link between nursing workflow change and telehealth adoption, and further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.CLINICALTRIAL:
View details for DOI 10.2196/36882
View details for PubMedID 35635840
Effectiveness of Social Needs Screening and Interventions in Clinical Settings on Utilization, Cost, and Clinical Outcomes: A Systematic Review.
2022; 6 (1): 454-475
Objective: This systematic review examined and synthesized peer-reviewed research studies that reported the process of integrating social determinants of health (SDOH) or social needs screening into electronic health records (EHRs) and the intervention effects in the United States.Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, a systematic search of Scopus, Web of Science Core Collection, MEDLINE, and Cochrane Central Register of Clinical Trials was performed. English language peer-reviewed studies that reported the process of integrating SDOH or social needs screening into EHRs within the U.S. health systems and published between January 2015 and December 2021 were included. The review focused on process measures, social needs changes, health outcomes, and health care cost and utilization.Results: In total, 28 studies were included, and half were randomized controlled trials. The majority of the studies targeted multiple SDOH domains. The interventions vary by the levels of intensity of their approaches and heterogeneities in outcome measures. Most studies (82%, n=23) reported the findings related to the process measures, and nearly half (43%, n=12) reported outcomes related to social needs. By contrast, only 39% (n=11) and 32% (n=9) of the studies reported health outcomes and impact on health care cost and utilization, respectively. Findings on patients' social needs change demonstrated improved access to resources. However, findings were mixed on intervention effects on health and health care cost and utilization. We also identified gaps in implementation challenges to be overcome.Conclusion: Our review supports the current policy efforts to increase U.S. health systems' investment toward directly addressing SDOH. While effective interventions can be more complex or resource intensive than an online referral, health care organizations hoping to achieve health equity and improve population health must commit the effort and investment required to achieve this goal.
View details for DOI 10.1089/heq.2022.0010
View details for PubMedID 35801145