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OBJECTIVE: The objective was to develop a decision aid (DA) to facilitate shared decision making (SDM) around whether to obtain computed tomography (CT) imaging in patients presenting to the emergency department (ED) with suspected uncomplicated ureterolithiasis. METHODS: We used evidence-based DA development methods, including qualitative methods and iterative stakeholder engagement, to develop and refine a DA. Guided by the Ottawa Decision Support Framework, International Patient Decision Aid Standards (IPDAS), and a steering committee made up of stakeholders, we conducted interviews and focus groups with a purposive sample of patients, community members, emergency clinicians, and other stakeholders. We used an iterative process to code the transcripts and identify themes. We beta-tested the DA with patient-clinician dyads facing the decision in real time. RESULTS: From August 2018 to August 2019, we engaged 102 participants in the design and iterative refinement of a DA focused on diagnostic options for patients with suspected ureterolithiasis. Forty-six were ED patients, community members, or patients with ureterolithiasis, and the remaining were emergency clinicians (doctors, residents, advanced practitioners), researchers, urologists, nurses, or other physicians. Patients and clinicians identified several key decisional needs including an understanding of accuracy, uncertainty, radiation exposure/cancer risk, and clear return precautions. Patients and community members identified facilitators to SDM, such as a checklist of signs and symptoms. Many stakeholders, including both patients and ED clinicians, expressed a strong pro-CT bias. A six-page DA was developed, iteratively refined, and beta-tested. CONCLUSIONS: Using stakeholder engagement and qualitative inquiry, we developed an evidence-based DA to facilitate SDM around the question of CT scan utilization in patients with suspected uncomplicated ureterolithiasis. Future research will test the efficacy of the DA in facilitating SDM.

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BACKGROUND AND OBJECTIVES: Physician nutrition counseling has become increasingly important due to increases in child and adult obesity. However, medical student education on nutrition counseling, especially for low-income families, is insufficient. METHODS: Eat Healthy, Stay Active! (EHSA) is a community-based child obesity program that provided experiential learning for medical students to counsel low-income Head Start families about nutrition. The authors conducted a focus group to explore medical students' opinions about the proficiency of their nutrition education skills, especially in low-income families, and the role of EHSA. The authors also surveyed students about their self-confidence in providing low-income families with nutrition counseling. RESULTS: Most students reported a favorable overall impression of EHSA with a mean score of 7 on a 10-point scale (1=poor experience, 10=very positive experience) and 70% reporting they would recommend EHSA to their classmates. They also reported a significant (80%, P< 0.0001) increase in their confidence of counseling patients about child obesity after participating in EHSA. In focus groups, students felt that EHSA improved their nutrition knowledge and helped them to understand barriers of low-income families for healthy nutrition. CONCLUSIONS: Students participating in EHSA, a novel, community-based, experiential learning project, gained self-confidence in providing nutrition counseling to low-income families. The program also positively impacted medical student personal opinions of low-income families by providing a personal reference for low-income struggles.

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Using mAbs as therapeutic molecules is complicated by the propensity of mAbs to aggregate at elevated concentrations, which can lead to a variety of adverse events in treatment. Here, we describe a proof-of-concept for new methodology to detect and quantify mAb aggregation. Assay development included using an aggregated mAb as bait for screening of phage display peptide library and identifying those peptides with random sequence which can recognize mAb aggregates. Once identified, the selected peptides can be used for developing quantitative methods to assess mAb aggregation. Results indicate that a peptide binding method coupled with mass spectrometric detection of bound peptide can quantify mAb aggregation and potentially be useful for monitoring aggregation propensity of therapeutic protein candidates.

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