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Three Duke University School of Nursing researchers and their collaborators were recently awarded new funding for pilot projects — all centered around reducing health inequities and improving patient care.

Awardees include Assistant Professors Stephanie Ibemere, PhD, RN, and Maryellen Kelly, DNP, CPNP, MHSc, and faculty John Myers, PhD, MSPH.

This year’s pilot program required that faculty members submit proposals that incorporate at least one of the following racial justice themes:

• Dismantling structures that perpetuate racism;
• Advancing solutions that ensure health equity in marginalized populations;
• Multilevel approaches to addressing social contributors to health;
• Methods that improve the participant experience and address racial equity in data collection, analysis, and reporting.

The School’s Center for Nursing Research (CNR) is pleased to announce this year’s grants address the clinical context of sickle cell disease (SCD) management and associated health disparities for adults in Sierra Leone; improve our understanding of the pediatric urobiome, particularly in underserved populations; and acquire large datasets that will allow Duke researchers access to variables needed to improve understanding of health disparities.

Since 2017, the pilot program has encouraged researchers to investigate relevant and innovative ideas that promote health equity and address the School’s Research Areas of Excellence: data science, health innovation, population health and precision health. The goal of the program is to encourage team science and endorse scientific inquiry that positions investigators to be competitive for extramural research funding. The program is administered by the CNR and funded through a generous award from A. Eugene Washington, M.D., M.P.H., M.Sc., chancellor for health affairs, Duke University, and president and CEO, Duke University Health System.

“It was important for the CNR to invest in pilot research that addresses health equity and racial justice so that we are well-positioned to contribute to the future of nursing science,” said Christin Daniels, assistant dean for research development. “This year’s topics tackle a wide variety of pressing challenges – locally and globally, and we’re thrilled to support our researchers’ endeavors toward solving big problems. This pilot program is made possible by our volunteer reviewers, and we’d like to thank them for their collegiality and service. We’d also like to thank Chancellor Washington for the generous award that allows us to offer this program.”

Extending SCD Management: Adapting Management Recommendations to Sierra Leonean Context

Ibemere serves as the principal investigator for her study entitled “Extending Sickle Cell Disease (SCD) Management: Adapting Management Recommendations to Sierra Leonean Context.” She is collaborating with Paula Tanabe, PhD, MSN, MPH, RN, FAEN, FAAN, vice dean, research, and Laurel Chadwick Professor of Nursing, Nirmish Shah, MD, associate professor of medicine, and Cheedy Jaja, PhD, assistant dean for global engagement, University of South Florida.

Evidence-based guidelines exist for sickle cell management, but they do not currently account for the unique perspectives of sub-Saharan populations, who have the greatest prevalence of SCD. Approximately 75 percent of those born with SCD are born in sub-Saharan Africa, and 50 to 90 percent will die before the age of 5. The estimated life expectancy for adults with SCD in Sierra Leone is 20 to 30 years shorter than in high-resourced settings. To reduce the inequitable access to a clinical model for SCD management, the project team will assess clinician and community member knowledge of the National Heart, Lung, and Blood Institute SCD recommendations and evaluate existing SCD management algorithms (e.g. SCD toolbox) for the clinical context in Sierra Leone.

The chasms between SCD outcomes in low-income settings contrasted with those in high-resource settings are linked to systematic decisions and structural barriers which impede workforce development and patient access to care. If left unaddressed, researchers expect continued poor health outcomes for individuals living with SCD in sub-Saharan Africa. Guided by the culture-centered approach, this study will engage Sierra Leonean colleagues, elevating the voices of historically marginalized and minoritized populations while investing in the clinical improvement of SCD disease management within this specific cultural context.

These findings will inform the development of a SCD care management model rooted in evidence-based practice for providers, and the preliminary data will help inform the development of a future NIH R21 submission.

Stability of the Pediatric Urinary Microbiome

Principal investigator Kelly will lead the study entitled “Stability of the Pediatric Urinary Microbiome” along with her collaborators Lisa Karstens, PhD, assistant professor, Oregon Health and Science University, and Tatyana Sysoeva, PhD, assistant professor of microbiology, The University of Alabama in Huntsville.

Urinary tract infections (UTIs) are the most common outpatient infections in the U.S. and are among the most serious bacterial infections encountered by pediatricians. In children, UTIs can result in life-long health consequences including renal scarring, hypertension, renal insufficiency, and pregnancy complications, such as preeclampsia and preterm birth. Antimicrobial resistance of urinary pathogens that cause UTIs is increasing, yet antibiotics remain the standard treatment for UTIs in children. Antibiotic use increases resistance and may change the child’s microbiome. There is a pressing need to develop non-antibiotic therapeutics for UTI treatment, especially in children.

UTIs are more common in Latinx and white children. Inability to make frequent trips to a clinic for urine collection presents a barrier to care that is exacerbated in marginalized populations. At-home urine collection and storage would improve adherence and enhance the quality of the urobiome data.

This pilot study will utilize urine samples in children taken over the course of two months to determine the stability of the urinary microbiome in children and determine if at-home collection is viable, particularly in the Latinx population. The team will translate their study materials into Spanish and work with a community advisory board to ensure the Latinx community helps guide the research. The long-term goal of this study is to develop a predictive test that can identify children at increased risk of UTIs as well as a non-antibiotic intervention strategy. Kelly and team anticipate using the study data towards a future R01 grant submission.

National Representative Databases for Clinical Research

Myers will serve as the principal investigator of the  study entitled “National Representative Databases for Clinical Research.” The research team includes Michael Cary,  PhD, RN, Elizabeth C. Clipp Term Chair in Nursing and associate professor and Nancy Crego, PhD, RN, CCRN, CHSE, assistant professor, and Michael J. Smith, MD, professor of pediatrics, Bradley Hammill, DrPH, associate professor, and Gina-Maria Pomann, PhD, assistant professor, with the School of Medicine.

National administrative databases are rich sources of clinical information that may serve as the basis for a multitude of research projects. The School of Nursing and overall Duke community have limited access to such databases. In addition, the databases are not in formats that allow untrained analysts to perform appropriate analyses. This pilot project seeks to purchase the following data sources and convert data into user-friendly formats for  Duke research utilization:

• Kid’s Inpatient Database  from Healthcare Cost and Utilization Project (HCUP)
• National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Surveys
• National Immunization Survey
• National Inpatient Survey
• National Emergency Department Sample Census Data and Area Health Resources Files

Myers and  team will use this data to build  the School of Nursing’s first data warehouse, Health e-Data. The data contained within the warehouse will significantly enhance our ability to access and study large-scale, national clinical data.

The warehouse will also advance our ability to address racial equity in data collection, analysis, and reporting. Incomplete race data is a serious and persistent problem that hampers progress. Fortunately, the HCUP databases have created multiple procedures to address this issue. They have identified standardized categories for race and ethnicity, developed novel imputation methods to reduce the impact of existing missing data on disparities research, and linked zip code-level information (e.g., racial distribution, income, education, and poverty level) from the U.S. Census to address socioeconomic status data. They now also include data examining social determinants of health . As such, the creation of the Health e-Data warehouse will allow researchers to examine racial disparities more robustly and rigorously.

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