Five Duke University School of Nursing researchers and their collaborators were awarded new funding for pilot projects beginning this winter.

Awardees include Assistant Professors Tara Albrecht, PhD, ACNP-BC, ACHPN, RN, Kais Gadhoumi, PhD, Brandon Knettel, PhD, and Allison Stafford, PhD, RN and Professor Bradi B. Granger, PhD, MSN, RN, FAAN.

This year’s grants address cancer recovery using physical activity, deep learning to improve EEG pattern detection, a community-based approach to eliminating hypertension disparities, treatment and mental health support for rural North Carolinians with Opioid Use Disorder, and depression treatment barriers for Latinx adolescents.

The pilot program encourages researchers to explore relevant and innovative ideas that promote health equity and address the School’s Research Areas of Excellence (RAEs). The four RAEs are: 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. This year, applicants could choose from two path options: new research at the assistant professor rank or revise and resubmit research at any rank. The program is administered by the Center for Nursing Research (CNR) and funded through a generous award from Duke Health Chancellor Eugene Washington. The pilot program has funded 25 projects since 2017.

“We are thrilled to be able to offer another round of pilot grants to seed future external research for our School of Nursing faculty members,” said Christin Daniels, assistant dean for Research Development.

“This year’s topics reflect the importance of today’s problems – including health inequity, and we’re inspired by our researchers’ rigorous approaches to developing much-needed solutions. We’d like to thank our reviewers and panel for their collegiality and service. We’d also like to thank Chancellor Washington for the generous award that allows us to offer this program.”

“Pilot Testing a Nurse-Led Exercise Program in Adults with Acute Leukemia"

Albrecht serves as the principal investigator for her study entitled “Pilot Testing a Nurse-Led Exercise Program in Adults with Acute Leukemia.” She is collaborating with Qing Yang, PhD, associate professor, Amy Pastva, professor of orthopaedic surgery and Tom LeBlanc, associate professor of medicine, of Duke University, and Ashley Leak Bryant, associate professor of nursing, of UNC-Chapel Hill.

Their study involves testing the Build Stamina intervention, a physical activity program for patients with acute leukemia that is tailored to each individual’s current physical abilities. Acute leukemias (AL) are aggressive, debilitating cancers of the blood and bone marrow with profound implications for the patient. The initial induction chemotherapy is aggressive and results in multiple symptoms, life-threatening complications, and long hospitalizations and often leads to diminished physical function, leaving individuals unable to function at pre-cancer levels. Diminished physical function is associated with poor survival and can delay or prevent future life-saving treatments such as stem cell transplant. Self-management interventions such as physical activity in adults during and after cancer treatment are associated with numerous benefits that include improved physical function and symptom severity, allowing the adult to function independently in their day-to-day life but are not yet well-tested in AL patients. This pilot study will yield preliminary data needed for a future R01 resubmission to the National Cancer Institute.

“Developing a Large Repository of Expert-annotated Critical Care EEG Recordings Using the American Clinical Neurophysiology Society Standardized Nomenclature"

Principal investigator Gadhoumi will also team up with Yang and Aatif Mairaj Husain, professor of neurology, of Duke University, to improve real-time brain monitoring for critically ill patients. The team’s long-term goal is to leverage deep learning methods to build a core algorithm of a critical care EEG pattern detector, but, in order to train the model, the data must first exist and be reliable. In their project entitled “Developing a Large Repository of Expert-annotated Critical Care EEG Recordings Using the American Clinical Neurophysiology Society Standardized Nomenclature,” Gadhoumi and team will build a large repository of continuous EEG recordings annotated by expert clinicians following the 2021 American Clinical Neurophysiology Society (ACNS) guidelines and standardized critical care EEG terminology and then analyze the inter- and intra-rater reliability between clinician annotators at multiple points throughout the annotation exercise. A tool for automatic detection and recognition of various EEG patterns does not currently exist and will ultimately contribute to a better understanding of abnormal critical care EEG patterns. Some of these have until recently been associated with epileptic activity including non-convulsive seizures and non-convulsive status epilepticus. These subclinical conditions may explain acute pathological insults such as stroke, trauma and central nervous system infection.

Gadhoumi and team’s finished product is the first step toward timely and precise diagnosis and treatment for critically ill patients. Their next step is to apply for a National Institute of Neurological Disorders and Stroke R21 exploratory grant.

“Exploring Telehealth Models to Extend Treatment for Opioid Use Disorder in Rural North Carolina"

In 2018, opioid overdose was the leading cause of injury death in North Carolina. The burden of opioid use disorder (OUD) is greatest in rural North Carolina where there are few treatment options. OUD often co-occurs with a variety of other social and health challenges including homelessness, traumatic injury, HIV, depression and PTSD. To address OUD and its rural burden, principal investigator Knettel along with Padma Gulur, Duke professor of anesthesiology, Aaron McKethan, Duke Margolis Center for Health Policy senior policy fellow, and Nidhi Sachdeva, Duke Department of Population Health senior research program leader, will launch a study entitled “Exploring Telehealth Models to Extend Treatment for Opioid Use Disorder in Rural North Carolina.”

The overall objective of this research is to develop a structured intervention to extend medication-assisted treatment (MAT) and mental health support for OUD in North Carolina’s rural communities. Knettel and team will first hold listening sessions with Buncombe and Granville Vance health departments to understand existing service needs. Next the team will conduct in-depth interviews with providers, health departments, people who use drugs or are in recovery, and experts in mental health. Finally, the team will employ user-centered design to develop the intervention. At the conclusion of this pilot study, the team will submit an NIH R21 to conduct a pilot feasibility trial of the intervention.

“Barriers, Facilitators, and Preferences Regarding Depression Treatment from the Perspectives of Latinx Adolescents, Parents, and Health Care Providers”

Principal investigator Stafford will work with Rosa Gonzalez-Guarda, PhD, MPH, RN, CPH, FAAN, associate professor, and Hayden Bosworth, professor of medicine, psychiatry and nursing, of Duke University, to examine “Barriers, Facilitators, and Preferences Regarding Depression Treatment from the Perspectives of Latinx Adolescents, Parents, and Health Care Providers.” Despite experiencing a higher prevalence of depressive symptoms, Latinx adolescents are significantly less likely to receive treatment for major depressive disorder (MDD) and are more likely to prematurely drop out of psychotherapy for depression than their non-Latinx White peers. This is concerning given that depressive symptoms among Latinx youth are associated with substance use, aggressive behavior and suicidality.

The purpose of this study is to identify a stakeholder-preferred implementation strategy that may improve psychotherapy attendance among Latinx adolescents. Specifically, the team will seek to determine facilitators of and barriers to receiving evidence-based psychotherapy for depression in this population from multiple stakeholder perspectives. Next they will seek to identify a stakeholder-preferred patient- and family-focused implementation strategy that will target known barriers. Data obtained from this pilot study will lay the foundation for an NIH R21 submission to test the effect of the identified implementation strategy on psychotherapy attendance among Latinx youth.

“Patients as Partners for Improving Blood Pressure”

The objective of principal investigator Granger’s project entitled “Patients as Partners for Improving Blood Pressure” is to test one component of a larger community-based intervention designed to reduce disparities among adults with high blood pressure and to improve treatment equity that would result in more adults with controlled hypertension. Hypertension is a significant risk factor for serious cardiovascular events such as stroke and heart failure. The study team also includes Jennifer Deyo, a pharmacist at Duke Regional and Lincoln Community Health Center, and Holly Biola, chief of family medicine at Lincoln Community Health Center. The team will engage the Duke Clinical and Translational Science Institute Community-Engaged Research Initiative as well as a patient team of 10 members known as “hypertension heroes.”

Granger and team aim to improve patient engagement in the experience of self-monitoring for blood pressure; medication management skills, medicine reconciliation, dose-optimization and adherence; and goal-concordance and patient-provider communication. Though many studies have evaluated strategies to improve medication management in hypertension, they have not included a patient-partner who is a peer in both literacy level, socio-economic position, and hypertension disease presentation and progression. Such a partner may be better equipped to establish a trusting relationship, share daily routines and medication-taking behaviors, and share tools. This pilot study will yield preliminary data needed for a future National Heart Lung and Blood Institute resubmission.