Gail D'Eramo Melkus

Faculty

Gail D'Eramo Melkus headshot

Gail D'Eramo Melkus

Florence and William Downs Professor in Nursing Research

1 212 998 5356

433 First Ave
Room 744
New York, NY 10010
United States

Gail D'Eramo Melkus's additional information

Gail D’Eramo Melkus, EdD, ANP, FAAN, is the vice dean for research and the Florence and William Downs Professor in Nursing Research at NYU Rory Meyers College of Nursing. Melkus’ sustained interest in eliminating health disparities among vulnerable populations earned her a reputation as a leader in the development and testing of culturally competent models of diabetes care. Her program of intervention research that focuses on physiological and behavioral outcomes of self-management interventions has served as an education and training ground for numerous multidisciplinary scientists. 

Melkus currently serves as co-PI and co-investigator or research mentor on numerous funded projects specific to biobehavioral interventions for prevention and management of chronic conditions and related co-morbidities, in mid-life and older adults, including national and international work. Melkus serves as sponsor of K-awards focused on health disparities among vulnerable populations (women with T2D and depression; elderly Blacks at-risk for depression, glycemic control and infection in oncology stem cell recipients, CHD in older adult workers, HIV in adolescents). She is PI for the NINR P20 Center for Precision Health in Diverse Populations.

Before joining the faculty at NYU Meyers, Melkus was the Independence Foundation Professor of Nursing at the Yale University School of Nursing, where, in collaboration with the Diabetes Research Center of Albert Einstein College of Medicine in NY, she developed and implemented the Diabetes Care Specialty for advanced practice nurses. 

In recognition of her mentorship, Melkus received the 1st Annual NYU CTSI Mentor Award in May 2011, and in 2015 was inducted into the STTI Nurse Researcher Hall of Fame.

Melkus earned her EdD from Columbia University, MS from Yale University, MS from Connecticut State University, and ASN/BS in Nursing from the University of Bridgeport.

MS - Yale University (2003)
EdD - Columbia University (1987)
MS - Connecticut State University (1978)
ASN/BS, Nursing - University of Bridgeport (1976)

Primary care
Non-communicable disease
Women's health
Immigrants
Adult health

American Academy of Nursing
American Diabetes Association
Council for the Advancement of Nursing Science
CT Nursing Association
Eastern Nursing Research Society
Society for Behavioral Medicine

Faculty Honors Awards

International Nurse Researcher Hall of Fame, Sigma Theta Tau (2015)
Distinguished Alumni Award, University of Bridgeport (2014)
Faculty Scholar Appointment, Universita' Tor Vergata (2014)
Fellow, New York Academy of Medicine (2014)
Affiliated Faculty Appointment, University of Georgia (2014)
Advisory Committee Member, Medicare Evidence Development & Coverage (2013)
1st annual Distinguished Mentor Award, NYU Clinical Translational Science Institute (2011)
Distinguished Scholar Award, New York University College of Nursing (2010)
Distinguished Nurse Researcher Award, New York State Nurse Foundation (2009)
Endowed Chair, New York University (2008)
Endowed Chair of the Independence Foundation, Yale University (2004)
Fellow, American Academy of Nursing (2003)
Excellence in Nursing Research Award, Diamond Jubilee Virginia Henderson (2003)

Publications

Addressing Challenges in Recruiting Diverse Populations for Research: Practical Experience from a P20 Center

Wright, F., Malone, S. K., Wong, A., Melkus, G. D., & Dickson, V. V. (2022). Nursing Research, 71(3), 218-226. 10.1097/NNR.0000000000000577
Abstract
Abstract
Background Improving the recruitment and retention of underrepresented groups in all research areas is essential for health equity. However, achieving and retaining diverse samples is challenging. Barriers to recruitment and retention of diverse participants include socioeconomic and cultural factors and practical challenges (e.g., time and travel commitments). Objectives The purpose of this article is to describe the successful recruitment and retention strategies used by two related studies within a P20 center funded by the National Institute of Nursing Research focused on precision health research in diverse populations with multiple chronic conditions, including metabolic syndrome. Methods To address the complexity, biodiversity, and effect of metabolic syndrome and multiple chronic conditions, we developed culturally appropriate, multipronged recruitment and retention strategies for a pilot intervention study and a longitudinal observational pilot study within our P20 center. The following are the underlying principles that guided the recruitment and retention strategies: (a) flexibility, (b) active listening and bidirectional conversations, and (c) innovative problem solving. Results The intervention study (Pilot 1) enrolled 49 participants. The longitudinal observational study (Pilot 2) enrolled 45 participants. Women and racial/ethnic minorities were significantly represented in both. In Pilot 1, most of the participants completed the intervention and all phases of data collection. In Pilot 2, most participants completed all phases of data collection and chose to provide biorepository specimens. Discussion We developed a recruitment and retention plan building on standard strategies for a general medical population. Our real-world experiences informed the adaption of these strategies to facilitate the participation of individuals who often do not participate in research - specifically, women and racial/ethnic populations. Our experience across two pilot studies suggests that recruiting diverse populations should build flexibility in the research plan at the outset.

Factors Associated With Cognitive Impairment in Heart Failure With Preserved Ejection Fraction

Faulkner, K. M., Dickson, V. V., Fletcher, J., Katz, S. D., Chang, P. P., Gottesman, R. F., Witt, L. S., Shah, A. M., & D’Eramo Melkus, G. (2022). The Journal of Cardiovascular Nursing, 37(1), 17-30. 10.1097/JCN.0000000000000711
Abstract
Abstract
BACKGROUND: Cognitive impairment is prevalent in heart failure and is associated with higher mortality rates. The mechanism behind cognitive impairment in heart failure with preserved ejection fraction (HFpEF) has not been established. OBJECTIVE: The aim of this study was to evaluate associations between abnormal cardiac hemodynamics and cognitive impairment in individuals with HFpEF. METHODS: A secondary analysis of Atherosclerosis Risk in Communities (Atherosclerosis Risk in Communities) study data was performed. Participants free of stroke or dementia who completed in-person assessments at visit 5 were included. Neurocognitive test scores among participants with HFpEF, heart failure with reduced ejection fraction (HFrEF), and no heart failure were compared. Sociodemographics, comorbid illnesses, medications, and echocardiographic measures of cardiac function that demonstrated significant (P < .10) bivariate associations with neurocognitive test scores were included in multivariate models to identify predictors of neurocognitive test scores among those with HFpEF. Multiple imputation by chained equations was used to account for missing values. RESULTS: Scores on tests of attention, language, executive function, and global cognitive function were worse among individuals with HFpEF than those with no heart failure. Neurocognitive test scores were not significantly different among participants with HFpEF and HFrEF. Worse diastolic function was weakly associated with worse performance in memory, attention, and language. Higher cardiac index was associated with worse performance on 1 test of attention. CONCLUSIONS: Cognitive impairment is prevalent in HFpEF and affects several cognitive domains. The current study supports the importance of cognitive screening in patients with heart failure. An association between abnormal cardiac hemodynamics and cognitive impairment was observed, but other factors are likely involved.

Identifying Patients with Hypoglycemia Using Natural Language Processing: Systematic Literature Review

Zheng, Y., Dickson, V. V., Blecker, S., Ng, J. M., Rice, B. C., Melkus, G. D., Shenkar, L., Mortejo, M. C. R., & Johnson, S. B. (2022). JMIR Diabetes, 7(2). 10.2196/34681
Abstract
Abstract
Background: Accurately identifying patients with hypoglycemia is key to preventing adverse events and mortality. Natural language processing (NLP), a form of artificial intelligence, uses computational algorithms to extract information from text data. NLP is a scalable, efficient, and quick method to extract hypoglycemia-related information when using electronic health record data sources from a large population. Objective: The objective of this systematic review was to synthesize the literature on the application of NLP to extract hypoglycemia from electronic health record clinical notes. Methods: Literature searches were conducted electronically in PubMed, Web of Science Core Collection, CINAHL (EBSCO), PsycINFO (Ovid), IEEE Xplore, Google Scholar, and ACL Anthology. Keywords included hypoglycemia, low blood glucose, NLP, and machine learning. Inclusion criteria included studies that applied NLP to identify hypoglycemia, reported the outcomes related to hypoglycemia, and were published in English as full papers. Results: This review (n=8 studies) revealed heterogeneity of the reported results related to hypoglycemia. Of the 8 included studies, 4 (50%) reported that the prevalence rate of any level of hypoglycemia was 3.4% to 46.2%. The use of NLP to analyze clinical notes improved the capture of undocumented or missed hypoglycemic events using International Classification of Diseases, Ninth Revision (ICD-9), and International Classification of Diseases, Tenth Revision (ICD-10), and laboratory testing. The combination of NLP and ICD-9 or ICD-10 codes significantly increased the identification of hypoglycemic events compared with individual methods; for example, the prevalence rates of hypoglycemia were 12.4% for International Classification of Diseases codes, 25.1% for an NLP algorithm, and 32.2% for combined algorithms. All the reviewed studies applied rule-based NLP algorithms to identify hypoglycemia. Conclusions: The findings provided evidence that the application of NLP to analyze clinical notes improved the capture of hypoglycemic events, particularly when combined with the ICD-9 or ICD-10 codes and laboratory testing.

Precision Health in Cardiovascular Conditions

Dickson, V. V., & D’Eramo Melkus, G. (2022). The Journal of Cardiovascular Nursing, 37(1), 56-57. 10.1097/JCN.0000000000000879

Changes in Gut Microbiome Associated With Co-Occurring Symptoms Development During Chemo-Radiation for Rectal Cancer: A Proof of Concept Study

González-Mercado, V. J., Henderson, W. A., Sarkar, A., Lim, J., Saligan, L. N., Berk, L., Dishaw, L., McMillan, S., Groer, M., Sepehri, F., & Melkus, G. D. (2021). Biological Research for Nursing, 23(1), 31-41. 10.1177/1099800420942830
Abstract
Abstract
Purpose: To examine a) whether there are significant differences in the severity of symptoms of fatigue, sleep disturbance, or depression between patients with rectal cancer who develop co-occurring symptoms and those with no symptoms before and at the end of chemotherapy and radiation therapy (CRT); b) differences in gut microbial diversity between those with co-occurring symptoms and those with no symptoms; and c) whether before-treatment diversity measurements and taxa abundances can predict co-occurrence of symptoms. Methods: Stool samples and symptom ratings were collected from 31 patients with rectal cancer prior to and at the end of (24–28 treatments) CRT. Descriptive statistics were computed and the Mann-Whitney U test was performed for symptoms. Gut microbiome data were analyzed using R’s vegan package software. Results: Participants with co-occurring symptoms reported greater severity of fatigue at the end of CRT than those with no symptoms. Bacteroides and Blautia2 abundances differed between participants with co-occurring symptoms and those with no symptoms. Our random forest classification (unsupervised learning algorithm) predicted participants who developed co-occurring symptoms with 74% accuracy, using specific phylum, family, and genera abundances as predictors. Conclusion: Our preliminary results point to an association between the gut microbiota and co-occurring symptoms in rectal cancer patients and serves as a first step in potential identification of a microbiota-based classifier.

Exploring the effects of genomic testing on fear of cancer recurrence among breast cancer survivors

Gormley, M., Knobf, M. T., Vorderstrasse, A., Aouizerat, B., Hammer, M., Fletcher, J., & D’Eramo Melkus, G. (2021). Psycho-Oncology, 30(8), 1322-1331. 10.1002/pon.5679
Abstract
Abstract
Objective: Fear of cancer recurrence (FCR) is the greatest unmet psychosocial need among breast cancer survivors (BCS). The Oncotype Dx® test predicts the 10-year risk of distant recurrence and benefit of adjuvant chemotherapy among women with early stage hormone receptor-positive breast cancer. Despite the test's clinical utility, psychosocial responses are poorly understood. Methods: A descriptive cross-sectional study was conducted to explore associations between Oncotype Dx® test results (Recurrence Score [RS]) and FCR, health-related quality of life (HRQOL), distress, anxiety, depression, illness representation and perceived risk. Bivariate analyses were used to examine the associations between variables followed by multiple linear regression to examine predictors of FCR. Results: Greater FCR was associated with higher distress, anxiety, depression, illness representation and poorer HRQOL. BCS's with a high Oncotype Dx® RS reported higher overall fear (p = 0.013) and greater perceived consequences of their cancer (p = 0.034) compared to BCS's with a low RS. Using multiple linear regression, anxiety ((Formula presented.) = 0.21, p = 0.016), greater emotional response (Formula presented.) = 0.45, p < 0.001) and perceived consequences ((Formula presented.) = 0.18, p = 0.039) of illness explained 58% of the variance (p < 0.001) in FCR. Conclusion: BCS's with higher risk of recurrence may experience higher FCR. However, for FCR, modifiable factors such as anxiety and illness representation (greater emotional response and perceived consequences of illness) may be more important than non-modifiable factors such as Oncotype Dx® test results and age. Further research is needed to develop personalized interventions to improve BCS's outcomes.

Habitual physical activity patterns in a nationally representative sample of U.S. adults

Malone, S. K., Patterson, F., Grunin, L., Melkus, G. D., Riegel, B., Punjabi, N., Yu, G., Urbanek, J., Crainiceanu, C., & Pack, A. (2021). Translational Behavioral Medicine, 11(2), 332-341. 10.1093/tbm/ibaa002
Abstract
Abstract
Physical inactivity is a leading determinant of noncommunicable diseases. Yet, many adults remain physically inactive. Physical activity guidelines do not account for the multidimensionality of physical activity, such as the type or variety of physical activity behaviors. This study identified patterns of physical activity across multiple dimensions (e.g., frequency, duration, and variety) using a nationally representative sample of adults. Sociodemographic characteristics, health behaviors, and clinical characteristics associated with each physical activity pattern were defined. Multivariate finite mixture modeling was used to identify patterns of physical activity among 2003-2004 and 2005-2006 adult National Health and Nutrition Examination Survey participants. Chi-square tests were used to identify sociodemographic differences within each physical activity cluster and test associations between the physical activity clusters with health behaviors and clinical characteristics. Five clusters of physical activity patterns were identified: (a) low frequency, short duration (n = 730, 13%); (b) low frequency, long duration (n = 392, 7%); (c) daily frequency, short duration (n = 3,011, 55%); (d) daily frequency, long duration (n = 373, 7%); and (e) high frequency, average duration (n = 964, 18%). Walking was the most common form of activity; highly active adults engaged in more varied types of activity. High-activity clusters were comprised of a greater proportion of younger, White, nonsmoking adult men reporting moderate alcohol use without mobility problems or chronic health conditions. Active females engaged in frequent short bouts of activity. Data-driven approaches are useful for identifying clusters of physical activity that encompass multiple dimensions of activity. These activity clusters vary across sociodemographic and clinical subgroups.

A mixed methods study describing the self-care practices in an older working population with cardiovascular disease (CVD): Balancing work, life and health

Dickson, V. V., Jun, J., & Melkus, G. D. (2021). Heart and Lung, 50(3), 447-454. 10.1016/j.hrtlng.2021.02.001
Abstract
Abstract
Background: Self-care is essential to cardiovascular disease (CVD) health outcomes, but may be challenging for older working adults. Objective: Describe self-care and the relationship of work-related characteristics to self-care among older workers with CVD. Methods: Convergent mixed methods design (n = 108) assessed self-care, organization of work, job-level and clinical factors; qualitative data (n = 40) explored self-care and working. Data integrated in the final analytic phase. Results: Sixty-eight percent reported adequate self-care maintenance (SC-CHDI maintenance ≥70); only 22% had adequate self-care management (SC-CHDI management ≥ 70). Controlling for physical capacity, work-related factors explained 22% variance in self-care maintenance; physical capacity was only significant determinant of self-care management. Individuals with poor self-care described low job control, job stress and work-life imbalance that interfered with routine self-care. Individuals with poor self-care management reported “feeling stressed out” and “extreme fatigue” attributed to their job. Conclusions: Interventions targeting self-care, stress management and work-life balance among older workers with CVD are needed.

Recruitment and enrollment of participants in an online diabetes self-management intervention in a virtual environment

Vorderstrasse, A., Reagan, L., D’Eramo Melkus, G., Nowlin, S. Y., Birdsall, S. B., Burd, A., Cho, Y. H., Jang, M., & Johnson, C. (2021). Contemporary Clinical Trials, 105. 10.1016/j.cct.2021.106399
Abstract
Abstract
Effective recruitment of research participants is essential for successful randomized controlled trials and remains one of the most challenging and labor-intensive aspects of conducting research. The purpose of this manuscript is to describe recruitment methods for this two-group, internet-based intervention trial and enrollment status in relation to recruitment methods, accounting for accrual rates and recruitment costs and to discuss our recruitment results and limitations informed by the Clinical Trials Transformation Initiative (CTTI) team's evidence and expert-based recommendations for recruitment. The primary study was a two-group randomized controlled trial designed to evaluate the efficacy of a virtual environment, Diabetes LIVE©, compared to a traditional website format to provide diabetes self-management education and support to adults with type 2 diabetes. Our recruitment experience was labor-intensive, multimodal, and required multiple iterations throughout the study to meet recruitment goals. To allow for more efficient and realistic budgets aligned with funding, researchers should engage stakeholders in recruitment planning and monitor and report personnel time and cost by recruitment methods. To allow for more efficient and effective recruitment into meaningful clinical trials and of interest to participants, researchers should use a participative approach during all study phases, including question development.

Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus

Dunn Navarra, A. M., Whittemore, R., Bakken, S., Rosenberg, M. J., Gormley, M., Bethea, J., Gwadz, M., Cleland, C., Liang, E., & D’Eramo Melkus, G. (2020). Nursing Research, 69(3), 197-209. 10.1097/NNR.0000000000000422
Abstract
Abstract
BACKGROUND: Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort. OBJECTIVES: As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior. METHODS: The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources. RESULTS: Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control. DISCUSSION: Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.