Browsing by Author "Holley, Bethany"
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Item Additive Effects of Diabetes and Lower-Limb Amputation on Osteoarthritis with Comparison to Diabetic and Healthy Controls(2022) Ngo, Wayne; Finnerty, Cait; Finco, MG; Holley, Bethany; Menegaz, Rachel A.Purpose: Individuals with type II diabetes and individuals with lower-limb amputation each have increased risks of developing osteoarthritis compared to the general population. Despite the high co-occurrence of type II diabetes with lower-limb amputations, the additive effects of these conditions are unclear. In order to better manage the risk of developing osteoarthritis in these populations, a better understanding of how diabetes and amputation might compound osteoarthritis risk is needed. Methods: We measured hip and knee joint space, as indicators of osteoarthritis, in four groups of individuals: 1) lower-limb amputees with diabetes, 2) lower-limb amputees without diabetes 3) diabetic controls, and 4) healthy controls. We hypothesized lower-limb amputees with diabetes would have the most impaired musculoskeletal health, followed by amputees without diabetes, diabetic controls, then healthy controls. 30 total CT scans of males (42-79 years; BMI 19.7 - 48.9 kg/m2) were obtained from the New Mexico Decedent Image Database. 10 scans were identified for amputees, diabetic controls, and healthy controls. Half of the lower-limb amputees had diabetes while half did not, to differentiate effects of diabetes and amputation on musculoskeletal health. 3D Slicer software was used to measure hip and knee joint spaces as indicators of osteoarthritis. Comparisons between groups were assessed using Kruskal-Wallis with Dunn's post hoc tests. Results: Amputees with and without diabetes showed significantly narrower hip (p=0.01) and knee (p=0.08) joint space bilaterally compared to diabetic and healthy controls. This result suggests amputees could be at a higher risk of developing lower-limb osteoarthritis compared to diabetic and healthy individuals, which is in line with prior work demonstrating the prevalence of osteoarthritis in the amputee population. Conclusions: In agreement with our hypothesis, box plots showed trends of amputees with diabetes having the most narrowed joint space, followed by amputees without diabetes, then diabetic controls, and healthy controls. While not statistically significant, these trends suggest amputees with diabetes are at increased risk of developing osteoarthritis compared to amputees without diabetes. Perhaps the aggressive management of blood glucose and post-amputation physiotherapy treatments could help reduce joint deterioration in these patients. Future work will focus on increasing sample size to assess if these findings are generalizable to a larger population. Increased risks of osteoarthritis can lead to pain, limited mobility, and decreased quality of life. This study can potentially inform clinical standards of care for patients with amputations. Earlier interventions such as proactive musculoskeletal screenings and targeted exercises may reduce risks of developing osteoarthritis, leading to improved clinical outcomes.Item Bridging the Gap - Partnering with Patients to Decrease Readmissions and Sustain Bronchiolitis Guideline Adherence(2022) Holley, Bethany; Hamby, Tyler; Vanvliet, Stacey; Lavin, StephaniePurpose: Quality improvement (QI) methodology has been used successfully to create change packages that increase adherence to evidence-based guidelines. Few have proposed solutions that promote sustained adherence to guidelines after discharge from the emergency department (ED) or inpatient setting. We sought to design a comprehensive strategy to both de-implement unnecessary interventions in the inpatient setting and ensure quality patient care in bronchiolitis after discharge. Methods: This project was a quality improvement initiative consisting of targeted initiatives to address key drivers contributing to suboptimal bronchiolitis care. Specific interventions included provider and patient education, development of an internal clinical practice guideline (CPG), implementation of order set changes, providing patients with an effective nasal aspiration device for inpatient and home use, and creation of a focused hospital-based follow-up clinic that could be utilized for an additional 7 days beyond discharge. This study included patients from 2015 to 2020 who were aged >60 days to < 24 months with a diagnosis of bronchiolitis and without prematurity, significant cardiac, respiratory, or neurologic disease, or intensive care unit admission. Rates of chest radiographs (CXR), antibiotic, bronchodilator, racemic epinephrine, and systemic steroid use were compared across interventions. Results: Through provider education efforts, decreases were seen in albuterol (from 47.7% to 34.5%; P < 0.000) and systemic steroid use (from 14.2%-10.7%; P < 0.003). Continued provider education as well as clear patient educational materials allowed for additional reductions in albuterol (from 34.5% to 22.2%; P < 0.000), CXR use (from 47.9% to 37.6%; P < 0.000), and racemic epinephrine use (from 3.3% to 1%; P < 0.000). A final expansion of provider education and workflow improvements plus the addition of an outpatient care bundle further reduced use of albuterol (from 22.2% to 17.7%; P < 0.000), steroids (from 8.8% to 3%; P < 0.000), and antibiotics (from 16.2% to 7.4%, P < 0.000). This change was sustained across 2 bronchiolitis seasons. Conclusions: Providing patients with education and resources to effectively manage bronchiolitis beyond hospital discharge can continue to drive adherence to evidence-based guidelines, improve patient outcomes, and enhance patient satisfaction.Item Demonstration of Ultrasound Competency for Hypertrophic Cardiac Abnormalities in Pediatric Patients(2022) Wyszynski, Katy; Weindruch, Louisa; Krishnagiri, Amogh; Do, Tien; Terlizzese, Taylor; Holley, Bethany; Broadbent, Dallen; Biggerstaff, Matthew; Schranz, DamonObjectives: Hypertrophic Cardiomyopathy (HCM) is an inherited disorder characterized by thickening of the left ventricular wall. In some cases, thickening of the interventricular septum against the motion of the mitral valve leads to impedance of the left ventricular outflow tract, also known as Hypertrophic Obstructive Cardiomyopathy (HOCM). This can result in sudden cardiac death. HOCM can be considered a "silent killer" in children, especially young athletes, as its presence is often subclinical and likely goes undetected and underreported. Point of care ultrasound (POCUS) is an efficient imaging modality that can diagnose HOCM in the pediatric population. We propose that 2nd and 3rd year medical students, all of whom are novice ultrasound users, are able to correctly visualize and measure the interventricular septum in pediatric patients using hand-held portable probes. This is relevant because it highlights the potential for medical students to use POCUS as a screening tool for HOCM. Methods: To evaluate our hypothesis, a group of nine 2nd and 3rd year medical students were asked to perform cardiac ultrasounds on pediatric patients during a pre-participation school sports physical event. While the students had some experience using point of care ultrasound, all were still considered novice ultrasound users. Prior to the event, the students attended a brief cardiac ultrasound training session with faculty. Following the school physical event, the student's images were evaluated by ultrasound-trained faculty members. Using a standardized rubric, the images were graded as either adequate or inadequate. No medical decisions were made during the process and the students were not diagnosing hypertrophic cardiomyopathy or any other heart defects. Results: While we are still in the data analysis phase of our project, preliminary results suggest that medical students are capable of visualizing the interventricular septum using hand-held portable ultrasounds. We aim to have all images evaluated by faculty within the next month. Conclusion: Overall, our project aims to show that medical students can effectively operate hand-held ultrasounds and identify the structures involved in hypertrophic cardiomyopathy. We hope to show that with minimal ultrasound training, both clinical and pre-clinical medical students can obtain cardiac ultrasound images. Our research further highlights the growing importance of point of care ultrasound and its future applications as a potential screening tool for HCM/HOCM during the physical exam.Item Musculoskeletal Differences Between Amputated and Non-Amputated Lower Limbs(2022) Finco, MG; Finnerty, Cait; Ngo, Wayne; Holley, Bethany; Menegaz, Rachel A.Purpose: People with lower limb amputations frequently experience greater risks of musculoskeletal injury. Forces active during walking help to develop and maintain the shape, volume, and strength of musculoskeletal tissues. Conversely, altered walking patterns following limb loss may lead to atrophy of muscle and bone tissues. Reductions in joint spaces are indicative of excess stress placed on the limb, which may lead to osteoarthritis. Bone loss in high stress regions like the femoral neck can reduce the bone's ability to resist compressive or rotational movements, making the bone more susceptible to fracture. The aim of this study was to measure musculoskeletal differences between an individual's residual (amputated) limb and intact (non-amputated) limb to identify structures vulnerable to injury. We hypothesized that the residual limb, compared to the intact limb, would show: 1) less muscle mass and more fat as indicators of muscle atrophy, 2) wider hip and knee joint spaces as indicators of osteoarthritis in the intact limb, and 3) decreased femoral neck width as an indicator of fracture risk. Methods: CT scans of 10 males (42-79 years) were obtained from the New Mexico Decedent Image Database. 3D Slicer software was used to measure gross skeletal properties, hip and knee joint dimensions, and cross-sectional muscle and fat tissue areas at the midshaft. A Wilcoxon Signed-Rank test was used to assess the differences between residual and intact limbs. The significance level was set at α ≤ 0.10 due to a small sample size. Results: Compared to the intact limb, the residual limb had significantly less muscle tissue area (p=0.010) and a significantly narrower femoral neck width (p=0.077). No significant differences were found in hip or knee joint spaces between limbs. Conclusions: In agreement with hypotheses 1 and 3, these results suggest residual limbs are at increased risk of muscle atrophy and femoral neck fracture compared to intact limbs. Loading inequalities between the residual and intact limb likely contribute to these results. A better understanding of the structural properties associated with musculoskeletal atrophy could inform targeted therapies to reduce the likelihood of injury in this population. Future studies will assess biomechanical properties, such as moment of inertia, to better understand the residual limb's ability to withstand torsional forces and fracture. Additional data on how musculoskeletal tissues respond to unloading at multiple structural levels can improve clinical interventions for lower limb strength and function in amputees.Item Social Needs Assessment in Women of Reproductive Age vs. the General Population(2024-03-21) Holley, BethanyPurpose The objective is to identify the most prominent social needs among women of reproductive age and how it impacts their health and ability to access health care. In 2018, the CDC reported that most preventable deaths among women of reproductive age are due to broader failures of social support. Despite comprising over half of the population and influencing the majority of healthcare decisions, there is minimal discourse within the industry regarding the distinct impact of social determinants of health (SDOH) on women. Methods Retrospective chart review of 1,478 completed social needs assessments among patients who visited the University of North Texas Health Science Center Central Family Medicine Clinic from June 2020 to December 2023. The PRAPARE (Protocol for Responding to & Assessing Patients’ Assets, Risks, & Experiences) screening tool, a nationally standardized tool created by the National Association of Community Health Centers, was used to assess social needs. The data was separated into two groups: reproductive-aged women 18-45 years old (288 patients) and the remainder of the study population (1,190 patients). The remainder of the study population was comprised of 752 females and 438 males, ranging in age from 1-90 years old. Descriptive statistical analysis was used to quantify the social needs among reproductive-aged women compared to the remainder of the study population. Results In each social needs category assessed by the PRAPARE screening tool, reproductive-aged women constitute a comparable or larger percentage of individuals impacted by the social need in question compared to the general population. Reproductive-aged women are most significantly affected by increased stress levels, inadequate healthcare access, difficulty obtaining childcare, unemployment, and domestic violence. Conclusions Reproductive-aged women have elevated and diverse SDOH-related needs, with notable disparities observed across race, ethnicity, and socioeconomic dimensions. In order to efficiently alleviate the effects of SDOH on reproductive-aged women, stakeholders must proactively invest in enhancing the capability of healthcare providers to identify and address SDOH-related needs. This includes actively involving reproductive health care providers, who often serve as the initial and primary point of contact within the healthcare system for women in this age group. As healthcare expenses in the United States continue to rise and disparities in health care access and outcomes persist, concentrating solely on clinical aspects of health proves inadequate. It is evident that effectively mitigating health disparities requires industry leaders to comprehend and allocate resources toward addressing the unique needs arising from social conditions.