Browsing by Author "Teigen, Kari"
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Item Barriers to Diabetes Management in the Homeless Population(2022) Scherer, Nathalie; Smith, Glen; Teigen, KariThere are few studies assessing outcomes for homeless patients with diagnosed diabetes, despite evidence that homeless patients suffer from diabetes at about the same rate as the general public, which as of 2018 is approximately 10.5% of the U.S. population. Diabetes is a chronic disease that usually does not present with acute symptoms until late into the course of disease progression. Due to social vulnerability, homeless patients often present a particular set of challenges that require different approaches from healthcare providers. These challenges include unstable housing, limited food choices, behavioral health problems, lack of access to stable care and transportation, and chronic stress. These challenges build barriers that prevent homeless patients from managing their chronic diseases effectively. There are very few studies looking at which particular barriers are the most challenging for patients, so we believe a survey quantifying the barriers will be useful for the field of diabetes management and for chronic disease management in the homeless population as a whole. We expect that by identifying specific barriers we could impact both better patient outcomes and lower healthcare costs for unhoused patients by targeting the specific issues that they struggle with. In our study, we will be operating out of the True Worth Clinic, which is a JPS clinic that primarily serves homeless patients. There is a robust diabetes education team that works to provide care to homeless patients with diabetes mellitus. Our aim is to work with the diabetes education team to create and implement a survey that will be administered to patients coming into the clinic over the next 6 months. The survey will focus on barriers to care that are unique for homeless patients managing chronic conditions, such as diabetes. Having data on patient's barriers to care will allow the True Worth Clinic to more effectively address the unique barriers that their patients face.Item Characteristics and Outcomes of Patients With Hepatocellular Carcinoma Diagnosed at John Peter Smith Hospital(2023) Hull, Madison; Teigen, Kari; Bullock, Jolonda; Basha, Riyaz; Narra, KalyaniPurpose: The incidence of hepatocellular carcinoma (HCC) is increasing in the US, particularly in individuals infected with hepatitis C (HCV). Although early detection is crucial for better outcomes, at present, there is conflicting evidence regarding HCC screening and its reduction on cancer-related mortality. This study aimed to determine overall survival, prognostic factors influencing survival, and the effects of screening at-risk patients on HCC-related mortality. Methods: A retrospective chart review of patients diagnosed with HCC from 1/1/2018 to 6/4/2021 for the one-year survival analysis and 6/4/2019 for the three-year analysis. Person-time was calculated as the days from the date of diagnosis until the last known encounter or death. The primary exposure of interest was screening within two years prior to the diagnosis date via ultrasound, MRI, and/or CT. Potential covariates were age at diagnosis, race/ethnicity, gender, insurance status, alcohol use disorder, HCV, HBV, and cirrhosis. Kaplan Meier, log rank test, and Cox proportional hazards (CPH) model were used to assess survival curves, survival distributions across screening status, and the effects of additional covariates on prognosis at one and three years, respectively. A backwards stepwise regression was used on the covariates identified via a pre-univariate filtering to construct a multivariable model. Results: There were 165 and 71 patients who met the one- and three- year inclusion criteria, respectively. Survival at one and three years was 38% and 14%, respectively. Median survival for the 165 patients was 265 days (95% CI: 166, 337). Overall, 36% (n=59/163; 2 missing) and 27% (n=19/70; 1 missing) were screened prior to diagnosis. The CPH model showed a statistically significant difference in hazard ratio of death in the first year for those without screening compared to patients with screening (HR: 1.9; 95% CI: 1.2, 3.0; p-value: 0.005). After adjusting for race/ethnicity and insurance type, the CPH model yielded similar results (HR: 2.2; 95% CI: 1.3, 3.6; p-value: 0.002). The CPH model showed a statistically significant difference in hazard ratio of death in three years for those without screening compared to patients with screening (HR: 3.4; 95% CI: 1.7, 7.1; p-value: 0.001). After adjusting for gender, HBV, and race/ethnicity, the CPH model yielded similar results (HR: 2.2; 95% CI: 1.2, 4.0; p-value: 0.009). Conclusion: Overall survival in patients diagnosed with HCC at JPS, a safety-net hospital, is similar to national statistics. Screening in patients at-risk for HCC shows improved survival at one and three years. Further evaluation based on the extent of disease at the time of diagnosis, treatment decisions, and type/timing of screening could be beneficial in determining the outcomes in HCC patients.Item Effects of Urinary Tract Infection on Hip and Knee Arthroplasty Outcomes(2021) Garcia, Laura; Barnes, Kalan; Dalton, Stewart; Teigen, Kari; Wagner, RussellIntroduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures performed in the United States. However, the effects of periprosthetic joint infections (PJI) can be devastating leading to invasive interventions and potentially impaired functionality, decreased patient satisfaction, and increased mortality. Risk factors for the development of PJIs have been well-documented, however, the association between urinary tract infections (UTIs) and PJIs remains controversial. Our aim was to establish the risk of developing a PJI in patients with an identified UTI in the preoperative, perioperative, and postoperative periods. Methods: Through retrospective chart review, data was abstracted from electronic medical records from JPS Health Network of all patients with a scheduled THA and TKA since 2014. We identified patients with UTIs 15 days prior to surgery and followed up with 12 months post-surgery for subsequent development of PJI. Results: A total of 2,220 surgeries were scheduled, and 1,697 surgeries were completed. Forty-six patients with a UTI completed surgery within 15 days of the UTI diagnosis, and 2 patients developed a PJI (4.3%, 95% Confidence limits: 0.5%, 14.8%) within 12 months post-surgery. Out of 1,274 patients with a surgery without UTI, 47 (3.7%, 95% confidence limit: 2.7%, 4.9%) developed a PJI. Conclusions: Our data does not suggest UTI in the preoperative period increases the risk of PJIs after THA and TKA. However, the study needs more power to establish significant results. Future analysis will look at the association between UTIs in the postoperative setting and PJI development.Item Effects of Urinary Tract Infection on Hip and Knee Arthroplasty Outcomes(2020) Wagner, Russell; Teigen, Kari; Barnes, Kalan; Garcia, Laura; Dalton, StewartIntroduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures performed in the United States. However, the effects of periprosthetic joint infections (PJI) can be devastating leading to invasive interventions and potentially impaired functionality, decreased patient satisfaction, and increased mortality. Many risk factors for the development of PJIs have been well-documented, however, the association between urinary tract infections (UTIs) and PJIs remains controversial. Our aim was to establish the risk of developing a PJI in patients with an identified UTI in the preoperative, perioperative, and postoperative periods. Methods: Through retrospective chart review, data was abstracted from electronic medical records from JPS Health Network of all patients with a scheduled THA and TKA since 2014. We identified patients with UTIs 15 days prior to surgery and followed up with 12 months post-surgery for development of PJI. Results: A total of 2,220 surgeries were scheduled, and 1,697 surgeries were completed. Forty-six patients with a UTI completed surgery within 15 days of the UTI diagnosis, and 2 patients developed a PJI (4.3%, 95% Confidence limits: 0.5%, 14.8%) within 12 months post-surgery. Out of 1,274 patients with surgery without UTI, 47 (3.7%, 95% confidence limit: 2.7%, 4.9%) developed a PJI. Conclusions: Our data does not suggest UTI in the preoperative period increases the risk of PJIs after THA and TKA. However, the study needs more power to establish significant results and future analysis will look at the association between UTIs in postoperative settings and development of PJI.Item HPV Vaccine Acceptability in Postpartum Women Up to 45 years old(2020) Allen, Ashley; Hoang, Christine; Nash, Madeline; Teigen, Kari; Dhume, MahimaBACKGROUND: Cervical cancer and dysplasia is a preventable cause of morbidity and mortality in women's health by virtue of the HPV vaccine. Initiating the HPV vaccine in the immediate postpartum period has proven to be an effective strategy to improve the low vaccine rate amongst women ages 16-26 years. In 2018, the FDA approved women to be vaccinated up to age 45. To impact newly eligible patients similar vaccination programs could be used. PURPOSE: To evaluate eligibility and acceptance of the HPV vaccination among postpartum women up to age 45 in an urban county hospital setting. METHODS: A questionnaire was used to survey postpartum women aged 16-45 on prior vaccination status, desire, and barriers to vaccination. 200 surveys were collected at John Peter Smith Hospital in Fort Worth, Texas. RESULTS: Overall, 18% of respondents reported being previously vaccinated. Among the 82% of patients eligible for vaccination, 69% (95% confidence interval 62% - 76%) desired vaccination. The most common barrier was lack of awareness of the HPV vaccine. CONCLUSION: Results of this survey shows a high proportion of postpartum women are eligible and willing to receive the vaccine if it were available to them. This is an opportunity for healthcare providers to initiate the HPV vaccine series. Methods to eliminate barriers to vaccination such as education of availability in the postpartum period can also improve vaccine acceptability. The results of the survey will be used to implement HPV vaccination accessibility to postpartum women at JPS Hospital.Item One Key Question at JPS Health Network: Pregnancy Intention as a Predictor of Pregnancy and Birth Outcomes(2024-03-21) Finley, Morgan; Sangha, Roopina; Teigen, Kari; Blair, SomerPurpose: One Key Question® (OKQ) is a patient-centered screening tool used in routine visits by asking, “Would you like to become pregnant within the next year?” with the goal of preventing unintended pregnancy. We aim to examine the effectiveness of the OKQ at a safety-net hospital by resulting pregnancy rates in the following year. Methods: We examined 5,318 OKQ responses from 8/1/2017 through 1/31/2021 and analyzed resulting pregnancies through 1/31/2022. We compared age category, race and ethnicity, and payor class on likelihood to answer “No” to OKQ, be on birth control, and become pregnant within a year (if answered no to OKQ), stratified by visit type (postpartum vs. well-woman). Chi squared tests assessed associations between these variables. Results: Almost all of the women responded “No” to the OKQ (96%), with 5.6% of those women becoming pregnant within the year. Most women responding were Hispanic (56%), ages 25-34 (51%) and at a postpartum visit (87%). Women at postpartum visits responding “No” to OKQ were less likely to be on birth control compared to women at well-woman visits (39% vs. 79%). Overall, being on birth control differed by race and ethnicity (p= <.0001) and age category (p= <.0001), but not by payor class. Conclusions: OKQ offers insight into continuing patient-centered education regarding pregnancy intention and birth control status to prevent unintended pregnancies and potential adverse pregnancy and birth outcomes.