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Item Strategies for Promotion of a Patient Portal in the UNT Geriatrics Clinic for Improved Satisfaction and Access(2017-03-14) Loza, Cynthia; Henderson, Leslie; Booker, Sandra; Prasad, Subhada; Ross, SarahPurpose: The use of electronic health records has become a vital part of patient care. Electronic health records have many benefits, including assisting providers with tracking tasks important for health maintenance and chronic disease management. Electronic health records also have patient portals, which are secure online websites that give patients access to their personal health information. NexGen is the electronic health records system used at the University of North Texas Health Sciences Center, and we have recently started using their Patient Portal. Our team has worked on promotion and training in the patient portal to assist with participation by both clinical staff and patients. The goal is improve patient and caregiver access to their personal health information, improved satisfaction, and improved communication with their care team. Additionally, the patient portal will support improved chronic disease management by providing a way to send electronic messages to patients with reminders of any necessary testing or notifications of any educational programs relevant to their condition. In the Geriatric population, we want to make use of a patient portal user friendly for those with low computer literacy and also usable by caregivers of patients with cognitive impairments. Methods: The team has used several tools for promotion of the patient portal. A video was produced to train staff on how to enroll patients in the portal and how view messages receive through the portal. A kiosk was set up in the waiting room of the UNT Geriatrics clinic with student volunteers to assist patients one-on-one with enrollment. Buttons for advertisement and awareness were distributed to office staff. We also created an icon in NexGen to easily recognize which patients have already enrolled. When the goal of 60% enrollment is achieved, the team plans to evaluate outcomes of improved access and satisfaction. Both a general and a patient portal specific patient satisfaction survey will be distributed to the UNT Geriatrics patients. We will also compare communication received from patients by phone which electronic communication through the patient portal. Results/Conclusions: Enrollment in the NexGen patient portal in the UNT Geriatrics clinic is on the rise. Patients who are participating have enjoyed the ability to email their care team with questions. In particular, we have had success in providing improved access for our hearing impaired patient, as the Geriatrics office staff have emailed for coordination of acute appointments to address urgent needs. As more patients and caregivers utilize this tool we hope to show improved patient satisfaction. Regarding access to the care team, we anticipate a slight decrease in phone calls with more use of the patient portal for electronic communication. Adjustments to the patient portal will be made over time to ensure that it is patient centered and providing patients and caregivers with the information they need to manage their health.Item A STEP in the Right Direction: An Interdisciplinary Approach to Transitional Care (2017)(2017-03-14) Connally, Patrica; Allen, John G.Background: The Affordable Care Act, calls for more focus on finding innovative delivery systems that improve care, increase efficiency, and reduce costs. Purpose: Hospital readmissions, excessive falls, and poor quality of life are factors that unnecessarily increase healthcare costs. The Safe Transitions for the Elderly Patients (STEP) program is a hybrid transitional care model developed by the UNT Health Science Center (UNTHSC) as part of an 1115 Waiver to address these factors in a home care setting in Tarrant County. Objectives: The primary goals of STEP are to reduce all-cause 30 day hospital readmissions, improve quality of life, and decrease falls among Medicaid patients over 50 years through a collaborative and interdisciplinary approach to patient care. Methods: An interprofessional team that includes a physician/geriatrician, nurse practitioner, physician assistant, social workers, physical therapists and a dietician assess and treats the patient in the home for up to 90 days post hospital discharge based on the individual patient needs. Conclusions: Through this model, UNT Health Science Center has the opportunity to demonstrate a unique transitional care model that will improve health care delivery post-hospitalization.Item Concomitant Opioid and Benzodiazepine Use: A Systematic Review(2017-03-14) White, PharmD, MS, PhD, Annesha; Vernachio, Kimberly PharmD; Pfluger, KassieObjective: In opioid users, the concomitant use of a benzodiazepine medication is associated with an increased risk of adverse reactions and overdose due to the synergistic effects on sedation and respiratory depression. The degree to which adverse events and overdoses occur is unclear when assessing patient characteristics, dosage and formulation. The objective of this study was to review the literature on the incidence and prevalence of an adverse event or death after concomitantly taking an opioid and benzodiazepine prescription medication and to assess the impact on the formulation, dosing, or administration of the medication in overdose. Methods: A review of the literature was performed using the following databases: PubMed, PsycINFO, the Cochrane Library, and Scopus for peer-reviewed journal articles in English to identify studies regarding concomitant benzodiazepine and opioid medication overdose in adolescents and adults for non-cancer pain August 2006 through August 2016. Relevant publications and their reference lists were reviewed to assess for inclusion criteria based upon relevance and quality. Applicable publications were reviewed and included whether outcomes of patients were clearly documented by medication use. Information on the study design, sample characteristics, purpose of study, intervention components, primary outcome, key findings and risk of bias were abstracted for each article and presented in a table. Articles were excluded from the review if concomitant use of benzodiazepine and opioid analgesic was not clear or intentional suicide was indicated as the cause of mortality. Key search terms utilized were: ‘opioid analgesic’, ‘benzodiazepine’, ‘non-cancer pain’, ‘substance-related disorders’, ‘polypharmacy’, ‘co-prescribing’, ‘illicit use’, and ‘overdose’. Results: Findings revealed 11 articles in the literature. Results are presented in a summary of findings table. Relevant studies assessed morbidity and mortality associated with opioid and benzodiazepine use, incidence of non-prescribed medications or illicit drug use, and descriptive information on patient populations of greatest risk of overdose. Common reasons for not selecting a particular article were due to study design and incomplete information of medications within each class. Conclusions: The prevalence of opioid and benzodiazepine misuse and abuse has warranted international attention due to the increased overdose risk with concomitant use. More information is needed regarding dosing, formulation, and particular agent for opioids and benzodiazepines. Assessment of mortality risk is lacking when comparing acute versus chronic drug users and abusers. The incidence of overdose increases as potency increases or when an illicit agent is included due to the central nervous system (CNS) depressant effects.Item Description of Home-Based Medication Therapy Management Services in an Interprofessional Transitional Care Program Aimed at Reducing 30-Day Hospital Readmissions(2017-03-14) Elrod, Shara; Rhoads, David; Nguyen, Benjamin; Li, DianaPurpose: Since the establishment of the Hospital Readmission Reduction Program (HRRP) in 2012, preventing 30-day unplanned hospital readmissions is crucial for reimbursement by Centers for Medicare & Medicaid Services. Published reports have shown pharmacist interventions after hospital discharge are associated with a smaller incidence of medication errors 30 days after hospital discharge, but most of these reports include pharmacists making follow-up phone calls. No published reports have described home-based pharmacy services as a part of transitional care programs designed to reduce unplanned 30-day hospital readmissions. This project describes the inclusion of a pharmacist as a part of an interprofessional transitional care team. Methods: Safe Transitions for the Elderly Patient (STEP) is a transitional care program for Medicaid-eligible adults at least 50 years of age who have been recently discharged from the hospital in Tarrant County, TX. Enrolled patients receive an intake home visit from a medical provider within the first 72 hours after discharge which includes referral to other STEP providers (e.g. pharmacists, physical therapists and social workers). Patients on high-risk medications, who are believed to be non-adherent to medications or need short-term medication management were referred to the pharmacist (0.3FTE) for home-based medication therapy management (MTM) services. All patient encounters are documented in an electronic health record (EHR). Risk stratification scores were calculated by including the total sum of each the following parameters: problem meds, psychiatry, polypharmacy, health literacy, patient support, prior hospitalization, and palliative care. High risk stratification scores were defined as those with 5 having or more risk factors. Descriptive statistics were used to characterize the study population. Pearson’s chi-square was used to examine the association between categorical variables. Results with a p value less than .05 were considered statistically significant. Patients enrolled in the STEP program during the time pharmacists provided services were included in this analysis (August 2014 to January 2015 and October 2015 to July 2016). Results: A total of 366 patients were enrolled in STEP during the specified time frame with 79 being seen by the pharmacist. The mean ages in those who were and were not seen by the pharmacist were 63.4 years (range 50-92) and 66.5 years (range 50-98), respectively (p=0.02). The majority of the patients seen by the pharmacist were women (72%, n=57), which was not significantly different than those not seen by the pharmacist (p=0.44). The median number of medications in those who were and were not seen by the pharmacist were 15 (range 3-38) and 11 (range 1-32), respectively (p=0.0002). Of the patients seen by the pharmacist who reported race/ethnicity, 35.4% identified as Black or African American (n=28). The proportion of all STEP patients with calculated risk stratification score was 93% (n=342). The proportion of patients with high risk stratification scores for those who were and were not seen by the pharmacist were 49% and 57%, respectively (p=0.22). The most common discharge diagnoses for patients seen by the pharmacist were heart failure and COPD exacerbations. Hospital readmission rates were not found to be significantly different in those who were seen by the pharmacist versus those who did not (10%, 14%, p=0.34). Conclusions: Hospital readmission rates were not found to be significantly different between those patients who were seen by a pharmacist as part of a home-based interprofessional transitional care team versus those who were not. Overall hospital readmission rates were low for both groups. In this program, patients who saw the pharmacist were more likely to be younger and be taking more medications than those who did not see the pharmacist. Patients who saw the pharmacist did not have significantly higher risk stratification scores than those patients who did not see the pharmacist. More research is needed to demonstrate the benefit of home-based pharmacy transitional care services.Item Identifying problem areas and providing solutions to coordination of care in Urgent Care to Emergency Department transfers within a pediatric health care system(2017-03-14) Severson, Samantha; Welch, JoAnn; Reed, AlexandraPurpose: Pediatric urgent care centers (UCCs) provide access to convenient, on demand medical care for patients who have non-emergent medical needs. Although, most patients who present to UCCs can be appropriately treated and discharged home, some patients present with medical needs outside the scope of practice for the UCC and are transferred to an emergency department (ED) for further evaluation. Currently, there are no established standards for such patients who need transfer of care from a pediatric UCC to an ED. This study examines the UCC to ED transfer process in an integrated pediatric health care system, identifies inefficiencies, and proposes a solution. Materials and Methods: The records of all patients transferred from a suburban UCC site to the urban, high volume ED between July 1, 2015 and May 16, 2016 were retrieved from the system’s transport department. Using retrospective chart review, UCC transfer diagnosis, ED discharge diagnosis, patient no shows, and those who left without being seen (LWBS). Results: Of the 245 transfers, 14 (6%) never arrived or LWBS and, 221 (96%) of these had non-missing values on the variables of interest. The ED provider noted in the ED record that the patient was a transfer from the system’s UCC in 167 (76%) cases. However, the review the UCC record was documented in only 58 (26%) cases. The patient was subsequently admitted to the ED in 51 (23%) cases. Using logistic regression, results showed that ED providers were more likely to review the UCC record when the chart stated that the patient was sent from the UCC (P Conclusions: This study revealed that in 1 out of 4 cases the ED providers were not aware that the patient was transferred from the UCC. Additionally, in 3 out of 4 known UCC transfers, the ED providers didn’t review the transfer records. These results demonstrate that the transfer of information from the UCC to ED during the transfer process has many opportunities for improvement. Based on these findings, a quality improvement initiative was implemented in November 2016: UCC providers now place bands on patients, who are to be transferred to the ED to signify to the ED staff that the patient was transferred. In summer 2017, transfer data based on this program will be compared to the results above to examine the efficacy of this initiative.Item Modulation of GABAA Receptor Function by Ascorbic Acid(2017-03-14) Huang, Ren-Qi; Dillon, Glenn; Claudio, CarmenPurpose: Ascorbic acid, commonly known as vitamin C, is a vital antioxidant in the brain and is present in millimolar concentrations in neuron-rich areas. Ascorbic acid has numerous functions including modulation of neurotransmission and maintaining redox balance. It has been shown to protect neurons from excitotoxicity induced by activation of the NMDA receptors. While neuronal excitability reflects a balance between excitation and inhibition, GABA is the main inhibitory neurotransmitter that binds to GABAA receptors and reduces neuronal excitability. The purpose of the present study is to determine whether ascorbic acid influences GABAA receptor function. Methods: Whole-cell currents were recorded with patch clamp technique from human embryonic kidney cell line (HEK 293) stably expressing recombinant human a1b2g2 GABAA receptor which is the most abundant form of GABAA receptors in the brain. Results: Ascorbic acid alone did not induce any current. However, when co-applied with 3 mM GABA, ascorbic acid concentration-dependently increased GABA response with an EC50 value of 201 mM and an efficacy of 231%. Ascorbic acid induced similar potentiation of the currents activated by muscimol, a GABAA receptor agonist. Pre-treatment with 100 mM ascorbic acid for 10 sec caused a persistent enhancement in GABA response. The potentiating effect on GABA-activated currents was also induced by D-isoascorbic acid, a steroisomer of ascorbic acid with similar antioxidant property. Conclusions: Ascorbic acid modulates GABAA receptor function and this effect is partially mediated by a redox-dependent mechanism. Furthermore, the enhancement of GABAergic inhibition by ascorbic acid can potentially contribute to neuroprotection against excitotoxicity.Item Recurrent Granuloma Gluteale Infantum Secondary to Encopresis(2017-03-14) Weis, Stephen D.O.; Ingersoll, ZacharyBackground: Granuoma Gluteale Infantum is a rare pediatric dermatological disorder of unknown etiology. Suggested causes have included fluorinated corticosteroids, candida and topical corticosteroids. The case is unique due to its prolonged and recurrent nature, as well as it being secondary to encopresis. The patient is a 3-year-old male that has a history of perianal sores since shortly after birth. The sores persisted for the first three years of life causing significant pain and discomfort. This was most severe during defecation. Pain resulted in avoiding defecation and to encopresis. The patient was referred by their primary care clinician to a pediatric gastroenterologist and was diagnosed with encopresis after an abdominal X-ray. The relationship between the persistent perianal sores and stool pattern was not noted. The patient was referred to dermatology and was treated with barrier creams and laxatives. Results/Conclusions: After initial resolution he returned several months later with a recurrence of the disease. The patient was in joint parental custody and alternated between two different homes. Care-givers were not in agreement with how to manage the patient’s constipation. The sores returned coincident with soiling liquid from liquid stool. The patient was treated again with complete resolution. Our case with its relapsing and remitting course occurring coincident with fecal soiling supports of irritant contact dermatitis as etiology Granuoma Gluteale Infantum.Item Interest and Attitudes Toward Global Health Training of Prospective Obstetrics and Gynecology Residents(2017-03-14) Nguyen, Nguyen; Felini, Martha J.; Hoang, ChristinePurpose: The benefits of global health training in residency clinical education have been well described in graduate medical education literature. Despite these benefits there is a lack of elective global health training opportunities offered by OBGYN residency programs nationally. The purpose of the study is to assess prospective OBGYN residents’ interests and attitudes toward global health training during their residency. Results of the survey can potentially help develop a global health educational curriculum and clinical training opportunity for the JPS OBGYN residency program. Methods: A survey was developed to assess the prospective residents’ views on global health training. Questions assessing interest and attitudes utilized a Likert scale response. Demographic information was collected and applicants self-reported whether they had prior global health experience. The survey was anonymous and voluntary and distributed to all JPS OBGYN residency applicants who interviewed during the 2016-2017 season. The responses were analyzed and summarized. Results: 50 applicants submitted survey responses. Of those applicants, 76% were likely or very likely to participate in a global health elective if offered by their residency program. 94% of applicants agreed that OBGYN residencies should offer voluntary electives in developing countries. 64% of applicants expressed an interest in incorporating global health involvement or international volunteer services into their future practice post-residency while 28% planned to focus their medical career on global health. Scheduling conflicts were perceived as the greatest barrier to participation. Learning about global public health systems and gaining procedural experience were the main interests expressed. Over half of the applicants had previously participated in a global health experience prior to applying for residency. There was a positive association between prior participation and future interest in incorporating global health into their post-residency practices. Conclusions: Information obtained from the survey demonstrated that applicants to the JPS OBGYN residency program believe that a global health elective opportunity should be offered in residency training, and a majority would participate if given the opportunity. With the strong interest and positive attitudes toward a global health elective, steps can be taken to develop a curriculum and training opportunity for the residents.Item An Evaluation of Attitudes and Understanding of Vaccinations in Rural Populations(2017-03-14) Mamun, Md Abdullah; Handoyo, Anthony; Pulvino, John; Abraham, Stacy; Kaushal, DeepikaBackground: Recently in the media, there has been a movement to abstain from childhood immunizations. At the same time, a rise in the rate of preventable childhood diseases for which there are available immunizations has also been witnessed. It is known that the attitude towards vaccination of both the parents and providers and the knowledge about vaccines all influence vaccination compliance. Methods: My colleagues and I surveyed rural communities in Texas to assess parental knowledge and how that affected vaccination compliance. Clifton, Texas is located in Bosque County. As of the census of 2000, there were 3,542 people. Plainview, Texas is located in Hale County. The current census data reports a population of 22,194. Bilingual versions of surveys developed by Zingg et al were distributed to participants with children up to 10 years of age who live in or near the rural towns of Clifton or Plainview between the fall of 2015 and the spring of 2016. Results: When analyzing survey results, correct knowledge was estimated by summing over the number of correct answers for the 11 items in the survey. Using a multiple linear regression model our study revealed that here is statistically significant difference in knowledge on vaccination for parents who has a Bachelor degree or more in comparison to parents who are high school graduate or less after adjusting for the effects of race and number of children. However, there is no statistically significant difference in knowledge on vaccination for parents who has some college degree in comparison to parents who are high school graduate or less after adjusting for the effects of race and number of children. Conclusions: On an average, parent’s knowledge on vaccination increases as their number of children increases after adjusting for the effects of educational status and race. There is no statistical difference on vaccination knowledge in White versus Hispanic and White versus Other racial groups after adjusting for the effects of parent’s education and number of children.Item Utilizing an Inter-Professional Approach to Enhance Patient Safety: Identifying Inefficiencies in PBM Prescription Processing(2017-03-14) White, Annesha; Alba, EstelaBackground: Pharmacy Benefit Managers (PBMs) offer health plans a variety of services including negotiating price discounts with retail pharmacies, negotiating rebates with manufacturers, and operating mail-order prescription services and administrative claims processing systems among other services. The impact of PBMs on patient health is significant; therefore, it is important to understand the current challenges this industry. Objective: The objective of this study was to review the literature within the last seventeen years regarding inefficiencies in PBM prescription processing. A secondary objective was to discuss solutions to decrease error assisting patient in the mail order process. Methods: Journal articles were compiled through use of PubMed, Scopus, and Google Scholar using specific key terms. Articles selected for review were published from January 1, 1999 through May 1, 2016. This timeframe was selected based on the technological advances in the early 2000’s. The articles required information on current challenges and inefficiencies in prescription processing; particularly, articles pertaining to time efficiency, limitations, and future needs. Articles pertaining to pharmacy dispensing accuracy were also utilized as a secondary search and mainly focused on U.S. data. Results: Twenty articles were found, seven pertaining to the inefficiency in the insurance claim process and formularies, seven pertaining to prescriber outreach, and five pertaining to prescription data entry. Possible solutions explored for insurance claim processing were the access of prescribers to up-to-date and reliable formularies. Solutions discussed for prescriber outreach, were the further implementation of eprescription with more efficient features such real time tracking and messaging between prescriber and pharmacy. Additionally, for prescription data entry, synchronizing the eprescribing system so the prescriber can directly enter a prescription into the pharmacy’s system without the need of a technician having to repeat this step. Conclusions: Future trends reveal that e-prescribing will provide favorable outcomes to patients by decreasing inefficiencies in the prescription fulfillment process as well as decreasing cost. Patient safety will remain at the forefront as New York and Maine have already passed legislation mandating the adoption of eprescriptions. Healthcare team management of patients’ therapy and delivery are growing. It is imperative to address current and future challenges with the purpose to improve patient outcomes and satisfaction.Item Decreasing Inefficiencies in the Community Pharmacy Setting: Addressing the Top Issues in Patient Centered Care(2017-03-14) White, Annesha; George, Emanuel; Butler, Michell; Tran, NganObjective: The objective of this study was to review the literature in the last decade regarding inefficiencies in the community setting with respect to patient centered care. A 2013 study showed that 46.3% of 162 indemnity claims paid to patients due to a medication error were attributed to independent community pharmacies, while 34.6% from chain pharmacies. Additionally, 43.8% of all claims paid were a result of the patients’ injuries due to dispensing error. Sources for dispensing errors included: patient misidentification, improper computer coding, and nonadherence. Nonadherence is estimated at $300 billion annually. In contrast to the institutional setting, there is lack of literature emphasizing the inefficiencies in the community setting. Methods: Articles identified from electronic databases, Google Scholar, PubMed, and Scopus, from January 2006 to December 2016, were summarized in a table. A diagram and a visual display were created to represent an ideal community pharmacy of the future. Key search terms were “community pharmacy and efficiencies”, “community pharmacy and inefficiencies”, “retail pharmacy and efficiencies”, “retail pharmacy and inefficiencies”, “retail pharmacy workflow”, “retail pharmacy medical error”, “retail pharmacy dispensing error”, “dispensing error cost”, “patient centered care”, and “nonadherence”. Results: Seventeen articles and reports identified were categorized into inefficiencies associated with workflow and patient nonadherence. Inefficient workflow leads to prescription errors, time loss, and decrease in patient care. Moreover, the generic layout of the pharmacy creates a barrier in pharmacist-patient interaction. Also, prescription abandonment added unnecessary labor and resulted in poor patient outcome. Conclusions: A more efficient, patient centered care layout of the pharmacy is proposed utilizing the six-sigma tools to drive process improvement in the pharmacy. Although studies shows tools and technologies are available to increase efficiency, utilization remains low. This study highlights the benefits of incorporating technology to improve pharmacy operations. Maximizing technology may give pharmacists more time for patient-centered care service.Item Treatment of Concurrent Ipsilateral Femoral Neck and Shaft Fractures(2017-03-14) Schaefer, Travis; Ming, Bryan; Caton, Tyler; Payne, JoshuaHypothesis: Ipsilateral femoral neck and shaft fractures occur in 6-9% of femur fractures (1), however; there is no current consensus for treatment in the Orthopaedic literature. The treatment of ipsilateral femoral neck and shaft fractures pose a technically difficult problem with nearly 60 different treatment methods (2), but no agreement exists regarding the ideal treatment method. Material and Methods: We propose our treatment algorithm for treating these fractures, as well as our cohort of six patients treated with the aforementioned algorithm. For stable intertrochanteric fractures and femoral neck fractures, we recommend a dynamic sliding hip screw and a retrograde femoral nail. For unstable intertrochanteric fractures, we recommend treatment with a single implant (cephalomedullary nail). We treated six patients with combination hip and femoral shaft fractures at a level 1 trauma hospital from April 2016 through February of 2017. Patients ranged from 19-42 years of age. Results: All fractures remain anatomically reduced, and have either gone on to union or are progressing to union in the expected time frame. One complication, a stiff knee below the fractures, has been reported for which the patient is still undergoing treatment. Conclusions: Our research is ongoing, but to this point, we conclude that this is a reliable method for treating these very challenging fractures.Item Impact of Palliative Care on Healthcare Outcomes in Complex Chronic Pediatric Patients(2017-03-14) Farias, Kimberly; Dang, The; Lawrence, Katie; Hoeft, Alice; Hamby, Tyler; Price, RachaelPurpose: Palliative Care (PC) has been correlated with decreased length of stay and cost of care and with fewer ICU visits, administered medications, and medical interventions. Additionally, research has correlated PC with better quality of life, quality of care, continuity of care, and management of family needs. Through patient and family health care education, PC services are able to reduce hospitalizations and normalize the patients’ lives as permitted by their medical conditions. The purpose of this research was to determine whether PC has had a positive impact on the care received by pediatric patients with complex chronic conditions at a single institution. Methods: A retrospective investigation was conducted on all pediatric patients with complex chronic conditions who died at Cook Children’s Medical Center between January 2013 and December 2014. For each patient, demographics, diseases, number of hospitalizations, and age at death were abstracted. For each patient visit, data collected included PC involvement, number of medications, length of stay, and whether a MOST form (medical orders for scope of treatment) was completed. Results: There were 43 total patients in this study (49% male), and 12 patients had at least 1 PC visit. Patients who had at least 1 PC visit did not differ from patients with no PC visits in demographic variables, disease, age at death, or in the rate of MOST orders, but they had greater number of hospitalizations, longer lengths of stay, and less medications per day than non-PC patients. Conclusions: The finding that PC patients had a smaller average number of medications per day could be due to the healthcare team taking into account the total effect of polypharmacy on a patient, and then selecting only the most necessary medications. The finding that PC patients had longer and more frequent hospitalizations could be due to the late initiation of PC, instead of PC’s intended early application. Lack of knowledge of what PC services offers to patients, and a misconstrued view of PC services could be contributing factors to the delay in start. Frequently providers view PC as end of life care only, so its late initiation most likely biased the results. Increasing providers’ knowledge of the services that PC has to offer could increase its early initiation with patients and possibly decrease the length of stay and frequency of hospitalizations.Item Tourniquet usage in Modern Conflict and in Emergency Medicine(2017-03-14) Hardy, Jonathan; Ebert, Didi D.O.; Pavlik, JoshuaPurpose: Our purpose is to identify and summarize relevant studies concerning tourniquet usage, safety, effectiveness, and identify obstacles preventing tourniquet implementation. Methods: Literature review covering the past 15 years of relevant studies concerning tourniquet usage in modern conflict as well as their implementation in civilian arenas. Results: Early and aggressive tourniquet application in extremity trauma has a negligible complication rate when compared against the lifesaving potential. Several studies list complication rates between 1% and 36%. The higher the complication rate is associated with increased tourniquet time with a cut off of 2 hours by one study. Conclusions: Tourniquet application is a safe and effective method to control a variety of extremity hemorrhage. Early and aggressive implementation of tourniquets is indicated in patients suffering from extremity hemorrhage not easily controlled through direct pressure. Barriers to use include: improper application, inappropriate implementation, fears of tissue ischemia, ischemic sequelae, and the liabilities associated with treatment complications.Item 'Happiness is the Path:' An Overview of and Initial Data from a Resident Wellness Program at Weatherford Regional Medical Center(2017-03-14) Rheams, Christopher; Nash, Lisa; Cash, Kyle; Finn, Stephanie; Pavelek, TaraPurpose: Resident education programs are challenging-mentally, physically, and emotionally. As residents progress through the training program, the novice physicians often neglect their own wellness. Poor self-care is primarily because of poor diet, lack of exercise, lack of sleep-hygiene, and a failure to maintain healthy personal relationships. Physician burnout brings a host of collateral consequences, including an increase in mental illnesses such as mood disorders, addiction disorders, and increased rates of suicide. Methods: Weatherford Regional Medical Center’s Graduate Medical education department implemented a resident wellness program during its inaugural year. The program helps to prevent or mitigate the burnout that often accompanies residents during their training. The Resident Wellness Committee coordinates the program. The interdisciplinary team consists of Residency Coordinators, Internal Medicine faculty, and residents. The Wellness Program uses a multi-faceted approach to both prevent and screen for physician burnout that utilizes a reporting system, didactics, and events. The program has created an anonymous reporting system that is available to all hospital employees; this allows all hospital employees to voice concern regarding the well-being of our residents. Focused didactics address topics related to resident stress, burnout, and emotional exhaustion. The program holds quarterly “Wellness Events” and all residents are excused from clinical duty to attend. This fosters a supportive atmosphere and provides activities geared towards enhancing the individual’s well-being. These activities include physical activity, designated personal time, and social activity to deepen interpersonal connections. The wellness committee has developed tools to evaluate and track the resident’s well-being. The program uses anonymous surveys collected from the residents twice a year to evaluate for signs of burnout, depersonalization, emotional exhaustion, and a sense of personal accomplishment. Feedback from the initial surveys allows for an early assessment of the program’s effectiveness. Each medical learner was asked to answer a series of questions that address personal levels of depersonalization, emotional exhaustion, and personal accomplishment. Nineteen medical learners participated in the survey (7 Internal Medicine residents, 6 students, and 6 traditional rotating interns). The scaled questions were tabulated and used to quantify each category. Results/Conclusions: The initial study yielded promising results. The Wellness Committee looks forward to seeing the impact of these programs as they continue to gather data and responses from residents. As the program continues, the Committee will continue to assess and expand the Wellness program. Unseen and unexploited opportunities exist for improving the quality of resident professional experience and their personal lives. Wellness programs such as Weatherford Regional’s also have a positive implication for the patient’s quality of care. By addressing the mental wellness of the medical professional community, the pool of healthcare providers in Texas will increase both in quantity and quality.Item Enhancing Healthcare Quality Research Efforts at UNTHSC: A Three-Phase Plan for Interprofessional, Student-Driven Projects(2017-03-14) Traylor, Kathleen; Sembajwe-Reeves, Catherine; Reynolds, ConnerBackground: According to recent epidemiological studies, medical error is the third leading cause of patient death in the United States. There are also many factors independent of delivery that prevent access to healthcare altogether, including lack of health insurance coverage, the financial burden of healthcare, and having a usual source of care. In order to fully optimize patient health, the practical implementation of care must be addressed. On May 17, 2016, in collaboration with Texas Christian University, John-Petersmith Health Network, and Cook Children’s Medical Center, the University of North Texas Health Science Center (UNTHSC) launched its Institute for Patient Safety (IPS). This institute aims to improve healthcare throughout the nation, by patient-centered, interprofessional initiatives that directly impact healthcare safety, delivery, and accessibility. Aim: The UNTHSC Institute for Healthcare Improvement (IHI) Chapter seeks to fortify IPS efforts by increasing student involvement in quality improvement projects. Methods: To achieve this aim we propose a three phase plan, utilizing students from a variety of academic and healthcare professional track backgrounds. In Phase 1, interprofessional teams will collaboratively generate a Needs Assessment Survey (NAS) to determine needs within a chosen target population. In Phase 2, subgroups will use NAS results to drive design and implementation of quality improvement measures from multiple healthcare professional levels. In Phase 3, all students will contribute to establishing a new NAS group, thus ensuring the stable growth and sustainability of new quality improvement at UNTHSC. Conclusions: We believe this plan is uniquely suited for UNTHSC, utilizing the breadth of healthcare specialties present on campus in a mission towards substantial improvement for target populations in North Texas.Item Is Weight Status Related to Asthma In Adult Males 35-54 Years Old?(2017-03-14) Houck, Steven; Baca, Ryan; Hockaday, Josh; Hartos, Jessica; Howard, HarrisonIntroduction: Asthma is a prevalent health issue today but the relationship between weight status and asthma in adult men has yet to be thoroughly explored. The purpose of this study was to assess the relationship between weight status and asthma in adult males 35-54 years old. Methods: This cross sectional analysis used 2014 BRFSS data for males ages 35-54 from Hawaii, Massachusetts, Michigan, and Oregon. Multiple logistic regression analysis was used to assess the relationship between weight status and current asthma while controlling for ethnicity/race, exercise, tobacco use, education level, income level, and metropolitan status. Results: Few males 35-54 years-old reported having current asthma (6-9%) and most reported being overweight (73-80%). After controlling for lifestyle and demographic factors asthma was not significantly related to weight status in any of the four states (Oregon, Hawaii, Michigan, Massachusetts). Conclusion: Weight status was not related to asthma in general population samples of adult males 35-54 years old. A limitation of this study was, we collected info about current asthma not asthma symptoms or severity. The sample was population-based and, therefore, may be reflective of the primary care population. It is recommended that primary care practitioners not automatically screen overweight patients for asthma; however, this may be different in specialty settings.Item Inter-professional Team Communication to Improve Patient Safety: A Medication Safety Tip Sheet(2017-03-14) Daugherty, Caleb; Fix, JenniferObjective: Communication in healthcare teams is essential to decrease medical errors and improve patient health outcomes. With these themes in mind, the objectives of this study were to: (1) Enhance patient safety (2) Demonstrate effective collaboration by members of the healthcare team (3) Address polypharmacy through patient education and (4) Develop a patient education tool that is endorsed by the Institute for Patient Safety and UNT Health. Methods: This descriptive study examined the process of establishing a group and tool to enhance patient safety. A work group was convened with the following members: Nurse Practitioner, Susan Matthew, a care provider for Mighty Care clinics, Associate Professor of Pharmacotherapy and Family Medicine, Dr. Jennifer Fix, clinical pharmacist provider of services for the Division of Family Medicine’s Mighty Care Medical Clinics. and fourth year student pharmacist Caleb Daugherty on his advanced pharmacy practice experiential (APPE) rotation tasked by NP Matthew to develop a tip sheet to hand out to patients to help them with understanding the dangers of mixing medications. Mr. Daugherty submitted his assignment prior to completing his rotation. Dr. Fix forwarded the first draft submitted by Mr. Daugherty to all providers within the Mighty Care Team who had an opportunity to provide input and edits to the document thereby developing a second draft of the document. Provider designations of contributors to the project included medical doctor, osteopathic doctor, nurse practitioner, physician assistant, medical assistant, social worker, pharmacist, and student pharmacist. Results: Because of the importance of communicating printed materials to consumers at an appropriate reading level, the Medication Safety Tip Sheet was presented to the Institute for Patient Safety for their review and assistance in revising the handout. The Medication Safety Tip Sheet is ready for patient distribution. Sharing of the Tip Sheet with patients has begun and patient as well as provider feedback is noted. Based on the positive feedback received on the use of the tool, a pre and post assessment survey is planned to track the usefulness of the tool. The survey will be administered prior to handing the patient the education tool and at a future visit not later than 180 days. Various providers also encourage adoption of the patient education tool by all UNT Health Prescribers. Conclusions: It is anticipated that the conclusions derived from the survey data will show that patients benefited from the educational tool and that it proves to be useful for enhancing patient safety while meeting the stated objectives for the project.Item Transitioning Children with Special Health Care Needs(2017-03-14) Fernando, Shane; Mauk, Joyce; Pham, KristinaPurpose: Children born with diseases and disabilities are living longer but continue to face a spectrum of mental and physical differences as they age. They are considered to be children with special health care needs (CSHCN) and can acquire the needed care due to higher prevalence of specially trained pediatric health professionals, but there is a lack of care and services once they transition into adults. This study aims to gather information about barriers to CSHCN transition in the North Texas area that health professionals, community leaders, and families face in order to provide evidence of health issues that needs to be addressed. Methods: Two surveys were designed and distributed to four groups. The first survey was targeted at health care and allied health professionals while the second survey was targeted at families of CSHCN and community leaders. To create the survey, we gathered information from interviewing members of the Transition Medicine Coalition at the University of North Texas Health Science Center, reviewing literature, and engaging in a clinical preceptorship. Surveys were delivered through electronic means and will be open until a suitable power has been achieved. Results: 60.0% of health providers report discussing transition, but only 9.5% of families/leaders report that their provider discussed it. 48% of health providers strongly disagreed that they had the capacity to provide primary care for adults with SHCN. Lack of referral options to providers knowledgeable about SHCN (42.9%) and education about what services are available for patients with SHCN (42.9%) were barriers that health providers often faced. Families/leaders reported inability to schedule timely appointments and insurance not covering services as the top two barriers. Both surveys reported behavioral therapy was the most difficult service to refer to or find. Conclusions: There is a disparity in perceptions of health professionals discussing transition and family’s reception of the counseling. Almost half of health professionals strongly felt they did not have the capacity to provide primary care for adults with SHCN. It appears that health professionals do not have many referral options for adults with SHCN. The most significant barrier for families is the inability to schedule timely appointments. This study shows that barriers to transition exist and that adult SHCN providers and services are important to address.Item Comprehensive literature examination to derive terminology currently used to describe pharmacist provided services and to develop a checklist for research and journal editors(2017-03-14) Huang, James; Clay, Patrick; Abebe, BrightonBackground: Reporting of pharmacist interventions in research publications requires a detailed description of the intervention and language used to evaluate them. However, reviews and meta-analyses of publications of pharmacist interventions often reveal insufficient and incomplete information. Further practitioners and policy makers who rely on pharmacists publications to inform decision making, identified lack of cohesiveness in the manner in which pharmacist interventions are described in publications. Incomplete reporting of interventions hinders the optimal use of research, and fails to meet broader applications. Pharmacist researchers are aware of CONSORT but the median overall compliance is low and the checklists is not fully appropriate for pharmacist interventions. The purpose of this research was to develop a checklist, with key emphasis in intervention and standardized lexicon to potentially enhance the quality of pharmacy research. Methods: This is a 4-step study. First stage was to extract the actual services provided by pharmacists from the methodology section of publications and compile a services provided category. The search for publications focused on PubMed database and evaluated using the PRISMA checklist. Second stage was to assess existing checklists used by researchers and design a draft checklist. The remaining two stages will externally validate the checklist by collecting qualitative feedback from experts in research, policy, and practice. Stage three is to validate the content of the draft checklist to a collection of relevant manuscripts with the help of independent reviews. State four is to conduct large-scale iterative testing to demonstrate relevance to a wider range of stakeholders. Results: From a database search of nearly 4,581 publications 30 RCT publications were eligible for extracting actual services provided by pharmacists. The SNOMED CT was also used to extract services. The terminologies were then added to the checklist. The checklist included 7 main questions (constructs) titled Intervention, Provider, Delivery Mode, Demographic, Schedule, Setting, and Authorization. Stage three and four are proceeding this summer. Conclusions: A draft pharmacist intervention lexicon and checklist has been developed for use by pharmacist. A unique advantage of this proposed checklist is the incorporation of an evidence based lexicon within the checklist providing the pharmacy service nomenclature to use in publications.