Community Medicine

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    Combination of Positive Airway Pressure Compliance and Efficacy Improves Subjective Sleepiness Compared to Compliance Alone
    (2016-03-23) Sori, Ermias; Jouett, Noah; Smith, Michael PhD; Watenpaugh, Don; Rao, Gautam
    INTRODUCTION: Purpose of this study was to evaluate whether high PAP compliance and PAP efficacy produces decreased subjective sleepiness compared to high compliance alone and compliance as measured by the Medicare standard. HYPOTHESIS: We hypothesized that (1) higher compliance will result in lower Epworth Sleepiness Scale (ESS) scores, (2) that higher PAP efficacy will also result in lower ESS scores, (3) that OSA patients with high PAP compliance but low PAP efficacy will exhibit higher ESS scores, and (4) OSA patients who exhibit very high PAP compliance and efficacy will have lower ESS scores than OSA patients who merely meet the Medicare threshold. METHODS: Patients were included if they had a diagnosis of OSA made by overnight polysomnography and in-lab PAP titration studies according to AASM criteria. In study 1, patients were arranged into quartiles of PAP compliance. In study 2, patients were arranged into tertiles of PAP effectiveness. In study 3, patients were arranged into two groups, one group with high compliance and low efficacy, and the other group with high compliance and high efficacy. In study 4, patients with high compliance compared with current Medicare standard. One-way ANOVA was used to test differences in study 1-2 and unpaired Student’s t-tests were used in study 3-4. RESULTS: In study 1, patients in the first and second quartile of compliance had higher subjective mean ESS (P CONCLUSIONS: We conclude that patients who are highly PAP compliant, but have relatively poor PAP effectiveness, are sleepier than patients who are highly compliant and effective with PAP treatment.
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    Outcome study for minimally invasive Sacroiliac joint fusion using the ifuse implant system
    (2016-03-23) Smith, Gregory Dr; Ebot, James
    Abstract: Outcome study for minimally invasive Sacroiliac joint fusion using the ifuse implant system Background: Sacroiliitis is a common source of low back pain. Some studies have shown that about 15 – 30% of all low back pain complains can be attributed to sacroiliac joint pain. The diagnoses and treatment of sacroiliitis remains controversial but consist mostly of non-surgical interventions like medical therapy, physical therapy, corticosteroid injections into the sacroiliac joint. These treatments only provide temporal relief of pain and disability but are less effective in long term control of pain and disability. There is increasing evidence that minimally invasive sacroiliac joint fusion has been shown to decrease pain and disability long term. Objective: To perform an outcome study on patients consecutively treated for sacroiliitis using the ifuse implant system by a single surgeon in a single hospital. Methods: A total of 45 patients were identified who had the surgery for minimally invasive sacroiliac joint fusion. A patient chart review showed all the patients were diagnosed through injection of an anesthetic into the sacroiliac joint. A decrease in pain of more than 75% was considered positive for sacroiliitis. While a disability survey was not conducted pre-surgery, a chart review showed that all the patients had significant pain and major disability. A follow up phone interview was conducted using the Oswestry disability index (ODI) survey. 30 patients answered the phone and agreed to respond to the survey questions. Results: Of the 45 participants identified for the study, 30 participants responded and agreed to be part of the study. 7(23%) where males and 23(77%) where females. The average age was 59 years (33 – 81) and the average follow up time was 29 months (12 – 38). Percentage disability scores using the ODI survey showed 77% of the participants reported zero/minimal disability to slight discomfort and the remaining 23% reported significant to very significant disability. Conclusion: Our results show that minimally invasive sacroiliac joint fusion can be used as an alternate therapy for long term control of sacroiliitis when conservative methods fail. The results also show that careful selection of patients who will benefit from this surgery is warranted and more studies are needed in this area as not all the participants were able to benefit from this procedure. IRB for this study was approved by Chesapeake IRB.
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    Epidemiology of Hip Fractures, a Retrospective Review
    (2016-03-23) Davis, Jacob; Sanchez, Hugo; Fairbanks, Carson
    Purpose: To determine the epidemiology and fracture characteristics of hip fractures at a level two trauma center. To establish a hip fracture database to further research on the subject. Methods: An IRB exempt retrospective chart review was undertaken on consecutive patients 55 years of age and greater from December, 2010 through July, 2013 who sustained a proximal femur fracture from a ground level fall. All of these patients underwent operative fixation at a single, urban, level two trauma center. X-rays were reviewed by three Orthopedic surgeons blinded to patient identification and were characterized using the AO/OTA classification system into fractures of the femoral neck (FN), intertrochanteric region (IT), and subtrochanteric region (ST). Fracture classification and fixation method were recorded and combined with clinical information from the hip fracture database. Results: There were 986 patients that met study characteristics including 281 (28.5%) males and 705 (71.5%) females, the average age was 79.5 years old. Fracture characteristics included 91 (9.2%) non displaced FN, 332 (33.7%) displaced FN, 275 (27.9%) stable IT, 169 (17.1%) unstable IT, 82 (8.3%) reverse obliquity IT, 28 (2.8%) ST, and 9 (0.1%) peri-prosthetic fractures. The average length of stay was 5.9 days (range 1-36 days), and the most common discharge destinations were 526 (53.35%) patients to a skilled nursing facility and 303 (30.7%) to a rehabilitation facility. Only 76 (7.7%) of patients were discharged home. The in hospital mortality rate was 1.6% (16 patients). Conclusion: Hip fractures in the geriatric population are very common and lead to significant morbidity, mortality, and loss of pre-injury functional level. Understanding the epidemiology of these fractures will better guide patient care and allow us to formulate treatment protocols to best serve this vulnerable patient population. Further research should continue on, among other things, the appropriate types of fixation for these fractures, factors that influence length of stay, and ways to improve function after hip fracture. The aim of this research should be to reduce the physical, psychological, financial, and social burden that hip fractures have on both patients and society as a whole.
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    Nutritional Barriers in Geriatrics
    (2016-03-23) Feezel, Ashlea; Irani, Ayesha; Joseph, Justin; Hersh, Jessica; Forner, Elizabeth
    There are many factors that contribute to weight loss and malnutrition in older adults and this is directly correlated with increased morbidity and mortality. We believe that Tarrant county has in place many programs that would be of benefit to our geriatric population in relation to their nutritional health. We first indicated the most important factors that contribute to the nutritional health in a geriatric population and then identified specific community programs and resources that could cater to improving each of these aspects. There are many factors that lend to alterations in nutritional health as patients age. Some of the factors discussed in this overview include socioeconomic factors, psychological factors, and physiological factors including oral and dental health, gastrointestinal health, and the frequent presence of multiple disease processes. We identified community resources to address each of these contributing factors including socioeconomic factors, psychological factors, and physiological factors including oral and dental health, gastrointestinal health, and the frequent presence of multiple disease processes. We concluded that many of these programs are easily accessible to every patient in the geriatric patient.
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    Influence of Stigma on Attitudes Towards Help-Seeking for Major Depression in Rural Central Texas
    (2016-03-23) Sharma, Sneha; Piraino, Javier; Mamun, Md Abdullah; Abraham, Stacy; Chiapa-Scifres, Ana; Bowling, John; McDermott, Catherine
    Objective: Stigma about depression may be perceived stigma or personal stigma (negative attitudes about oneself as a result of internalization of stigmatizing ideas held by society). Both types may inhibit help-seeking. Few researchers have reported on these constructs in rural samples despite higher prevalence and completion rates of suicide among rural residents. The current study investigated the relationship between attitude towards professional mental health help-seeking and personal and perceived stigmas towards depression among rural central Texas residents. Methods: This analytical, cross-sectional study used the Stigma and Attitudes towards Depression Questionnaire (SAD-Q) to determine a) contact with help-seeking, b) personal stigma and perceived stigma, c) attitudes toward seeking help from a mental health professional, and d) depression status of 273 residents of the towns and surrounding areas of Eastland, Dublin, and Gatesville, Texas. Through factor analysis, factors were identified that attribute to personal stigma and perceived stigma. After adjusting socio-demographic variables, multiple linear regression was fitted on help-seeking attitude to understand the relationship of history of seeking help from a mental health professional for depression, current depression status, and personal stigma and perceived stigma factors. Results: Personal stigma and perceived stigma factors were distinguished with Cronbach alpha coefficients of 0.90 and 0.94, respectively. Female gender and having a history of help-seeking for depression were found to be significantly related to an attitude favorable towards help-seeking for depression. Participants with possible depression status were found to have significantly more personal help-seeking contact than participants who screened negative for depression. Depression status was not significantly related to either perceived stigma or personal stigma. Contrary to the authors’ expectations and the findings of previous studies, personal and perceived stigmas were not significantly related to help-seeking attitudes in these samples. Conclusion: Some of these results are reassuring: many rural Texas residents who have symptoms of major depression are seeking help from mental health professionals and b) many rural Texas residents who have sought mental health help in the past seem to maintain a positive attitude towards help-seeking. However, the question remains: for those who are depressed but do not seek help, why not? These results suggest that factors other than stigmas influence help-seeking attitudes. Exploring these factors would help inform interventions to address social barriers to help-seeking. Further work could assess the following factors’ influences on attitudes towards help-seeking: perceptions of a) effectiveness of mental health services and b) barriers to obtaining them.
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    Services Available for Homeless Veterans
    (2016-03-23) Zovath, Andrew; Fritts, George; Sanchez, Roberto; Takach, Timothy; Findlay, Nicole
    Many factors contribute to homelessness, including shortage of affordable housing, inability to access health care, less than adequate income and a lack family and social support networks. For veterans, the effects of post-traumatic stress disorder and substance abuse can compound these issues. (National Coalition for Homeless Veterans, 2014). The objective of this search was to determine what resources are available to homeless veterans in Tarrant County. Methods were to search public databases for resources and determine common obstacles in accessing those resources. It was discovered that there are multiple resources available for veterans who are faced with homelessness in Tarrant County, although the need and requisition of appropriate paperwork is a consistent barrier. It can be concluded that although there are a variety of resources available, there are several barriers to accessing the appropriate help that should be addressed by organizations intending to serve the veteran population.
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    Tarrant County Resources for Vision Disabilities
    (2016-03-23) Kalra, Kyle; Merchant, Azhar; Davis, Marcus; Thomas, Joseph; Rao, Chethan
    Vision is a sense that often goes underappreciated among the many sighted members of our community. Everyday activities such as commuting to and from one’s home, participating in classroom learning, or finding appropriate employment would be drastically hindered by loss of sight. Diseases like glaucoma, macular degeneration, and cataracts affect people in our own community every day. Thankfully, Tarrant County has a variety of resources available for those with vision disabilities. Some of these organizations provide clinical services to prevent and treat blindness, while others provide economic, social, and emotional support to help those with vision disabilities regain important aspects of their daily lives. Others still, provide our county’s indigent children with routine eye exams and glasses that may make all the difference in their school and home lives. In this poster, we provide a summary of the resources available in Tarrant County to meet the needs of those with vision disabilities.
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    Resources for Patients with Partial Hearing Loss
    (2016-03-23) Yadav, Menaka; Lopez, Jennifer; Smith, Morgan; Lamping, Ashley; Akchurin, Peri
    The purpose of this research was to explore and summarize resources in Tarrant County, Texas for those with partial hearing loss. Our goal was to create an easy-to-read overview of resources for patients and future-providers alike. We primarily used web search and online information pamphlets to identify organizations and resources in the county. We summarized the services offered by each resource and identified potential barriers to access. As with many health challenges, patients are faced with an uphill obstacle course of navigating resources and appointments, finding funds, and shuttling records and paperwork, all while striving to maintain as productive and happy life as possible. We were surprised to find that children comprise a large percentage of those who are hard of hearing, making resources for parents and adult caretakers all the more vital. Tarrant County has several resources to assist those with partial hearing loss in a variety of ways. Through the process of creating this overview, we gained insight into what has the potential to be a very difficult and frustrating process to obtain resources and assistance, especially for those with financial concerns. We also gained an appreciation for the number of people affected by hearing loss and are more prepared to assist future patients who will benefit from these resources.
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    MedStar Mobile Healthcare Programs Improve Patient Health While Reducing ED Utilization and Hospital Costs
    (2016-03-23) Nejtek, Vicki Ph.D.; Ebbett, Daniel EMT-P,CCP-C; Partain, Desiree CCP-C; Wang, Hao M.D.; Talari, Deepika M.P.H
    Purpose: Locally, over 50% of Emergency Department (ED) visits in Tarrant County are associated with inappropriate ED use totaling ~$2 billion. To help mitigate inappropriate local ED use, the county’s primary 9-1-1 emergency response team, MedStar Mobile Healthcare, introduced several Mobile Health Program (MHP) interventions. Here, we evaluated outcomes from a high utilizer group (HUG) and a congestive heart failure (CHF) group to determine whether or not the MedStar MHP intervention would reduce ED transports and overutilization, inpatient admissions, and hospitalization costs. Hypothesis: Patients participating in the MedStar MHP intervention will experience a significant reduction in ED transports, utilization, inpatient admissions, and generate less hospitalization costs than before they participated in the MedStar MHP. Methods: Pre- and post-program data of patients who participated in the HUG or CHF Readmission Avoidance program from July 2009 to October 2015 were evaluated retrospectively. Hospitalization costs were determined using data from 2013-2015. Data were analyzed using SPSS (version 21) and included descriptive statistics, frequency distributions, paired t-tests, ANOVA, and regression modeling, as appropriate. All analyses were conducted using a 95% confidence level and an alpha level of 0.05 was used to determine statistical significance. Results: A total of 629 participants participated in the HUG (n = 406) or CHF (n = 223) MedStar programs. Those in the HUG program experienced an overall reduction in ED encounters of 72.5% resulting in a cost avoidance of over $ 6 million for ED transports. They also self-reported a 22% decrease in pain-discomfort and a 26% reduction in anxiety and depression. Participants in the CHF program had 48% fewer ED visits and experienced a 56% drop in inpatient encounters resulting in a total of $378,741 cost avoidance for ED transports during the program. Conclusion: The HUG and CHF MedStar MHP interventions appear highly effective at reducing ED transports, utilization, and inpatient admissions while improving patient health outcomes. Reducing ED overutilization and inpatient admissions also resulted in a significant reduction in hospitalization costs. MedStar MHP interventions appear to promote substantial health improvements in chronically ill patients which frees emergency transport and hospital teams to provide acute crisis treatment to high-acuity patients community-wide.