General Medicine

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    Comprehensive literature examination to derive Terminology Currently Used to Describe Pharmacist Provided Medication Therapy Management from which a proposed lexicon for use in the literature will be proposed.
    (2015-03) Abebe, Brighton; Dokpesi, Philip; Clay, Patrick
    Hypothesis: An evidenced based and validated lexicon providing the nomenclature to use when designing Medication Therapy Management protocols and in publications will be accepted by the profession and agencies responsible for patient care reimbursement. Methods: This is 4-step approach. First stage (completed fall 2014) was to work with medical literature research specialists (M. Whitehead) to identify the most comprehensive way to extract MTM terms from current literature. Remaining project components are: (2) to retrieve the publications, extract the actual service provided from the methodology of the publication and compile a services provided category terminologies; (3), to develop lexicon and; (4) to validate lexicon using MTM experts. Results: Preliminary searches using frequently occurring terms to describe Medication Therapy Management identified 503,953 unique articles with pharmaceutical care generating 69,689 alone. Methodically refining and combining search terms (98 iterations) generated a meaningful and manageable volume of publications (N = 1,031). Stage 2 is proceeding this spring. Conclusion: Stage 1 presented substantial challenges given the complete lack of consistency in the literature and delayed proposed timeline. Stage 2 is expected to be completed by June 2015.
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    Variation of Sternalis Muscle: A Case Report
    (2015-03) Liu, Hao (Howe); Holmes, Victor L.; Kirchhoff, Claire A.; Reeves, Rustin
    Purpose: The sternalis muscle was first documented in the 19th century and since has been shown to have variations in its origins, insertions, direction, extra muscle slips, and nerve innervations. This case report describes anomalous features not previously reported in the medical literature. Methods: During routine gross anatomy dissection of the anterior chest wall of an 100-year old woman who died of “natural causes” at UNTHSC, obvious anomalies in the bilateral appearance of the sternalis muscle were observed and documented. Results: The left sternalis originated from the clavicular origin of the left sternocleidomastoid (SCM) muscle, while the right emerged from the sternal origin of the right SCM muscle. Both the left and right original tendons of the sternalis’ were separated but wrapped in a tight connective tissue band. The fleshy muscle bellies of each sternalis travelled down inferolaterally to insert on the aponeurosis of the left and right external oblique muscles, respectively. The innervation to the muscle could be traced to the 4th, 5th, and 6th anterior intercostal nerves. Conclusions: Several anomalies found here have not been previously reported in the literature including (1) the sternalis muscles originating from the clavicular head of the SCM muscle, (2) the tendinous band suspended over and slightly left of the sternal angle with only a loose connection to the underlying sternal angle, and (3) the inferolateral and nearly symmetrical 30 degree angle traveled by the sternalis to the sternum. Awareness of the location of the sternalis will help radiologists and reconstructive surgeons avoid misdiagnosis during mammography or misjudgment during breast surgery. Because of its superior attachment to the sternocleidomastoid muscle, therapists may need to be aware that a person with such an anomaly may have an automatic accessory inspiration with head rotation.
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    A Variant of Extensor Medii Proprius: A Case Report
    (2015-03) Holmes, Victor L.; Liu, Hao (Howe); Rosales, Armando; Kirchhoff, Claire A.
    Purpose: The extensor medii proprius (EMP), a documented variation of human hand extensor muscles, originates from the distal 1/3 of the ulna and inserts on the dorsal aponeurosis (extensor expansion) of the 3rd manual digit. This case report describes an anomaly in which the EMP originates from the lunate, an origination reported in the medical literature. Methods: During routine gross anatomy dissection of the left hand of a 67-year old female who died of “stroke,” an unusual EMP muscle was observed and documented. Results: The flat, fleshy muscle originated from the lunate bone, narrowed into a flat tendon near the 3rd metacarpophalangeal joint, and continued distally to insert on the extensor expansion of the 3rd digit. A branch from the posterior interosseous nerve was traced to the EMP. We propose that this previously unreported variation be termed extensor medii proprius brevis (EMPB). Conclusions: Several anomalies found here have not been previously reported in the literature. First, the EMP originated at the lunate, which means the muscle does not cross the radiocarpal joint as described in previous reports. Second, the co-existence of the EMP with the extensor indicis or related muscles was not observed in this case. Third, the EMP tendon traveled deep to the intertendinous connection between the 2nd and 3rd tendon slips of the extensor digitorum muscle. Finally, this is the first time that the EMP was found to be innervated by a branch from the posterior interosseous nerve. In functional terms, the EMP/EMPB may act as an accessory MCP extensor. Due to its small size, however, the impact of EMP/EMPB on MCP extension may be negligible. Clinicians should still be aware of this variation, since swelling or tenderness of the muscle may lead to misdiagnoses of ganglion cysts or adipose tumors around this area of the dorsal hand.
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    Do You Have A Plan? Are Healthcare Providers Discussing Emergency Preparedness Planning with Families of Children with Special Healthcare Needs and Genetic Disorders?
    (2015-03) Homan, Sharon M.; O'Meara, Stephanie; Ilouga, Nnamdi; Kaye, Celia I.; Aponte, Sondi; Castro, Dina; Brown, Marilyn
    Purpose: The mission of the Mountain States Genetics Regional Collaborative (MSGRC) is to ensure access to exemplary genetic and newborn screening services in the eight states of the region (Arizona, Colorado, Montana, Nevada, New Mexico, Texas, Utah and Wyoming). Advancing equitable access to quality health services, particularly genetics services, is a challenge in the mountain state region due to rural and frontier health care access challenges, including geographic barriers and provider shortage. The MSGRC Emergency Preparedness Workgroup surveyed genetics healthcare providers to understand provider perceptions about emergencies, and the associated risks for their patients. Our purpose was to: (1) understand provider risk perceptions regarding the impact of emergencies and disasters on their patients, and (2) identify specific guidelines and practices used by mountain state providers to help families of children with genetic disorders, or other special healthcare needs, be prepared for a natural disaster or other emergency. Methods: We analyzed the 2014 MSGRC Emergency Preparedness Provider Survey to understand risk perceptions associated with ten emergencies that could affect families of children with genetic disorders, and the healthcare provider’s ability to maintain care for them during such emergencies (natural disasters, electricity blackout, snowstorm, widespread flu outbreak, medication or metabolic food shortage, financial crisis, lack of transportation, loss of utilities, home emergency and school lock down). Using multivariable logistic regression modeling, we estimated the effect of provider emergency risk perceptions and practice composition on whether providers discuss emergency preparedness planning with families. Results: For each of the ten emergency types, 28% to 65% of the providers reported that it is likely/ highly likely that the particular emergency would affect families of children with genetic disorders, and the provider's ability to maintain care for them. Natural disaster ranked at the top of their concerns. Only 19% (n=14) of providers indicated that they, and the other providers in the office, discuss emergency preparedness planning with families of children with special healthcare needs. Practices with a dietician on staff were 3.8 (95%CI: 1.2, 15.8) times more likely to discuss emergency preparedness planning. Conclusion: In the mountain states region, an area of vast rural and frontier areas combined with geographic barriers to providing emergency assistance, few healthcare practices have in place emergency preparedness policies, and less than one in five discuss emergency preparedness planning with families of children with genetic disorder and other special healthcare needs. The MSGRC Emergency Preparedness Workgroup is developing fact sheets, education and outreach activities to address this serious problem. Providers indicated that they would like to receive resources to assist them in preparing their families for disasters.
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    Geriatric Exercise: Get Them Moving!
    (2015-03) Kalathil, Josin; Ebot, James; Patel, Amol; Rao, Gautam; Gregorio, David
    As we get older, the physiological changes that occur in our body systems begin to limit our ability to perform at the level we once did as young adults. Most people gain weight, and on average there is an increase in Blood pressure and cholesterol levels. Limitations in our musculoskeletal system puts a strain on movement and most adults 65 years and above are living with multiple comorbidities either in hospitals or nursing homes. While these changes are inevitable and will eventually catch up with each and every one of us, numerous studies have shown that a healthy life style which includes good nutrition and regular exercise can slow down these changes, prevent some of these diseases and even enable most adults to lead healthy and independent lives into their 80s. Exercise is especially important, not only because it can prevent high blood pressure and its related comorbidities, it can also strengthen the joints and help with movement and stability. In this poster, we show how to conduct a fall assessment and identify local community resources that are available to help older adults live more active and healthy lives.
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    Relationship of Metabolic Syndrome Risk Factors and Reported Depression Among Hispanic Men and Women
    (2015-03) Hall, Amanda B.; Franks, Susan F.; Hall, James R.
    Background: Hispanics are disproportionately affected by metabolic syndrome (MetS). The link between depression and MetS has been of increasing clinical interest but has not been well studied among racial/ethnic groups. This study aims to determine relationships between number of MetS risk factors and self- and caregiver-reported depression among Hispanics. Hypotheses: (1) Hispanic women with increased number of MetS risk factors will have more depression symptoms by self- and caregiver-report. (2) Hispanic men with increased number of MetS risk factors will not have more reported depression symptoms. Methods: Data were analyzed from Hispanic women (n=589) and men (n=277) in the Texas Alzheimer’s Research and Care Consortium (TARCC) Longitudinal Research Cohort. Participants were given the Geriatric Depression Scale (GDS). Caregivers were given the Neuropsychiatric Inventory Questionnaire (NPI-Q). GDS total score, NPI-Q occurrence and occurrence by severity scores were analyzed in relationship to total number of selected risk factors of MetS (hypercholesterolemia, hypertension, and obesity). Data were analyzed using Chi square, t-test and multivariate analysis of variance. Results: Men and women did not differ on number of risk factors (X2=.34, p=.560). Women scored higher on GDS (p=.044) but not on NPI-Q. A significant main effect for number of risk factors was found for NPI-Q but not for GDS. Number of risk factors was not related to depression symptoms for men, although the GDS score approached significance when comparing no risk factors to three risk factors (p=.07). Women with three risk factors had significantly higher. Conclusion: Hispanic women with three risk factors of MetS have significantly higher rates of depression symptoms when compared to Hispanic women with fewer risk factors. This finding did not hold for men. When examining Hispanic women with increased risk factors of MetS, it is important to evaluate for depression.
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    Million Veteran Program
    (2015-03) Bhat, Nikhil U.; Rastogi, Padmashri; Reeves, Rustin
    Purpose: The Million Veteran Program (MVP) is a national, voluntary research study conducted by the Department of Veterans Affairs Office of Research & Development. It is collaboration between the VA and veterans, whose goal is to illuminate potential links between genetic heterogeneity and disease. This is an important step in our scientific understanding about how genetic, as well as epigenetic makeup impinges upon disease characteristics and drug efficacy. Methods: Veterans who are treated in Veteran Affairs are eligible to participate. Those who provide consent are contacted by one of the researcher in the group. Veteran fills the survey related to their health and consent to give a blood sample. Central MVP biorepository saves the sample. Each sample is coded and so is their corresponding health information. Neither the person in the lab nor in the analysis knows the identity of the veteran. The key to the code is known to only a few personnel who are highly trained in research ethics thus safeguarding the privacy of the veterans. Results: Though the collection of data is ongoing, based on the analysis done so far, the correlation found between genetic and phenotypic pattern is helping to improve current treatment for certain cancers. Strong links that will very likely be found in this study, due to the large number of participating veterans (1 million), will be used to generate testable hypotheses for future study, such as if a particular gene polymorphism or epigenetic mark leads to a particular disease trait. This will enhance our understanding about how to better prevent and treat various diseases such as heart disease, diabetes, cancer, and post-traumatic stress disorder. Conclusions: Our site has contributed actively in the recruitment of veterans for this study by enrolling approximately 5000 veterans till now. With the help of research program, at our institution, we continue to work towards achieving our target. All over US, more than 250,000 patients have been enrolled in MVP. The research on the 250,000 samples has helped us discover a couple of useful drugs for cancer and schizophrenia. MVP aims to establish the largest of its kind database in the United States.
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    Quality of life in Medicaid patients 50 and over
    (2015-03) Large, Stephanie; Mathew, Susan; Richardson, Janice; Gamboa, Adriana; Vintimilla, Raul; Connally, Patrica; O'Jile, Judith R.; Johnson, Leigh; O'Bryant, Sid
    Introduction: Mighty Care is a community-based geriatric primary care program designed to reach Medicaid eligible adults and elders who are 50 and above, with the purpose of increasing access to care and improve patient quality of life. This is a new initiative for UNTHSC that utilizes mobile teams and clinics to increase access to care by providing appropriate levels of care within the community where the patients live. Generally, research indicates that as people age their quality of life (QOL) declines. The purpose of this study is to do a preliminary analysis of the QOL of the patients seen through this program, and examine age related differences in scores. Methods: QOL was assessed using the 36-item short form health survey (SF-36). The SF 36 is a widely used tool, and possesses good psychometric properties. The SF 36 consists of eight domains, which make up the physical and mental health composite scales. Descriptive statistics were calculated to compare the scores from our sample to the national means. To examine the impact of age, we split the sample into two groups: those 64 and under and 65 and older. Independent t test were used to examine the impact of the age groups on QOL scores. Results: The sample consisted of 229 patients (53 males and 176 females) with a mean age of 61. The average of PCS was 34.78 (SD= 9.87) and MCS was 45.075, falling slightly below the national average. For physical health there was a significant difference in the scores between the two groups, t (227) =-2.458, p=.015, with participants 64 and below (M= 33.7, SD=9.27) having lower scores that the 65 and above group (M=37.15, SD=10.84). For the mental health scores, there was a significant difference between the two groups, t (227)=-3.934, p= .000; suggesting that participants 64 and below (M= 42.71, SD= 13.66) had lower scores those over 65 (M=50.18, SD=12.18). Conclusion: Past research has indicated that age decreases scores on the physical and mental health scales. However, these results indicated that individuals 65 and older reported better QOL than their younger counterparts. One potential explanation for these findings has to do with the fact that at 65 most of these patients are able to apply for Medicare. All participants in this program have Medicaid, however as an individual reaches 65 they are considered dually eligible which means they can have both Medicare and Medicaid. This gives this population access to a wider array of health services and benefits. The data is from baseline QOL measures in the Mighty Care program. This study had a small sample size, therefore more data is needed.