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UNTHSC Ion Channel Screening and Drug Discovery
(2017-03-14) Gonzales, Eric
Background: The cost to develop a new drug is in the billions of dollars. In the drug development timeline, there are numerous hurdles that must be addressed. These range from generating novel ligands to target a receptor (e.g. ion channels) to toxicology studies. Furthermore, cardiotoxicity studies are needed before any compound can be studied clinically. Many companies and research laboratories start with compound libraries, containing hundreds to thousands of potential drugs. Screening these libraries for ion channel activity may necessitate partnering with laboratories focused on these screens. Discussion: In 2017, UNT Health Science Center will obtain a computer assisted patch-clamp electrophysiology system that will aid in the screening of ligands and candidate drug libraries for ion channel activity and cardiotoxicity screening. This system will be available for use by UNTHSC laboratories and industry collaborators. This presentation will outline the system's capabilities, potential screens for pharmacological targets, and develop collaborations to develop tomorrow's therapies.
Assessment of a Faculty Mentoring Program Implemented at the UNT System College of Pharmacy
(2017-03-14) Gibson, Caitlin; White, Annesha; Bullock, Katura
Objectives: As new pharmacy schools continue to be established, design and structure of faculty mentoring programs continues to receive increased attention. Effective mentoring can lead to increased faculty productivity and retention, and enhanced career satisfaction and achievement. Few studies have evaluated pharmacy faculty mentoring programs. The objective of this study was to (1) describe the nature and extent of mentoring relationships established at a new college of pharmacy and (2) compare those relationships based on whether the mentor involved was an on-site or off-site mentor. Methods: In 2016, a QualtricsTM survey was developed by members of the College Faculty Mentoring Study Group and the Assessment Committee and sent to faculty members with(1=strongly disagree, 5=strongly agree) and open ended questions. Descriptive statistics were used to summarize responses to both surveys. This study was approved by the IRB. Results: Of the 13 survey responses, the majority of mentees were female (69%), non tenure track (54%) and had one (38%) or two (54%) mentors. The preferred mentoring type was unstructured but in person (69%) and optimal duration for more than 1 year (54%). Time commitment to partnership was 1-2 hours per month (85%). General attitude towards mentoring was positive (85%). Respondents agreed or strongly agreed that their mentoring partnership increased their confidence in teaching (38%), research (69%) and service (69%). Mean scores were: My mentor was readily available (4.23), My mentor was a good match for me (4.00), I benefited from my mentoring partnership in terms of my personal growth (4.00), I am better prepared to advance my career (4.00) and overall satisfaction with the mentoring process (4.08). A comparison of on-site (77%) vs. off-site (23%) mentors showed a significant difference in responses to the items ‘I benefited from my mentoring partnership in terms of my personal growth’ (on-site mean 4.00 vs. off-site mean 5.00) and ‘My mentoring partnership has increased my work productivity’ (on-site mean 3.44 vs. off-site mean 5.00) (p Conclusions: Findings from the faculty mentoring program may assist other health disciplines in planning similar programs. Future research includes aims to compare views on mentoring by clinical vs. non clinical faculty.
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, Harrison
Introduction: 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.
Recurrent Granuloma Gluteale Infantum Secondary to Encopresis
(2017-03-14) Weis, Stephen D.O.; Ingersoll, Zachary
Background: 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.
Rotational Alignment in the Coronal Plane During Tibial Tubercle Osteotomy Background & Significance
(2017-03-14) Webb, Brian; Gonzales, Gabriel
Significance & Hypothesis: Prior literature has demonstrated the effects of translation of the tibial tubercle during tibial tubercle osteotomy (TTO) procedures in both the sagittal and transverse planes but there has not been much investigation into the effects of adjustment of the rotation alignment of the tibial tubercle in the coronal plane. Since changes in the positioning of the tibial tubercle in all three planes has the opportunity to yield significant physiological changes in range of motion, the results of this study would possibly provide insight on how to optimize this procedure. Specifically, a margin of error determination may be made from the data to guide surgeon fixation of the tubercle post osteotomy. This study is aimed at the effects of variations to the tibial tubercle in the TTO procedure, specifically investigating effects of rotational alignment of the tibial tubercle in the coronal plane. The hypothesis of this study is that coronal plane rotation during TTO must be within 5 degrees of native orientation to prevent poor patellofemoral kinematic effects. Materials & Methods: At least 10 frozen, fresh, prepared specimens would have the musculature of the thigh exposed with specific muscles sutured to accommodate loads of weight specific to each muscle type to achieve standardized range of motion. The specimens would be secured into a knee-rig structure allowing full flexion and extension. Each specimen would be initially range of motion tested and used as control for comparison to the resulting range of motion after the TTO is performed. A tracking system will be utilized, recording patellar range of motion data with 6 degrees of freedom during leg range of motion testing cycles. For each specimen, initial native patellar motion would be documented, and then compared against resultant patellar motion as the degree of tibial tubercle rotational alignment in the coronal plane is incrementally adjusted. Comparison will involve evaluation of the Euler angle changes of the native patella against measurements as the rotational alignment is adjusted. A repeated one-way ANOVA will be used with a post hoc tukey test to find statistical significance. Results: Pathologic rotational motion of the tibia on femur has been noted grossly with alterations of coronal alignment of the tibial tubercle, especially at the end range of extension. Detailed statistical analysis is currently pending on gathered data. Conclusions: Rotational alignment modification of the patellar tendon insertion, the tibial tubercle, causes unilateral unloading and loading of the quadriceps musculature. This change in force vectors results in gross change to lower extremity flexion and extension mechanics. Further data analysis is required to make specific comments on the details of this change.
"Kidney Bucks": An Incentives Program for Pediatric Dialysis Patients
(2017-03-14) Ma, Brenda; Hamby, Tyler; Gillespie, Robert; Verma, Akanksha
Background: Pediatric dialysis patients are at risk for a variety of metabolic derangements, including hyperkalemia, hyperphosphatemia, and fluid overload. Management of these problems includes patient education, dietary restrictions, and the use of phosphate-binding medications. Hypothesis: The purpose of the present research is to examine the efficacy of an incentives program, “Kidney Bucks”, which offers rewards in exchange for fluid control and normal lab values for phosphorus and potassium. Methods: The study was a retrospective investigation initiated in January 2015 at Cook Children’s Medical Center (CCMC). To be included in this study, patients had to be dialysis patients from July 2014 to June 2015, and had to be between the ages of 5 and 21 during this time. Longitudinal analyses were utilized to test whether the amounts of Kidney Bucks earned--overall and for each of the three components--differed before and after the intervention. For this purpose, the amount of Kidney Bucks that patients would have hypothetically earned preintervention in 2014 was computed and compared to the amount actually earned postintervention in 2015. Fourteen peritoneal dialysis patients and 13 hemodialysis patients met the inclusion criteria, totaling 27 patients. Results: Peritoneal dialysis (P=.01) patients earned more Kidney Bucks overall postintervention. Hemodialysis (P=.02), but not peritoneal dialysis, patients earned more Kidney Bucks for potassium postintervention, but neither group differed in phosphorus values. Lastly, peritoneal dialysis, but not hemodialysis, patients earned much more Kidney Bucks for fluid control post-intervention (P Conclusions: The study’s limitations include the relatively small sample size and the retrospective design. This study has important implications for practitioners who face the challenge of dietary adherence in pediatric populations and, despite its limitations, serves as a good foundation for future studies.
Utilizing an Inter-Professional Approach to Enhance Patient Safety: Identifying Inefficiencies in PBM Prescription Processing
(2017-03-14) White, Annesha; Alba, Estela
Background: 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.
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.
Treatment of Concurrent Ipsilateral Femoral Neck and Shaft Fractures
(2017-03-14) Schaefer, Travis; Ming, Bryan; Caton, Tyler; Payne, Joshua
Hypothesis: 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.
Benefits of a Pediatric Home Visitation Program Involving TCOM Students
(2017-03-14) Raines-Milenkov, Amy; Bowman, Paul; Shah, Deep; Calder, Brittany
Background: Home visitation programs increase child development, access to healthcare, and attendance at well child visits as well as decrease accidental injuries. By focusing on maternal and child health, there is the opportunity to prevent disease development, improve overall health, and decrease infant mortality. Including medical students in home visitation has the potential to build relationships and understanding that increases quality of care and learning. The purpose of this project was to assess the feasibility and benefits of incorporating Texas College of Osteopathic Medical (TCOM) students into an existing UNT Health Science Center home visitation program. Methods: To assess the feasibility of this type of model at UNTHSC, a literature review of home visitation programs that involve medical students was conducted. Additionally, an interview and review of similar UNTHSC programs were conducted. Results: The literature revealed several benefits for student learning. For example, medical students found that many of their misconceptions about their patients and their care were corrected by visiting the patient's home. Additionally, students felt they could provide better care after seeing the environments where their patients lived. The experience also helped the students view the patient as a person not just their disease and increased humanism in their care. Conclusions: The literature suggests incorporating medical students into home visitation programs has benefits for the medical students and their future practice. UNTHSC has existing assets that could foster this type of educational experience. For example, the Healthy Start Program is a home visitation program with the intention of improving maternal and infant health. This program would be the backbone for a program involving medical students. Additionally, TCOM has a geriatric home visitation program whose logistics and curriculum could be used as a layout for a similar pediatric based program. A logic model detailing a sample pilot project will be presented. By building from established programs, instituting a pediatric home visitation program involving TCOM students could improve the quality of the medical students’ education while embracing the osteopathic model and providing service to the community. However, more research is needed to understand the program participant’s perspectives and acceptability of receiving services from medical students.
Interest and Attitudes Toward Global Health Training of Prospective Obstetrics and Gynecology Residents
(2017-03-14) Nguyen, Nguyen; Felini, Martha J.; Hoang, Christine
Purpose: 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.
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, Diana
Purpose: 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.
An Evaluation of Attitudes and Understanding of Vaccinations in Rural Populations
(2017-03-14) Mamun, Md Abdullah; Handoyo, Anthony; Pulvino, John; Abraham, Stacy; Kaushal, Deepika
Background: 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.
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, Alexandra
Purpose: 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.
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, Sarah
Purpose: 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.
Effect of Screw Type and Pilot Hole on Screw Fixation in Osteoporotic Metaphyseal Bone
(2017-03-14) Nana, Arvind; Kosmopoulos, Victor; Patel, Shiv; Smith, Morgan; Rowland, Ryan
Introduction: Osteoporosis is a disease in which weakening of the bone occurs due to increased bone resorption and/or decreased bone deposition. Adequate screw fixation can be difficult to achieve in osteoporotic bone leading to hardware loosening or failure. With the steady increase in the number of geriatric fractures as well as the incidence of osteoporosis, it is important to investigate the relationship between screw type and pilot hole diameter in order to use the best combination when fixating screws in osteoporotic bone. Thus, this study aims to compare osteoporotic bone screw fixation using cortical and cancellous screws placed with two different pilot holes. Fixation success was mechanically evaluated using screw pullout strength and stiffness. Methods: Eighty osteoporotic metaphyseal sawbone model blocks (10# cellular foam 40 mm thick, laminated on 1 side with 20# solid foam 3 mm thick, finished dimension 40x40x43 mm, standard tolerances; Pacific Research Laboratories Inc., Vashon, WA) were equally divided into 2 separate groups. Forty blocks received 2.0 mm pilot holes and the other forty 2.5 mm pilot holes. Each of the two different pilot hole groups then had a total of twenty 3.5 mm cortical screws and twenty 3.5 mm cancellous screws placed by a junior resident and a staff orthopedic surgeon. This resulted in the following four, 20 sample, testing configurations: (A) 3.5 mm cortical, 2.5 mm pilot; (B) 3.5 mm cortical, 2.0 mm pilot; (C) 3.5 mm cancellous, 2.5 mm pilot; and (D) 3.5 mm cancellous, 2.0 mm pilot. Pullout strength and stiffness were studied using a material testing system (MTS 858 Mini Bionix, MTS Systems Corp., Eden Prairie, MN) following the American Society for Testing and Materials standard (ASTM F543-13). A two-way balanced ANOVA was used to compare and identify differences between the 4 different configurations. Results: Configuration (D) resulted in the highest mean pullout strength (481.4 N) and stiffness (557.8 N/mm) and was thus the best configuration for this bone type. The 2.0 mm pilot holes outperformed the 2.5 mm pilot holes for each screw type. Furthermore, the 2.0 mm pilot holes were more important in the success of fixation than the type of screw. These conclusions are evident when comparing the resulting 372.2 N and 433.4 N pullout strengths of configurations (A) and (B), respectively, and the 433.4 N and 413.2 N pullout strengths of configurations (B) and (C). Significant differences in pullout strength (p=1.17e-5) and stiffness (p=0.0087) were found between different pilot holes. Significant differences were also found in pullout strength (p=0.0018) but not stiffness (p=0.3022) between the different screw types. Conclusions: With the incidence of osteoporosis on the rise, there is a need for improved hardware fixation. The results from this study support the use of configuration (D) for this type of bone. This configuration, with the 3.5 mm cancellous screw and the 2.0 mm pilot hole, resulted in highest pullout strength and stiffness as compared to the others tested in this study. Furthermore, the results show that pilot hole size is more important in successful fixation than screw type.
Tourniquet usage in Modern Conflict and in Emergency Medicine
(2017-03-14) Hardy, Jonathan; Ebert, Didi D.O.; Pavlik, Joshua
Purpose: 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.
'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, Tara
Purpose: 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.
Efficacious Integration of Health and Wellness Coaching into Clinical Care for Weight Management: A Review and Proposal
(2017-03-14) Lee, Jenny; Alpini, Sarah
Objective: We examined health and wellness coaching in a clinical setting to motivate patients to pursue healthy lifestyles towards effective and sustainable weight management, and proposed an efficacious approach to integrate coaching into clinical care weight management. Methods: We conducted a systematic review of literature for the past 10 years concerning coaching for weight loss in a primary care setting, which yielding 75 studies. Abstracts were reviewed and excluded if they concerned non-coaching interventions or coaching in the context of non-obesity. After exclusion and inclusion criteria, 11 coaching studies were considered for evaluation. Studies were considered efficacious if the coaching intervention resulted in clinically meaningful weight loss (> 5% initial body weight in six months) or statistically significant weight loss compared to standard care. Selected studies were analyzed according to the approach coaching was applied towards weight management including: who administered coaching, how patients coaching, dosage of coaching intervention, and the results of treatment. Results: Coaching resulted in clinically meaningful weight loss in nine studies and statistically significant weight loss in four. Coaching offered at least at a moderate dose (>1/month) with a trained coach was most efficacious in achieving clinically meaningful weight loss. Coaching interventions for longer time frames was more likely to foster sustained weight loss. Coaching was successful in a variety of settings and with electronic support. Coaching also significantly improved diabetes and cardiovascular risk factors, healthy behaviors, and self-sufficiency for maintaining these changes. Conclusions: The present study may contribute to the growing evidence of coaching as an efficacious and sustainable lifestyle intervention strategy for clinical weight management. It is recommendable for primary care practitioners to integrate health and wellness coaching into their clinical encounters to promote behavioral changes in patients who are overweight or obese. We propose that coaching is most successful when integrated for a prolonged time frame, minimally at a moderate to high intensity frequency, via various modes of delivery, and with a coach who has completed coaching training. Coaching was also successful when personalized to suit patient needs, which will help providers optimize patient care and enable patients become advocates for their own health.
Severe Psoriatic Disease in the Setting of Hypocalcemia
(2017-03-14) Reagin, Heather; Weis, Stephen; Workman, Ashleigh
Purpose: To present a patient suffering from severe psoriatic disease in the setting of hypocalcemia and determine the best treatment. Methods: N/A Results: The patient’s psoriatic plaques cleared three months after presentation when she had achieved normocalcemia with 0.75 mcg calcitriol. Conclusions: Psoriasis is a chronic, inflammatory, systemic disease that affects approximately three percent of the US adult population. While its exact cause is uncertain, it is thought to be an autoimmune disorder. There have been very rare cases of psoriasis developing in patients with hypocalcemia. Treatment of such patients is directed at restoring the calcium to the normal range, not immunosuppressive medications.

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