Digital Commons Network^™

Multidisciplinary Amputation Prevention At The Debakey Va Hospital: Our First Decade, Neal R Barshes, Aimee D Garcia, Cezarina Mindru, Maria Rodriguez-Barradas, Panos Kougias, David M Green, Samir S Awad

Faculty, Staff and Students Publications

BACKGROUND: In 2011, the Veterans Health Administration (VHA) undertook multidisciplinary efforts to improve care for patients with nonhealing foot ulcers and reduce leg amputation rates. This article examines the impact of interdisciplinary care for amputation prevention in the VHA.

METHODS: The VHA patient population was characterized using internal registries. Texas hospital admission data were used to identify sex and zip-code matched cohorts. VHA provided data on national and local frequencies of various amputations and the number of patients with diabetes.

RESULTS: Compared to matched nonveteran patients, veterans treated at VHA hospitals were older and more often self-identified as Black. They …

Ga2len Anacare Consensus Statement: Potential Of Omalizumab In Food Allergy Management, Torsten Zuberbier, Antonella Muraro, Ulugbek Nurmatov, Stefania Arasi, Katarina Stevanovic, Aikaterini Anagnostou, Roberta Bonaguro, Sharon Chinthrajah, Gideon Lack, Alessandro Fiocchi, Thuy-My Le, Paul Turner, Montserrat Alvaro Lozano, Elizabeth Angier, Simona Barni, Phillippe Bégin, Barbara Ballmer-Weber, Victoria Cardona, Carsten Bindslev-Jensen, Antonella Cianferoni, Nicolette De Jong, Debra De Silva, Antoine Deschildre, Audrey Dunn Galvin, Motohiro Ebisawa, David M Fleischer, Jennifer Gerdts, Mattia Giovannini, Josefine Gradman, Susanne Halken, Syed Hasan Arshad, Ekaterina Khaleva, Susanne Lau, Richard Loh, Mika J Mäkelä, Mary Jane Marchisotto, Laura Morandini, Charlotte G Mortz, Caroline Nilsson, Anna Nowak-Wegrzyn, Marcia Podestà, Lars K Poulsen, Graham Roberts, Pablo Rodríguez Del Río, Hugh A Sampson, Angel Sánchez, Sabine Schnadt, Peter K Smith, Hania Szajewska, Natasa Teovska Mitrevska, Alice Toniolo, Carina Venter, Amena Warner, Gary W K Wong, Robert Wood, Margitta Worm

Faculty, Staff and Students Publications

Immunoglobulin E (IgE)‐mediated food allergies are the most common type of food allergy, often causing rapid symptoms after exposure to allergens posing a serious health risk and a high impact on patient's and caregiver's quality of life. Omalizumab, a humanized anti‐IgE monoclonal antibody, reduces allergic reactions by binding to circulating IgE. Omalizumab has been successfully used in allergic asthma, chronic rhinosinusitis with nasal polyps, and chronic urticaria, and was recently approved for treating IgE‐mediated food allergies by the US Food and Drug Administration (FDA). This GA2LEN ANACARE Consensus Statement presents our position on the use of omalizumab for treating IgE‐mediated …

Antibiotic-Associated Neutropenia Is Marked By The Depletion Of Intestinal Lachnospiraceae And Associated Metabolites In Pediatric Patients, Josaura Fernandez-Sanchez, Rachel Rodgers, Arushana A Maknojia, Nusrat Shaikh, Hannah Yan, Marlyd E Mejia, Hope Hendricks, Robert R Jenq, Pavan Reddy, Ritu Banerjee, Jeremy M Schraw, Megan T Baldridge, Katherine Y King

Faculty, Staff and Student Publications

Prolonged antibiotic exposure causes dangerous hematologic side effects, including neutropenia, in up to 34% of patients. Murine studies established a link between the intestinal microbiota and hematopoiesis. To identify factors that predispose to neutropenia in pediatric patients, we evaluated changes in microbiota‐derived metabolites and intestinal microbiota composition after prolonged courses of antibiotics. In this multi‐center study, patients with infections requiring anticipated antibiotic treatment of two or more weeks were enrolled. Stool samples were obtained at the start and completion of antibiotics or at neutropenia onset (prospective arm). Some patients were enrolled in a retrospective arm in which a stool sample …

A Comparison Of The Diagnostic Capability Of Kato-Katz And Real-Time Pcr For The Assessment Of Treatment Efficacy Of Ivermectin And Albendazole Combination Against T Trichiura Infections, Gabriela Matamoros, Ana Sanchez, Ruben Cimino, Alejandro Krolewiecki, Rojelio Mejia

Faculty, Staff and Students Publications

BACKGROUND: Trichuris trichiura is humans' second most prevalent soil-transmitted helminth (STH) infection after Ascaris lumbricoides, affecting approximately 460 million people worldwide. Despite its sub-optimal sensitivity, especially in low prevalence and infection intensity settings, the modified Kato-Katz (K-K) is still recommended as a diagnostic method by the World Health organization (WHO) guidelines.

METHODOLOGY/PRINCIPAL FINDINGS: Within a randomized clinical trial (RCT) comprising four treatment arms with two different anthelmintics, the present study reports an important secondary research objective to determine the diagnostic agreement between K-K and real-time PCR evaluating treatment efficacy against T. trichiura. The parasitological results were analyzed, including cure rates …

Automated Electronic Health Record Data Extraction And Curation Using Extractehr, Tamara P Miller, Kelly D Getz, Edward Krause, Yun Gun Jo, Sandhya Charapala, M Monica Gramatages, Karen Rabin, Michael E Scheurer, Jennifer J Wilkes, Brian T Fisher, Richard Aplenc

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Although the potential transformative effect of electronic health record (EHR) data on clinical research in adult patient populations has been very extensively discussed, the effect on pediatric oncology research has been limited. Multiple factors contribute to this more limited effect, including the paucity of pediatric cancer cases in commercial EHR-derived cancer data sets and phenotypic case identification challenges in pediatric federated EHR data.

Methods: The ExtractEHR software package was initially developed as a tool to improve clinical trial adverse event reporting but has expanded its use cases to include the development of multisite EHR data sets and the support …

Car-Redirected Natural Killer T Cells Demonstrate Superior Antitumor Activity To Car-T Cells Through Multimodal Cd1d-Dependent Mechanisms, Xin Zhou, Ying Wang, Zhangqi Dou, Gloria Delfanti, Ourania Tsahouridis, Caroline Marnata Pellegry, Manuela Zingarelli, Gatphan Atassi, Mark G Woodcock, Giulia Casorati, Paolo Dellabona, William Y Kim, Linjie Guo, Barbara Savoldo, Ageliki Tsagaratou, J Justin Milner, Leonid S Metelitsa, Gianpietro Dotti

Faculty, Staff and Students Publications

Human natural killer T (NKT) cells have been proposed as a promising cell platform for chimeric antigen receptor (CAR) therapy in solid tumors. Here we generated murine CAR-NKT cells and compared them with CAR-T cells in immune-competent mice. Both CAR-NKT cells and CAR-T cells showed similar antitumor effects in vitro, but CAR-NKT cells showed superior antitumor activity in vivo via CD1d-dependent immune responses in the tumor microenvironment. Specifically, we show that CAR-NKT cells eliminate CD1d-expressing M2-like macrophages. In addition, CAR-NKT cells promote epitope spreading and activation of endogenous T cell responses against tumor-associated neoantigens. Finally, we observed that CAR-NKT cells …

Overcoming The Effects Of Increasing Antimicrobial Resistance On Helicobacter Pylori Therapy, David Yates Graham, Theodore Rokkas

Faculty, Staff and Students Publications

Introduction: Resistance to the antibiotics used to treat Helicobacter pylori (H. pylori) has risen to alarming levels worldwide emphasizing the need to reconsider the approach to therapy generally and to reconsider whether to continue use of many previously highly effective treatment regimens.

Areas covered: This review covers current aspects management of the response to the effects of antimicrobial resistance on H. pylori therapy.

Expert opinion: The prevalence of antimicrobial resistance to H. pylori is increasing and must now be integrated into management of the infection. Bacterial factors responsible for resistance include mutations, efflux pumps, and biofilm formation. Societal …

Access To Treatment For Chronic Obstructive Pulmonary Disease In The Americas: A Call For Action A Joint Perspective From The Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, And The American Thoracic Society, Francesca Polverino, Mohit Bhutani, Gustavo Zabert, Frederico Leon Arrabal Fernandes, Karen Czischke, Luiz Fernando Pereira Ferreira, Lian Szabo, Juan P Wisnivesky, Margareth Pretti Dalcolmo, Juan C Celedón

Faculty, Staff and Students Publications

Chronic obstructive pulmonary disease (COPD) is a major public health problem in the Americas (a region of the world comprising North, Central, and South America), although there is substantial variation in disease prevalence, morbidity, and mortality between and within nations. Across the Americas, COPD disproportionately affects vulnerable populations, including minoritized populations and impoverished persons, who are more likely to be exposed to risk factors such as tobacco use, air pollution, infections such as tuberculosis, and biomass smoke, but less likely to have adequate healthcare access. Management of COPD can be challenging across the Americas, with some barriers being specific to …

Learning Problems Related To Stochastic Differential Equations, Jinpu Zhou

LSU Doctoral Dissertations

Stochastic differential equations (SDEs) are essential for modeling systems influenced by both deterministic dynamics and random fluctuations, with applications in a wide variety of disciplines. This thesis develops a Bayesian framework for nonparametric learning in SDEs, addressing key challenges in inference, particularly when dealing with complex systems and incomplete data. The thesis begins by establishing a theoretical foundation in optimization over Hilbert spaces, including a generalized representer theorem to address infinite-dimensional optimization problems encountered in nonparametric inference. Building on this, we introduce a Bayesian framework with shrinkage priors to learn drift functions from high-frequency data. Bayesian approach incorporates low-cost sparse …

Effectiveness Of Original Monovalent And Bivalent Covid-19 Vaccines Against Covid-19-Associated Hospitalization And Severe In-Hospital Outcomes Among Adults In The United States, September 2022-August 2023, Jennifer Decuir, Diya Surie, Yuwei Zhu, Adam S Lauring, Manjusha Gaglani, Tresa Mcneal, Shekhar Ghamande, Ithan D Peltan, Samuel M Brown, Adit A Ginde, Aimee Steinwand, Nicholas M Mohr, Kevin W Gibbs, David N Hager, Harith Ali, Anne Frosch, Michelle N Gong, Amira Mohamed, Nicholas J Johnson, Vasisht Srinivasan, Jay S Steingrub, Akram Khan, Laurence W Busse, Abhijit Duggal, Jennifer G Wilson, Nida Qadir, Steven Y Chang, Christopher Mallow, Jennie H Kwon, Matthew C Exline, Nathan I Shapiro, Cristie Columbus, Ivana A Vaughn, Mayur Ramesh, Basmah Safdar, Jarrod M Mosier, Jonathan D Casey, H Keipp Talbot, Todd W Rice, Natasha Halasa, James D Chappell, Carlos G Grijalva, Adrienne Baughman, Kelsey N Womack, Jillian P Rhoads, Sydney A Swan, Cassandra Johnson, Nathaniel Lewis, Sascha Ellington, Fatimah S Dawood, Meredith Mcmorrow, Wesley H Self, Investigating Respiratory Viruses In The Acutely Ill (Ivy) Network

Faculty, Staff and Students Publications

BACKGROUND: Assessments of COVID-19 vaccine effectiveness are needed to monitor the protection provided by updated vaccines against severe COVID-19. We evaluated the effectiveness of original monovalent and bivalent (ancestral strain and Omicron BA.4/5) COVID-19 vaccination against COVID-19-associated hospitalization and severe in-hospital outcomes.

METHODS: During September 8, 2022 to August 31, 2023, adults aged ≥ 18 years hospitalized with COVID-19-like illness were enrolled at 26 hospitals in 20 US states. Using a test-negative case-control design, we estimated vaccine effectiveness (VE) with multivariable logistic regression adjusted for age, sex, race/ethnicity, admission date, and geographic region.

RESULTS: Among 7028 patients, 2924 (41.6%) were …

Lack Of Detection Of Norwalk Virus In Saliva Samples From A Controlled Human Infection Model, Robert L Atmar, Frederick H Neill, Nicole M Hayes, Antone R Opekun, David Y Graham, Mary K Estes, Sasirekha Ramani

Faculty, Staff and Students Publications

Following recent reports of norovirus replication in salivary gland cells, we examined whether the prototype norovirus strain, Norwalk virus (GI.1), could be detected in the saliva of 21 experimentally infected persons. Viral RNA was not detected in saliva 2 and 7 days after challenge despite high levels being present in feces.

Circulating Galectin-3: A Prognostic Biomarker In Hepatocellular Carcinoma, Shadi Chamseddine, Betul Gok Yavuz, Yehia I Mohamed, Sunyoung S Lee, James C Yao, Zishuo Ian Hu, Michael Lapelusa, Lianchun Xiao, Ryan Sun, Jeffrey S Morris, Rikita I Hatia, Manal Hassan, Dan G Duda, Maria Diab, Amr Mohamed, Ahmed Nassar, Hesham M Amin, Ahmed Omar Kaseb

Faculty, Staff and Student Publications

INTRODUCTION: Galectin-3 plays critical roles in the adhesion, proliferation, and differentiation of tumor cells. Recent data have suggested that galectin-3 plays a role in the development of hepatocellular carcinoma (HCC); however, its prognostic value has not been validated. The aim of our study was to evaluate the clinical and prognostic value of galectin-3 in patients with HCC.

METHODS: We prospectively enrolled and collected clinicopathologic data and serum samples from 767 patients with HCC between 2001 and 2014 at The University of Texas MD Anderson Cancer Center. Two hundred patients without HCC were also enrolled and had data collected. The Kaplan-Meier …

Revealing Patterns Of Sars-Cov-2 Variant Emergence And Evolution Using Rbd Amplicon Sequencing Of Wastewater, Xingwen Chen, John Balliew, Cici X Bauer, Jennifer Deegan, Anna Gitter, Blake M Hanson, Anthony W Maresso, Michael J Tisza, Catherine L Troisi, Janelle Rios, Kristina D Mena, Eric Boerwinkle, Fuqing Wu

Faculty, Staff and Student Publications

Objectives: Rapid evolution of SARS-CoV-2 has resulted in the emergence of numerous variants, posing significant challenges to public health surveillance. Clinical genome sequencing, while valuable, has limitations in capturing the full epidemiological dynamics of circulating variants in the general population. This study aimed to monitor the SARS-CoV-2 variant community dynamics and evolution using receptor-binding domain (RBD) amplicon sequencing of wastewater samples.

Methods: We sequenced wastewater from El Paso, Texas, over 17 months, compared the sequencing data with clinical genome data, and performed biodiversity analysis to reveal SARS-CoV-2 variant dynamics and evolution.

Results: We identified 91 variants and observed waves of …

Covid-19 Breakthrough Infection After Vaccination And Substance Use Disorders: A Longitudinal Cohort Of People With And Without Hiv Receiving Care In The United States Veterans Health Administration, Elena M Soyer, Kathleen A Mcginnis, Amy C Justice, Evelyn Hsieh, Maria C Rodriguez-Barradas, Emily C Williams, Lesley S Park

Faculty, Staff and Students Publications

Research regarding HIV, substance use disorders (SUD), and SARS-CoV-2 infections after COVID-19 vaccination is limited. In the Veterans Aging Cohort Study (VACS)-HIV cohort, we followed vaccinated persons with HIV (PWH) and without HIV (PWoH) from 12/2020 to 3/2022 and linked SARS-CoV-2 test results for laboratory-confirmed breakthrough infection through 9/2022. We examined associations of substance use (alcohol use disorder [AUD], other SUD, smoking status) and HIV status and severity with breakthrough infections, using Cox proportional hazards regression hazard ratios (HR). To test for potential interactions between substance use and HIV, we fit survival models with a multiplicative interaction term. Among 24,253 …

Diclofenac Sensitizes Multi-Drug Resistant Acinetobacter Baumannii To Colistin, Fabiana Bisaro, Clay D. Jackson-Litteken, Jenna C. Mcguffey, Anna J. Hooppaw, Sophie Bodrog, Leila Jebeli, Manon Janet-Maitre, Juan C. Ortiz-Marquez, Tim Van Opijnen, Nichollas E. Scott, Gisela Di Venanzio, Mario F. Feldman

2020-Current year OA Pubs

Acinetobacter baumannii causes life-threatening infections that are becoming difficult to treat due to increasing rates of multi-drug resistance (MDR) among clinical isolates. This has led the World Health Organization and the CDC to categorize MDR A. baumannii as a top priority for the research and development of new antibiotics. Colistin is the last-resort antibiotic to treat carbapenem-resistant A. baumannii. Not surprisingly, reintroduction of colistin has resulted in the emergence of colistin-resistant strains. Diclofenac is a non-steroidal anti-inflammatory drug used to treat pain and inflammation associated with arthritis. In this work, we show that diclofenac sensitizes colistin-resistant A. baumannii clinical strains …

The Post-Transplant Lymphoproliferative Disorders-Metagenomic Shotgun Microbial Sequencing (Ptld-Msms) Study Methods And Protocol, Vikas R. Dharnidharka, Kristine M. Wylie, Todd N. Wylie, Marianna B. Ruzinova, Charles W. Goss, Gregory A. Storch, Neha Mehta-Shah, Derek Byers, Leslie Walther, Lujain Jaza, Hongjie Gu, Mansi Agarwal, Et Al.

2020-Current year OA Pubs

Post-transplant lymphoproliferative disorders (PTLDs) remain a feared complication of transplantation, with significant morbidity and mortality. The oncogenic Epstein-Barr virus (EBV) is a key pathogenic driver in 50%-80% of cases. Numerous prognostic indices, comprising multiple clinical, epidemiological and tumor characteristics, including EBV tumor positivity, do not consistently associate with worse patient survival, suggesting a potential role for EBV genome variants in determining outcome. However, the precision medicine tools for determining if a viral genome variant is pathogenic are very limited compared with human genome variants. Further, targeted studies have not implicated a specific viral etiological agent in EBV-negative PTLD. Using novel …

Noncontact Diffuse Reflectance Spectroscopy Of Synovial Fluid Samples For Rapid Identification Of Infections, Erin E. Drewke, Robert L. Brand, Caroline G. Geels, Hanna K. Jensen, Kevin Wong, Jarret D. Sanders, Narasimhan Rajaram

Biomedical Engineering Faculty Publications and Presentations

Severe joint infections, such as septic arthritis, require rapid diagnostic testing of the synovial fluid aspirated from joints level so that a surgical team can be assembled quickly. We present a diffuse reflectance spectroscopy (DRS) system for noncontact determination of infection. Using a light-tight syringe holder and fiber optic probe, diffusely reflected light from 475 to 655 nm was acquired from 18 patient samples through the wall of a syringe in a noncontact and sterile manner. We determined the reflectance ratios at two different wavelengths—R ₄₉₀/R ₆₀₀ and R ₅₈₀/R ₆₀₀ and found statistically significant …

Fusobacterium Nucleatum Abundance Is Associated With Cachexia In Colorectal Cancer Patients: The Colocare Study, Mmadili N Ilozumba, Adetunji T Toriola, Et Al.

2020-Current year OA Pubs

BACKGROUND: Cachexia accounts for about 20% of all cancer-related deaths and indicates poor prognosis. The impact of Fusobacterium nucleatum (Fn), a microbial risk factor for colorectal cancer (CRC), on the development of cachexia in CRC has not been established.

METHODS: We evaluated the association between Fn abundance in pre-surgical stool samples and onset of cachexia at 6 months post-surgery in n = 87 patients with stages I-III CRC in the ColoCare Study.

RESULTS: High fecal Fn abundance compared to negative/low fecal Fn abundance was associated with 4-fold increased risk of cachexia onset at 6 months post-surgery (OR = 4.82, 95% …

A Unique Case Of Cutaneous Melanoma: Case Report And Literature Review, Iulia Maria Teodora Leulescu, Grigore Bălan, Claudia Ioana Dogaru, Maria Moga, Emil Catalin Popa, Irina Popescu, Mircea Tampa, Simona Roxana Georgescu

Journal of Mind and Medical Sciences

Introduction. According to the European Cancer Information System, melanoma is the sixth most diagnosed cancer in Europe (following breast, colorectal, prostate, lung, and bladder cancer) and ranks among the top 20 most common causes of cancer-related death. The diagnosis of melanoma can be a clinical challenge due to the variety of signs and symptoms, ranging from small, asymptomatic lesions with slow progression to large, painful tumors with rapid growth. In this paper, we will report an exceptional case of cutaneous melanoma with an atypical presentation in a patient with no personal or family history of skin cancer. Case presentation. We …

Exploring The Air Pollution With Particulate Matter - Pm10, Covid-19 Cases Evolution In Romania And Exposure To Aeroallergens, Irina Mihaela Stoian, Simona Parvu, Radu Cucuiu, Dana Galieta Minca

Journal of Mind and Medical Sciences

Constant exposure to the atmospheric air polluted with particulate matter is considered to have a negative influence on human health, even if it is found at values that may not exceed the maximum allowable concentration. Starting from the correlation between atmospheric air polluted with PM and COVID-19 incidence/mortality, this research had as first objective to assess the exposure to an average concentration of PM10 in Romania and, in particular, in Bucharest for a period of six years and the cumulative incidence of COVID-19 cases per 1000 inhabitants (continuing previous research, from 2020). Subsequently, we studied the cumulative incidence of COVID-19 …

Weight Loss In Subjects With Type 2 Diabetes Before And After Sars-Cov2 Infection - A Retrospective Observational Study, Roxana Adriana Stoica, Florentina Gherghiceanu, Denisa Nedelcu, Valeria- Anca Pietrosel, Cristina Ioana Bica, Teodor Salmen, Claudiu Teodorescu, Mihaela Simona Popoviciu, Anca Pantea Stoian

Journal of Mind and Medical Sciences

Objectives. As weight modification during the COVID-19 pandemic was reported in several circumstances, we aimed to assess the body composition changes using bio impedance in patients with type 2 diabetes mellitus (T2DM) during this period. Materials and Methods. We conducted an observational, retrospective study, from January 2021- June 2021, in two outpatient clinics, enrolling all patients with T2DM and SARS-CoV2 infection that presented for evaluation after the infection. Blood tests (serum creatinine, urea, blood glucose, lipid profile, transaminases, HbA1c) were available before the onset of infection as well as at an interval of 1-3 months post-infection. Results. From a total …

Artificial Intelligence And Liver Transplantation; Literature Review, Maria Serban, Irina Balescu, Sorin Petrea, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Marilena Stoian, Camelia Diaconu, Cristian Balalau, Nicolae Bacalbasa

Journal of Mind and Medical Sciences

Liver transplantation is the last life-saving solution for patients with end stage liver disease. The discrepancy between waiting list and available organs has led to the appearance of extended donation criteria and the development of several scores (Child-Pugh score, MELD score, DRI score, SOFT score), in order to find the most suitable donor-recipient match. But none of these scores can predict survival after transplantation. Artificial Intelligence (AI) has recently been shown as an excellent tool for the study of the liver and comes in this aid with its various methods (random forest, artificial neural networks, decision tree, Bayesian networks, and …

Memory Impairment In Post-Covid-19 Syndrome; What Is The Evidence?, Luciano Luiz Alt, Amanda Delai Bortolini, Bruna Santin Andreis, Caroline Arais Schmidt, Giovana Rugeri, Maria Clara Tonini Pagliarin, Maria Eduarda Dupond Kindel, Maria Fernanda Almeida Costa, Nathália Lorenzoni Costa, Pedro Henrique Sarmento Dariz, Vinícius Grasselli Omizzolo

Journal of Mind and Medical Sciences

Objectives. Although COVID-19 mainly affects the respiratory system, it can also cause neurological complications like memory impairment, which may be part of post-COVID-19 Syndrome. Identifying these impairments is challenging due to the lack of approaches and limited follow-up. This systematic review aimed to identify the effects of COVID-19 on memory. Methods. Analyzing articles from PubMed, SciELO, and VHL databases, focusing on the relationship between COVID-19 infection and memory impairment. Results. COVID-19 infection was linked to significant declines in memory function. The severity of infection correlated with the intensity of neurological sequelae, particularly memory impairment, with cognitive and executive functions most …

Acute Syphilitic Posterior Placoid Chorioretinopathy: A Case Report, Kendra R. Null Od, Danielle E. Toms Od, Elizabeth M. Phillips Od, Candice A. Law Od, Ms

Optometric Clinical Practice

Abstract

Background: Acute syphilitic posterior placoid chorioretinopathy is a rare manifestation of ocular syphilis that can significantly impact the patient’s vision. However, it has been shown to have a good prognosis with the appropriate diagnosis and treatment of the underlying systemic syphilis infection. In addition to discussing the details of the case, this report also highlights the systemic staging, diagnosis, and treatment of syphilis. Case Report: This case features a 60-year-old Caucasian male diagnosed and treated for acute syphilitic posterior placoid chorioretinopathy after a recent diagnosis of syphilis. Conclusion: With the incidence rates of syphilis infections increasing, it is imperative …

Nursing And Supply Chain As Critical Partners In Enterprise-Level Efforts To Prevent Hemodialysis Associated Central Line-Associated Blood Stream Infections: A Case Study, Dana L. Blayney, Julia Moody, James Pittman, Noah Zanville, Missy Pennington, Sarah A. Fraker, E. Jackie Blanchard

HCA Healthcare Journal of Medicine

Background

Preventing central line-associated bloodstream infections (CLABSIs) remains a critical national focus for health care facilities. This notion is particularly true for patients undergoing hemodialysis (HD), where the associated mortality rates for HD-CLABSI range from 12% to 25%. Studies show that the use of central venous catheter (CVC) end caps coated with antiseptic agents, such as chlorhexidine gluconate (CHG) on HD-CVCs, can reduce the incidence of CLABSIs. However, issues ranging from difficulty finding and maintaining an adequate (and fully standardized) supply of CHG-impregnated HD end caps and ensuring consistent practice by clinicians can prevent the use of this valuable tool. …

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Improving Maintenance Of Central Line Dressing To Reduce Risk Of Central Line-Associated Bloodstream Infections In An Acute-Care Setting, Kristi Gaskill, Kerry Wilder, Emily Sneed, Astrid J. Pujals, Kim Newman

HCA Healthcare Journal of Medicine

Background

Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs. Central venous access device (CVAD) dressing integrity is critical to prevent CLABSI. From the First Quarter to the Third Quarter of 2023, CLABSI rates related to disruption in CVAD dressing integrity increased significantly at our facility. Despite the delivery of education, competency validation, and checklist implementation, CLABSI rates remained high, making this our top strategic priority.

The purpose of this quality improvement initiative was to determine if gum mastic adhesive and hemostatic powder would improve dressing integrity and decrease CLABSI rates related to disruption of central line dressings. …

Enhancing Patient Safety: The Role Of Interdisciplinary Teams In Reducing Blood Culture Contamination, Austin Patrick Eisenberg, Fady M. Awad, Brian Watson, Mohammed Faris

HCA Healthcare Journal of Medicine

Background

Blood cultures are vital to diagnostic workups among many hospitalized patients, providing valuable information about bloodstream infections (BSIs), which cause roughly 250 000 deaths annually between North America and Europe. Despite advances in health care, blood culture contamination remains a substantial problem, with deleterious effects on patient mortality, patient and hospital costs, and microbial resistance. This article reviews the repercussions of blood culture contamination on the health care system and delineates evidence-based strategies to decrease contamination rates.

Methods

To reduce blood culture contamination rates, our health care facility undertook a quality improvement initiative. A task force was created, consisting …

Infection Prevention: The Small But Mighty Teams In Health Care, E. Jackie Blanchard

HCA Healthcare Journal of Medicine

Infection prevention is a team within health care facilities and systems whose members are vital to reducing and mitigating patient harm secondary to infectious disease. Infection preventionists are subject matter experts who reside in the quality department and are responsible for multiple areas beyond infectious disease spread. They assist nursing teams, employee health programs, and epidemiologists in decreasing the spread of illness. They are widely under-recognized, though they have a significant impact on the overall stability of the health care system and the communities they serve.

Equalizing Disproportionate Death And Punishment In Black And Brown Communities: An Emergency Shutdown On Death, Inequality, And Deliberate Indifference, Angela Dixon

Journal of Civil Rights and Economic Development

(Excerpt)

According to an old saying, “death is the great equalizer.” But is it? It may be in the sense that absent a contravening force, it is an appointment that all must keep. Yet data indicates that all do not die equally. Socioeconomic status (“SES”), which includes levels of occupation, education, income, and wealth, all delay or advance mortality. People of a higher SES outlive, generally, people of a lower SES; moreover, such disparities continue to widen as trends of income inequality intensify.

Perhaps predictably, race, just like class, exacerbates inequities. Black Americans in the United States remain the pivotal …