Medicine and Health Sciences Commons^™

Covid-19 Disrupted Provision And Utilization Of Health And Nutrition Services In Uttar Pradesh, India: Insights From Service Providers, Household Phone Surveys, And Administrative Data, Phuong H. Nguyen, Shivani Kachwaha, Anjali Pant, Lan M. Tran, Monika Walia, Sebanti Ghosh, Praveen K. Sharma, Jessica Escobar-Alegria, Edward A. Frongillo Jr., Purnima Menon, Rasmi Avula

Faculty Publications

BACKGROUND: The coronavirus (COVID-19) pandemic may substantially affect health systems, but little primary evidence is available on disruption of health and nutrition services. OBJECTIVES: This study aimed to 1) determine the extent of disruption in provision and utilization of health and nutrition services induced by the pandemic in Uttar Pradesh, India; and 2) identify how adaptations were made to restore service provision in response to the pandemic. METHODS: We conducted longitudinal surveys with frontline workers (FLWs, n = 313) and mothers of children < 2 y old (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests. RESULTS: Compared with prepandemic, service provision reduced substantially during lockdown (83-98 percentage points, pp), except for home visits and take-home rations (∼ 30%). Most FLWs (68%-90%) restored service provision in July 2020, except for immunization and hot cooked meals (< 10%). Administrative data showed similar patterns of disruption and restoration. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service provision. Key adaptations made to provide services were delivering services to beneficiary homes (∼ 40%-90%), social distancing (80%), and using PPE (40%-50%) and telephones for communication (∼ 20%). On the demand side, service utilization reduced substantially (40-80 pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing the challenges of limited travel (30%), nonavailability of services (26%), and fear of catching the virus when leaving the house (22%) or meeting service providers (14%). CONCLUSIONS: COVID-19 disrupted the provision and use of health and nutrition services in Uttar Pradesh, India, despite adaptations to restore services. Strengthening logistical support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19.

A Cbct Based Evaluation Of Root Proximity Of Maxillary Posterior Teeth To Sinus Floor In A Subset Of Pakistani Population, Momina Motiwala, Aysha Arif, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objective: To evaluate the vertical relationship of the roots of maxillary posterior teeth with maxillary sinus floor, and its association with age, gender and bilateral jaw symmetry.
Methods: The cross-sectional study was conducted at a tertiary care hospital in Karachi from June to December 2018, and comprised patients who visited the dental clinics and underwent cone-beam computed tomography scans. The scans were evaluated in the axial, coronal and sagittal planes and roots were classified using Jungs classification for proximity to maxillary sinus floor. The distance between the sinus floor and the apices of maxillary posterior teeth was measured. Data was …

A Pilot Exploration Using Optical Coherence Tomography Angiography Analysis Of Capillary Vascular Density And Foveal Avascular Zone For The Diagnosis Of Uveal Melanoma, Jason Chien, Alicia Valverde-Megías, Gwo Farn Chien, Carol L Shields

Wills Eye Hospital Papers

No abstract provided.

The Use Of Isbared/Ishaped And Elimination Of Reviewing Patients’ Chart Before Handoff To Decrease Incremental Overtime, Sheila Bucao

Master's Projects and Capstones

Problem: Incremental overtime was found to majorly impact the financial well-being of a stroke unit. From an allocated budget of 22 hours per pay period, the unit’s incremental overtime averaged 40 hours. The stroke unit had skilled-mix competencies, further complicating handoffs. The absence of a standard reporting method means that reviewing patients’ charts takes approximately 10 to 15 minutes, extending what should be a quick, but thorough nurse knowledge exchange.

Context: The body of evidence reviewed indicated that pertinent information to patient care is not left out or missed when a standardized tool is used during handoff. Based on Lean …

Ischemic Bowel Disease In 2021, Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Ischemic bowel disease (ISBODI) includes colon ischemia, acute mesenteric ischemia (AMI) and chronic mesenteric ischemia (CMI). Epidemiologically, colon ischemia is the most common type followed by AMI and CMI. There are various risk factors for the development of ISBODI. Abdominal pain is the common presenting symptom of each type. High clinical suspicion is essential in ordering appropriate tests. Imaging studies and colonoscopy with biopsy are the main diagnostic tests. Treatment varies from conservative measures to surgical resection and revascularization. Involvement of multidisciplinary team is essential in managing ISBODI. Although open surgery with revascularization plays an important role, recently there is …

Oral Bisacodyl Is Effective And Safe For Short Term Treatment Of Chronic Constipation, Akanksha Vaishnav

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Kamm MA, Mueller-Lissner S, Wald A, Richter E, Swallow R, Gessner U. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol. 2011;9(7):577-583. https://doi.org/10.1016/j.cgh.2011.03.026

to evaluate potential long term treatment with oral Bisacodyl in a patient with a history of chronic constipation and recent non-surgical treatment of ischemic colitis.

A Moral Dilemma: The Use Of Zinc In Patients Hospitalized With Covid Pneumonia, Ebony M. Manigault, Laura Donohue, Elizabeth Moore, Yara Abuaita

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yao JS, Paguio JA, Dee EC, Tan HC, Moulick A, Milazzo C, Jurado J, Della Penna N, Celi LA. The minimal effect of zinc on the survival of hospitalized patients with COVID-19: an observational study. Chest. 2021 Jan;159(1):108-111. https://doi.org/10.1016/j.chest.2020.06.082

for a patient hospitalized with COVID pneumonia requiring high flow oxygen.

2021-08-06_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated three times a week on Mondays, Wednesdays, and Fridays.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, …

Medical School Watercooler Newsletter - August 6, 2021, Lindsey Lyle

Watercooler Newsletter

This is the August 6, 2021 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents include:

• Meet a Med Student: Tiara Dean
• Medical student aids woman in cardiac arrest
• Mark your calendar for upcoming grand rounds
• Register now: Paddle the Delta CME Conference
• USA researchers study cat flea saliva to uncover how diseases are spread
• Faculty Spotlight: Benjamin Niland, M.D.
• Neonatologist Kelechi Ikeri joins pediatrics faculty
• Save the date: OB-GYN Conference set for Oct. 14-15

Comparing Downstream Consequences Of Normal Exercise Stress Echocardiograms And Cardiac Computed Tomography Angiography Scans In Patients Suspected Of Having Of Obstructive Coronary Artery Disease: A Retrospective Cohort Study Of Tricare Beneficiaries., Cory G Madigan, Michael B Adams, Chu-Chiao Chu, Laith R Dinkha, Samuel J Farrell, Robert T Hoard, Andrea N Keithler, Kevin A Loudermilk, Jessica Rouse, Brandon L Walker, Susan G Williams, Andrew C Wyatt, Rosco S Gore, Dustin M. Thomas Md

Parkview Heart Institute

To compare overall number of downstream tests and total costs between negative exercise stress echocardiograms (ESE) or cardiac computed tomography angiography scans (CCTA) in symptomatic Tricare beneficiaries suspected of having coronary artery disease (CAD). This is a retrospective cohort study examining 651 propensity-matched patients who underwent ESE or CCTA with normal results between 2008 and 2014 at the United States' largest Department of Defense hospital. The total number of additional downstream tests over the next five years was determined. The total costs associated with each arm, inclusive of the initial test and all subsequent tests, were calculated using the 2018 …

Malignant Hyperthermia, Emmanuel Mensah

Nursing Student Class Projects (Formerly MSN)

Malignant Hyperthermia is a rare but fatal disorder usually triggered using succinylcholine, a depolarizing muscle blocker, or other volatile anesthetics (Yang et al., 2020). MH is characterized by signs and symptoms including Hyperthermia, acidosis, tachycardia, hypercarbia, acidosis, etc. (Yang et al., 2020). When the signs and symptoms of MH are recognized, the provider should stop what he or she is doing and call for immediate help. When additional assistance arrives, the patient must receive Dantrolene. Dantrolene is a muscle relaxant that prevents the sarcoplasmic reticulum from releasing calcium. Additional interventions include cooling the patient using ice packs, treating electrolyte abnormalities, …

Alcohol Use Disorder (Aud) In The Elderly Population, Anthony Oguogho

Nursing Student Class Projects (Formerly MSN)

There is a substantial and growing population of elderly adults (65years and older) who misuse alcohol, and psychoactive prescription drugs. Evidence suggests that alcohol dependence and alcohol abuse which is now collectively known as alcohol use disorder (AUD) is common among 65years and older due to socioeconomic circumstances of aging. These socioeconomic circumstances include empty nest syndrome (when children grow up and move away), loss of friendships due to moves, health complications or death, deteriorating health conditions, traumatic events like a spouse’s illness or death, sadness after downsizing a home, and boredom from retirement or lack of socialization. ETOH is …

Chronic Obstructive Pulmonary Disease, Aaron Mcneilan

Nursing Student Class Projects (Formerly MSN)

The following poster presentation provides a brief overview of the disease process of Chronic Obstructive Pulmonary Disease (COPD). COPD is one of the leading causes of disability and death worldwide, and its incidence does not appear to be declining. The most common factor causing COPD is cigarette smoking, which is modifiable. Other contributors are environmental air pollutants which some people may encounter depending on where they live or their occupation. This presentation is a culmination of information from different scholarly sources which discuss the symptoms, pathophysiology, causes, management, and prevention of COPD.

Polycystic Ovarian Syndrome: Pathophysiology And Chronic Health Implications, Makilah Witt

Nursing Student Class Projects (Formerly MSN)

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. If untreated, women suffer a myriad of secondary sequala and chronic diseases. The prevalence of PCOS is rising and greatly impacts patients' physical, mental, and emotional health, diminishes community health, and increases healthcare costs. However, many providers fail to properly diagnose patients, understand how this disease impacts women, or provide appropriate interventions to prevent chronic health problems. This paper outlines the pathophysiology of PCOS, identifies signs and symptoms, and provides recommendations for treatment and holistic patient care for the role of the Advance Practice Nurse.

2021-08-06_Michiganoverview_Covidvaccinestats, Michigan Department Of Health & Human Services

Michigan COVID-19 Vaccine Data

The COVID Vaccine Dashboard page was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus/0,9753,7-406-98178_103214-547150--,00.html.

Previously reported numbers of administered vaccine doses may change as new data are received. A possible lag in reporting vaccine doses will result in increases in numbers previously reported.

This report is created by the Michigan Department of Health and Human Services Division of Immunization from data reported to the Michigan Care Improvement Registry (MCIR).

The dashboard contained the tabs Vaccines Delivered, Delivery Trend, Doses Administered, Doses by Vaccine, Doses Metrics, Coverage, Coverage Metrics, State Level Metrics, Enrolled …

2021-08-06_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …

2021-08-06_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled. COVID case and testing data will be posted three times a week on Mondays, Wednesdays and Fridays.
This report is provisional and subject to change. City of Detroit and Wayne County are reported separately. MDHHS began tracking probable cases April 5, 2020. FCI indicates federal correctional institute. MDOC indicates Michigan Department of Corrections. Diagnostic tests, including nucleic acid amplification/real-time …

Coronavirus Update 8-6-21, The Coronavirus Planning Team

University Briefings & Virtual Events

As you know, the rise of the delta variant has put a little bit of a damper on things by necessitating, for now, that everyone wears masks indoors whether vaccinated or not. We know you are disappointed—we all are. But it is a small price to pay for the health and safety of our community. Here are some things we know about COVID-19 and the delta variant.

*Correction* Coronavirus Update 8-6-21, The Coronavirus Planning Team

University Briefings & Virtual Events

CORRECTION: The following statement from this morning’s coronavirus message was incorrect. Upperclassmen will move in on Sunday, August 29, not August 28. We apologize for any inconvenience.

Workforce Capacity At Fqhc Clinics In South Carolina During The Choose Well Contraceptive Access Initiative, Center For Applied Reasearch And Evaluation In Women's Health, East Tennessee State University

Center for Applied Research and Evaluation (CARE) in Women's Health Issue Briefs

In the initial two years of the Choose Well initiative, partnered South Carolina Federally Qualified Health Center (FQHC) clinics reported that efforts directed toward expanding workforce capacity positively impacted contraceptive service provision and patient access. We conducted key informant interviews with FQHC clinical and administrative staff (N= 45) to assess progress in achieving this aim during the first two years of program implementation (2017 and 2018). Several respondents highlighted how funding to expand clinic workforce directly increased capacity for contraceptive provision. Other key findings supporting contraceptive provision noted that funding allowed enhanced hiring practices due to expanded service lines, increased …

Covid-19 Impact On Contraceptive & Clinic Services At Health Departments & Federally Qualified Health Centers In South Carolina, Center For Applied Reasearch And Evaluation In Women's Health, East Tennessee State University

Center for Applied Research and Evaluation (CARE) in Women's Health Resources

No abstract provided.

2021-08-06_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

Contains the tables Statewide Hospital Capacity Report for COVID-19, COVID-19 Metrics, Statewide Hospital Available PPE Tracking for COVID-19, as well as the tables PPE Days On Hand and Patient Census.

Facilitator Of Contraceptive Access At Fqhc Clinics In South Carolina During The Choose Well Initiative, Center For Applied Reasearch And Evaluation In Women's Health, East Tennessee State University

Center for Applied Research and Evaluation (CARE) in Women's Health Issue Briefs

The Choose Well initiative aims to improve contraceptive access at partnered Federally Qualified Health Centers (FQHCs) in South Carolina. We conducted key informant interviews with FQHC clinical and administrative staff (N= 45) to assess progress in achieving this aim during the first two years of program implementation (2017 and 2018). The interviews were recorded, transcribed and analyzed for emerging themes. Respondents highlighted facilitators of contraceptive access during Choose Well including: enhanced contraceptive counseling, funding for implants and IUDs, the availability of same-day implant and IUD placement procedures, and increased patients enrolling in Medicaid.

Covid-19 Impact On Contraceptive & Clinic Services At Health Departments & Federally Qualified Health Centers In Alabama, Center For Applied Reasearch And Evaluation In Women's Health, East Tennessee State University

Center for Applied Research and Evaluation (CARE) in Women's Health Resources

No abstract provided.

Dose Adjustment Of Antidiabetic Medications In Chronic Kidney Disease, Matthew Salvatore Snyder, Joshua Fogel, Svetlana Pyatigorskaya, Sofia Rubinstein

Publications and Research

Purpose: The purpose of this study is to identify whether Internal Medicine house-staff (IMHS) have awareness and knowledge about the correct dosage of antidiabetic medications for patients with chronic kidney disease (CKD), as dosing errors result in adverse patient outcomes for those with diabetes mellitus (DM) and CKD.

Methods: There were 353 IMHS surveyed to evaluate incorrect level of awareness of medication dose adjustment in patients with CKD (ILA) and incorrect level of knowledge of glomerular filtration rate level for medication adjustment (ILK-GFR) for Glipizide, Pioglitazone, and Sitagliptin.

Results: Lack of awareness and knowledge was high, with the highest for …

Steroidogenic Enzyme And Steroid Receptor Expression In The Equine Accessory Sex Glands, Robyn E. Ellerbrock, Giorgia Podico, Kirsten E. Scoggin, Barry A. Ball, Mariano Carossino, Igor F. Canisso

Maxwell H. Gluck Equine Research Center Faculty Publications

The expression pattern and distribution of sex steroid receptors and steroidogenic enzymes during development of the equine accessory sex glands has not previously been described. We hypothesized that equine steroidogenic enzyme and sex steroid receptor expression is dependent on reproductive status. Accessory sex glands were harvested from mature stallions, pre-pubertal colts, geldings, and fetuses. Expression of mRNA for estrogen receptor 1 (ESR1), estrogen receptor 2 (ESR2), androgen receptor (AR), 3β-Hydroxysteroid dehydrogenase/Δ5-4 isomerase (3βHSD), P450,17α hydroxylase, 17–20 lyase (CYP17), and aromatase (CYP19) were quantified by RT-PCR, and protein localization of AR, ER-α, ER-β, and 3βHSD were investigated by immunohistochemistry. Expression of …

Post-Discharge Phone Calls In The Emergency Department: Do Follow-Up Calls Increase Patient Satisfaction And Reduce Post-Discharge Complications?, Saraann K. Fagan

Doctor of Nursing Practice Scholarly Projects

Improvements in discharge instructions are necessary in emergency departments (EDs) across the United States (US). Multiple factors, such as the fast-paced environment and varying levels of acuity in the ED, contribute to inadequate discharge instructions and change is necessary to further prevent negative outcomes. The purpose of the evidence-based practice project was to implement post-discharge follow-up phone calls to ED patients to improve patient satisfaction scores regarding discharge instructions for at-home care and to reduce post-discharge complications. The project was implemented over a three-month period in early 2021 in the ED of a local hospital in Charleston, South Carolina (SC). …

Comparative Efficacy, Safety, Tolerability, And Effectiveness Of Antipsychotics In The Treatment Of Dementia-Related Psychosis (Drp): A Systematic Literature Review, Ismaeel Yunusa, N. Rashid, V. Abler, Krithika Rajagopalan

Faculty Publications

Objectives

To evaluate the comparative efficacy, safety, tolerability, and effectiveness of atypical antipsychotics (AAPs) for the treatment of dementia related psychosis (DRP) in older adults.

Methods

In this systematic literature review (SLR), we qualitatively synthesized evidence on the comparative efficacy (based on neuropsychiatric inventory), tolerability (weight gain), and safety (cerebrovascular adverse events [CVAE], cardiovascular events, mortality, somnolence, extrapyramidal symptoms [EPS]) of AAPs used to treat DRP. We also assessed effectiveness based on all-cause discontinuations and discontinuations due to lack of efficacy or adverse events (AE). Published articles from through March 2021 from PubMed, EMBASE, PsycINFO, and Cochrane databases evaluated. We …

Monogenic Diabetes In Youth With Presumed Type 2 Diabetes: Results From The Progress In Diabetes Genetics In Youth (Prodigy) Collaboration, Jennifer N Todd, Jeffrey W Kleinberger, Haichen Zhang, Shylaja Srinivasan, Sherida E Tollefsen, Lynne L Levitsky, Lorraine E Levitt Katz, Jeanie B Tryggestad, Fida Bacha, Giuseppina Imperatore, Jean M Lawrence, Catherine Pihoker, Jasmin Divers, Jason Flannick, Dana Dabelea, Jose C Florez, Toni I Pollin

Children’s Nutrition Research Center Staff Publications

Objective: Maturity-onset diabetes of the young (MODY) is frequently misdiagnosed as type 1 or type 2 diabetes. Correct diagnosis may result in a change in clinical treatment and impacts prediction of complications and familial risk. In this study, we aimed to assess the prevalence of MODY in multiethnic youth under age 20 years with a clinical diagnosis of type 2 diabetes.

Research design and methods: We evaluated whole-exome sequence data of youth with a clinical diagnosis of type 2 diabetes. We considered participants to have MODY if they carried a MODY gene variant classified as likely pathogenic (LP) or pathogenic …

Reduction Of Clabsi In Telemetry Patients Through Limiting Central Line Blood Draw, Caselyn Lok

Student Scholarly Projects

CLABSI is known to be one of the many healthcare-associated infections that has led to an increase in health complications, length of hospital stays, and increased in healthcare cost. There is about 25000 bloodstream infection that occurs annually (Haddadin, Annamaraju, & Regunath, 2020). The PICOT question that guided this project was “How does limiting blood-draw from central venous catheter lines influence the rate of central-line associated bloodstream infections (CLABSI) post-implementation compared to rate of CLABSI pre-implementation after eight weeks?” CLABSI prevention bundles were already being used to guide healthcare providers in handling CVC access. There were 15 scholarly articles that …