Health Services Research Commons^™

Managing Interruptions To Improve Diagnostic Decision-Making: Strategies And Recommended Research Agenda, Jennifer F Sloane, Chris Donkin, Ben R Newell, Hardeep Singh, Ashley N D Meyer

Faculty, Staff and Students Publications

Interruptions are an inevitable occurrence in health care. Interruptions in diagnostic decision-making are no exception and can have negative consequences on both the decision-making process and well-being of the decision-maker. This may result in inaccurate or delayed diagnoses. To date, research specific to interruptions on diagnostic decision-making has been limited, but strategies to help manage the negative impacts of interruptions need to be developed and implemented. In this perspective, we first present a modified model of interruptions to visualize the interruption process and illustrate where potential interventions can be implemented. We then consider several empirically tested strategies from the fields …

Margetuximab In Her2-Positive Metastatic Breast Cancer, William J Gradishar, Ruth O'Regan, Mothaffar F Rimawi, Jeffrey L Nordstrom, Minori K Rosales, Hope S Rugo

Faculty, Staff and Students Publications

Several anti-HER2 agents are approved for third-line treatment and beyond (after first-line and second-line); however, no specific treatment strategy is recommended for third-line and beyond. Although these agents improve disease outcomes, HER2-positive metastatic breast cancer remains incurable and there is an unmet need for effective therapies in the later line setting. This review focuses on the development of margetuximab-cmkb, a novel, Fc-engineered, anti-HER2 monoclonal antibody, and its role in the systemic treatment of adult patients with metastatic HER2-positive breast cancer who have received two or more prior anti-HER2 regimens, at least one of which was for metastatic disease.

Framework Of The Centralized Interactive Phenomics Resource (Cipher) Standard For Electronic Health Data-Based Phenomics Knowledgebase, Jacqueline Honerlaw, Yuk-Lam Ho, Francesca Fontin, Jeffrey Gosian, Monika Maripuri, Michael Murray, Rahul Sangar, Ashley Galloway, Andrew J Zimolzak, Stacey B Whitbourne, Juan P Casas, Rachel B Ramoni, David R Gagnon, Tianxi Cai, Katherine P Liao, J Michael Gaziano, Sumitra Muralidhar, Kelly Cho

Faculty, Staff and Students Publications

The development of phenotypes using electronic health records is a resource-intensive process. Therefore, the cataloging of phenotype algorithm metadata for reuse is critical to accelerate clinical research. The Department of Veterans Affairs (VA) has developed a standard for phenotype metadata collection which is currently used in the VA phenomics knowledgebase library, CIPHER (Centralized Interactive Phenomics Resource), to capture over 5000 phenotypes. The CIPHER standard improves upon existing phenotype library metadata collection by capturing the context of algorithm development, phenotyping method used, and approach to validation. While the standard was iteratively developed with VA phenomics experts, it is applicable to the …

Alcohol-Associated Liver Disease Mortality Rates By Race Before And During The Covid-19 Pandemic In The Us, Neeti S Kulkarni, Divneet K Wadhwa, Fasiha Kanwal, Jagpreet Chhatwal

Faculty, Staff and Students Publications

This cross-sectional study examines the national- and state-level age-adjusted mortality rates for alcohol-associated liver disease in 4 racial groups, with a focus on the American Indian or Alaska Native population.

Chemical Reprogramming Takes The Fast Lane, Emily J Park, Srikanth Kodali, Bruno Di Stefano

Faculty, Staff and Students Publications

Small molecule-induced cell fate transitions are characterized by low efficiency and slow kinetics. An optimized chemical reprogramming approach now facilitates the robust and rapid conversion of somatic cells to pluripotent stem cells, unlocking exciting avenues to study and manipulate human cell identity.

Early Lead Extraction For Infected Implanted Cardiac Electronic Devices: Jacc Review Topic Of The Week, Dhanunjaya R Lakkireddy, Douglas S Segar, Ami Sood, Maryann Wu, Archana Rao, M Rizwan Sohail, Sean D Pokorney, Carina Blomström-Lundqvist, Jonathan P Piccini, Christopher B Granger

Faculty, Staff and Students Publications

Infection remains a serious complication associated with the cardiac implantable electronic devices (CIEDs), leading to substantial clinical and economic burden globally. This review assesses the burden of cardiac implantable electronic device infection (CIED-I), evidence for treatment recommendations, barriers to early diagnosis and appropriate therapy, and potential solutions. Multiple clinical practice guidelines recommended complete system and lead removal for CIED-I when appropriate. CIED extraction for infection has been consistently reported with high success, low complication, and very low mortality rates. Complete and early extraction was associated with significantly better clinical and economic outcome compared with no or late extraction. However, significant …

Pattern Dynamics And Stochasticity Of The Brain Rhythms, Clarissa Hoffman, Jingheng Cheng, Daoyun Ji, Yuri Dabaghian

Faculty, Staff and Students Publications

Our current understanding of brain rhythms is based on quantifying their instantaneous or time-averaged characteristics. What remains unexplored is the actual structure of the waves—their shapes and patterns over finite timescales. Here, we study brain wave patterning in different physiological contexts using two independent approaches: The first is based on quantifying stochasticity relative to the underlying mean behavior, and the second assesses “orderliness” of the waves’ features. The corresponding measures capture the waves’ characteristics and abnormal behaviors, such as atypical periodicity or excessive clustering, and demonstrate coupling between the patterns’ dynamics and the animal’s location, speed, and acceleration. Specifically, we …

Oral Health In Relation To The Covid-19 Pandemic, Anika L. Gram

Honors Thesis

Oral health has seen significant changes through the Covid-19 pandemic. Many people experienced the lifestyle alteration of wearing a mask for a major portion of their day-to-day life, and some went to the dentist significantly less than they did pre-pandemic. The literature review explores dental practices during the Covid-19 pandemic. It also examines mask-wearing behaviors both before and during the pandemic and the research that has been conducted previously regarding the potential effects of mask-wearing. Despite the decrease in use of masks post-pandemic, many healthcare professionals continue to wear masks daily. Additionally, in the event of future disease outbreak, it …

Accuracy Of Therapeutic Drug Monitoring In Vancomycin And The Pharmacist Role: A Retrospective Case-Series, Kateryna Parkhomenko

Senior Theses

Vancomycin is a mainstay of therapy for treating virulent and resistant infections, especially methicillin-resistant Staphylococcus aureus (MRSA). However, vancomycin requires therapeutic drug monitoring (TDM) for optimal dosing and treatment. This requires pharmacists to calculate a dosing regimen that correlates to appropriate goal vancomycin concentrations in the blood. Dosing vancomycin can be difficult, as it varies on a patient’s weight, renal function, age, etc. Doses may have to be adjusted in response to out-of-range concentrations, which requires further pharmacy calculations. Inaccurate dosing poses a risk to patient safety and places a resource and time burden on pharmacists. If vancomycin dosing methods …

Fear Of Recurrence, Emotional Well-Being And Quality Of Life Among Long-Term Advanced Ovarian Cancer Survivors, Kathryn Osann, Lari Wenzel, Chelsea Mckinney, Lynne Wagner, David Cella, Giulia Fulci, Mary J Scroggins, Heather A Lankes, Victoria Wang, Kenneth P Nephew, George L Maxwell, Samuel C Mok, Thomas P Conrads, Austin Miller, Michael Birrer

Faculty, Staff and Student Publications

OBJECTIVE: Although advanced stage epithelial ovarian cancer is widely considered life-threatening, 17% of women with advanced disease will survive long-term. Little is known about the health-related quality of life (QOL) of long-term ovarian cancer survivors, or how fear of recurrence might affect QOL.

METHODS: 58 long-term survivors with advanced disease participated in the study. Participants completed standardized questionnaires to capture cancer history, QOL, and fear of recurrent disease (FOR). Statistical analyses included multivariable linear models.

RESULTS: Participants averaged 52.8 years at diagnosis and had survived >8 years (mean:13.5); 64% had recurrent disease. Mean FACT-G, FACT-O, and FACT-O-TOI (TOI) scores were …

Telemental Health In Emergency Care Settings: A Qualitative Analysis Of Considerations For Sustainability And Spread, Mckenzie K Roddy, Patricia Chen, Alvin D Jeffery, Jeydith Gutierrez, Melissa Rubenstein, Corey Campbell, Eric Blake, Michael J Ward

Faculty, Staff and Students Publications

Objectives: Following rapid uptake of telehealth during the COVID-19 pandemic, we examined barriers and facilitators for sustainability and spread of telemental health video (TMH-V) as policies regarding precautions from the pandemic waned.

Methods: We conducted a qualitative study using semistructured interviews and observations guided by RE-AIM. We asked four groups, local clinicians, facility leadership, Veterans, and external partners, about barriers and facilitators impacting patient willingness to engage in TMH-V (reach), quality of care (effectiveness), barriers and facilitators impacting provider uptake (adoption), possible adaptations to TMH-V (implementation), and possibilities for long-term use of TMH-V (maintenance). Interviews were recorded, transcribed, and analyzed …

Paving The Road For Chimeric Antigen Receptor T Cells: American Society For Transplantation And Cellular Therapy 80/20 Task Force Consensus On Challenges And Solutions To Improving Efficiency Of Clinical Center Certification And Maintenance Of Operations For Commercially Approved Immune Effector Cell Therapies, Sarah Nikiforow, Matthew J Frigault, Noelle V Frey, Rebecca A Gardner, Krishna V Komanduri, Miguel-Angel Perales, Partow Kebriaei, Phyllis Irene Warkentin, Marcelo Pasquini, Joy Lynn Aho, Bruce L Levine, Helen E Heslop, Tracey L Hlucky, Karen Habucky, Mecide Gharibo, Madan Jagasia, Frederick L Locke

Faculty, Staff and Students Publications

As the number and type of regulatory authority-approved cellular therapies grow, clinical treatment centers face a heavy burden of duplicative documentation around initial qualification, ongoing auditing, and reporting, with overlapping requirements from each manufacturer to ensure safe use of their specific product, which in the United States are stipulated under individual Food and Drug Administration (FDA) Biologic License Applications. The American Society for Transplantation and Cellular Therapy (ASTCT) convened the 80/20 Task Force to consider challenges and potential solutions to these issues. The Task Force proposed that 80% of manufacturers' requirements for onboarding and ongoing operations of commercially available products …

Lung Volume Reduction In Copd: Scope Or Surgery, Francesca Polverino, Frank Sciurba

Faculty, Staff and Students Publications

No abstract provided.

Advancing Diagnostic Equity Through Clinician Engagement, Community Partnerships, And Connected Care, Traber D Giardina, Lechauncy D Woodard, Hardeep Singh

Faculty, Staff and Students Publications

No abstract provided.

Functional Effects Of Disease-Associated Variants Reveal That The S1-M1 Linker Of The Nmda Receptor Critically Controls Channel Opening, Lingling Xie, Miranda J Mcdaniel, Riley E Perszyk, Sukhan Kim, Gerarda Cappuccio, Kevin A Shapiro, Beatriz Muñoz-Cabello, Pedro A Sanchez-Lara, Katheryn Grand, Jing Zhang, Kelsey A Nocilla, Rehan Sheikh, Lluis Armengol, Roberta Romano, Tyler Mark Pierson, Hongjie Yuan, Scott J Myers, Stephen F Traynelis

Faculty, Staff and Students Publications

The short pre-M1 helix within the S1-M1 linker (also referred to as the pre-M1 linker) between the agonist-binding domain (ABD, S1) and the M1 transmembrane helix of the NMDA receptor (NMDAR) is devoid of missense variants within the healthy population but is a locus for de novo pathogenic variants associated with neurological disorders. Several de novo variants within this helix have been identified in patients presenting early in life with intellectual disability, developmental delay, and/or epilepsy. In this study, we evaluated functional properties for twenty variants within the pre-M1 linker in GRIN1, GRIN2A, and GRIN2B genes, including six novel missense …

Exploration Of Data Science Toolbox And Predictive Models To Detect And Prevent Medicare Fraud, Waste, And Abuse, Benjamin P. Goodwin, Adam Canton, Babatunde Olanipekun

SMU Data Science Review

The Federal Department of Health and Human Services spends approximately $830 Billion annually on Medicare of which an estimated $30 to $110 billion is some form of fraud, waste, or abuse (FWA). Despite the Federal Government’s ongoing auditing efforts, fraud, waste, and abuse is rampant and requires modern machine learning approaches to generalize and detect such patterns. New and novel machine learning algorithms offer hope to help detect fraud, waste, and abuse. The existence of publicly accessible datasets complied by The Centers for Medicare & Medicaid Services (CMS) contain vast quantities of structured data. This data, coupled with industry standardized …

The Role Of Vigorous And High Intensity Interval Training Physical Activity Counseling In Prenatal Care, Emily Lau, Brendan T. Lynch, Sonia Hassan

Medical Student Research Symposium

Background: Physical activity is becoming a more common component of preventative medicine and patient counseling; however, the prevalence of physical activity counseling and specific social determinants of health have prevented women, namely prenatal patients, from receiving this counseling from their providers¹. Physical activity, including high intensity interval training (HIIT), has been shown to be feasible for implementation in patient counseling³ and shown to be safe for pregnant women, even into the third trimester². We hypothesize that the current percentage of patients, including prenatal patients, being counseled on physical activity is lacking. In addition, we hypothesize …

Asthma And Cardiovascular Disease: A Bidirectional Association?, Muhammad Adrish, Nicola A Hanania

Faculty, Staff and Students Publications

No abstract provided.

Ferroptosis In Life: To Be Or Not To Be, Ling Xu, Yu'e Liu, Xi Chen, Hua Zhong, Yi Wang

Faculty, Staff and Students Publications

Ferroptosis is a novel type of programmed cell death, characterized by a dysregulated iron metabolism and accumulation of lipid peroxides. It features the alteration of mitochondria and aberrant accumulation of excessive iron as well as loss of the cysteine-glutathione-GPX4 axis. Eventually, the accumulated lipid peroxides result in lethal damage to the cells. Ferroptosis is induced by the overloading of iron and the accumulation of ROS and can be inhibited by the activation of the GPX4 pathway, FS1-CoQ10 pathway, GCH1-BH4 pathway, and the DHODH pathway, it is also regulated by the oncogenes and tumor suppressors. Ferroptosis involves various physiological and pathological …

Types Of Diagnostic Errors Reported By Paediatric Emergency Providers In A Global Paediatric Emergency Care Research Network, Prashant Mahajan, Joseph A Grubenhoff, Jim Cranford, Maala Bhatt, James M Chamberlain, Todd Chang, Mark Lyttle, Rianne Oostenbrink, Damian Roland, Richard M Rudy, Kathy N Shaw, Robert Velasco Zuniga, Apoorva Belle, Nathan Kuppermann, Hardeep Singh

Faculty, Staff and Students Publications

Background: Diagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related to MOIDs reported by physicians working in paediatric EDs.

Methods: We developed a web-based survey in which physicians participating in the international Paediatric Emergency Research Network representing five out of six WHO regions, described examples of MOIDs involving their own or a colleague's patients. Respondents provided case summaries and answered questions regarding harm and factors contributing to the event.

Results: Of 1594 physicians surveyed, 412 (25.8%) responded (mean age=43 …

Excess Folic Acid Intake Increases Dna De Novo Point Mutations, Xuanye Cao, Jianfeng Xu, Ying L Lin, Robert M Cabrera, Qiuying Chen, Chaofan Zhang, John W Steele, Xiao Han, Steven S Gross, Bogdan J Wlodarczyk, James R Lupski, Wei Li, Hongyan Wang, Richard H Finnell, Yunping Lei

Faculty, Staff and Students Publications

No abstract provided.

Intellectual Disability Related To De Novo Germline Loss Of The Distal End Of The P-Arm Of Chromosome 17: A Case Report, Eden Pope, Matthew Huertas, Amar Paul, Braden Cunningham, Matthew Jennings, Ryan Perry, Stephanie Chavez, John A. Kriak, Kyle B. Bills, David W. Sant

Annual Research Symposium

Hypothesis/Purpose: In this report we present a case of a 20-year-old female with congenital intellectual disability, stunted growth, and hypothyroidism. Competitive genetic hybridization (CHG) revealed a loss of 17p13.3, and the deletion was not present in either parent. This deletion has not previously been characterized, but mutations on the p-arm of chromosome 17 are responsible for Miller-Dieker Syndrome and Isolated Lissencephaly Sequence, both of which share symptoms in common with the patient.

Methods: Peripheral mononuclear cells (PBMCs) were used for karyotyping and competitive genetic hybridization (CHG). Bioinformatic analysis was carried out using the Genome Data Viewer (ncbi.nlm.nih.gov/genome/gdv).

Results: Karyotype was …

Investigating Respiratory Simplification Caused By Prenatal Rage Upregulation, Paul Reynolds

Annual Research Symposium

No abstract provided.

Potential Role For Rage In The Development Of Secondhand Smoke-Induced Chronic Sinusitis, Paul Reynolds

Annual Research Symposium

No abstract provided.

Rage Inhibition Reduces Timp And Decreases Cell Invasion In Cigarette Smoke Extract (Cse) Treated Oral Squamous Carcinoma Cells, Paul Reynolds

Annual Research Symposium

No abstract provided.

Inflammatory Cytokine Elaboration Following Secondhand Smoke Exposure Is Mediated In Part By Rage Signaling, Paul Reynolds

Annual Research Symposium

No abstract provided.

Rage Availability Lessens The Degree Of Dysfunctional Mitochondrial Bioenergetics Following Chronic Secondhand Smoke Exposure, Paul Reynolds

Annual Research Symposium

No abstract provided.

Gestational Dependent Responses To Second Hand Smoke (Shs) In Mouse Pregnancies, Paul Reynolds

Annual Research Symposium

No abstract provided.

Reversible Emerging Neuropsychological Pattern In Chronic Intractable Migraine, Tanner Williford, Pooja Chemiti, Mason Allen, Brandon Burrell, Stephanie Chavez, Jude Emego, Bridger Gunter, Matthew Huertas, Matthew Jennings, Roshni Jogin, Paulo Kelly, Laura Minor, Steven Salazar, Jameson Williams, David W. Sant, John A. Kriak, Kyle B. Bills

Annual Research Symposium

No abstract provided.

Comparison Of Dna Extraction Methods For Soft Tissue Samples, Steve Guzman, Nathaniel E. Hill, Mujtaba Shah, Jonathon Reynolds, Cole Farnsworth, Molly Henley, Alfred Amendolara, Laura Minor, John Dougherty Jr., John A. Kriak, Kyle B. Bills, David W. Sant

Annual Research Symposium

No abstract provided.