Health Services Research Commons^™

Are Veterans At Increased Risk Of Myeloproliferative Neoplasms?, Christin B Destefano, Nicholas Burwick, Drew A Helmer

Faculty, Staff and Students Publications

No abstract provided.

Inhaled Corticosteroids Attenuate The Association Of Fine Particulate Matter And Acute Asthma Events, Kristen A Staggers, Paula Sierra, Drew A Helmer, Charles Minard, Meredith C Mccormack, Tianshi David Wu

Faculty, Staff and Students Publications

No abstract provided.

Perineuronal Nets’ Role In Metabolism, Nan Zhang, Beite Song, Peng Bai, Li Du, Lulu Chen, Yong Xu, Tianshu Zeng

Faculty, Staff and Students Publications

Perineuronal nets (PNNs), specialized extracellular matrix (ECM) structures that envelop neurons, have recently been recognized as key players in the regulation of metabolism. This review explores the growing body of knowledge concerning PNNs and their role in metabolic control, drawing insights from recent research and relevant studies. The pivotal role of PNNs in the context of energy balance and whole body blood glucose is examined. This review also highlights novel findings, including the effects of astroglia, microglia, sex and gonadal hormones, nutritional regulation, circadian rhythms, and age on PNNs dynamics. These findings illuminate the complex and multifaceted role of PNNs …

Evaluating Progress And Accountability For Achieving Cop26 Health Programme International Ambitions For Sustainable, Low-Carbon, Resilient Health-Care Systems, Iris Martine Blom, Fawzia N Rasheed, Hardeep Singh, Matthew J Eckelman, Meghnath Dhimal, Martin Hensher, Renzo R Guinto, Alice Mcgushin, Xuejuan Ning, Poornima Prabhakaran, Marina Romanello, Dana Van Alphen, Nick Watts, Jessica C Yu, Carol Zavaleta-Cortijo, Andrea J Macneill, Jodi D Sherman

Faculty, Staff and Students Publications

A global initiative to develop low-carbon, resilient health systems-the COP26 Health Programme-launched at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in 2021. As of May, 2024, 83 nations have committed to participate in this initiative. This analysis evaluates the effectiveness of existing and proposed indicators towards public monitoring and accountability to these commitments. Our findings reveal substantial gaps in data availability and indicator relevance, with many countries reporting process indicators that do not reflect actual progress towards achieving sustainable health-care systems. We found a dearth of suitable indicators and an urgent need to develop …

Cost-Effectiveness Analysis: Automated Auditory Brainstem Response (Aabr) Diagnostic Test Compared To Transient Evoked Otoacoustic Emission Screening (Teoae) For Universal Newborn Hearing Screenings (Unhs) In High-Risk Neonates, Teresa Anthony, Troy Quast, Sarah Warren

Journal of Early Hearing Detection and Intervention

Purpose: Comorbidities and ototoxic medications increase risk of hearing loss (HL) in infants admitted to neonatal intensive care units (NICU; 6 per 1000 births) compared to well-babies (1.7 per 1000 births). For newborn hearing screening (NBHS), transient evoked otoacoustic emissions (TEOAE) testing is more efficient and less costly. Automated auditory brainstem response (aABR) testing yields higher sensitivity and specificity. This study will identify if aABR is cost-effective compared with TEOAE for NBHS in high-risk neonates.

Methodology: Cost-effectiveness analysis was conducted from a healthcare system perspective. Prevalence and outcomes data for aABR, TEOAE, and auditory brainstem response (ABR) were obtained …

Analysis Protecting The Health Workers From The Transmission Of Tuberculosis At Teaching Hospital: A Review Of Policy And Practice, Arifah Alfiyyah, Robiana Modjo, Adang Bachtiar

Journal of Indonesian Health Policy and Administration

The Tuberculosis (TB) remains a significant threat, especially to healthcare workers exposed by the infected patients in hospitals. Hospital staff with latent TB are at risk of developing active TB. To mitigate this risk, enhancing hospitals through infection prevention and control (IPC) measures is essential. This study aimed to identify policies and practices related to TB prevention, particularly in a teaching hospital where healthcare workers, including medical students, need protection. The research was conducted at a teaching hospital in Depok, West Java, from January to February 2024. The research took place at a teaching hospital in Depok, West Java, from …

Implementation Of Sugar-Sweetened Beverages Excise Policy And Its Implications In Various Countries: Literature Review, Roissiana Khotami, Vetty Yulianty, Ratih Oktarina

Journal of Indonesian Health Policy and Administration

The prevalence of diabetes in the world is projected to continue to increase to 643 million in 2030. Indonesia is ranked 7th with the highest number of diabetes mellitus sufferers and the only one in Southeast Asia with a total of 10.7 million sufferers. Consumption of sweetened drinks is the most dominant factor in the incidence of diabetes mellitus in Indonesia. Indonesia ranks third highest in Southeast Asia in sweetened drink consumption. Excise on sweetened drinks is an effective intervention to reduce consumption of sweetened drinks, but Indonesia has not yet implemented it. This research aims to determine the implementation …

Analysis Of Non-Prescription Drug Services Via Telemedicine Using The Lean Six Sigma Method: Case Study In A Company Clinic, Labbaika Nurmadani, Masyitoh Basabih

Journal of Indonesian Health Policy and Administration

The non-compounded prescription drug service via telemedicine became an alternative solution to continue providing pharmaceutical services while simultaneously controlling physical contact in hospitals during the COVID-19 pandemic. However, after its implementation, hospitals still need to improve the effectiveness of this telemedicine service. This study aims to propose improvements to enhance the effectiveness and efficiency of non-compounded drug services via telemedicine using the Lean Six Sigma method. This method is used to identify and eliminate all waste in the business process (service) to make efficient use of time and other resources. The study uses both quantitative and qualitative approaches, with data …

Evaluation Of The Water Ambulance Service Program At The Health Crisis And Emergency Center Province Health Office Of Dki Jakarta In 2023, Shella Cahya Eka, Kurnia Sari

Journal of Indonesian Health Policy and Administration

The high demand for ambulance services at the 119 Public Safety Center of the DKI Jakarta Health Office, including in the Administrative District of the Kepulauan Seribu, highlights the importance of providing water ambulances. This study aims to analyze the implementation of the Water Ambulance Service by the DKI Jakarta Health Office using the Context, Input, Process, Product (CIPP) program evaluation approach. Using a qualitative approach, primary and secondary data were collected through observations, in-depth interviews, and document review. The findings show that implementing the Water Ambulance Service aligns with the context, objectives, and targets of the DKI Jakarta Health …

Optimizing The Use Of Online Systems In Health Care Facilities, Wendy Damar Aprilano, Mardiati Nadjib

Journal of Indonesian Health Policy and Administration

The use of web-based information technology or online services can accelerate service delivery. Digitalisation of online health services is one of the growing issues, along with the increasing need for access to health services globally. However, there are things that must be considered in implementing an online health service system so the utilisation can be optimal. This study examines the factors that can support the optimisation of online service systems in health facilities so that innovation can continue to grow and provide benefits in the future. The authors conducted a literature review, with PRISMA guidelines according to the PEO …

Exploring Racial Disparities In Awareness And Perceptions Of Oncology Clinical Trials: Cross-Sectional Analysis Of Baseline Data From The Mychoice Study, Ariel Hoadley, Linda Fleisher, Cassidy Kenny, Patrick Ja Kelly, Xinrui Ma, Jingwei Wu, Carmen Guerra, Amy E. Leader, Mohammed Alhajji, Paul D'Avanzo, Zoe Landau, Sarah Bauerle Bass

Kimmel Cancer Center Faculty Papers

BACKGROUND: Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity.

OBJECTIVE: This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process.

METHODS: As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported …

A Framework For Human Evaluation Of Large Language Models In Healthcare Derived From Literature Review, Thomas Yu Chow Tam, Sonish Sivarajkumar, Sumit Kapoor, Alisa V Stolyar, Katelyn Polanska, Karleigh R Mccarthy, Hunter Osterhoudt, Xizhi Wu, Shyam Visweswaran, Sunyang Fu, Piyush Mathur, Giovanni E Cacciamani, Cong Sun, Yifan Peng, Yanshan Wang

Faculty, Staff and Student Publications

With generative artificial intelligence (GenAI), particularly large language models (LLMs), continuing to make inroads in healthcare, assessing LLMs with human evaluations is essential to assuring safety and effectiveness. This study reviews existing literature on human evaluation methodologies for LLMs in healthcare across various medical specialties and addresses factors such as evaluation dimensions, sample types and sizes, selection, and recruitment of evaluators, frameworks and metrics, evaluation process, and statistical analysis type. Our literature review of 142 studies shows gaps in reliability, generalizability, and applicability of current human evaluation practices. To overcome such significant obstacles to healthcare LLM developments and deployments, we …

Noninvasive Multi-Cancer Detection Using Blood-Based Cell-Free Micrornas, Jason Zhang, Hallgeir Rui, Hai Hu

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Patients diagnosed with early-stage cancers have a substantially higher chance of survival than those with late-stage diseases. However, the option for early cancer screening is limited, with most cancer types lacking an effective screening tool. Here we report a miRNA-based blood test for multi-cancer early detection based on examination of serum microRNA microarray data from cancer patients and controls. First, a large multi-cancer training set that included 1,408 patients across 7 cancer types and 1,408 age- and gender-matched non-cancer controls was used to develop a 4-microRNA diagnostic model using 10-fold cross-validation. In three independent validation sets comprising a total of …

Sequencing-Based Detection Of Avian Influenza A(H5n1) Virus In Wastewater In Ten Cities, Michael J Tisza, Blake M Hanson, Justin R Clark, Li Wang, Katelyn Payne, Matthew C Ross, Kristina D Mena, Anna Gitter, Sara J Javornik Cregeen, Juwan Cormier, Vasanthi Avadhanula, Austen Terwilliger, John Balliew, Fuqing Wu, Janelle Rios, Jennifer Deegan, Pedro A Piedra, Joseph F Petrosino, Eric Boerwinkle, Anthony W Maresso

Faculty, Staff and Students Publications

No abstract provided.

Examining Management And Employees' Perceptions Of Occupational Heat Exposure And The Effectiveness Of A Heat Stress Prevention Intervention On Safety And Well-Being Among Natural Gas Construction Workers: A Qualitative Field-Based Study, Muinat Abolore Idris, Christine Markham, Kristina D Mena, William B Perkison

Faculty, Staff and Student Publications

BACKGROUND: Numerous risk factors have been identified as significantly influencing outdoor workers' risk for heat stress and heat-related conditions, impacting their health, well-being, and productivity. However, the specific effects of these factors on construction workers' safety, health, and well-being remain under-researched. With climate change increasing temperatures, assessing heat stress among construction workers is imperative.

OBJECTIVE: To identify the barriers and facilitators influencing the safety of natural gas construction workers and evaluate an implemented heat stress intervention.

METHODS: In the summer of 2023, two semi-structured interviews and six focus groups were conducted with twenty-one stakeholders at a Texas natural gas construction …

Implementation Of Healthy Heart Ambassador To Improve Blood Pressure Control At Community Health Centers In Texas, Natalia I Heredia, Ella R Garza, Fernanda Velasco-Huerta, Tracy L Swoboda, Pierre Fwelo, Patenne D Mathews, Maria E Fernandez

Faculty, Staff and Student Publications

BACKGROUND: Hypertension is one of the most prevalent chronic diseases in the United States and can increase a person's risk of stroke and other cardiovascular complications. Yet only 1 in 4 people with high blood pressure in the United States have their blood pressure managed. To improve hypertension control, we supported 9 health centers in Texas with the implementation of the Healthy Heart Ambassador Blood Pressure Self-Monitoring (HHA) Program.

METHODS: We provided health center training using the HHA Program Facilitation Training Guide, recorded barriers to implementing the HHA program, and employed strategies to overcome those barriers.

RESULTS: There were 68 …

Rethinking Health Systems Responsiveness In Low- And Middle-Income Countries: Validation Study, Meesha Iqbal, Cecilia Ganduglia Cazaban, Robert Morgan, Cici Bauer, Sameen Siddiqi

Faculty, Staff and Student Publications

BACKGROUND: Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries.

OBJECTIVE: We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to …

The Impact Of Hypertension On Clinical Outcomes In Moyamoya Disease: A Multicenter, Propensity Score-Matched Analysis, Basel Musmar, Joanna Roy, Hammam Abdalrazeq, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan Grossberg, Adam Dmytriw, Aman Patel, Mirhojjat Khorasanizadeh, Christopher Ogilvy, Ajith Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo Cortez, Ricardo Hanel, Guilherme Porto, Alejandro Spiotta, Anthony Piscopo, David Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid Nimjee, Kimon Bekelis, Mohamed Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian Howard, Rosalind Lai, Rose Du, Rawad Abbas, Georgios Sioutas, Abdelaziz Amllay, Alfredo Munoz, Nabeel Herial, Stavropoula Tjoumakaris, Michael Gooch, Robert Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Faculty Papers

BACKGROUND: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive steno-occlusive changes in the internal carotid arteries, leading to an abnormal vascular network. Hypertension is prevalent among MMD patients, raising concerns about its impact on disease outcomes. This study aims to compare the clinical characteristics and outcomes of MMD patients with and without hypertension.

METHODS: We conducted a multicenter, retrospective study involving 598 MMD patients who underwent surgical revascularization across 13 academic institutions in North America. Patients were categorized into hypertensive (n=292) and non-hypertensive (n=306) cohorts. Propensity score matching (PSM) was performed to adjust for baseline differences.

RESULTS: …

Transcatheter Aortic Valve Replacement Is Ready For Most Low-Risk Patients: A Systematic Review Of The Literature, Ahmad Jabri, Anas Alameh, Gennaro Giustino, Pedro Engel Gonzalez, Brian O'Neill, Rodrigo Bagur, Pedro Cox, Tiberio Frisoli, James Lee, Dee Dee Wang, William W. O'Neill, Pedro Villablanca

School of Medicine Faculty Publications

Transcatheter aortic valve replacement (TAVR) has undergone rapid expansion, emerging as a viable therapeutic option for low-risk patients in lieu of surgical aortic valve replacement. This paper aims to provide a review of the scientific evidence concerning TAVR in low-risk patients, encompassing both observational and clinical trial data. Furthermore, a substantial proportion of low-risk patients possesses a bicuspid aortic valve, necessitating careful examination of the pertinent anatomic and clinical considerations to TAVR that is highlighted in this review. Additionally, the review expands upon some of the unique challenges associated with alternate access in low-risk patients evaluated for TAVR. Last, this …

Effect Of Cemented Vs Uncemented On Outcomes For Hemiarthroplasty In The Elderly: A Meta-Analysis Of Randomized Clinical Trials, Yuning Feng, Jun Wan, Haidong Deng, Lvlin Chen, Yangchun Xiao, Tiangui Li, Jialing He, Peng Wang, Weelic Chong, Yang Hai, Lu Jia, Yu Zhang

Department of Medical Oncology Faculty Papers

PURPOSE: In patients undergoing hemiarthroplasty in the elderly, the choice of the cemented method remains controversial. This meta-analysis was undertaken to compare the impact of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly.

METHODS: This study included randomized controlled trials comparing the postoperative effects of cemented vs uncemented in patients with hemiarthroplasty. With no language restrictions, we searched Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Cochrane Collaboration), Clinical Trials.gov, the ISRCTN registry, as well as gray literature with no language restrictions from January 1966 to April 2023. Data were quantitatively summarized using a random-effects model. …

Efficacy Of Thoracic Endovascular Aortic Repair Versus Medical Therapy For Treatment Of Type B Aortic Dissection, Karam Motawea, Samah Rouzan, Rowan Elhalag, Abdelrhaman Abdelwahab, Hussam Al Hennawi, Salem Elshenawy, Mai Saad Mohamed, Pensée Chébl, Mohamed Salem Madian, Mostafa Elsayed Elsayed Hewalla, Sarya Swed, Wael Hafez, Bisher Sawaf, Samer Kaspo, Naim Battikh, Mohammed Najdat Seijari, Amr Farwati, Amine Rakab

Abington Jefferson Health Papers

BACKGROUND: Techniques in endovascular therapy have evolved to offer a promising alternative to medical therapy alone for Type B aortic dissections (TBADs).

AIM: The aim of this meta-analysis was to compare mortality and overall complications between thoracic endovascular aortic repair (TEVAR) and best medical therapy (BMT) in patients with TBADs.

METHODS: We included randomized control trials and prospective or retrospective cohort studies that compared TEVAR and BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched.

RESULTS: Thirty-two cohort studies including 150,836 patients were included. TEVAR was associated with a significantly lower 30-day mortality rate than …

Birth Defect Trends Within Texas Public Health Region 11, 2000-2019: An Analysis Of Texas Department Of State Health Services Public Data, Jonathan M. Hebert, Miguel A. Lopez, Padmanabhan Rengasamy

Research Colloquium

Background: South Texas is a medically underserved area with pockets of low socioeconomic status and poor access to healthcare, including prenatal care. This paper aims to monitor the changes in prevalence for cardiac, circulatory, gastrointestinal, genitourinary, and neural tube birth defects in this region in the last two decades to monitor the effectiveness of current public health efforts.

Methods: Public data on 20 birth defects from the Texas Department of State Health Services were obtained for decades 2000-2010 and 2010-2019 in Texas Public Health Region 11 and the remaining regions of Texas. Prevalences and odds ratios for all birth defects …

Final Outcomes From A Phase 2 Trial Of Posoleucel In Allogeneic Hematopoietic Cell Transplant Recipients, Sanjeet S Dadwal, Rajat Bansal, Michael W Schuster, Jean A Yared, Gary Douglas Myers, Michelle Matzko, Sama Adnan, David Mcneel, Julie Ma, Sarah A Gilmore, Spyridoula Vasileiou, Ann M Leen, Joshua A Hill, Jo-Anne H Young

Faculty, Staff and Students Publications

Allogeneic hematopoietic cell transplantation (allo-HCT) recipients are susceptible to viral infections. We conducted a phase 2 trial evaluating the safety and rate of clinically significant infections (CSIs; viremia requiring treatment or end-organ disease) after infusion of posoleucel, a partially HLA-matched, allogeneic, off-the-shelf, multivirus-specific T-cell investigational product for preventing CSIs with adenovirus, BK virus, cytomegalovirus, Epstein-Barr virus, human herpesvirus-6, or JC virus. This open-label trial enrolled allo-HCT recipients at high risk based on receiving grafts from umbilical cord blood, haploidentical, mismatched, or matched unrelated donors; post-HCT lymphocytes of < 180/mm3; or use of T-cell depletion. Posoleucel dosing was initiated within 15 to 49 days of allo-HCT and subsequently every 14 days for up to 7 doses. The primary end point was the number of CSIs due to the 6 target viruses by week 14. Of the 26 patients enrolled, only 3 (12%) had a CSI by week 14, each with a single target virus. In vivo expansion of functional virus-specific T cells detected via interferon-γ enzyme-linked immunosorbent spot assay was associated with viral control. Persistence of posoleucel-derived T-cell clones for up to 14 weeks after the last infusion was confirmed by T-cell–receptor deep sequencing. Five patients (19%) had acute graft-versus-host disease grade 2 to 4. No patient experienced cytokine release syndrome. All 6 deaths were due to relapse or disease progression. allo-HCT recipients at high risk who received posoleucel had low rates of CSIs from 6 targeted viruses. Repeat posoleucel dosing was generally safe and well tolerated and associated with functional immune reconstitution.

สถานการณ์โรคไม่ติดต่อ และปัจจัยที่สัมพันธ์กับการใช้บริการรักษาพยาบาลในกลุ่มประชากรไทยอายุตั้งแต่ 45 ปี ที่เป็นโรคไม่ติดต่อ: ข้อค้นพบจากโครงการสำรวจด้านสุขภาพ การสูงอายุ และการเกษียณในประเทศไทย 2564 (Health, Aging, And Retirement In Thailand 2021: Hart 2021), Arnat Wannasri

Journal of Demography

บทคัดย่อ

การวิจัยนี้มีวัตถุประสงค์เพื่อการศึกษาสถานการณ์โรคไม่ติดต่อและปัจจัยที่สัมพันธ์กับการใช้บริการรักษาพยาบาลแบบผู้ป่วยนอกและผู้ป่วยใน ในประชากรไทยอายุตั้งแต่ 45 ปีขึ้นไป โดยการใช้ข้อมูลจากโครงการสำรวจด้านสุขภาพ การสูงอายุ และการเกษียณในประเทศไทย (Health, Aging, and Retirement in Thailand: HART) รอบที่ 3 ปี พ.ศ. 2564 เป็นการวิจัยเชิงวิเคราะห์แบบภาคตัดขวาง (cross-sectional analytical study) ผลการวิจัยพบว่า ปัจจัยด้านอายุ เพศ สถานภาพสมรส การศึกษา การสูบบุหรี่ สถานะสุขภาพกาย สถานะสุขภาพจิต ภูมิภาค และสิทธิหลักประกันสุขภาพ สัมพันธ์กับการเจ็บป่วยด้วยโรคไม่ติดต่อ ยกเว้นการออกกำลังกาย สำหรับการใช้บริการรักษาพยาบาล พบว่า ผู้ที่ป่วยด้วยโรคไม่ติดต่อตั้งแต่ 2 โรคขึ้นไป มีโอกาสในการใช้บริการรักษาพยาบาล จำนวนครั้ง (กรณีผู้ป่วยนอกและผู้ป่วยใน) และจำนวนวันนอนรักษาในโรงพยาบาล (กรณีผู้ป่วยใน) สูงกว่าผู้ที่ป่วยด้วยโรคไม่ติดต่อเพียง 1 โรค ปัจจัยที่สัมพันธ์กับการใช้บริการรักษาพยาบาลผู้ป่วยนอก ได้แก่ ปัจจัยด้านการออกกำลังกาย สถานะสุขภาพจิต และภูมิภาค ในขณะที่บริการรักษาพยาบาลผู้ใน พบว่า การเจ็บป่วยด้วยโรคไม่ติดต่อตั้งแต่ 2 โรคขึ้นไป อายุ และสถานะสุขภาพกาย สัมพันธ์กับการใช้บริการรักษาพยาบาลผู้ป่วยใน นอกจากนี้แล้ว การวิจัยนี้ไม่พบว่า สิทธิหลักประกันสุขภาพที่แตกต่างกันสัมพันธ์กับการใช้บริการรักษาพยาบาลทั้งผู้ป่วยนอกและผู้ป่วยในที่แตกต่างกัน ข้อค้นพบจากการวิจัยนี้สามารถนำไปใช้ประโยชน์ในการกำหนดนโยบายสาธารณสุขด้านโรคไม่ติดต่อและเพื่อพัฒนาระบบสาธารณสุขของประเทศไทยต่อไปได้

Abstract

This research aimed to study the situation on noncommunicable diseases (NCDs) and the factors associated with outpatient and inpatient care utilization among the Thai population aged 45 and older using the Health, Aging, …

Hyperglycemia And Venous Thromboembolism, Neha Panchagnula, William Philip Brasher

Faculty, Staff and Students Publications

Patients with diabetes mellitus (DM) have chronically increased blood glucose and multiple physiologic alterations that place them at elevated risk for vascular disease. Traditionally, this vascular risk has mainly referred to chronic atherosclerosis and embolic arterial disease. Retrospective studies have suggested an increased risk of a pulmonary embolism (PE) and deep vein thrombosis (DVT), collectively termed venous thromboembolism (VTE), in patients with DM, but this association has been difficult to demonstrate with comorbidities such as obesity in meta-analysis. Clinical studies have demonstrated worse outcomes for patients with DM who suffer from VTE. In vitro studies show multiple physiologic abnormalities with …

Tranq Dope: Characterization Of An Ed Cohort Treated With A Novel Opioid Withdrawal Protocol In The Era Of Fentanyl/Xylazine, Kory London, Yutong Li, Jennifer Kahoud, Davis Cho, Jamus Mulholland, Sebastian Roque, Logan Stugart, Jeffrey Gillingham, Elias Borne, Benjamin Slovis

Department of Emergency Medicine Faculty Papers

BACKGROUND: Treating opioid use disorder has reached a new level of challenge. Synthetic opioids and xylazine have joined the non-medical opioid supply, multiplying the complexities of caring for individuals in emergency departments (ED). This combination, known as 'tranq dope,' is poorly described in literature. Inadequate withdrawal treatment results in a disproportionately high rate of patient-directed discharges (also known as against medical advice dispositions, or AMA). This study aimed to describe a cohort of individuals who received a novel order set for suspected fentanyl and xylazine withdrawal in the ED.

METHODS: This is a descriptive study evaluating a cohort of ED …

Development And Preliminary Validation Of A Screener For Digital Health Readiness, Kristin Rising, Amanda Guth, Alexzandra Gentsch, Karla Martin Gonzalez, Richard Hass, Lindsey Shughart, Serena Gelfer, Megan Mcvane, Brooke Worster, Amy Leader

Department of Medicine Faculty Papers

IMPORTANCE: While telehealth use has grown, patient uptake is variable, which has the potential to increase health disparities. Identifying and understanding individuals' barriers to digital health readiness can help health systems efficiently deploy resources to provide personalized patient-centered support.

OBJECTIVE: To develop and validate an instrument to evaluate digital health readiness to identify and quantify barriers to digital readiness.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative mixed-methods study conducted from April 26, 2022, to June 8, 2023, the instrument was created in 4 phases. Patients and health care professionals were interviewed to explore barriers to telehealth use, scale items were …

Human Papillomavirus Vaccination And Human Papillomavirus-Related Cancer Rates, Victor Adekanmbi, Itunu Sokale, Fangjian Guo, Jessica Ngo, Thao N Hoang, Christine D Hsu, Abiodun Oluyomi, Abbey B Berenson

Faculty, Staff and Students Publications

IMPORTANCE: To inform the design and implementation of targeted interventions to reduce the future burden of human papillomavirus (HPV)-related cancers in Texas, it is necessary to examine the county and health service region (HSR) levels of (1) the proportion of children and teenagers aged 9 to 17 years who initiated and were up to date for HPV vaccination series and (2) HPV-related cancer incidence rates (IRs).

OBJECTIVE: To evaluate temporal trends and geospatial patterns of HPV vaccination initiation and up-to-date status as well as HPV-related cancer rates at county and HSR levels in Texas.

DESIGN, SETTING, AND PARTICIPANTS: This population-based …

Enterococcus Faecalis-Derived Adenine Enhances Enterohaemorrhagic Escherichia Coli Type 3 Secretion System-Dependent Virulence, Fernando H Martins, Thibaut Rosay, Anubama Rajan, Hannah E Carter, Tayah Turocy, Andres Mejia, Jason M Crawford, Anthony W Maresso, Vanessa Sperandio

Faculty, Staff and Students Publications

Interactions between microbiota and enteric pathogens can promote colonization resistance or enhance pathogenesis. The pathobiont Enterococcus faecalis increases enterohaemorrhagic E. coli (EHEC) virulence by upregulating Type 3 Secretion System (T3SS) expression, effector translocation, and attaching and effacing (AE) lesion formation on enterocytes, but the mechanisms underlying this remain unknown. Using co-infection of organoids, metabolomics, supplementation experiments and bacterial genetics, here we show that co-culture of EHEC with E. faecalis increases the xanthine-hypoxanthine pathway activity and adenine biosynthesis. Adenine or E. faecalis promoted T3SS gene expression, while transcriptomics showed upregulation of adeP expression, which encodes an adenine importer. Mechanistically, adenine relieved …

A Case Of Persistent Intra-Abdominal Stenotrophomonas Maltophilia Infection Despite Bacteriophage Therapy, Grace D Cullen, Keiko Christine Salazar, Austen Lee Terwilliger, Saima Aslam, Justin R Clark, Anthony W Maresso, Paul L Bollyky, Jenny R Aronson

Faculty, Staff and Students Publications

Multidrug resistant infections are a challenge in the health care setting and a cause of patient morbidity and mortality. Bacteriophages (phages) are viruses that target and kill bacteria and have been used in patients to treat bacterial infections. We present a case of disseminated Stenotrophomonas maltophilia infection, with pulmonary, intra-abdominal and bloodstream involvement. The patient was treated with a combination of antibiotics and personalized phage therapy, administered daily for 12 days both intravenously as well as via intra-abdominal drains. Phage therapy was well-tolerated, the patient cleared S. maltophilia from their bloodstream and their intra-abdominal abscesses were stable or decreased in …