Leveraging Healthcare System Data to Identify High-Risk Dyslipidemia Patients.

PURPOSE OF REVIEW: While randomized controlled trials have historically served as the gold standard for shaping guideline recommendations, real-world data are increasingly being used to inform clinical decision-making. We describe ways in which healthcare systems are generating real-world data related to dyslipidemia and how these data are being leveraged to improve patient care. RECENT FINDINGS: The electronic medical record has emerged as a major source of clinical data, which alongside claims and pharmacy dispending data is enabling healthcare systems the ability to identify care gaps (underdiagnosis and undertreatment) in patients with dyslipidemia. Availability of this data also allows healthcare systems the ability to test and deliver interventions at the point-of-care. Real-world data possess great potential as a complement to randomized controlled trials. Healthcare systems are uniquely positioned to not only define care gaps and areas of opportunity, but to also to leverage tools (e.g., clinical decision support, case identification) aimed at closing them

The VITA Service Learning Project – Business and Accounting Majors Making a Difference in our Community

Students in Intermediate Accounting I and Advanced Financial Accounting are required to complete a significant service learning project. Students participate in the United Way\u27s Volunteer Income Tax Assistance program (VITA) and are required to pass certification exams, complete at least 15 hours of service preparing tax returns for free for low income tax payers, and prepare reflections. During this session, students will share their experiences and talk about what VITA service has meant to them

Traffic Injury on Tribal Lands in California

There is a disproportional risk of motor vehicle death and injury among American Indian/Alaska Native (AI/AN) populations in the United States. As home to the nation’s largest population of AI individuals, it is vital that California develop a better understanding of the factors contributing to this risk to guide the development and implementation of interventions to improve traffic safety for this population on the nearly 100 Rancherias and reservations in the state. However, there is very little data about the numbers and types of collisions, and driver and environmental factors contributing to the collisions that occur on tribal lands. As a first step toward better understanding the scope of the risk disparity, and the shortcomings in data collection, SafeTREC conducted a literature review and crash analysis using data from the Statewide Integrated Traffic Record System (SWITRS) and tribal area base maps targeting these communities. As a result of presentations and discussions at a California Tribal Safety conference where these analyses were presented, a number of procedural and institutional challenges were identified. Addressing these issues will not only help policymakers identify interventions to improve traffic safety on tribal lands, but it will give tribal jurisdictions tools to compete for scarce safety funding through the use of data documenting the need for safety improvements. Future research efforts should be aimed at refining these and other initiatives to address both the dire conditions of traffic safety on California’s tribal lands, and the limitations of the data

Study design and rationale for ELPIS: A phase I/IIb randomized pilot study of allogeneic human mesenchymal stem cell injection in patients with hypoplastic left heart syndrome

Despite advances in surgical technique and postoperative care, long-term survival of children born with hypoplastic left heart syndrome (HLHS) remains limited, with cardiac transplantation as the only alternative for patients with failing single ventricle circulations. Maintenance of systemic right ventricular function is crucial for long-term survival, and interventions that improve ventricular function and avoid or defer transplantation in patients with HLHS are urgently needed. We hypothesize that the young myocardium of the HLHS patient is responsive to the biological cues delivered by bone marrow-derived mesenchymal stem cells (MSCs) to improve and preserve right ventricle function. The ELPIS trial (Allogeneic Human MEsenchymal Stem Cell Injection in Patients with Hypoplastic Left Heart Syndrome: An Open Label Pilot Study) is a phase I/IIb trial designed to test whether MSC injection will be both safe and feasible by monitoring the first 10 HLHS patients for new major adverse cardiac events. If our toxicity stopping rule is not activated, we will proceed to the phase IIb component of our study where we will test our efficacy hypothesis that MSC injection improves cardiac function compared with surgery alone. Twenty patients will be enrolled in a randomized phase II trial with a uniform allocation to MSC injection versus standard surgical care (no injection). The 2 trial arms will be compared with respect to improvement of right ventricular function, tricuspid valve annulus size, and regurgitation determined by cardiac magnetic resonance and reduced mortality, morbidity, and need for transplantation. This study will establish the safety and feasibility of allogeneic mesenchymal stem cell injection in HLHS patients and provide important insights in the emerging field of stem cell-based therapy for congenital heart disease patients

Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments

OBJECTIVES: To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality. METHODS: Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored. RESULTS: A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores. CONCLUSIONS: A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores