Make It Real - Undergraduate Research Opportunities

Theme one in the Quest for Distinction is for VCU to become a leader among national research universities in providing all students with high quality learning/living experiences focused on inquiry, discovery, and innovation in a global environment. Quest is grounded in a commitment to providing students with a diversity of experiences which are available at a premiere public research university. The goal of this project is to take advantage of the wealth of research resources at the Medical College of Virginia Campus, coordinate cross campus efforts to facilitate the use of these resources and increase faculty participation in mentoring undergraduate research projects

Differences in Physical Activity Participation between University Employees With and Without a Worksite Health Promotion Program

The purpose of this study was to assess differences in physical activity (PA) among university employees with and without a formal health promotion program. Three state university campuses without health promotion programs and four campuses with a program participated in this study. PA participation was assessed via survey to all campus employees. PA was compared for those with (n=426) and without a program (n=371). The results indicated that there was no significant difference (p>.05) in the amount of vigorous PA days per week between those with (M=1.87 ± 2.29) and without a program (M=1.6 ± 1.87).There was no significant difference (p>.05) in the amount of moderate PA days per week between those with (M= 2.18 ± 2.43) and without a program (M= 1.88 ± 2.03). There were significant differences (p<.05) for walking days per week, with the employees with a program having the highest number of days (M= 4.06 ± 3.57) compared to those without a program (M= 3.38 ± 2.28). Overall, findings indicate that presence of a health promotion program was only associated with more walking days per week. Therefore, programs must strive to increase moderate intensity PA participation, perhaps through more innovative means, in order to improve the health of their employees

Centering Health Equity and Structural Racism in Health Sciences Curriculum

This paper overviews scientific evidence and some of the local Richmond, Virginia history related to structural racism and health disparities. The paper then describe recent demands for racial justice and curriculum transformation that have been made by Virginia Commonwealth University (VCU) health sciences students, faculty and community members as well as the action steps the university has taken to address these demands. The paper concludes by calling on VCU health sciences faculty members to take action in the following three ways: (a) by participating in professional conversations about the intersections of health equity, structural racism, and health sciences education, (b) by familiarizing themselves with available institutional resources for creating inclusive and social justice oriented curriculum and learning environments, and (c) by considering participation in new systemic racism and implicit bias faculty learning communities offered by the VCU Office of the Senior Vice President for Health Sciences

Development and Psychometric Evaluation of the Lung Cancer Screening Health Belief Scales

Background: Lung cancer screening is a recent recommendation for long-term smokers. Understanding individual health beliefs about screening is a critical component in future efforts to facilitate patient-provider conversations about screening participation. Objective: The aim of this study was to describe the development and psychometric testing of 4 new scales to measure lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, self-efficacy). Methods: In phase I, 4 scales were developed from extensive literature review, item modification from existing Breast and Colorectal Cancer Screening Health Belief Scales, focus groups with long-term smokers, and evaluation/feedback from a panel of 10 content experts. In phase II, we conducted a survey of 497 long-term smokers to assess the final scales’ reliability and validity. Results: Phase I: content validity was established with the content expert panel. Phase II: internal consistency reliability of the scales was supported with Cronbach’s α’s ranging from .88 to .92. Construct validity was established with confirmatory factor analysis and testing for differences between screeners and nonscreeners in theoretically proposed directions. Conclusions: Initial testing supports the scales are valid and reliable. These new scales can help investigators identify long-term smokers more likely to screen for lung cancer and are useful for the development and testing of behavioral interventions regarding lung cancer screening. Implications for Practice: Development of effective interventions to enhance shared decision making about lung cancer screening between patients and providers must first identify factors influencing the individual’s screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision

Which comorbid conditions should we be analyzing as risk factors for healthcare-associated infections?

OBJECTIVETo determine which comorbid conditions are considered causally related to central-line associated bloodstream infection (CLABSI) and surgical-site infection (SSI) based on expert consensus.DESIGNUsing the Delphi method, we administered an iterative, 2-round survey to 9 infectious disease and infection control experts from the United States.METHODSBased on our selection of components from the Charlson and Elixhauser comorbidity indices, 35 different comorbid conditions were rated from 1 (not at all related) to 5 (strongly related) by each expert separately for CLABSI and SSI, based on perceived relatedness to the outcome. To assign expert consensus on causal relatedness for each comorbid condition, all 3 of the following criteria had to be met at the end of the second round: (1) a majority (&gt;50%) of experts rating the condition at 3 (somewhat related) or higher, (2) interquartile range (IQR)≤1, and (3) standard deviation (SD)≤1.RESULTSFrom round 1 to round 2, the IQR and SD, respectively, decreased for ratings of 21 of 35 (60%) and 33 of 35 (94%) comorbid conditions for CLABSI, and for 17 of 35 (49%) and 32 of 35 (91%) comorbid conditions for SSI, suggesting improvement in consensus among this group of experts. At the end of round 2, 13 of 35 (37%) and 17 of 35 (49%) comorbid conditions were perceived as causally related to CLABSI and SSI, respectively.CONCLUSIONSOur results have produced a list of comorbid conditions that should be analyzed as risk factors for and further explored for risk adjustment of CLABSI and SSI.Infect Control Hosp Epidemiol 2017;38:449–454</jats:sec

Treatment Patterns for Early Pregnancy Failure in Michigan

Abstract Aims: We describe current treatment patterns for early pregnancy failure (EPF) among women enrolled in two Michigan health plans. Methods: We conducted a retrospective review of EPF treatment among Michigan Medicaid enrollees between January 1, 2001, and December 31, 2004, and enrollees of a university-affiliated health plan between January 1, 2001, and December 31, 2005. Episodes were identified by the presence of a diagnostic code for EPF. Surgical treatment was distinguished from nonsurgical management using procedure codes. Facility charges, procedure, and place of service codes were used to determine whether a procedure was done in an office as opposed to an operating room. Cases without a claim for surgical uterine evacuation were examined for a misoprostol pharmacy claim and, if present, were classified as medical management. Cases without a procedure or pharmacy claim were classified as expectant management. Results: Respectively, we identified 21,311 and 1,493 episodes of EPF in the Medicaid and university-affiliated health plan databases, respectively. Women enrolled in Medicaid were more likely to be treated with surgery than were enrollees of the university-affiliated health plan (35.3 vs. 18.0%, respectively, p<0.000). Among Medicaid enrollees, only 0.5% of surgical evacuations occurred in the office, but office procedures were common among enrollees of the university-affiliated health plan (30.5%, p<0.000). The proportion of cases managed with misoprostol was <1% in both groups. Caucasian race and age were both associated with having a surgical uterine evacuation (p<0.001). Conclusions: EPF is primarily being treated with expectant management or surgical evacuation in an operating room and may not reflect evidence-based practices or patient preferences.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78155/1/jwh.2008.1091.pd

Fostering Local Health Department and Health System Collaboration Through Case Conferences for At-Risk and Vulnerable Population

In case conferences, health care providers work together to identify and address patients' complex social and medical needs. Public health nurses from the local health department joined case conference teams at federally qualified health center primary care sites to foster cross-sector collaboration, integration, and mutual learning. Public health nurse participation resulted in frequent referrals to local health department services, greater awareness of public health capabilities, and potential policy interventions to address social determinants of health

The effect of adding comorbidities to current centers for disease control and prevention central-line–associated bloodstream infection risk-adjustment methodology

BACKGROUNDRisk adjustment is needed to fairly compare central-line–associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes.METHODSUsing a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank.RESULTSOverall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51–0.59) for the ICU-type model and 0.64 (95% CI, 0.60–0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model.CONCLUSIONSOur risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.Infect Control Hosp Epidemiol 2017;38:1019–1024</jats:sec

VCU Stress Relief: Programs and Tools to Ease Student Stress

Examine how VCU can support students who are having trouble, especially in the freshman year, due to economic challenges their families are facing (parent\u27s loss of jobs, parent\u27s loss of home, students tuition debt, etc). Explore ways to address these issues in the classroom or in individual or group settings