Project #4: The Effects of a Pharmacist-Led Transitions of Care Program after Hospital Discharge

Our program is designed to help facilitate the transitions of care (TOC) of select patients discharged from Henry Ford Hospital (HFH) with the aim of preventing 30-day readmissions, as well as improving cost avoidance measures. TOC, as defined by the Centers of Medicare and Medicaid, is a complex process requiring several actions and multiple disciplines to work together to ensure effective communication and coordination of care. Transitioning from the hospital setting to home, specifically, exposes vulnerability within our health systems, and errors have a high chance of occurring. Medication management and follow-up care are included in “the seven essential elements” needed for successful TOC. According to Burke and colleagues, an ideal framework for establishing successful transitions of care includes 10 domains, amongst which are: medication safety, educating patients to promote self-management, enlisting help of social and community supports, coordinating care among team members and monitoring and managing symptoms after discharge and outpatient follow-up, all of which are embedded into our program.https://scholarlycommons.henryford.com/qualityexpo2022/1000/thumbnail.jp

Hydrogen-Poor Disks in Compact X-Ray Binaries

We show that accretion disks in several compact X-ray binaries with hydrogen-depleted donors are likely subject to a thermal ionization instability, unless they are strongly irradiated. These disks are particularly interesting in that their MHD-turbulent properties in the neutral phase may be quite different from those of standard, hydrogen-rich disks.Comment: 10 pages, accepted for publication in ApJ

Application of Geographic Information Systems (GIS) in the Study of Prostate Cancer Disparities: A Systematic Review

Introduction: PCa is one of the cancers that exhibits the widest disparity gaps. Geographical place of residence has been shown to be associated with healthcare access/utilization and PCa outcomes. Geographical Information Systems (GIS) are widely being utilized for PCa disparities research, however, inconsistencies in their application exist. This systematic review will summarize GIS application within PCa disparities research, highlight gaps in the literature, and propose alternative approaches. Methods: This paper followed the methods of the Cochrane Collaboration and the criteria set of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles published in peer-reviewed journals were searched through the PubMed, Embase, and Web of Science databases until December 2022. The main inclusion criteria were employing a GIS approach and examining a relationship between geographical components and PCa disparities. The main exclusion criteria were studies conducted outside the US and those that were not published in English. Results: A total of 25 articles were included; 23 focused on PCa measures as outcomes: incidence, survival, and mortality, while only 2 examined PCa management. GIS application in PCa disparities research was grouped into three main categories: mapping, processing, and analysis. GIS mapping allowed for the visualization of quantitative, qualitative, and temporal trends of PCa factors. GIS processing was mainly used for geocoding and smoothing of PCa rates. GIS analysis mainly served to evaluate global spatial autocorrelation and distribution of PCa cases, while local cluster identification techniques were mainly employed to identify locations with poorer PCa outcomes, soliciting public health interventions. Discussion: Varied GIS applications and methodologies have been used in researching PCa disparities. Multiple geographical scales were adopted, leading to variations in associations and outcomes. Geocoding quality varied considerably, leading to less robust findings. Limitations in cluster-detection approaches were identified, especially when variations were captured using the Spatial Scan Statistic. GIS approaches utilized in other diseases might be applied within PCa disparities research for more accurate inferences. A novel approach for GIS research in PCa disparities could be focusing more on geospatial disparities in procedure utilization especially when it comes to PCa screening techniques. Conclusions: This systematic review summarized and described the current state and trend of GIS application in PCa disparities research. Although GIS is of crucial importance when it comes to PCa disparities research, future studies should rely on more robust GIS techniques, carefully select the geographical scale studied, and partner with GIS scientists for more accurate inferences. Such interdisciplinary approaches have the potential to bridge the gaps between GIS and cancer prevention and control to further advance cancer equity

COVID-19 vaccine acceptance in older Syrian refugees : Preliminary findings from an ongoing study

Funding source This work was supported by ELRHA’s Research for Health in Humanitarian Crisis (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome, and the UK National Institute for Health Research (NIHR). The views expressed herein should not be taken, in any way, to reflect the official opinion of the NRC or ELRHA. The funding agency was not involved in the data collection, analysis or interpretation.Peer reviewedPublisher PD

Racial/Ethnic Disparities in Prostate Cancer 5-Year Survival: The Role of Health-Care Access and Disease Severity

Introduction: Prostate cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location, as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various USA counties in function of different socioeconomic profiles and discuss the role of potential intermediary factors. Methods: The SEER database linked to county-level SES was utilized. Five-year PCa-specific survival using the Kaplan–Meier method was performed for five racial/ethnic categories in function of SES quintiles. Multilevel Cox proportional hazards regression was performed to assess the relationship between county-level SES and PCa survival. Multivariate regression analysis was performed to examine the role of healthcare utilization and severity. Results: A total of 239,613 PCa records were extracted, and 5-year PCa-specific survival was 94%. Overall, living in counties in the worst poverty/income quintile and the worst high-school level education increased PCa mortality by 38% and 33%, respectively, while the best bachelor’s-level education rates decreased mortality risk by 23%. Associations varied considerably upon racial/ethnic stratification. Multilevel analyses showed varying contributions of individual and area-level factors to survival within minorities. The relationship between SES and PCa survival appeared to be influenced by healthcare utilization and disease stage/grade. Discussion: Racial/ethnic categories responded differently under similar county-level SES and individual-level factors to the point where disparities reversed in Hispanic populations. The inclusion of healthcare utilization and severity factors may provide partial early support for their role as intermediaries. Healthcare access (insurance) might not necessarily be associated with better PCa survival through the performance of biopsy and or/surgery. County-level education plays an important role in PCa decision making as it might elucidate discussions of other non-invasive management options. Conclusions: The findings of this study demonstrate that interventions need to be tailored according to each group’s needs. This potentially informs the focus of public health efforts in terms of planning and prioritization. This study could also direct further research delving into pathways between area-level characteristics with PCa survival

Primary Klebsiella pneumoniae Osteomyelitis with Bacteremia and Sepsis in a Patient with Cirrhosis

Osteomyelitis is commonly caused by Staphylococci, Streptococci, Escherichia coli, and anaerobes. There have been cases of rare organisms like Klebsiella pneumoniae (Kp) being initially overlooked as causes of osteomyelitis. We report a case of an elderly cirrhotic adult male transferred for further management of liver failure, who was subsequently diagnosed with Kp osteomyelitis and sepsis. He had a history of blunt leg trauma, and MRI of the leg revealed osteomyelitis, with a negative workup for other sources of infection. Kp osteomyelitis is reported in less than 100 cases, mainly in pediatric and sickle-cell patients. There are no pathognomonic imaging findings. Lesions may be metastatic, with rapid widespread destruction and exuberant periosteal reaction. Kp is a rare, under recognized cause of osteomyelitis in immune-suppressed adults. Given its pathogenicity, early identification is critical

The effect of entomopathogenic nematodes and fungi against four xylophagous pests

The effects of entomopathogenic nematodes EPN (Steinernematidae and Heterorhabditidae) and fungi EPF (Beauveria bassiana) strains were evaluated in laboratory assays against larvae of four xylophagous pests: the Asparagus moth Parahypopta caestrum, the European goat moth Cossus cossus, the pine longhorn Arhopalus syriacus and the black Buprestid Capnodis tenebrionis. Due to their biology and ethology, these insects may be included in the category of pests residing in cryptic habitats. The control of these species is considered difficult, due to the inability of chemical pesticides to penetrate the cryptic habitats and reach the targets. The pathogenicity of the entomopathogenic nematodes and fungi was tested in vitro against the pests. Two experimental models were considered and aimed to imitate the natural environment of the pests, in Petri dishes filled with plant material and inside wood galleries respectively. Main results showed that the majority of the tested strains of nematodes and fungi affected the insects’ survival rate. Steinernema feltiae and B. bassiana caused the highest percentage of larval mortality (80–100%). Considering the lack of effective chemical control means, the microbial control of the xylophagous pests by EPN and EPF reveals promising perspectives. Nematodes and fungi are able to penetrate the cryptic habitats because they are living organisms and may be horizontally transmitted by infected hosts. The distribution of EPF as preventive control method and the injection of EPN suspensions to reach and infect the larvae inside the wood galleries can be a combined sustainable control system

Project #17: Impact of Pharmacist Generated Discharge Antimicrobial Cost Inquiry on Access and Patient Outcome

Identifying barriers to accessing and affording discharge antimicrobials early in the hospitalization course in order to facilitate discharge, enhance compliance, and reduce unnecessary length of stay. In 6/2018, a pharmacist initiated “cost-inquiry” workflow was developed to capture such obstacles. The study evaluated the process and safety of the discharge antimicrobial cost inquiry (DACI) workflow as well as the challenges to accessing discharge antimicrobials. It also assessed the differences in outcomes in patients discharged with (DACI group) and without (standard of care, SOC, group) a cost inquiry. Early identification of barriers to accessing discharge antimicrobials allows clinicians to mitigate the challenges by either discussing with patients regarding affordability or designing an alternative and affordable therapeutic regimen. This novel process provides an enhanced safety-net to assure accessibility and adds to person-centered care by involving patients to confirm affordability.https://scholarlycommons.henryford.com/qualityexpo2022/1001/thumbnail.jp

ELN and FBN2 gene variants as risk factors for two sports-related musculoskeletal injuries

The proteins ELN and FBN2 are important in extracellular matrix function. The ELN rs2071307 and FBN2 rs331079 gene variants have been associated with soft tissue pathologies. We aimed to determine whether these variants were predisposing factors for both Achilles tendinopathy (AT) and anterior cruciate ligament (ACL) ruptures. For the AT study, 135 cases (TEN group) and 239 asymptomatic controls were recruited. For the ACL rupture study our cohort consisted of 141 cases (ACL group) and 219 controls. Samples were genotyped for both the ELN rs2071307 and FBN2 rs331079 variants using TaqMan assays. Analysis of variance and chi-squared tests were used to determine whether either variant was associated with AT or ACL rupture with significance set at p<0.05. The GG genotype of the FBN2 variant was significantly over-represented within the TEN group (p=0.035; OR=1.83; 95% CI 1.04–3.25) compared to the CON group. We also found that the frequency of the G allele was significantly different between the TEN (p=0.017; OR=1.90; 95% CI 1.11–3.27) and ACL groups (p=0.047; OR=1.76; 95% CI 1.00–3.10) compared to controls. The ELN rs207137 variant was not associated with either AT or ACL rupture. In conclusion, DNA sequence variation within the FBN2 gene is associated with both AT and ACL rupture

Relaxation of the lower esophageal sphincter in response to reduced volume distension during FLIP Panometry.

The esophageal response to stepwise distension during the functional lumen imaging probe (FLIP) Panometry study often parallels high-resolution manometry (HRM) motility diagnoses. This study aimed to describe the changes in FLIP metrics during FLIP emptying, that is, reduced volume distension. Adult patients who completed FLIP and HRM for esophageal motility evaluation were included. Esophagogastric junction (EGJ) opening parameters were assessed during stepwise FLIP filling to volumes of 60 mL ("filling 60 mL"), then 70 mL, and then back to 60 mL ("emptying 60 mL"). HRM studies were analyzed per Chicago classification version 4.0 (CCv4.0). Among 265 patients included, HRM/CCv4.0 diagnoses included achalasia in 80 patients (30%), normal motility in 70 (26%), and ineffective esophageal motility (IEM) in 43 (16%). EGJ-distensibility index (DI) and EGJ diameter were greater during emptying 60 mL than filling 60 mL in achalasia, normal motility, and IEM (p values &lt;0.002). If applying the emptying 60 mL EGJ-DI (vs. filling 60 mL EGJ-DI), EGJ opening classification changed from reduced EGJ opening to borderline EGJ opening in 31% of achalasia patients and in 2% of patients with normal motility or IEM. EGJ opening classification was unchanged in 69% achalasia and 96% of normal motility/IEM. This study suggests that isotonic or auxotonic relaxation of the lower esophageal sphincter occurs with reduced volume distension in patients with achalasia and normal motility. The study also supports the importance of utilizing a standardized FLIP motility study protocol (i.e., controlled, stepwise filling to 50 mL, 60 mL, then 70 mL) to provide reliable and generalizable FLIP metrics to facilitate diagnosis of esophageal motility disorders