Baseline Assessment of Providers\u27 Perspectives on Integrating Community Health Workers into Primary Care Teams to Improve Diabetes Prevention

• Type 2 Diabetes Mellitus (T2DM) affects 11% of U.S. adults • Additional 35% considered pre-diabetic, at-risk for developing T2DM1 • Bellevue Hospital and the VA NY Harbor Hospital disproportionately affected: 2x the prevalence in the general population, and increasing2 • Only 55% of adults receive recommended preventive services3 • Panel management: each care team is responsible for preventive care, disease management, and acute care of a patient panel • Community health worker (CHW): non-clinical frontline public health professional trained in behavioral counseling, care follow-up, program referrals, and health education4-8 • Come from the community that they serve, so they can offer ongoing social support, key to successful behavior change9-12 • CHW interventions have been shown to improve diabetes outcomes and progression to diabetes13 • Lack of literature on integrating CHWs on a larger scale into a clinical care team • CHORD study: Community Health Outreach to Reduce Diabetes • Randomized controlled intervention trial to assess the efficacy of integrating CHWs into primary care teams at Bellevue and the VA to prevent T2DM in pre-diabetic patients • Present study is a baseline assessment in preparation for the CHORD studyhttps://jdc.jefferson.edu/cwicposters/1036/thumbnail.jp

Highly selective and sensitive macrocycle-based dinuclear foldamer for fluorometric and colorimetric sensing of citrate in water.

The selective detection of citrate anions is essential for various biological functions in living systems. A quantitative assessment of citrate is required for the diagnosis of various diseases in the human body; however, it is extremely challenging to develop efficient fluorescence and color-detecting molecular probes for sensing citrate in water. Herein, we report a macrocycle-based dinuclear foldamer (1) assembled with eosin Y (EY) that has been studied for anion binding by fluorescence and colorimetric techniques in water at neutral pH. Results from the fluorescence titrations reveal that the 1·EY ensemble strongly binds citrate anions, showing remarkable selectivity over a wide range of inorganic and carboxylate anions. The addition of citrate anions to the 1·EY adduct led to a large fluorescence enhancement, displaying a detectable color change under both visible and UV light in water up to 2 μmol. The biocompatibility of 1·EY as an intracellular carrier in a biological system was evaluated on primary human foreskin fibroblast (HF) cells, showing an excellent cell viability. The strong binding properties of the ensemble allow it to be used as a highly sensitive, detective probe for biologically relevant citrate anions in various applications

Zero Tolerance – Mitigating the Opioid Epidemic Amongst Minimally Invasive Urologic Patients

Introduction: Opioids are routinely prescribed following minimally invasive surgery (MIS), yet the majority of medication remains unused. However, the literature is lacking evidence for non-narcotic analgesia in MIS urologic procedures. The purpose of this study is to evaluate the efficacy of a non-narcotic postoperative pain management regimen in reducing opioid use following MIS urologic procedures. Methods: In this prospective study, 51 MIS urologic patients were recruited over two months. Patients in the first month cohort (P1) were managed with the established pain management standard-of-care, while patients in the second month (P2) followed a non-narcotic postoperative pain management protocol that included an “opt-in” requirement for opioids. Protocol efficacy was assessed using self-reported patient pain scores at three time points, total postoperative hospital opioid utilization, and the need for opioids at discharge. Data analysis included descriptive statistics and student’s t-test. Results: Total mean values revealed 27.9% reduction in morphine equivalent dose (MED) prescribed, 19.7% reduction in MED used by patients, and 70% reduction in number of patients prescribed any opioids at time of discharge in P2 patients compared to P1 patients (p-value \u3c0.001). There was no significant difference between P1 and P2 in patient pain scores at each time point. Discussion: Overall, the new non-narcotic pain management protocol reduced postoperative opioid utilization in patients undergoing urologic MIS without compromising pain control. This study demonstrates that instituting a single “opt-in” postoperative pain management protocol with appropriate patient education helped significantly reduce the use of postoperative opioids

Socioeconomic Disparities Exist in Access to Rotator Cuff Repair Surgery

Background: The relationship of socioeconomic disparity in access to rotator cuff repair (RCR) has not been well studied. Socioeconomic, racial, and ethnic disparities in access to surgical management of rotator cuff tears have previously been described in patients with commercial insurance. This study is a population-level analysis which investigates racial and ethnic disparities in access to surgical rotator cuff repair across multiple health insurance statuses. Purpose: (1) Is non-white race and ethnicity associated with lower rates of RCR? (2) Do these associations change throughout different insurance statuses? Methods: We used the Healthcare Cost and Utilization Project (HCUP) database to identify patients who underwent elective RCR in Florida, Maryland, Iowa, and Wisconsin in 2016 and 2017. White and non-white patients who underwent RCR were compared by insurance status. To evaluate whether demographics of patients who underwent RCR reflected the general population, patients within the HCUP sample were compared to US census-level data for the same states and years, including a subgroup analysis by insurance status. Results: There were 81,607 patients in the HCUP sample who underwent rotator cuff repair, of whom 81% were white and 19% were non-white. 55% had commercial insurance, 39% had Medicare insurance, and 5% had Medicaid insurance. Compared to census data, all races/ethnicities other than non-Hispanic white were underrepresented in the sample of patients who underwent rotator cuff repair (p Conclusion: This analysis of disparities is the first large database study to examine the relationship between gender, race, insurance status, and elective RCR. Regardless of insurance status, patients who underwent elective RCR were more likely to be white and male when compared with the general population, suggesting a persistence of disparities

Assessing Student Opinion on Autopsy as a Supplement to Medical Education

Purpose: Medical schools in the United States have decreased use of autopsy as a teaching tool in undergraduate medical education (UME). However, there are no recent data to understand how undergraduate medical students (UMS) value autopsies in their education, thus limiting suggestions for improving UME. This study aims to assess UMS opinion regarding autopsies as a supplement to their medical curriculum: is autopsy important and how? Methods: This was a questionnaire study targeted to UMS at Sidney Kimmel Medical College. The questionnaire contained 51 closed- and open-ended questions (e.g. multiple choice, Likert scale, free response), and was distributed electronically. Data were collected and analyzed using RedCap. Results and Conclusions: 103 respondents completed the survey: 84.5% (n=87) were preclinical medical students; 63.1% (n=65) identified as female, 34% (n=35) as male, and 2.9% (n=3) as gender non-conforming or preferred not to answer. 85.4% (n=88) respondents were interested in witnessing an autopsy. On Likert scale (1=Strongly Disagree; 5=Strongly Agree) questions, respondents were neutral in its importance in pathology thread (x̅=3.66) and overall medical (x̅=3.63) education. They agreed that witnessing an autopsy can improve anatomical knowledge (x̅=4.27), observational skills (x̅=4.1), and clinico-pathological correlations (x̅=4.28). Respondents agreed that it can also increase understanding of the role of pathologists (x̅=4.33) and autopsy (x̅=4.25) in patient care. However, 39.8% (n=41) reported “I don’t know” for UMS eligibility and 42.7% (n=44) reported “I don’t know” who to request permission. Overall, the data suggest that UMS are interested in witnessing autopsies, believe it can improve specific knowledge and skill sets, but lack information on access. This implies that UME will benefit from expanding access to the autopsy witness program