Leveraging Partnerships for a Nursing Home COVID Learning Community

Abstract The rapid and uncertain trajectory of community spread in nursing homes statewide spurred action by the University of North Texas Health Science Center to create a nursing home (NH) COVID learning community. As an existing ECHO hub, we assembled an interdisciplinary team leveraging local NH partnerships, a regional Quality Improvement Organization (QIO), and a regional emergency response task force to rapidly scale up delivery. Specialist teams include a geriatrician and NH medical director, administrator, nursing administration, infection control expert, and a QIO specialist. With the IHI curriculum as a road map for essential training elements, we adapt each week’s agenda based on the interests and concerns of the participating nursing facilities and the incidence rate in our community. At this time, we have two more sessions before completion of phase 1. The three cohorts are engaging 151 participants from 68 nursing facilities with a total attendance of 747.

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Factors affecting influenza vaccine uptake among health care workers in the Medical and Health Sciences Center of Debrecen University, Hungary

Orvosi Hetilap ◽

10.1556/oh.2012.29328 ◽

2012 ◽

Vol 153 (13) ◽

pp. 505-513 ◽

Cited By ~ 2

Author(s):

Piroska Orosi ◽

Ágnes Borbély ◽

Judit Szidor ◽

János Sándor

Keyword(s):

Health Care ◽

Influenza Vaccination ◽

Health Care Workers ◽

Vaccination Rate ◽

Internal Communication ◽

Health Science ◽

Vaccine Uptake ◽

Science Center ◽

Family Doctors ◽

Care Workers

Influenza vaccination is the most effective way of influenza prevention. The vaccination rate is low worldwide. In Hungary, the vaccine is free of charge to health care workers and, therefore, the low vaccination rate is unaccountable. Aims: In this study, the authors wanted to explore those factors which influence the refusal of vaccination. Methods: The Health Science Center of Debrecen University has about 4000 employees. The authors adjusted a questionnaire with 45 questions and sent it to 525 randomly selected health care workers, 294 of whom responded (response rate, 56%). The Epiinfo software was used for statistical evaluation. Results: The respondents strongly agreed that the vaccine is free and easy to obtain at the workplace. Official recommendations of the occupational health, the Medical Association of Hungary and advice of the family doctors failed to influence the decision. However, a significant impact of communication with family members, friends and colleagues on the decision was documented. Conclusions: The results indicate that the most important tool in decision making of influenza vaccination is the internal communication, but this effect is not a permanent one. International data show highly variable vaccination rates (between 2.1% and 82%). A better vaccination rate (98% or above) may be achieved with a mandatory influenza vaccination program among health care workers. Orv. Hetil., 2012, 153, 505–513.

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When People Come First

10.23943/princeton/9780691157382.001.0001 ◽

2013 ◽

Cited By ~ 1

Keyword(s):

Global Health ◽

Scale Up ◽

Moral Economy ◽

Health Science ◽

Health It ◽

Left Behind ◽

New Research ◽

Health Enterprise ◽

Conceptual Work

This book critically assesses the expanding field of global health. It brings together an international and interdisciplinary group of scholars to address the medical, social, political, and economic dimensions of the global health enterprise through vivid case studies and bold conceptual work. The book demonstrates the crucial role of ethnography as an empirical lantern in global health, arguing for a more comprehensive, people-centered approach. Topics include the limits of technological quick fixes in disease control, the moral economy of global health science, the unexpected effects of massive treatment rollouts in resource-poor contexts, and how right-to-health activism coalesces with the increased influence of the pharmaceutical industry on health care. The chapters explore the altered landscapes left behind after programs scale up, break down, or move on. We learn that disease is really never just one thing, technology delivery does not equate with care, and biology and technology interact in ways we cannot always predict. The most effective solutions may well be found in people themselves, who consistently exceed the projections of experts and the medical-scientific, political, and humanitarian frameworks in which they are cast. This book sets a new research agenda in global health and social theory and challenges us to rethink the relationships between care, rights, health, and economic futures.

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Pulmonary Hypertension Roundtable: COPD, IPF, and Pulmonary Hypertension: A Clinician's Dilemma

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-12.3.145 ◽

2013 ◽

Vol 12 (3) ◽

pp. 145-151

Keyword(s):

Pulmonary Hypertension ◽

Rhode Island ◽

Medical Center ◽

Puget Sound ◽

Health Science ◽

Pulmonary Vascular Disease ◽

University Hospitals ◽

Science Center ◽

University Of Texas ◽

Transplant Program

On October 9, 2013, a group of experts met by telephone to discuss PH in the setting of COPD and IPF. The group consisting of guest editor of this issue Jeffrey Edelman, MD, Head, Lung Transplant Program VA Puget Sound Health System, University of Washington; Deborah J. Levine, MD, Director, Pulmonary Hypertension Center, University of Texas Health Science Center at San Antonio; James Klinger, MD, Director, Rhode Island Hospital Pulmonary Hypertension Center; and Robert Schilz, DO, PhD, Director of Pulmonary Vascular Disease and Lung Transplantation, University Hospitals, Case Medical Center; provided perspective and insight into how clinicians can approach these patients most effectively.

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PATH-19. MOLECULAR, HISTOLOGIC AND CLINICAL CHARACTERISTICS OF OLIGODENDROGLIOMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE STUDY

Neuro-Oncology ◽

10.1093/neuonc/noaa215.701 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii168-ii168

Author(s):

Antonio Dono ◽

Kristin Alfaro-Munoz ◽

Yuanqing Yan ◽

Carlos Lopez-Garcia ◽

Zaid Soomro ◽

...

Keyword(s):

Health Science ◽

Cancer Center ◽

Subtotal Resection ◽

Adjuvant Radiation ◽

Science Center ◽

Who Grade ◽

Pik3ca Mutations ◽

Increased Risk ◽

Significant Difference ◽

Grade 3

Abstract In the 2016 WHO classification of CNS tumors, oligodendrogliomas are molecularly defined by IDH1 or IDH2 mutations and 1p/19q co-deletion. Some reports suggest that PI3K pathway alterations may confer increased risk of progression and poor prognosis in oligodendroglioma. However, factors that influence prognosis in molecularly defined oligodendroglioma (mOGD) have not been thoroughly studied. Also, the benefits of adjuvant radiation and temozolomide in mOGDs remain to be determined. 107 mOGDs diagnosed between 2008-2018 at the University of Texas Health Science Center at Houston (n= 39) and MD Anderson Cancer Center (n= 68) were included. A retrospective review of the demographic, clinical, histologic, molecular, and outcomes were performed. Median age at diagnosis was 37 years and 61 (57%) patients were male. There were 64 (60%) WHO Grade 2 and 43 (40%) WHO Grade 3 tumors. Ninety-five (88.8%) tumors were IDH1-mutant and 12 (11.2%) were IDH2-mutant. Eighty-two (77%) patients were stratified as high-risk: older than 40-years and/or subtotal resection (RTOG 9802). Gross-total resection was achieved in 47 (45%) patients. Treatment strategies included observation (n= 15), temozolomide (n= 11), radiation (n= 13), radiation with temozolomide (n= 62) and other (n= 6). Our results show a benefit of temozolomide vs. observation in progression-free survival (PFS). However, no benefit in PFS or overall survival (OS) was observed when comparing radiation vs. radiation with temozolomide. PIK3CA mutations were detected in 15 (14%) cases, and patients with PIK3CA-mutant mOGDs showed worse OS (10.7-years vs 15.1-years, p= 0.009). Patients with WHO Grade 3 tumors had shorter PFS but no significant difference in OS was observed compared to grade 2. Our findings suggest that mOGDs harboring PIK3CA mutations have worse OS. Except for an advantage in PFS in temozolomide treated patients, adjuvant treatment with radiation or the combination of both, showed no significant advantage in terms of OS.

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Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone

Malaria Journal ◽

10.1186/s12936-021-03615-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Maria Lahuerta ◽

Roberta Sutton ◽

Anthony Mansaray ◽

Oliver Eleeza ◽

Brigette Gleason ◽

...

Keyword(s):

Sierra Leone ◽

Phase 1 ◽

Scale Up ◽

Intermittent Preventive Treatment ◽

Vaccine Dose ◽

Preventive Treatment ◽

Household Survey ◽

Phase 2 ◽

Pentavalent Vaccine

Abstract Background Intermittent preventive treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a proven strategy to protect infants against malaria. Sierra Leone is the first country to implement IPTi nationwide. IPTi implementation was evaluated in Kambia, one of two initial pilot districts, to assess quality and coverage of IPTi services. Methods This mixed-methods evaluation had two phases, conducted 3 (phase 1) and 15–17 months (phase 2) after IPTi implementation. Methods included: assessments of 18 health facilities (HF), including register data abstraction (phases 1 and 2); a knowledge, attitudes and practices survey with 20 health workers (HWs) in phase 1; second-generation sequencing of SP resistance markers (pre-IPTi and phase 2); and a cluster-sample household survey among caregivers of children aged 3–15 months (phase 2). IPTi and vaccination coverage from the household survey were calculated from child health cards and maternal recall and weighted for the complex sampling design. Interrupted time series analysis using a Poisson regression model was used to assess changes in malaria cases at HF before and after IPTi implementation. Results Most HWs (19/20) interviewed had been trained on IPTi; 16/19 reported feeling well prepared to administer it. Nearly all HFs (17/18 in phase 1; 18/18 in phase 2) had SP for IPTi in stock. The proportion of parasite alleles with dhps K540E mutations increased but remained below the 50% WHO-recommended threshold for IPTi (4.1% pre-IPTi [95%CI 2–7%]; 11% post-IPTi [95%CI 8–15%], p < 0.01). From the household survey, 299/459 (67.4%) children ≥ 10 weeks old received the first dose of IPTi (versus 80.4% for second pentavalent vaccine, given simultaneously); 274/444 (62.5%) children ≥ 14 weeks old received the second IPTi dose (versus 65.4% for third pentavalent vaccine); and 83/217 (36.4%) children ≥ 9 months old received the third IPTi dose (versus 52.2% for first measles vaccine dose). HF register data indicated no change in confirmed malaria cases among infants after IPTi implementation. Conclusions Kambia district was able to scale up IPTi swiftly and provide necessary health systems support. The gaps between IPTi and childhood vaccine coverage need to be further investigated and addressed to optimize the success of the national IPTi programme.

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Development of a Remote Public Health Advanced Pharmacy Practice Experience in Response to COVID-19

Journal of Pharmacy Practice ◽

10.1177/08971900211004830 ◽

2021 ◽

pp. 089719002110048

Author(s):

Tyler Marie Kiles ◽

Tracy Hagemann ◽

Brianna Felts ◽

Catherine Crill

Keyword(s):

Public Health ◽

Disaster Response ◽

Pharmacy Practice ◽

Health Department ◽

Health Science ◽

Science Center ◽

Health Crisis ◽

University Of Tennessee ◽

Practice Experience ◽

Phone Calls

Objectives: In order to meet the needs of the COVID-19 public health crisis and to actively engage students in patient care opportunities, the University of Tennessee Health Science Center College of Pharmacy in partnership with the Tennessee Health Department, developed a remote Public Health Advanced Pharmacy Practice Experience (APPE) Elective. The objectives of this paper are to describe the development of and students’ experiences and learning outcomes during the elective. Faculty preceptor and experiential administrator’s perspectives are also described. Methods: This month-long APPE was developed in mid-March and delivered in April and May of 2020. The students volunteered in-person with the State of Tennessee COVID-19 Hotline call centers and conducted topic discussions and assignments virtually with a remote preceptor. Results: A total of 16 students completed this rotation experience. Student ratings of the experience were positive, and their knowledge improved in all topic areas. Students collectively completed approximately 700 hours manning the COVID-19 hotline and logged over 1,000 phone calls. Conclusions: In a time of unprecedented disruption to experiential learning, the development of this unique public health APPE directly benefited the college, the students, and the citizens of our state. The APPE described in this paper could be replicated in additional waves of the pandemic or adapted for similar disaster response.

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Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00003.1 ◽

2010 ◽

Vol 2 (2) ◽

pp. 278-282 ◽

Cited By ~ 4

Author(s):

Colleen Y. Colbert ◽

Curtis Mirkes ◽

Paul E. Ogden ◽

Mary Elizabeth Herring ◽

Christian Cable ◽

...

Keyword(s):

Internal Medicine ◽

Medical School ◽

Advance Directives ◽

Advance Directive ◽

Residency Program ◽

Health Science ◽

Science Center ◽

Sufficient Knowledge ◽

Significant Difference ◽

School Curricula

Abstract Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n = 32) and The University of Texas Medical School at Houston (n = 27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

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