Health Science Center Research Articles

Validation and Feasibility of the Postnatal Growth and Retinopathy of Prematurity Retinal Screening Criteria at a Level IV Tertiary Care Neonatal Intensive Care Unit.

Retinopathy of prematurity (ROP) is detected in preterm infants by standardized screening programs, but in general, they have poor sensitivity. The Postnatal Growth and Retinopathy of Prematurity (G-ROP) algorithm uses weight gain to predict ROP superior reported sensitivity. Our objectives are to (1) independently validate the sensitivity of G-ROP criteria for the detection of ROP in infants born at >28 weeks' gestation in a tertiary care unit in the United States and (2) to calculate the cost savings associated with a potential reduction in examinations. This is a retrospective analysis of retinal screening examination data, with post-hoc application of G-ROP criteria to determine whether G-ROP criteria had acceptable sensitivity and specificity in diagnosing Type 1 and Type 2 ROP. All infants born at >28 weeks who were screened by current American Academy of Pediatric Ophthalmologists/American Academy of Pediatrics guidelines at Oklahoma Children's Hospital at the University of Oklahoma Health Sciences Center, between 2014 and 2019, were included. Subset analysis of infants screened by second tier criteria was also performed. Potential cost savings were estimated by analyzing frequency of billing codes. And by calculating the number of infants who could have potentially been spared examination. The G-ROP criteria had 100% sensitivity in detecting type 1 and 87.6% sensitivity in detecting type 2 ROP, which would have reduced infants screened by 50%. All infants in the second tier who would require treatment were detected. A cost saving of 49% was projected. The G-ROP criteria are easy to apply in real-world setting, thus establishing feasibility. The algorithm identified all cases of type 1 ROP; however, some cases of type 2 ROP were not detected. The annual savings in hospital examination cost by using these criteria would be 50%. Therefore, G-ROP criteria can safely be used to screen for ROP and may reduce the number of unnecessary examinations. · The G-ROP screening criteria are safe and predict 100% of treatment warranted ROP.. · Adoption of G-ROP criteria is feasible for level IV NICUs.. · Adoption of G-ROP screening guidelines will result in significant cost savings..

A Miniaturized System for Rapid, Isothermal Detection of SARS-CoV-2 in Human and Environmental Samples.

We report a small-footprint cost-effective isothermal rapid DNA amplification system, with integrated microfluidics for automated sample analysis and detection of SARS-CoV-2 in human and environmental samples. Our system measures low-level fluorescent signals in real-time during amplification, while maintaining the desired assay temperature on a low power, portable system footprint. A unique soft microfluidic chip design was implemented to mitigate thermocapillary effects and facilitate optical alignment for automated image capture and signal analysis. The system-on-board prototype, coupled with the LAMP primers designed by BioCoS, was sensitive enough to detect large variations in viral loads of SARS-CoV-2 corresponding to a threshold cycle range of 16 to 39. Furthermore, tested samples consisted of a broad range of viral strains and lineages identified in Canada during 2021-2022. Clinical specimens were collected and tested at the Kingston Health Science Centre using a clinically validated PCR assay, and variants were determined using whole genome sequencing.

Facilitators and barriers in oncology clinical practice influencing nurses' completion of GRASP Workload Measurement System to ensure patient-centred care.

Hospital administrators have a great interest in obtaining a valid and reliable nursing workload measurement to help determine the hours of care needed per patient; one such method available is the GRASP Workload Measurement System. At Sunnybrook Health Sciences Centre, nurses' GRASP compliance and accuracy varies and often does not meet the target of 90%. The target assists the organization in estimating ongoing nursing workload and patients' care needs, while ensuring the provision of safe and appropriate care that is fiscally responsible. The objective of the quality initiative reported in this paper was to identify the facilitators and barriers that influence nurses' completion of GRASP. The quality improvement project was conducted using a mixed-method design with a sample of 28 nurses working in oncology acute care and palliative care inpatient units. The Theoretical Domain Framework (TDF), often used in behaviour change studies, was used in designing the questionnaire survey and interview questions that listed pertinent and measurable factors that may influence nurses' GRASP completion. Facilitators included: nurses' knowledge about the role GRASP has in funding and staffing levels, job responsibility, and perception of GRASP as a potential tool to organize work. Barriers identified by nurses included insufficient GRASP knowledge, limited access to workstations and computers, GRASP tool elements not capturing the complexity of the nursing work, time constraints, increased patients' acuity, and care demands. In addition to the Theoretical Domain Framework, the Normalization Process Theory was used to guide the implementation and evaluation of the recommendations to enhance nurses' GRASP compliance and adherence practice.

Analysis of a Community Health Screening Program and the Factors Affecting Access to Care.

Introduction Free community health fairs and screening initiatives can be effective in broadening access to care and improving health outcomes in historically marginalized communities. UTHealthCares is a community health-focused organization developed at the University of Texas Health Science Center in Houston. At the beginning of 2023, UTHealthCares oversaw a free community health fair in the Eastex-Jensen Area - a medically underserved area in Northeast Houston. The health fair consisted of four stations - vitals and body mass index collection, vision screening, blood glucose screening, and dental screening. Participants also received coronavirus disease 2019 vaccinations, referrals, and health education. The purpose of this study is to evaluate the effectiveness of the UTHealthCares community health fair while assessing the factors that influence participants' access to medical care. Methods After completing the health fair, participants filled out an optional questionnaire. The questionnaire contained items that assessed satisfaction with the health fair, improvements in managing health, and access to resources. We calculated descriptive statistics, including mean response and 95% confidence intervals for rating scale questions. We used the chi-squared test to evaluate the independence of categorical variables and the Mann-Whitney U test to evaluate differences in means between distributions. Results A total of 111 people participated in the health fair, 91 of which completed a questionnaire. When participants rated their satisfaction with the health fair, the average response was 4.62 out of five. Participants also reported that they were more comfortable managing areas of health related to the stations offered at the fair. Many participants reported limited access to fresh food and long travel times to the physician. Participants that traveled further to reach one resource also tended to have significantly higher travel times for the other: X2 (4, N=78)=28.04, p<0.0001. However, 77.8% of respondents reported that the lack of insurance or cost was their greatest barrier to seeing a medical provider, while only 2.47% reported the lack of transportation as their greatest barrier. Participants who reported having health insurance also had a significantly higher probability of visiting a medical provider when they had a health issue: U=928.5, p=0.0006. Conclusion Overall, participants reported high satisfaction with the health fair. Participants also gave valuable feedback for improving future community health initiatives. Although many participants reported travel times greater than 30 minutes to reach community resources, very few participants indicated that transportation was their largest barrier to accessing medical care. Instead, the lack of insurance and high costs seem to be participants' most significant hindrances. Therefore, interventions in the Eastex-Jensen area focused on expanding access to care should also include components that improve access to insurance.

HER2-LOW BREAST CANCER BRAIN METASTASES: INCIDENCE AND TREATMENT IMPLICATIONS

Abstract Brain metastases (BrM) are a major cause of morbidity and mortality among women with breast cancer (BC). Central nervous system (CNS)-penetrating systemic therapies for patients with HER2-negative BrM are lacking; given CNS activity of trastuzumab deruxtecan, efficacy for patients with HER2-low BrM is of interest. METHODS: A retrospective study of two cohorts of consecutive patients who underwent surgery for BC BrM at Sunnybrook Health Sciences Centre were identified. BrM subtype was assessed based on 2018 ASCO/CAP guidelines. HER2-zero was defined as immunohistochemistry (IHC) 0; HER2-low was defined as IHC 1+ or 2+ and fluorescence in situ hybridization (FISH) negative status. HER2-positive was defined as IHC 3+ or IHC 2+ with positive FISH. We also assessed the prognostic association between extent of HER2 expression and i) brain-specific progression free survival (bsPFS), as well as ii) overall survival (OS). RESULTS: Out of 137 patients with resected BrM, tissue for HER2 assessment was available in 74.5% (n=102) of cases. In this cohort, the median age at BrM diagnosis was 53.5 (range, 32- 85). 68.6% (n=70) had extracranial disease. 53% (n=54) of the BrM were HER2-positive; 29.4% (n=30) were HER2-low and 17.6% (n=18) had HER2-zero status. Among BrM that were triple negative based on ASCO/CAP guidelines, 14 out of 22 cases (63.6%) were re-classified as being HER2-low. 15/25 (60%) BrM that were hormone receptor positive/HER2 negative (HR+/HER2-) based on ASCO/CAP guidelines were re-classified as being HER2-low. There was no significant association between the extent of HER2 expression (HER2-zero, HER2-low versus HER2-positive status) in BrM and either bsPFS or OS. CONCLUSION: Among patients with surgically resected BrM, a high proportion of those with metastatic TNBC and HR+/HER2-negative disease have “HER2-low” BrM with potential to benefit from HER2-targeted therapy.

Prospective Evaluation of Pregnancy Outcomes after Gestational Exposure to Prazosin.

Prazosin is an antihypertensive medication which can be used to help with post-traumatic stress disorder (PTSD) symptoms. Little data is currently available on its safety in pregnancy. To assess the fetal and pregnancy safety associated with prazosin exposures in early pregnancy. Subjects were 11 patients who took prazosin during pregnancy and were counselled at the FRAME clinic in London Health Sciences Centre (Ontario, Canada) between January 1, 2000 to December 31, 2021. Data on their other exposures and pregnancy outcomes were collected from medical records and through telephone questionnaires. It was found that 6/11 (54.5%) subjects did not report any adverse outcomes and were uneventful pregnancies. There were 2 miscarriages. Birthweights were within the normal range for the remaining 9 pregnancies. Adverse events reported were consistent with background population expectation, including: 1 postpartum hemorrhage, 1 case of preeclampsia, 1 preterm birth, 2 NICU admissions, and 2 caesarean sections. For these 11 subjects, pregnancy outcomes after exposure to prazosin were consistent with typical outcomes from unexposed pregnancies. More data are needed to conclude that prazosin is safe for use in pregnant subjects. However, the lack of adverse effects above baseline is reassuring to future patients who may be unintentionally exposed to prazosin while pregnant. Therefore, this study contributes valuable data toward monitoring safety of prazosin in Pregnancy.

Introducing Graduate Students in Biomedical Sciences to an Institutional Animal Research Program.

At the University of Oklahoma Health Sciences Center, graduate students enrolled in biomedical science programs comprise a significant portion of personnel working with research animals. Although the University requires that all personnel receive appropriate training before working with animals, veterinarians and research mentors agreed students would benefit from additional training. As a result, a course entitled "Laboratory Animal Use and Concepts" was added to the curriculum of the University's largest graduate program in biomedical sciences starting in 2017. The course introduces students to a number of topics relevant to the use of animals in biomedical research, with an emphasis on mice. Here we present a summary of the course and an assessment of its impact during the initial 5 y, from 2017-2021. Enrollment, student outcomes, and student evaluation surveys were included in this assessment. The course was offered to 6 classes totaling more than 120 students during this period. After completing the course, nearly 80% of students used animals as part of their graduate training. Among those, at least 21% sought additional training through formal workshops that offered supplemental opportunities to practice animal handling techniques. Student feedback suggested strong satisfaction with the course content and an appreciation for wet lab sessions. Providing enhanced training for incoming graduate students through this structured course appears to help students improve knowledge, skills, and attitudes that facilitate the responsible and ethical use of animals in biomedical research.

Assessment of dental student education and preparedness in periodontics in two different models: Discipline-based and general practice-based learning.

To compare dental students' preparedness in clinical periodontal education following their participation in a discipline-based predoctoral periodontics clinic with dental students that received a general practice-based periodontal education. 114 third-year dental students and 112 fourth-year dental students at the University of Texas Health Science Center in San Antonio, were emailed an online survey consisting of questions on their proficiency and confidence levels in diagnosing periodontal diseases and conditions, treatment planning, performing non-surgical periodontal treatment, identifying the need for referral, and their perceived impediments on their clinical periodontics education. Approximately 97% of third-year dental students that participated in discipline-based predoctoral periodontics agree that they are overall confident in providing excellent periodontal care to their patients, and 91% of these students feel that their participation in the predoctoral periodontics clinic has enhanced their knowledge in periodontics as well as their confidence level when providing periodontal patient care. While 95% of fourth-year dental students agree that they feel confident in providing excellent periodontal care to their patients, only 83% felt that level of confidence during their third-year in dental school, and 77% believe that given the option to participate in the pre-doctoral periodontics clinic, their periodontal education would have been strengthened. Our results show that the integration of a discipline based predoctoral periodontics clinic has benefited the dental students and boosted their knowledge and confidence in diagnosing and treating periodontal patients. This model can be improved by addressing space and time limitations.

Editorial introductions.

Editorial introductions.

Improving hand therapy delivery during care transitions in multisystem trauma patients

High-quality hand therapy is critical to maximising functional capacity and optimising overall outcomes following hand injuries. Therapy delivery requires clear communication between surgeons and occupational therapists. At Sunnybrook Health Sciences...

From the Editors.

From the Editors.

Student Perceptions of Substance Use Disorder Stigma as a Factor for Health Disparities: A Mixed-Methods Study.

The prevalence of substance use disorders (SUDs) is an alarming problem in the United States; however, only a fraction of patients receive treatment. Stigma from both healthcare professionals and society at large negatively impacts SUD treatment. There are limited data regarding the perceptions of healthcare students on SUD stigma as a health disparity. We conducted a concurrent mixed-methods study among students enrolled in six health-related colleges at one mid-south health science center in the US over 3 months. Both an electronic survey consisting of 17 close-ended questions and researcher-led focus groups were conducted to understand their perceptions of stigma and SUDs. The research team followed the six steps recommended by Braun and Clarke regarding the data that aimed to capture associations between categories and extract and conceptualize the themes, and thematic analysis was done using Dedoose® (Manhattan Beach, CA, USA) qualitative software, which facilitated all the codes being kept organized and compared the frequency of codes across categories. A total of n = 428 students participated in the survey (response rate = 13%), and n = 31 students took part in five focus groups. Most student respondents, on average, either agreed or strongly agreed that: stigma currently exists in the healthcare field; stigma can lead to patients' not receiving the appropriate care for an SUD; and stigma can lead to lower quality care provided to patients with SUDs. Two themes were identified based on the thematic analysis: (1) additional training is necessary to better equip students for addressing SUDs in practice and (2) suggestions were formed to develop synergy between didactic and clinical rotations to improve SUD training. It is evident that students perceive the stigma surrounding SUDs as a detriment to patient care. Opportunities may exist in professional training programs to more seamlessly and intentionally weave SUD treatment and management concepts throughout the curriculum, as well as to empower students to operate in the complex regulatory scheme that exists for SUDs in the US.

The Influence of Religious Affiliation and Attitudes of Clinical Genetic Testing Among Medical Students in the West Texas Region.

Genetic counseling is an essential and pertinent field in any society to lower the prevalence of hereditary disorders. However, the desire to undergo counseling and genetic testing varies widely depending on the cultural background and level of scientific literacy of the individual. In this survey, we examine the perspectives of medical students on clinical genetic testing based upon their religious tradition. The total number of participants in the study was 257 (122 male and 135 female) second year medical students at Texas Tech University Health Sciences Center (TTUHSC). The distribution of religious identification (Atheist, Christian, Hindu, Jewish, Muslim, Spiritual/not Affiliated, and Other) among the second-year medical students. The survey was available to students through TTUHSC's Omnibus survey program for a period of two weeks. Most of the second-year medical students interviewed identified as being Christian (67%) with the next highest religious identification being Spiritual/not Affiliated (9%), Atheist (8%), and Muslim (6%). With regards to genetic tests, most of the students (95%), regardless of religious identification, have not used any commercial genetic testing services. Most second year medical students regardless of religious affiliation had similar agreement with questions regarding clinical genetic testing. However, there was a similar drop in agreement when it came on where students would want genetic screening to be performed regularly in clinics/hospitals. Given the numerous factors that must be considered, such as the patient's attitudes, knowledge, and beliefs towards the counseling process and genetic testing, genetic counseling is a challenging problem. Each target population's history, relevant exposure to, and domain expertise must be considered while promoting decision-making in genetic testing.

Meet the First Authors.

Meet the First Authors.

Seeking Education, Equity, and Diversity (SEED)

Introduction Health care work cultures that embrace diversity, equity, and inclusion (DEI) foster innovations, synergy, and appreciation for differences. To promote DEI, health care systems have encouraged professional development on cultural humility, which is awareness of one’s values, beliefs, and social position, given the current cultural context while mindful of history. The national SEED Project (Seeking Educational Equity and Diversity) is a professional development program that prompts reflection and perspective shifting about workplace culture and systemic change. However, reports that examine the SEED learning experience and the participants’ intention for behavior change are lacking. The purpose of our study was to examine: (a) The SEED learning experience, (b) How personal views can foster cultural humility, and (c) The impact of SEED on intentions to effect change. Methods A purposive sample of eight (N = 8) faculty and staff from a SEED cohort at an academic health science center, with regional programs, participated in in-depth interviews to explore their personal views of how to foster cultural humility in health care and the impact of SEED to prompt intentions for behavior change. The investigators conducted a thematic analysis using an inductive, iterative method. Independently, they read each transcript and created codes for each comment. Subsequently, they compared findings, developed a coding frame, and grouped codes into potential themes. They then individually applied the coding frame to the data and considered themes. Finally, they built consensus on codes and synthesized codes into themes. Results Thematic analysis indicated the participants had a profound learning experience, which prompted them to develop cultural humility by re-framing cultural experiences and resolving to become more proactive about DEI in the workplace. They found small group discussions were insightful and provocative. These discussions led to new perspectives and behavior change or intentions for behavior change. Our analysis generated three themes: (1) Connecting with diverse perspectives, (2) Developing new perspectives, and (3) Being proactive with advocacy and new strategies. Conclusion Health care professionals and organizations can use our findings to encourage professional development that potentially stimulates behavior change, the ultimate goal of professional development, related to DEI. Future studies should examine the impact of this professional development within their organization and in the delivery of health care.

The impact of COVID-19 on the experiences of patients and their family caregivers with medical assistance in dying in hospital

BackgroundThe COVID-19 pandemic and its containment measures have drastically impacted end-of-life and grief experiences globally, including those related to medical assistance in dying (MAiD). No known qualitative studies to date have examined the MAiD experience during the pandemic. This qualitative study aimed to understand how the pandemic impacted the MAiD experience in hospital of persons requesting MAiD (patients) and their loved ones (caregivers) in Canada.MethodsSemi-structured interviews were conducted with patients who requested MAiD and their caregivers between April 2020 and May 2021. Participants were recruited during the first year of the pandemic from the University Health Network and Sunnybrook Health Sciences Centre in Toronto, Canada. Patients and caregivers were interviewed about their experience following the MAiD request. Six months following patient death, bereaved caregivers were interviewed to explore their bereavement experience. Interviews were audio-recorded, transcribed verbatim, and de-identified. Transcripts were analyzed using reflexive thematic analysis.ResultsInterviews were conducted with 7 patients (mean [SD] age, 73 [12] years; 5 [63%] women) and 23 caregivers (mean [SD] age, 59 [11] years; 14 [61%] women). Fourteen caregivers were interviewed at the time of MAiD request and 13 bereaved caregivers were interviewed post-MAiD. Four themes were generated with respect to the impact of COVID-19 and its containment measures on the MAiD experience in hospital: (1) accelerating the MAiD decision; (2) compromising family understanding and coping; (3) disrupting MAiD delivery; and (4) appreciating rule flexibility.ConclusionsFindings highlight the tension between respecting pandemic restrictions and prioritizing control over the dying circumstances central to MAiD, and the resulting impact on patient and family suffering. There is a need for healthcare institutions to recognize the relational dimensions of the MAiD experience, particularly in the isolating context of the pandemic. Findings may inform strategies to better support those requesting MAiD and their families during the pandemic and beyond.

Influences of race/ethnicity in periodontal treatment response and bacterial distribution, a cohort pilot study.

Periodontitis disproportionately affects different racial and ethnic populations. We have previously reported the higher levels of Porphyromonas gingivalis and lower ratios of Streptococcus cristatus to P. gingivalis may contribute to periodontal health disparities. This prospective cohort study was designed to investigate if ethnic/racial groups responded differently to non-surgical periodontal treatment and if the treatment outcomes correlated to the bacterial distribution in patients with periodontitis before treatment. This prospective cohort pilot study was carried out in an academic setting, at the School of Dentistry, University of Texas Health Science Center at Houston. Dental plaque was collected from a total of 75 African Americans, Caucasians and Hispanics periodontitis patients in a 3-year period. Quantitation of P. gingivalis and S. cristatus was carried out using qPCR. Clinical parameters including probing depths and clinical attachment levels were determined before and after nonsurgical treatment. Data were analyzed using one-way ANOVA, the Kruskal-Wallis test, the paired samples t-test and the chi-square test. The gains in clinical attachment levels after treatment significantly differed amongst the 3 groups-Caucasians responded most favorably, followed by African-Americans, lastly Hispanics, while numbers of P. gingivalis were highest in Hispanics, followed by African-Americans, and lowest in Caucasians (p = 0.015). However, no statistical differences were found in the numbers of S. cristatus amongst the 3 groups. Differential response to nonsurgical periodontal treatment and distribution of P. gingivalis are present in different ethnic/racial groups with periodontitis.

Introducing the New Editorial Team

Introducing the New Editorial Team

GR.5 Incidence of orbital infarction syndrome following endovascular thrombectomy

Background: Orbital infarction syndrome (OIS) is a rare entity defined as acute ischemia of intraorbital structures. Three case reports of OIS post-endovascular thrombectomy (EVT) have recently been published, two demonstrating absent choroid blush (CB) on digital subtraction angiogram (DSA). Our goals are to determine the true incidence of OIS post-EVT and to identify imaging findings (e.g. CB) that may alert neurologists to potential cases. Methods: A retrospective cohort study including all EVT patients from Health Sciences Center (HSC), Winnipeg in 2019-20 was performed. Patient charts were reviewed to determine the incidence of OIS. Pre- and post-EVT DSA images were reviewed, and the sensitivity and specificity of absent CB for OIS was calculated. Results: Out of 248 patients, 13 were excluded for incomplete charts, and 4 cases (1.7%) of OIS were discovered. During sensitivity/specificity analysis of absent CB for OIS, 51 patients were excluded for inadequate imaging. There were 4 true positives, 0 false-negatives, 113 true-negatives, and 67 false-positives; resulting in a sensitivity of 100% and worst-case scenario specificity of 63% (assuming all 51 indeterminate cases were false positives). Conclusions: OIS is rare post-EVT with an incidence of 1.7%. Absent CB is very sensitive for diagnosing OIS with lower specificity.

Thyroid Function Abnormalities in Childhood Cancer Survivors

Clinical ThyroidologyVol. 35, No. 6 Pediatric ThyroidologyThyroid Function Abnormalities in Childhood Cancer SurvivorsGary L. FrancisGary L. FrancisDivision of Endocrinology, Department of Pediatrics and Mays Cancer Center, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A.Search for more papers by this authorPublished Online:13 Jun 2023AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 35Issue 6Jun 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Gary L. Francis.Thyroid Function Abnormalities in Childhood Cancer Survivors.Clinical Thyroidology.Jun 2023.224-228.http://doi.org/10.1089/ct.2023;35.224-228Published in Volume: 35 Issue 6: June 13, 2023PDF download