Health Science Center Research Articles

Examining the Emergency Department Care Experiences of Equity-Deserving Groups Using an Intersectional Lens.

Equity-deserving groups (EDGs) face societal barriers, including healthcare barriers within the emergency department (ED), due to discrimination. Most patient-care experience research considers only a single-axis perspective, neglecting multifaceted impacts of discrimination, or intersectionality. Detailed is a secondary analysis of a mixed-methods, cross-sectional study conducted at the Kingston Health Sciences Centre (KHSC) between June and August 2021. A quantitative analysis was conducted to identify differences between participants who did not identify as equity-deserving (controls), and those who identified with 1, 2, or 3 EDGs, respectively. The research team conducted thematic analysis on the shared micronarratives to contextualize the quantitative results. The research team also held focus groups with community partners that served EDGs to gain their insights on study findings and add their perspectives to the captured themes. Comparing 1973 individuals belonging to none, 1, 2, or 3 EDGs revealed significant differences in patient-perceived attention to their needs (P < .001), patient-control in health care decision-making (P = .001), and whether quality medical care or experiencing kindness/respect was more important (P = .003). Three themes were identified: stigma and discrimination, lack of patient-centered care, and need for improved patient-provider communication. The study's findings contribute to a sparse body of evidence on EDG-care experiences in the ED through an intersectionality lens. Future research efforts should evaluate the complex interactions of specific EDG memberships to improve care experiences.

Long-term impact of COVID-19 pandemic: Moral tensions, distress, and injuries of healthcare workers.

Given the longevity of the COVID-19 pandemic, it is important to address the perceptions and experiences associated with the progression of the pandemic. This narrative can inform future strategies aimed at mitigating moral distress, injury, and chronic stress that restores resilience and well-being of HCWs. In this context, a longitudinal survey design was undertaken to explore how health care workers are experiencing the COVID-19 pandemic over time. A qualitative design was employed to analyze the open ended survey responses using a thematic analysis approach. All physicians and staff at an academic health science centre in Toronto, Ontario, Canada were invited to participate in the survey. The majority of survey respondents were nurses and physicians, followed by researchers/scientists, administrative assistants, laboratory technicians, managers, social workers, occupational therapists, administrators, clerks and medical imaging technologists. The inductive analysis revealed three themes that contributed to moral tensions and injury: 1) experiencing stress and distress with staffing shortages, increased patient care needs, and visitor restrictions; 2) feeling devalued and invisible due to lack of support and inequities; and 3) polarizing anti- and pro-public health measures and incivility. Study findings highlight the spectrum, magnitude, and severity of the emotional, psychological, and physical stress leading to moral injury experienced by the healthcare workforce. Our findings also point to continued, renewed, and new efforts in enhancing both individual and collective moral resilience to mitigate current and prevent future moral tensions and injury.

Community Engagement Studios to advance multi-site research with older adults

Abstract Introduction: Operationalizing multi-site Community Engagement (CE) Studios to inform a research program is valuable for researchers. We describe the process and outcomes of hosting three CE Studios with Community Experts aged 65 years or older with chronic conditions and care partners of older adults. Experts gave feedback about processes for testing the feasibility, efficacy, effectiveness, and implementation of audio recording clinic visits and sharing recordings with patients who have multimorbidity and their care partners. Methods: The CE Cores of the Clinical and Translational Science Awards Programs at three academic health science centers created a joint CE Studio guide. Studios were conducted iteratively by site. Following receipt of the final reports, responses were compared to find themes, similarities, and differences on four topics in addition to overall commentary: Recruitment and Retention, Study Protocol, Study Reminders and Frequency, and Recording Technology. Results: Eighteen older adults and care partners in three states provided valuable feedback to inform multi-site trials. Feedback influenced multiple aspects of trials in process or subsequently funded. Experts provided critique on the wording of study invitations, information sheets, and reminders to engage in study procedures. Experts were concerned for participants being disappointed by randomization to a control arm and advised how investigators should prepare to address that. Conclusions: Multi-site CE Studios should be consecutive, so each team can learn from the previous teams. Using the CES Toolkit ensures that final reports were easily comparable and utilized to develop a research program that now includes three federally funded clinical trials.

Association Between First Post-operative Day Urine Output Following Kidney Transplantation and Short-Term and Long-Term Outcomes: A Retrospective Cohort Study.

The relationship between post-operative urine output (UO) following kidney transplantation and long-term graft function has not been well described. In this study, we examined the association between decreased UO on post-operative day 1 (POD1) and post-transplant outcomes. This is a retrospective cohort study. Atlantic Canada. Patients from the 4 Atlantic Canadian provinces (Nova Scotia, New Brunswick, Newfoundland, and Prince Edward Island) who received a live or deceased donor kidney transplant from 2006 through 2019 through the multiorgan transplant program at the Queen Elizabeth II Health Sciences Centre (QEII) hospital in Halifax, Nova Scotia. Using multivariable Cox proportional hazards models, we assessed the association of low POD1 UO (defined as ≤1000 mL) with death-censored graft loss (DCGL). In secondary analyses, we used adjusted logistic regression or Cox models as appropriate to assess the impact of UO on delayed graft function (DGF), prolonged length of stay (greater than the median for the entire cohort), and death. Of the 991 patients included, 151 (15.2%) had a UO ≤1000 mL on POD1. Low UO was independently associated with DCGL (hazard ratio [HR] = 4.00, 95% confidence interval [CI] = 95% CI = 1.55-10.32), DGF (odds ratio [OR] = 45.25, 95% CI = 23.00-89.02), and prolonged length of stay (OR = 5.06, 95% CI = 2.95-8.69), but not death (HR = 0.81, 95% CI = 0.31-2.09). This was a single-center, retrospective, observational study and therefore has inherent limitations of generalizability, data collection, and residual confounding. Overall, reduced post-operative UO following kidney transplantation is associated with an increased risk of DCGL, DGF, and prolonged hospital length of stay.

Pandemic Patient Engagement Success: Maintaining Family Presence Through Partnership

This presentation is relevant for patients of hospitals and residents of long-term care facilities, their loved ones and essential partners in care, and staff and leadership of healthcare facilities.&#x0D; A painful pandemic challenge for patients, families and staff in hospitals was the absence of loved ones or essential care partners through Family Presence/Visitor Policy restrictions. Leadership at Kingston Health Sciences Centre (KHSC) worked proactively with the Patient and Family Advisory Council and a small, diverse group of Patient Experience Advisors to plan for possible restrictions and consider how best to approach ongoing changes and challenges to the policy expected in the face of the pandemic. The group continues to work together at this time of uncertainty.&#x0D; An initial meeting of eight advisors and leaders took place prior to the World Health Organization’s official announcement of the pandemic. Due to growing concern about hospital infections, the meeting venue was a local coffee shop, hence the group became known throughout the hospital as The Balzac’s Group. Synchronous virtual meetings and asynchronous communication were employed by the group to address concerns and create family presence opportunities on a rapid response basis. Group collaboration remains evident as new concerns arise with the ongoing ebb and flow of COVID-19 hospitalizations, staff shortages and less restrictive family presence policies. This partnership has been pivotal to the organization’s pandemic planning and response, enabling family presence while respecting government directives, organizational challenges, and patient/family priorities.&#x0D; This collaboration informed several new and sustained initiatives including: a virtual visits process, ePostcards, a Care Partner Program, expanded cell phone use in restricted areas, resources for loved ones traveling distances, careful and measured increases in family presence and a family presence policy Exceptions Committee.&#x0D; An unexpected outcome was an increased level of respect and strengthened patient engagement. Factors influencing this success were transparency and trust in sharing sensitive or confidential information, mutual decision-making, frank and honest sharing of both personal and professional perspectives, and active listening. Many KHSC advisors increased their patient partnership activities during the pandemic and felt an enhanced sense of agency in their efforts to improve the patient experience in healthcare.&#x0D; &#x0D; This initiative may be a source of new ideas, inspiration, and encouragement for patient partners and hospital leaders to actively partner in co-design and delivery of compassionate person-centred policies and care, especially during times of crisis.&#x0D; The group continues to be the “go-to” group for family presence policy questions. The strengthened relationship with Patient Advisors has had a spillover effect more broadly into other hospital initiatives and increased awareness of the value of their input. We hope to continue to share this success story broadly to encourage other healthcare facilities to partner with the precious resource of patients, families, and patient advisors, at all levels of health care. We are considering a Patient Advisor led publication in the future.

Hippo Signaling: Advances in Potential Therapeutic Targets for Sinoatrial Node Disorders

Review Hippo Signaling: Advances in Potential Therapeutic Targets for Sinoatrial Node Disorders Julianna N. Quinn 1,2, and Jun Wang 1,2, * 1 Department of Pediatrics, McGovern Medical School at UTHealth, The University of Texas Health Science Center at HoustonHoustonTX77030USA 2 McGovern Medical School at UTHealth, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, The University of Texas Health Science Center at HoustonHoustonTX77030USA * Correspondence: jun.wang@uth.tmc.edu Received: 16 June 2023 Accepted: 31 July 2023 Published: 27 December 2023 Abstract: The cardiac conduction system (CCS) propagates electrical impulses, generates cardiac contractions, and ultimately ensures regular heartbeats. Disruptions within the CCS lead to cardiac arrhythmias, which are known to be the leading cause of cardiac-related mortalities in humans. The sinoatrial node (SAN) is a key component of the CCS and functions as the natural cardiac pacemaker to initiate normal cardiac impulse and conduction. The SAN is characterized by significant heterogeneity and contains various cell types, including pacemaker cells that spontaneously generate action potentials to maintain a constant beating rhythm. The fundamental Hippo signaling pathway plays a key role in heart development and regeneration. Recently, the Hippo signaling pathway is indicated as a critical pathway for maintaining SAN homeostasis, suggesting therapeutic targets for SAN disorders. This mini-review focuses on the recent molecular and mechanistic findings of Hippo’s involvement in regulating SAN homeostasis and discusses potential new therapeutic targets for SAN pathologies.

Court rules against former medical resident

Case name: Texas Tech University Health Sciences Center — El Paso v. Niehay, No. 22‐0179 (Texas 06/30/23).

LINKING MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) MEASURES TO AGE-FRIENDLY HEALTH SYSTEMS

Abstract IHI’s Age-Friendly Health Systems initiative provides a framework for older adult primary care focused on the 4Ms: Mentation, Mobility, Medications, and What Matters which addresses the need for an integrated system of care. Additionally, the Centers for Medicare &amp; Medicaid Services have implemented merit-based incentivized payment system (MIPS) measures to promote provider practices that improve healthcare quality. MIPS measures and age-friendly care practices may be improved through training, which may lead to better patient outcomes. To integrate the 4Ms to improve care and patient safety, the Center for Older Adults at the University of North Texas Health Science Center standardize workflows and increase the number of annual wellness visits (AWV). A standardized template in the electronic medical record was created, questions in the patient registration software were added to identify eligible patients, and three different types of AWVs were standardized. Training courses were developed and completed by providers. The percentage of patients who receive an AWV is measured on an annual basis. Learnings have been integrated into training courses. Between July 2020 to June 2021, 297 healthcare professionals completed online training modules, with post-survey ratings showing helpful content with learning objectives being met. Provider support through training and incorporating MIPS measures and the Age-Friendly 4Ms framework into the AWV can support consistent outcome measurement and improve quality care for older adults.

GERIATRIC WORKFORCE ENHANCEMENT PROGRAMS AS AAA AGE-FRIENDLY INITIATIVES PARTNER

Abstract The Health Resources and Services Administration funded 48 Geriatric Workforce Enhancement Programs (GWEPs) to partner with community-based organizations in addressing gaps in health care for older adults, promoting Age-Friendly ecosystems, and addressing social determinants of health. This paper discusses three GWEPs collaborative projects with Area Agencies on Aging (AAAs) that deliver community-based programs . The University of Utah’s GWEP, a rural AAA, the Alzheimer’s Association, and the Utah Department of Veterans and Military Affairs provided a hybrid Dementia Caregiver Conference to six counties, reaching 65 in-person attendees and 10 senior centers online. Attendees agreed the content met their educational needs, would positively influence care, and was motivation to form a caregiver coalition. The University of Louisville Trager Institute (Trager), AAA, and Kentucky Coalition for Healthy Communities provided focused regional training and sharing of community resources utilizing the Project ECHO training model for 11 AAA regions, reaching 412 home and community-based services professionals. The University of North Texas Health Science Center, AAA, and emergency management services expanded evidence-based programs in falls prevention, medication safety, and dementia caregiving, serving an additional 23 urban postal codes, rural counties, and over 1,900 individuals. These examples utilize unique community relationships and partnership strategies to identify local needs, maximize older adult and family caregiver engagement, measure outcomes, and achieve GWEP goals to educate diverse, underserved and rural communities.

EVALUATING PROGRAMS WITH OLDER ADULTS AND CAREGIVERS AS PARTNERS IN PATIENT EDUCATION

Abstract The Geriatrics Workforce Enhancement Program at the University of North Texas Health Science Center has several programs where patients, older adults, caregivers and healthcare stakeholders are incorporated directly into the educational experience or provide feedback to inform the design of educational programs. In addition to the program design, there are evaluation considerations related to incorporating these important stakeholders to best capture the impact of this group. The goal of evaluation research has become more and more important in program design, especially with interdisciplinary programs and programs involving multiple stakeholder groups. Evaluation research is the assessment of outcomes and information that will inform future decision making. These stakeholders are important partners and have an important impact on program design and research outcomes, which is something that should be measured along the way. The University of North Texas Health Science Center Community Advisory Council, Infection Control Advocate and Resident Education (ICARE), Dementia Education, and Seniors Assisting in Geriatric Education are programs that will be included in this evaluation discussion. For these projects, we included evaluation components to keep the patient’s voice at the center of education planning, delivery, and improvement. This presentation will discuss the evaluation of impact in these programs, discuss barriers to measurement, and report early results. One key finding is the lack of systematic measurement tools available and the need for additional tools that can be used across settings where patients are part of the education program design.

Using Data Interviews to Map Research Data Services (RDS) Needs at a Health Science Institution

Objective: On January 21, 2023 the National Institutes of Health Data Management and Sharing Policy (NIH DMSP 2023) went into effect. Ahead of these expanded data sharing requirements, the Health Sciences Library at the University of Tennessee Health Science Center (UTHSC) set out to better understand health science research data service (RDS) needs and how the Library could develop new services in alignment with existing institutional support.Methods: Building upon a set of data interview questions created by Read et al. (2015), the author conducted a series of semi-structured interviews with 10 researchers in the fall of 2022. The interview transcripts were inductively coded and analyzed for themes relevant to RDS needs.Results: Analysis of the interviews identified several opportunities for the Library to take ownership of RDS activities in the areas of support services, training and instruction, and tools and technology. Additionally, these interviews helped to characterize existing institutional support and to develop an informal community of practice at the University of Tennessee Health Science Center (UTHSC). These RDS topics were mapped onto Harvard’s Biomedical Data Lifecyle to further clarify areas of need and opportunities for growth for the Library and institutional RDS partners.&amp;nbsp;Conclusions: The study identified critical RDS needs among UTHSC researchers and highlighted the potential role of the Library as a valuable partner in addressing these needs and fostering collaboration among campus stakeholders. Conversations informed by these findings continue with stakeholders about the best way to meet the needs of researchers on campus as well as centralize and coordinate existing endeavors.

Thiazide-associated hyponatremia increases the risk of major adverse cardiovascular events among elderly Taiwanese patients

BackgroundThiazide-associated hyponatremia (TAH) has been supposed to increase the risk of major adverse cardiovascular events (MACE) in the elderly. Therefore, this study aimed to evaluate the association of TAH with the risk of MACE in elderly Taiwanese patients.MethodsData from the longitudinal generation tracking database (LGTD 2010) of the Health and Welfare Data Science Center (HWDC) were retrospectively assessed. The TAH study group was defined as using > 30 cumulative daily defined doses (CDDDs) thiazide diuretics within one year before diagnosis of hyponatremia. The control group (1:3 propensity score matching) had no diagnosis of hyponatremia but had used > 30 CDDDs thiazide diuretics within one year. Data on MACE were extracted using International Classification of Diseases codes. Outcomes were assessed using a multivariable Cox proportional hazard model and Kaplan-Meier analysis.ResultsA total of 1155 and 3465 individuals were enrolled in the TAH and the control groups, respectively. The rates of MACE (11.1% vs. 7.3%) and death (22.8% vs.12.2%) were significantly higher in the TAH group than the control group. In the TAH group, the adjusted HRs were 1.29 (CI 1.01 ‒ 1.65) for MACE, 1.39 (CI 1.19 ‒ 1.63) for all-cause death, and 1.61 (CI 0.90 ‒ 2.92) for stroke.ConclusionTAH in patients above 65-years-old is associated with a 29% higher risk of MACE, 39% higher risk of all-cause death, and 61% higher risk of stroke. This work suggests that thiazides prescription in elderly patients should be more careful. However, further research is required to confirm our findings.

Implementing Next-Generation Sequencing Process Changes to Increase Capacity and Improve Timeliness of Molecular Biomarker Profiling for Lung Cancer Patients.

Faced with expansion of molecular tumor biomarker profiling, the molecular genetics laboratory at Kingston Health Science Centre experienced significant pressures to maintain the provincially mandated 2-week turnaround time (TAT) for lung cancer (LC) patients. We used quality improvement methodology to identify opportunities for improved efficiencies and report the impact of the initiative. We set a target of reducing average TAT from accessioning to clinical molecular lab report for LC patients. Process measures included percentage of cases reaching TAT within target and number of cases. We developed a value stream map and used lean methodology to identify baseline inefficiencies. Plan-Do-Study-Act cycles were implemented to streamline, standardize, and automate laboratory workflows. Statistical process control (SPC) charts assessed for significance by special cause variation. A total of 257 LC cases were included (39 baseline January-May 2021; 218 post-expansion of testing June 2021). The average time for baseline TAT was 12.8 days, peaking at 23.4 days after expansion of testing, and improved to 13.9 days following improvement interventions, demonstrating statistical significance by special cause variation (nonrandom variation) on SPC charts. The implementation of standardized manual and automated laboratory processes improved timeliness of biomarker reporting despite the increasing volume of testing at our center.

Spasticity Matters: A Call to Action Following an Acute Stroke

More than half of survivors of stroke experience some degree of motor impairment, and spasticity can develop within days of the initial event. Patients with post-stroke spasticity (PSS) report a lower quality of life than those without spasticity, and they require regular long-term follow-up and monitoring within the healthcare system. This symposium supported a non-promotional discussion regarding the prevalence, burden, consequences, and need for identification of PSS. The benefits of PSS identification within 3 months of stroke were discussed by a panel of key opinion leaders, including Ted Wein, Neurologist and Assistant Professor of Neurology and Neurosurgery at McGill University, Montréal, Quebec, Canada; Ganesh Bavikatte, Consultant and Clinical Lead in rehabilitation medicine at the Walton Centre, Liverpool, and Honorary Senior Clinical Lecturer at the University of Liverpool, UK; and Sean Savitz, Professor of Neurology and Physical Medicine and Rehabilitation, Frank M. Yatsu MD Chair in Neurology, and Director of the Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston (UTHealth), Texas, US. These key opinion leaders explained that early prediction of PSS could be improved by increased awareness of the associated risk factors and tools, such as the Post-Stroke Checklist (PSC), the Spasticity Screening Tool, and the PSS Referral Tool. Finally, potential barriers to the early identification of PSS were presented, alongside strategies to overcome these barriers.

Abstract IA005: Persistent poverty and cancer disparities

Abstract This session will highlight the challenges that persistent poverty poses for achieving health equity. In working with the US Department of Agriculture’s Economic Research Service, the NCI defines persistent poverty areas, wherein 20% or more of the population at the census tract level is below the federal poverty line based on the 1990, and 2000 decennial censuses and 2007-11 and 2015-2019 American Community Survey 5-year estimates. Most of our research and interventions are not focused in these areas and thus do not consider these contextual factors associated with persistent poverty in addressing cancer disparities. The three speakers will highlight the challenges and opportunities to promote research and training with communities in focusing their research on persistent poverty areas. The speakers and titles of the talks are: NCI’s persistent poverty research agenda Amy Kennedy, National Cancer Institute, Gaithersburg, Maryland HCV screening in border areas of persistent poverty Bertha E. Flores, UT Health Science Center at San Antonio, San Antonio, Texas Relationship between measures of social determinants of health at the census tract level and cancer incidence and survival: An analysis of persistent poverty, socioeconomic index, and measures of rurality Kathy Cronin, National Institutes of Health, Bethesda, Maryland Citation Format: Shobha Srinivasan. Persistent poverty and cancer disparities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA005.

Abstract A019: Busting myths in healthcare: Establishment of a bilingual health education platform in a border community

Abstract Introduction: The Texas Tech University Health Sciences Center (TTUHSC) El Paso Health Education and Awareness Team (EP-HEATTM) was established in 2020, focusing on disseminating bilingual (English/Spanish) health education material to the border community. A co-production effort was established with EP-HEAT consisting of TTUHSC El Paso students, faculty, and Promotoras, also known as Community Health Workers. These events allow students to interact directly with the community and serve as healthcare educators to better prepare them for the community-facing aspects of being a physician and developing a professional identity. The goal of this project was to provide an environment where community members, students, Promotoras and healthcare experts work together to identify and dispel myths in healthcare. Methods: The EP-HEAT students and Promotoras work collaboratively with community members to identify myths in healthcare field, including cancer and treatment for the Hispanic population.​ Students then identify experts in the healthcare field who can address the myths. The promotoras invite community members to attend the event and finally, the Myth Busters event occurs in a pseudo-talk-show manner. Students and Promotoras, serve as the hosts, interviewing the expert in the field in a bilingual (English/Spanish format), with the audience being he community members. Results: Community members who attended the Myth Buster events received a survey to obtain demographic data, identify the motivation behind attendance, and evaluate the benefit and effectiveness of the event. Our results showed that 81% of our attendees identified as Hispanic, with 45% older than 46 years old. Discussion: An unanswered question that is pending is whether attending the Myth Buster events enabled community members to seek out additional resources for the identified healthcare topics (such as vaccinations, antibiotics, and Diabetes/healthy living) for example. We also need to determine whether students’ professionalism and networking increased as a result of the events. Citation Format: Sara Mansour, Lorena Fernandez, Jesse Allen, Veeravenkata Garikiparthy, Laura Renovato, Maria Land, Ricardo Belmares, Tanis Hogg, Nathan Holland, Jessica Chacon. Busting myths in healthcare: Establishment of a bilingual health education platform in a border community [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A019.

Covid‐19 may have a detrimental impact on sensorimotor function

AbstractBackgroundThe long‐term impact of COVID‐19 on global health is still unknown. Sensorimotor biomarkers may be promising indicators of lasting effects of COVID‐19. Although normal aging may cause changes in sensorimotor function, more severe changes may indicate the subsequent impacts of COVID‐19 on brain health. The objective of this study was to investigate the association between COVID‐19 and sensorimotor markers (grip strength, gait, and smell) in the 7T neuroCOVID consortium, which is comprised of 5 sites: The University of Texas Health Science Center at San Antonio, Houston Methodist Research Institute, The University of Pittsburgh, Massachusetts General Hospital, and Nottingham University (UK).MethodsWe studied 101 adult participants (mean age 60.9 ± 8.5 years, range 45‐80 years, 51% women) without prior cognitive impairment or cerebrovascular disease from the 7T consortium across 3 US and 1 UK sites. The sample included 77 COVID‐19 survivors and 24 healthy controls. Sensorimotor markers were measured for olfaction (n = 59; 12‐item Brief Smell Identification Test (B‐SIT)), grip strength (n = 97; measured using a hand dynamometer), and Gait (n = 101; 4‐meter normal walk time and n = 99; 4‐meter fast‐paced walk time). To assess the association between COVID‐19 and sensorimotor outcomes, we performed a series of linear regression models adjusting for age, sex, site, and handedness (grip strength only). Statistical significance was set at a 5% level.ResultsAs compared to healthy controls, COVID‐19 survivors, on average had a significantly reduced hand grip in the right hand (β ± standard error: ‐0.18 ± 0.07, p = 0.006). We also observed associations with reduced gait speed. COVID‐19 survivors, on average, had a slower walk time in both normal (0.17 ± 0.06, p = 0.004) and fast‐paced (0.04 ± 0.02, p = 0.022) as compared to healthy controls. We did not observe any statistical associations between COVID‐19 survivors and left‐hand grip strength or B‐SIT.ConclusionsThese results highlight that Covid‐19 infection may have a detrimental impact on sensorimotor function. Additional analysis with a larger sample size are ongoing, which will allow us to further assess the effect of infection severity. Future studies will look to evaluate the association between sensorimotor markers, cognition, and ultra‐high field 7T MRI‐based imaging markers. Funding:R56AG074467P30AG066546

Formulating a code of ethics for Kuwaiti pharmacists using FIP ethical standards: A Delphi study

Abstract Introduction Pharmacists play a crucial role in healthcare and are expected to adhere to high ethical standards. Ethical values provide a practical basis for identifying valued actions, intentions, and motives. Regulatory organizations in developed countries have established codes of ethics for various professions, including pharmacy, which support improved patient outcomes and increased trust in the healthcare system. While a national code of ethics for pharmacists in Kuwait is not currently published. Aim To formulate a code of ethics for pharmacists in Kuwait through a modified Delphi technique that is relevant and applicable for Kuwait context. Methods A 2-round E-Delphi consensus technique using the International Pharmaceutical Federation’s (FIP) 14 ethical standards was conducted. An ethical approval for this study was obtained from Human Ethical Committee, Health Sciences Center, Kuwait University (270). Pharmacy expertise were recruited through purposive and snowballing sampling method. Consensus was achieved when at least 90% of acceptance and clarity level of the FIP's ethical standards were reached. Round 1: Expertise were asked to indicate their level of acceptance and clarity of the 14 FIP ethical standards in both the Arabic and English languages. Round 2: This round discussed seven standards, which were unaccepted, unclear, and did not reach the cut-off point from round 1. Results Round 1 response rate achieved 100% (30) and seven standards were accepted in terms of acceptance and languages’ clarity. Round 2 response rate was 93.3% (28), including the rest 7 standards that did not reach the required consensus’s percentage. Through the 2nd round, it ended up with 2 standards, accomplishing consensus. The remaining five standards need to be reconsidered in a follow-up study. Discussion/Conclusion The positive reception and understanding of the FIP ethical standards among pharmacists suggest that the regulatory authority in Kuwait can use this study's data to advance its efforts in adopting these standards. Therefore, it is essential for the regulatory authority to consider the study's findings when evaluating the implementation of ethical standards in Kuwait's healthcare system.

The Impact of Out-of-Hospital Time and Prehospital Intubation on Return of Spontaneous Circulation following Resuscitative Thoracotomy in Traumatic Cardiac Arrest

Introduction Resuscitative thoracotomy (RT) is a critical procedure performed in certain trauma patients in extremis, with extremely low survival rates. Currently, there is a paucity of data pertaining to prehospital variables and their predictive role in survival outcomes in traumatic cardiac arrest (TCA) patients requiring RT. The aim of the study was to determine the impact of prehospital intubation and out-of-hospital time (OOHT) on return of spontaneous circulation (ROSC) and survival in TCA requiring RT. Methods This was a retrospective cohort study of trauma patients presenting to two level-1 trauma centers, St. Michael’s Hospital and Sunnybrook Health Sciences Center, in Toronto, Canada (January 1, 2005-December 31, 2020). Our exposures of interest were any prehospital intubation attempt and OOHT. Primary and secondary outcome measures were ROSC post-RT and survival to hospital discharge, respectively, and data analysis was performed using univariate logistic regression. Results A total of 195 patients were included, of which 86% were male, and the mean age was 33 years. ROSC and survival to hospital discharge were achieved in 30% and 5% of patients, respectively. Of those who survived to discharge, 89% sustained penetrating trauma. There was no association between OOHT and ROSC (OR = 1.00, 95% CI 0.97–1.03) or survival (OR = 0.99, 95% CI 0.94–1.05). The odds of ROSC were lower in penetrating trauma in the presence of any prehospital intubation attempt (OR = 0.39, 95% CI 0.19–0.82, p = 0.01). ROSC was less likely among all patients with no prehospital signs of life (SOL) compared to those who had prehospital SOL (OR = 0.30, 95% CI 0.13–0.69, p < 0.01). Conclusions There was a significant association between prehospital intubation and lower likelihoods of ROSC in the penetrating TCA population requiring RT, as well as with the absence of prehospital SOL in all patients. OOHT did not appear to significantly impact ROSC or survival.

SH2B3 Mutations in Patients with JAK2-Negative Erythrocytosis

Introduction: Erythrocytosis is a common reason for referral to Hematology clinics. Molecular testing for JAK2 mutations, often by next-generation sequencing (NGS), has become part of the diagnostic workup of patients with erythrocytosis, increasing the molecular characterization of this previously undifferentiated patient population. A recent study (Bhai et al. 2022) found that 4% of patients referred for JAK2-negative erythrocytosis harboured variants in the SH2B3 gene, which encodes the LNK protein, a known negative regulator of JAK2/STAT5 signaling. The objective of this study was to characterize a cohort of patients with JAK2-negative erythrocytosis with SH2B3 mutations, evaluating clinical presentation, hematologic parameters, as well as cardiovascular and thrombotic outcomes. Methods: All adult patients referred to the London Health Sciences Centre, a tertiary care centre in Southwestern Ontario, for assessment of erythrocytosis (hemoglobin &amp;gt;160g/L in women; &amp;gt;165g/L in men) between January 1, 2018 and December 31, 2022 and who underwent NGS testing were reviewed. NGS testing was performed using the Oncomine Myeloid Research Assay (Thermofisher Scientific, MA, USA). Patients with JAK2, CALR, MPL, or BCR::ABL1 mutations were excluded. Patients without JAK2 mutations ( JAK2-negative) with variants in SH2B3 were further characterized. Clinical variables included risk factors for secondary erythrocytosis and occurrence of arterial/venous thrombotic events. Laboratory variables included complete blood count and white cell differential. Results: Sixteen patients with JAK2-negative erythrocytosis met inclusion criteria with mutations in SH2B3. All mutations in SH2B3 were characterized as Tier III variants (Variants of Uncertain Significance). Laboratory and clinical parameters in this patient population are presented in Table 1. Mean hemoglobin was 181 g/L, hematocrit 0.54 L/L, leukocyte count 7.2 x10 9 cells/L, and platelets 229 x10 9 cells/L. Secondary causes of erythrocytosis were identified in 13 (81%) patients: 10 (63%) reported active smoking or had a smoking history, 4 (25%) had obstructive sleep apnea, 2 (13%) had chronic obstructive pulmonary disease, 1 (6%) had a right-to-left cardiac shunt, 4 (25%) were on an SGLT2 inhibitor, and 1 (6%) reported testosterone use. Of note, one patient had a history of stroke and another had a myocardial infarction both of which predated the development of erythrocytosis and NGS testing. One patient had a recurrent deep vein thrombosis (DVT) at the time of NGS testing. Full molecular data and comparative analysis with other cases of JAK2-negative erythrocytosis will be presented at ASH. Discussion: SH2B3 mutations have been identified in rare cases of congenital erythrocytosis and implicated in the pathogenesis of erythropoiesis. To our knowledge, this is the largest cohort of patients with JAK2-negative erythrocytosis with variants in SH2B3 reported to date. This cohort showed similar laboratory parameters and prevalence of secondary risk factors for erythrocytosis as previously reported in the general population of patients with JAK2-negative erythrocytosis at our centre (Chin-Yee et al. 2022). Thrombotic outcomes were also similar, and lower than patients with polycythemia vera. Given the high prevalence of potential secondary causes of erythrocytosis in our cohort we cannot confirm that SH2B3 mutations are causally implicated in elevated hemoglobin in these cases. Nonetheless, we cannot exclude that SH2B3 variants may confer an additional risk factor for erythrocytosis in this patient population. Further research is required to elucidate the potential impact of SH2B3 variants in patients with JAK2-negative erythrocytosis.