Mexico Health Sciences Center Research Articles

Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol

IntroductionSevere inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality,...

Key conditions for the successful implementation of evidence-based practice in concurrent disorder nursing care with the ECHO® model: Insights from a mixed-methods study

BackgroundPeople with concurrent mental health and substance use disorders have complex biopsychosocial problems but risk not having their healthcare needs met. Nurses are positioned to meet these needs but often lack training in concurrent disorder management. Extension for Community Healthcare Outcomes (ECHO®, University of New Mexico Health Sciences Center, 2003) is a promising technology-enabled collaborative learning model used to implement evidence-based practice and build capacity among healthcare professionals in managing complex, chronic, health conditions. ObjectiveTo understand how an ECHO program for concurrent disorder management impacts nurses’ competency development and clinical practice and uncover key conditions for successful uptake and implementation. DesignA convergent mixed-methods design comprising a quantitative, uncontrolled before-and-after study and a qualitative study using interpretive description methodology. Setting and participantsAn ECHO program for concurrent disorder management was implemented in 2018 at a quaternary academic hospital centre in metropolitan Western Canada. All 65 nurses who registered in the program between 2018 and 2020 were invited to participate in the study. MethodsOnline surveys completed by the participating nurses (N = 28) were administered at baseline and six and 12 months following entry-to-program to measure changes in nurse-related outcomes. The survey data were analyzed using descriptive statistics and repeated measures analysis. Semi-structured interviews were conducted with a nurse subgroup (n = 10) to explore how they developed and implemented competencies and what factors influenced this process. Interview transcripts were analyzed using inductive thematic analysis. Using the Pillar Integration Process, we analyzed results from both methods to provide a richer understanding of the phenomena. ResultsWe identified six interrelated key conditions for successful uptake and implementation of evidence-based practice in concurrent disorder nursing care with ECHO: (1) Practice and validation opportunities; (2) Reciprocal and trusting relationships in an interprofessional education context; (3) Peer-to-peer experience sharing; (4) Collaboration with experts; (5) Reinforcement of positive attitudes towards one's professional role; and (6) Organizational support. ConclusionsOutcome measures, perspectives, and experiences collected over 12 months indicated that ECHO contributed to nurses’ competency development and, under some conditions, to effective nursing practice changes. Given the challenges in implementing clinical guidelines in concurrent disorder nursing care, our results highlight the importance of understanding the key conditions for successful uptake and implementation. This informs approaches to optimally adapt implementation strategies to the needs and specificities of nurses to obtain impactful and sustainable results.

Clear the Floor: One Library’s Approach to the Removal and Integration of Items from Two Print Journal Collections

Due to the desire for more student space at the University of New Mexico Health Sciences Center, the Health Sciences Library and Informatics Center reviewed its serial holdings both in the library and in its offsite storage facility and determined which titles to retain and discard. This paper will briefly describe the selection process and then discuss the methods and phases of the project used to discard material in two shelving locations including auctioning material, donating material to another library, removing unselected material, and repurposing material for a decorative noise-abatement wall. This paper will also discuss the process of integrating items selected for retention from two shelving locations in separate buildings into one shelving location. The author will share the lessons learned throughout the project.

The value of adult relationships in preventing youth suicide attempts

The value of adult relationships in preventing youth suicide attempts Suicide is the third leading killer of teens in the U.S., after unintentional injury (including drug overdose) and homicide, and suicide death rates have increased in this age group relatively steadily for 20 years (1). In 2019, the Center for Disease Control and Prevention's (CDC) biennial Youth Risk Behavior Survey (YRBS) indicated that in the previous year, suicide was attempted by 8.9% of high school (HS) students. However, the percentage varied widely by race and ethnicity: American Indian or Alaska Native (AI/AN) 25.5%; Asian 7.7%; Black or African American (AfAmer) 11.8%; Hispanic or Latino (Hisp) 8.9%, White 7.9%, and multiple races 12.9% (2). Here Associate Professor Lynne Fullerton, PhD, University of New Mexico Health Sciences Center, examines the results of a recent study exploring the link between positive adult relationships and the impact on youth suicide attempt resilience.

121-LB: Prescribing Patterns of Sodium–Glucose Cotransporter 2 Inhibitors in Patients with Heart Failure With or Without Type 2 Diabetes

The goal of heart failure (HF) pharmacotherapy is to improve disease-related morbidity and mortality. Recent clinical trials demonstrated a reduction in cardiovascular death and HF-related hospitalizations with the addition of sodium glucose co-transporter 2 inhibitors (SGLT2i) in patients with HF with reduced ejection fraction (HFrEF) , as well as HF with preserved ejection fraction (HFpEF) with or without type 2 diabetes (T2D) . The objective of this study was to identify SGLT2i prescribing rates in these patients and to identify predictors of drug class utilization. The University of New Mexico (UNM) Health Sciences Center IRB approved this retrospective, single-center, descriptive study. Individuals ≥ 18 years with a diagnosis of HF, an eGFR of ≥ 20 ml/min/1.73m2, and a visit to the UNM Hospital system between August 17, 2020 to August 16, 2021 were included. Patients were excluded if they were diagnosed with type 1 diabetes or had no documented EF in their patient chart. A total of 2,905 patients with HF were identified, of which 1,101 were randomly reviewed. After exclusion, the study sample included: 377 with HFrEF, 335 with HFpEF, and 88 with HF with mid-range ejection fraction. The mean age was 65 years; 60% were female; 76% were white; 47% were Hispanic; and 49% had established atherosclerotic cardiovascular disease. Overall, 42% (n = 339) had T2D with a mean A1C of 8.0%. SGLT2is were prescribed in 6.5% of patients overall, 14.7% of patients with T2D, and 0.4% of patients without T2D. Predictors of SGLT2i prescribing were: T2D (OR = 38.4; 95% CI, 8.9 - 165.58) , HFrEF (OR = 3.7; 95% CI, 1.79 - 7.47) , having a cardiology provider (OR = 2.2; 95% CI, 1.79 - 7.47) , being seen by a pharmacist with prescriptive authority (OR = 4.1; 95% CI, 2.01 - 8.26) , and enrollment in UNM’s patient assistance program (OR = 2.3; 95% CI, 1.08 - 4.97) . Despite guideline recommendations, SGLT2is are underutilized in patients with HF with or without T2D. Future studies are needed to determine the barriers to utilization. Disclosure S. R. Bermudez: None. J. R. Anderson: None. G. Ray: None.

The PARP inhibitor ABT-888 impairs the suppressive capacity of regulatory T cells through modulation of FoxP3 and CTLA-4.

Abstract Immune checkpoint blockade (ICB) has achieved long-term survival in melanoma but results remain limited in other solid malignancies including ovarian cancer. Combination treatments are a promising strategy to optimize responses to ICB. We have previously shown that the PARP inhibitor (PARPi) ABT-888 synergizes with CTLA-4 ICB to achieve long-term survival in a preclinical model of ovarian cancer. While the role of PARPi on DNA repair is well established, the impact on T cells is unclear. Published data using PARP1-KO mice suggests that PARP impairs regulatory T cell (Treg) function through modulation of FoxP3. Tregs suppress conventional T cell responses using multiple mechanisms including consumption of co-stimulatory molecules via the inhibitory receptor CTLA-4. Here we sought to define the impact of ABT-888 on the suppressive function of Tregs using FoxP3-eGFP transgenic mice. Using flow cytometry, we examined the levels of FoxP3 and CTLA-4 in Tregs stimulated in the presence of increasing doses of ABT-888 (0 – 50μM). Independent of stimulation, the GMFI of FoxP3 and CTLA-4 were significantly reduced by ABT-888 in a dose-dependent manner (P < 0.05). To test suppressive function, we pre-treated Tregs with increasing doses of ABT-888 prior to use in a standard proliferation assay. Similarly, ABT-888 pre-treatment significantly reduced the suppressive capacity of Tregs in a dose-dependent manner (P < 0.05). Taken together, these data identify a potentially novel area of synergy between PARPi and ICB. Furthermore, these data highlight the immunomodulatory effects of PARPi which are independent of their role in DNA repair. Future studies will focus on the impact of ABT-888 on tumor-associated Tregs and optimization of ICB therapy. This research was supported by NCI R37CA229221 (PI: Adams) and UNM Comprehensive Cancer Center Support Grant NCI P30CA11810. D.F. was supported by the Academic Science Education and Research Training program at the University of New Mexico Health Sciences Center (NIGMS Institutional Research and Academic Career Development Award; K12-GM088021).

Police-reported pedestrian crash matching and injury severity misclassification by body region in New Mexico, USA

Between 2009 and 2019, pedestrian fatalities in the U.S. increased 51.0% while all other traffic fatalities increased 0.4%. To mitigate pedestrian safety issues, practitioners increasingly use police-reported data to identify and treat locations that experience either serious or fatal injuries. We investigated how many and which types of pedestrian injuries were misclassified by police-reported data in New Mexico between 2014 and 2018 by matching pedestrian-vehicle crash victims reported in New Mexico Department of Transportation (NMDOT) crash data to patients treated at University of New Mexico Health-Science Center, an American College of Surgeons-certified level 1 trauma center (n = 3097 pedestrians in NMDOT data; n = 512 matched pedestrians). Findings suggest that injuries involving older pedestrians, males, alcohol, more serious injuries, and those that occur at night are more likely to match to the hospital data. Of the non-fatally injured pedestrians who police estimated as seriously-injured (n = 207), 21.7% were no more than minorly-injured (n = 45) (KABCO A and ISS < 9). Of pedestrians who police estimated as minorly-injured (n = 239), 55.6% were seriously-injured (n = 133) (KABCO B,C,O and ISS ≥ 9). Of pedestrians with true serious injuries (n = 295) (ISS ≥ 9), 45.1% were under-estimated by police (n = 133) (KABCO B,C,O and ISS ≥ 9) whereas 29.8% of pedestrians with true minor injuries (n = 151) (ISS < 9) were over-estimated by police (n = 45) (KABCO A and ISS < 9). Minorly-injured pedestrians who were over-estimated by police (KABCO A and ISS < 9) were more likely to have lower extremity injuries (62.2% vs 42.5%, p-value = 0.013) compared to minorly-injured pedestrians whose injury severities were estimated correctly (KABCO B,C,O and ISS < 9). Seriously-injured pedestrians who were under-estimated (KABCO B,C,O and ISS ≥ 9) were less likely to have injuries to the head (39.8% vs. 55.6%, p-value = 0.003), spine (30.1% vs. 50.0%, p-value < 0.001), thorax (53.4% vs. 66.7%, p-value = 0.0139), or abdomen (18.8% vs. 32.1%, p-value = 0.005) compared to seriously-injured pedestrians whose injury severities were estimated correctly (KABCO A and ISS ≥ 9). This research illustrates the importance of linking police and health outcome databases to provide a more complete understanding of traffic safety.

Infectious Titres of Human Papillomaviruses (HPVs) in Patient Lesions, Methodological Considerations in Evaluating HPV Infectivity and Implications for the Efficacy of High-Level Disinfectants

Background: Recent publications from a single research group have suggested that aldehyde-based high-level disinfectants (HLDs), such as ortho-phthalaldehyde (OPA), are not effective at inactivating HPVs and that therefore, patients may be at risk of HPV infection from medical devices. These results could have significant public health consequences and therefore necessitated evaluation of their reproducibility and clinical relevance. Methods: We developed methods and used standardised controls to: (1) quantify the infectious levels of clinically-sourced HPVs from patient lesions and compare them to laboratory-derived HPVs, (2) evaluate experimental factors that should be controlled to ensure consistent and reproducible infectivity measurements of different HPV genotypes, and (3) determine the efficacy of select HLDs. Findings: A novel focus forming unit (FFU) infectivity assay demonstrated that exfoliates from patient anogenital lesions and respiratory papillomas yielded infectious HPV burdens up to 2·7x103 FFU; therefore, using 2·2x102 to 1·0x104 FFU of laboratory-derived HPVs in disinfection assays provides a relevant range for clinical exposures. RNase and neutralising antibody sensitivities were used to ensure valid infectivity measures of tissue-derived and recombinant HPV preparations. HPV infectivity was demonstrated over a dynamic range of 4 to 5 log10; and disinfection with OPA and hypochlorite was achieved over 3 to >4 log10 with multiple genotypes of tissue-derived and recombinant HPV isolates. Interpretation: This work, along with a companion publication from an independent lab in this issue, address a major public health question by showing that HPVs are susceptible to HLDs. Funding: Advanced Sterilization Products; US NIH (R01CA207368, U19AI084081, P30CA118100). Declaration of Interests: M.A.O. reports grants, personal fees and non-financial support from Advanced Sterilization Products, grants from U.S. National Institutes of Health, during the conduct of the study; In addition, Dr. Ozbun has a patent “Quantitative Methods for Assessing Papillomavirus Infections” pending. A.G.W. reports personal fees and non-financial support from ASCCP, non-financial support from ACOG, non-financial support from Loktal Medical Electronics, personal fees and non-financial support from CSCCP (Chinese Society for colposcopy and cervical pathology, personal fees and non- financial support from Henan People's Regional Hospital, personal fees from SouthCentral Foundation (Alaska Native Corp), non-financial support from FECOLSOG (Colombian colposcopy society), non- financial support from COMEGIC (Mexican colposcopy society), non-financial support from Doctors Hospital at Renaissance, non-financial support from MD Anderson, non-financial support from Univ Texas Rio Grande Valley, non-financial support from Global Coalition against Cervical Cancer, non-financial support from AIDS Malignancy Consortium, personal fees and non-financial support from Deaconess Beth Israel Hospital, personal fees and non-financial support from Texas Tech University, personal fees and non-financial support from ABPTGIC (Brazilian colposcopy society), outside the submitted work. V.B., N.A.P, R.T.S., E.C.B. and R.M. have nothing to disclose. A.S., J.Y. and M.R. are employees of Advanced Sterilization Products. G.E. is an employee and shareholder of Johnson & Johnson, which was the parent company for Advanced Sterilization Products and Janssen Pharmaceutica NV at the time the research was conducted. Ethics Approval Statement: The collection of clinical material used in this study complied with the Helsinki Declaration of 1975, as revised in 1983 and described previously and was approved by the University of New Mexico Health Sciences Center’s Human Research Protections Office (UNM HRPO #17-202 IRB Approved Protocol).

Behind the Mask: An Exploratory Assessment of Female Surgeons' Experiences of Gender Bias.

Though overt sexism is decreasing, women now experience subtle, often unconscious, gender bias as microaggressions. The authors sought to explore the prevalence and impact of the sexist microaggressions female surgeons experience, using a sequential exploratory mixed methods approach (January 2018-April 2018), to identify opportunities for education and prevention. First, all resident, fellow, and attending female surgeons at the University of New Mexico Health Sciences Center (UNM HSC) were invited to participate in focus groups conducted by experienced moderators using a semistructured interview guide based on the 7 Sexist Microaggressions Experiences and Stress Scale (Sexist MESS) domains. Qualitative analysis was performed using line-by-line manual coding to identify themes aligned with the Sexist MESS domains as well as other gender bias experiences of female surgeons. Next, a survey was sent to all resident, fellow, and attending female surgeons at the UNM HSC, which included the Sexist MESS questionnaire and questions related to surgeon-specific experiences of gender bias that the authors developed based on major thematic categories from the focus groups.Four focus groups of 23 female surgeons were conducted, revealing 4 themes: exclusion, increased effort, adaptation, and resilience to workplace slights. The survey response rate was 64% (65/101 surgeons). Across Sexist MESS domains, the frequency and severity of microaggressions was higher for trainees than attendings. The variables of non-White race/ethnicity, having children under 18, and fellowship training generally did not demonstrate statistical significance. This exploratory study adds to the growing body of evidence that gender bias in surgery continues and frequently manifests as microaggressions. Trainees reported the highest rates and severity of microaggressions and bias experiences. Further research should investigate how to address microaggressions, the experiences of male surgeons, the perspectives of medical students and groups who were reported as often perpetuating gender bias, and the efficacy of possible interventions.

The COVID-19 pandemic: broad partnerships for the rapid scale up of innovative virtual approaches for capacity building and credible information dissemination in Africa.

The Corona Virus Disease 2019 (COVID-19) pandemic has rapidly spread in Africa, with a total of 474,592 confirmed cases by 11th July 2020. Consequently, all policy makers and health workers urgently need to be trained and to access the most credible information to contain and mitigate its impact. While the need for rapid training and information dissemination has increased, most of Africa is implementing public health social and physical distancing measures. Responding to this context requires broad partnerships and innovative virtual approaches to disseminate new insights, share best practices, and create networked communities of practice for all teach, and all learn. The World Health Organization (WHO)-Africa region, in collaboration with the Extension for Community Health Outcome (ECHO) Institute at the University of New Mexico Health Sciences Center (UNM HSC), the West Africa college of nurses and the East Central and Southern Africa college of physicians, private professional associations, academia and other partners has embarked on a virtual training programme to support the containment of COVID-19. Between 1st April 2020 and 10th July 2020, about 7,500 diverse health professionals from 172 locations in 58 countries were trained in 15 sessions. Participants were from diverse institutions including: central ministries of health, WHO country offices, provincial and district hospitals and private medical practitioners. A range of critical COVID-19 preparedness and response interventions have been reviewed and discussed. There is a high demand for credible information from credible sources about COVID-19. To mitigate the “epidemic of misinformation” partnerships for virtual trainings and information dissemination leveraging existing learning platforms and networks across Africa will augment preparedness and response to COVID-19.

Use of erector spinae fascial plane blocks in open pancreatic surgery

Presenter: Hannah Wilcox | University of New Mexico Health Sciences Center Background: Bilateral erector spinae fascial plane blocks (ESPB) are a novel method of regional analgesia. The use of ESPB in abdominal surgery has sparked interest as an adjunct to opioid-sparing post-operative pain regimens. In this study, we describe our initial experience of ESPB in open pancreatectomy procedures. Methods: A retrospective analysis of a prospectively-maintained database was performed of all patients from August 2018 to March 2019 who received bilateral-ESPB for post-operative pain control after open pancreatectomy. Ultrasound-guided ESPB at the T7 or T8 level was performed in a cranial to caudal direction with infiltration of liposomal bupivacaine. Patient demographics, intraoperative and postoperative factors, including quality end points and intravenous morphine milligram equivalent (MME) requirements, were examined. Results: Twenty-nine patients met inclusion criteria, including 21 pancreaticoduodenectomy and 8 distal pancreatectomy patients. All incisions were via midline laparotomy. Diagnosis in 15 patients (52%) was ductal adenocarcinoma. Mean patient age was 66 years, and 48% were male (n=14). Average patient BMI was 28.7. Mean anesthesia preparation time was 82 minutes. Return of bowel function was a mean of 3.5 days post-operatively and urinary catheter removal was 1.8 days. Median hospital length of stay was 6.5 days. Seven patients were readmitted within 30 days of surgery (24%) and there were no deaths. Ten patients (34%) had complications within 30 days of surgery which included 3 superficial site infections, 2 organ space infections, 1 patient with atrial fibrillation, 1 patient with bleeding and 3 other causes. There were no recorded adverse events related to the ESPB procedure. No patients required rescue thoracic epidural catheter placement or intravenous patient controlled analgesia (PCA). Mean MME for first 72 hours after surgery was 40 mEq and 82 mEq for the entire inpatient stay. Nine patients received a mean of 18 mEq of opioid medications in the first 24 hours after surgery, followed by no further opioids. Three patients did not require any opioids after surgery. Conclusion: ESPB presents an effective and safe mode of regional analgesia in patients undergoing open pancreatectomy and shows promise as a key element in opioid-sparing post-operative pain regimens. The expanded role of ESPB in major abdominal surgery warrants further investigation.

Hypothyroidism, Sex, and Age Predict Future Thromboembolic Events Among Younger People.

Aberrant thyroid function causes dysregulated metabolic homeostasis. Literature has demonstrated hypercoagulability in hypothyroidism, suggesting a risk for thromboembolic events (TEE). We hypothesize that individuals with hypothyroidism will experience more clinically-diagnosed TEE than euthyroid individuals. De-identified patient data from the University of New Mexico Health Sciences Center were retrieved using thyrotropin (TSH; thyroid-stimulating hormone) for case-finding from 2005 to 2007 and ICD billing codes to identify TEE during the follow-up period of 10 to 12 years. Diagnoses affecting coagulation were excluded and 12 109 unique enrollees were categorized according to TSH concentration as Hyperthyroid (n = 510), Euthyroid (n = 9867), Subclinical Hypothyroid (n = 1405), or Overtly Hypothyroid (n = 327). Analysis with multiple logistic regression provided the odds of TEE while adjusting for covariates. There were 228 TEEs in the cohort over 5.1 ± 4.3 years of follow-up. Risk of TEE varied significantly across study groups while adjusting for sex, race/ethnicity, levothyroxine, oral contraceptive therapy, and visit status (outpatient vs non-outpatient), and this risk was modified by age. Overt Hypothyroidism conferred a significantly higher risk of TEE than Euthyroidism below age 35, and Hyperthyroidism conferred an increased risk for TEE at age 20. Analysis also demonstrated a higher age-controlled risk for a subsequent TEE in men compared with women (odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.02-1.81). Subanalysis of smoking status (n = 5068, 86 TEE) demonstrated that smokers have 2.21-fold higher odds of TEE relative to nonsmokers (95% CI, 1.41-3.45). In this retrospective cohort study, Overt Hypothyroidism conferred increased risk of TEE over the next decade for individuals younger than 35 years of age, as compared with Euthyroidism.

Effectiveness of a Faculty Mentor Development Program for Scholarship at an Academic Health Center.

Mentors are in short supply at academic health centers (AHCs). The effectiveness of training mentors (without preselection for their research skills) to support faculty mentees in scholarly activities at AHCs is not well known. The University of New Mexico Health Sciences Center has a two-component program to develop effective mentors for scholarship for faculty mentees. It has an online component supplemented by an optional face-to-face (F2F) component. Study outcomes included changes in self-reported knowledge scores for online users and Mentoring Competency Assessment scores for F2F users. One hundred five mentors, mostly women associate professors, used the online program. Online users demonstrated improvement in self-reported knowledge scores. Thirty-eight users additionally completed the F2F program-63% on a clinician-educator track and none with a National Institutes of Health-funded K-award mentee. The self-reported Mentoring Competency Assessment composite score rose from 4.3 ± 1.0 to 5.5 ± 0.8 (paired t = 7.37, df = 37, P < .001) for the F2F participants, with similar improvement noted in the clinician-educator subgroup. Users of the online and F2F components of the program improved their self-assessed knowledge and mentoring skill, respectively, demonstrating the effectiveness of the program. Such programs may help AHCs enhance the scholarship and the diversity of their scientific and clinician-educator workforce.

MON-190 Endo ECHO Improves Patient-Reported Measures of Access to Care, Health Care Quality, Self-Care Behaviors, and Overall Quality of Life for Patients with Complex Diabetes in Medically Underserved Areas of New Mexico

Background Individuals living with complex diabetes experience limited access to endocrine care due to a nationwide shortage of endocrinologists. Project ECHO (Extension for Community Healthcare Outcomes) is an innovative, scalable model of health care that extends specialty care to medically underserved areas through ongoing telementorship of community primary care providers (PCPs). The purpose of this study was to assess whether participation in the first iteration of the Endocrine ECHO (Endo ECHO) program resulted in changes to patient well-being, health behaviors and quality of care. Methods PCPs from 10 federally qualified health centers in NM participated in Endo ECHO, facilitated by a team of specialists at the University of New Mexico Health Sciences Center. Endo ECHO patients were eligible for the study if they were 18 years or older with “complex” diabetes: type 1 diabetes or type 2 diabetes and insulin dependent, and/or with an HbA1c of 9% or higher. Patients took a comprehensive survey during enrollment and again after one year. The Diabetes Comprehensive Care Clinic (DCCC) at UNM was included as a means of benchmarking specialized diabetes care, and a sample of DCCC patients completed surveys during the post-test time frame. We assessed ECHO patients for pre/post change using McNemar’s tests for paired data and then compared intervention group post-test scores to the DCCC patient scores. Results Five hundred thirty-three ECHO patients and completed pre and post surveys (62% response rate) and 139 DCCC patients completed surveys during the post survey period. At follow-up, 42% of ECHO patients reported their health status as excellent, very good or good at compared to 30% before program participation (p<0.0001), and 43% reported five or more days of physical activity per week, compared to 29% at baseline (p<0.0001). Endo ECHO patients reported more frequent provider-initiated tests for A1C (81% to 91%; p<0.0001), foot examinations (68% to 87%; p<0.0001), and eye exams (63% to 69%; p=0.0266), and 84% of patients felt confident in managing their blood sugar levels at follow-up compared to 62% at baseline (p<0.0001). Although Endo ECHO patients exhibited statistically significant improvements across all key measures at follow-up, they lagged behind DCCC patients in some areas, including positive health status (42% Endo ECHO post vs 68% DCCC), daily physical activity (43% ECHO post vs 50% DCCC) and daily blood sugar testing (70% ECHO post vs. 83% DCCC). Conclusions Endo ECHO appears to be effective means of improving the health and quality of life for patients with complex diabetes, although opportunities exist to further improve care as compared to care delivered at a university based specialty clinic. Endo ECHO may be a suitable alternative for patients in medically underserved communities where access to an endocrinology referral center is restricted.

Project ECHO: Telehealth to Expand Capacity to Deliver Best Practice Medical Care.

Project ECHO (Extension for Community Healthcare Outcomes) was developed at the University of New Mexico Health Sciences Center to educate health care professionals in underserved communities to treat chronic complex diseases, allowing patients to receive better care, closer to home, with greater convenience, and at lower cost than referral to a specialty center. Videoconferencing technology is used to create learning networks, with case-based discussions as the primary method of education. The 3-year experience of Bone Health TeleECHO, a strategy to improve the care of osteoporosis and reduce the large treatment gap, is discussed.

An Introduction to Economic Analysis of Food Security and Nutrition Interventions

Thorough, well-documented economic analyses can make an important contribution to the evidence base on what works, and at what cost, in improving food security and nutrition in varying contexts and circumstances. Some nutrition and food security intervention studies have explicitly incorporated economic analyses into their evaluations. Examples include evaluations of interventions to address micronutrient deficiencies in low- and middle-income countries and behavior change programs aimed at diet modifications as summarized in two review articles, 1 Fattore G. Ferrè F. Meregaglia M. Fattore E. Agostoni C. Critical review of economic evaluation studies of interventions promoting low-fat diets. Nutr Rev. 2014; 72: 691-706 Crossref PubMed Scopus (8) Google Scholar , 2 Gyles C.L. Lenoir-Wijnkoop I. Carlberg J.G. et al. Health economics and nutrition: A review of published evidence. Nutr Rev. 2012; 70: 693-708 Crossref PubMed Scopus (34) Google Scholar school meal programs, 3 Woodward-Lopez G. Kao J. Kiesel K. et al. Is scratch-cooking a cost-effective way to prepare healthy school meals with us department of agriculture foods?. J Acad Nutr Diet. 2014; 114: 1349-1358 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar school-based nutrition education, 4 Graziose M.M. Koch P.A. Wang Y.C. Lee Gray H. Contento I.R. Cost-effectiveness of a nutrition education curriculum intervention in elementary schools. J Nutr Educ Behav. 2017; 49 (e681): 684-691 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar the Expanded Food and Nutrition Education Program, 5 Baral R. Davis G.C. Blake S. You W. Serrano E. Using national data to estimate average cost effectiveness of EFNEP outcomes by state/territory. J Nutr Educ Behav. 2013; 45: 183-187 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar , 6 Serrano E. McFerren M. Lambur M. et al. Cost-effectiveness model for youth EFNEP programs: What do we measure and how do we do it?. J Nutr Educ Behav. 2011; 43: 295-302 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar and a hypothetical US sugar-sweetened beverage tax. 7 Long M.W. Gortmaker S.L. Ward Z.J. et al. Cost effectiveness of a sugar-sweetened beverage excise tax in the U.S. Am J Prev Med. 2015; 49: 112-123 Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar K. P. Adams is an assistant project scientist, Department of Nutrition, University of California, Davis. J. A. Lee is an Altarum fellow, Altarum, Ann Arbor, MI. E. Piltch is a Hunger Free Communities Study Coordinator, Academy of Nutrition and Dietetics Foundation, Chicago, IL. E. Y. Jimenez is director, Nutrition Research Network, Academy of Nutrition and Dietetics, Chicago, IL, and research associate professor, Departments of Pediatrics and Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque.

173. Brief Overdose Prevention Training For Adolescents Released From Juvenile Detention

The purpose of the study was to evaluate the feasibility of providing naloxone and brief overdose prevention and harm reduction educational training to a high-risk population of teens in juvenile detention. We sought to evaluate rates of increased knowledge, confidence, and readiness regarding overdose prevention training with detained youth who report contact with opioid users. Training satisfaction was evaluated using qualitative measures. Residents at the Bernalillo County Youth Services Center (YSC), the juvenile detention center in Albuquerque, NM, were screened at the YSC medical clinic for exposure to opioid users and risk of witnessing an opioid overdose in their lives outside of YSC. The project was reviewed and approved by University of New Mexico Health Sciences Center IRB. Interested participants were enrolled and consented to participate in the study during the clinic visit. Participants completed a baseline assessment measuring demographic characteristics and knowledge and attitudes regarding Narcan and overdose prevention. Participants attended a one-on-one, patient centered training on recognizing an opioid overdose and conducting rescue procedures utilizing Narcan, a nasal spray delivery method of naloxone. Participants completed post-training measures of Narcan and overdose prevention knowledge and attitudes as well as measures of training satisfaction. The participants were then provided with a Narcan kit upon discharge from the YSC. Each Narcan kit contains two doses. Pre-post scores were compared using paired-sample t-tests and standardized effect sizes (Cohen’s d) were calculated to quantify the magnitude of change. 65% of the residents screened were eligible. Of those eligible, 100% agreed to participate. 30% were lost prior to baseline assessment because of release from YSC. Baseline knowledge of Narcan and overdose prevention was 6.3/10 on average (SD=1.2). Confidence in Narcan and overdose prevention was 6.7/10 (SD=2.7) and readiness to use Narcan was 6.4/10 (SD=3.9). After training, knowledge (7.7/10; SD=.5), confidence (7.9/10; SD= 1.8), and readiness (8.9/10; SD=1.3) all increased. All changes were statistically significant (p<.05). Standardized effect sizes were all in the moderate to large range (knowledge, d = 1.6, confidence, d=.5, readiness, d=.86). Satisfaction with the training was high. Qualitative assessment of satisfaction revealed several themes, including: general enthusiasm about the training; feelings of personal empowerment from having knowledge and ability to use Narcan; and desire to disseminate the information to friends and family on overdose prevention techniques and Narcan uses. Results suggest that implementation of Narcan and overdose prevention training with at-risk detention center teens is feasible and promising. Teens report high satisfaction and accurate recall of the training information. Feelings of confidence and readiness to use Narcan increased with the training. Potential is high for overdose prevention trainings to empower at-risk youth to save lives within communities. Future research will investigate the impact of Narcan and overdose prevention training on rates of actual overdose prevention in the community.

Interactive Case-based Postgraduate Medical Education with Bone Health TeleECHO

Background Bone Health TeleECHO is a non-profit collaborative medical educational project developed at ECHO Institute at the University of New Mexico Health Sciences Center in association with the Osteoporosis Foundation of New Mexico. It uses videoconferencing technology to link healthcare professionals interested in achieving an advanced level of knowledge about the evaluation and treatment of osteoporosis and metabolic bone diseases. Weekly online sessions have been held since October 2015. Participants use videoconferencing technology with a computer or smartphone for discussion of real de-identified patient cases, with brief didactic presentations on topics of interest. Bone Health TeleECHO has been shown to improve self-confidence of healthcare professionals treating patients with osteoporosis. The ECHO model of learning aims to improve the care of patients with osteoporosis and reduce the osteoporosis treatment gap. Methods Online registration captures the demographics of Bone Health TeleECHO participants. Attendance is tracked for each session. Electronic queries record anticipated changes in the clinical practice. A self-efficacy assessment questionnaire retrospectively evaluated the effect of the intervention on confidence in managing patients with osteoporosis. Results During the first 24 months of weekly Bone Health TeleECHO, 224 individuals attended at least 1 online session. Of those who attended at least once, 115 (51.3%) were classified as physicians (MD, DO, DC), 53 (23.7%), advanced practice providers (PA, CNP, RN, CNM), 43 (19.2%), other (PT, OT, PhD), and 13 (5.8%) unknown. Number of Bone Health TeleECHO clinics attended ranged from 1 to 79, with a mean of 10.2. There were 36 learners (excluding faculty) who attended more than 20 TeleECHO clinics and 29 who attended more than 30. Attendees were located in 37 US states plus 8 other countries. Two additional TeleECHO programs devoted to skeletal health, based in Michigan and Washington, DC, were established in 2017. Summary Bone Health TeleECHO educates healthcare professionals to provide better care, closer to home, with greater convenience, and lower cost than referral to a specialty center. It relieves professional isolation that may occur in urban as well as rural settings. Bone Health TeleECHO can be scaled to any level through replication in other US states and other countries.

A Comprehensive Approach to Community Recruitment for Clinical and Translational Research.

Recruitment and engagement for clinical and translational research is challenging, especially among medically underserved and ethnic or racial minority populations. We present a comprehensive model developed through the Clinical and Translational Science Center at the University of New Mexico Health Sciences Center that addresses three critical aspects of participant recruitment. The components of the model are: 1) Recruitment from within UNM to UNM-centered studies, 2) recruitment from within UNM to community-based studies, and 3) recruitment from outside UNM to UNM-centered studies. This model has increased research participant recruitment, especially among medically underserved populations, and offers generalizable translational solutions to common clinical and translational research challenges, especially in settings with similar demographic and geographic characteristics.

Host-Pathogen-Treatment Triad: Host Factors Matter Most in Methicillin-Resistant Staphylococcus aureus Bacteremia Outcomes.

ABSTRACTPrevious studies have separately emphasized the importance of host, pathogen, and treatment characteristics in determining short-term or in-hospital mortality rates for patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections. Less is known about the relative importance of these factors and their interactions in determining short-, medium-, and long-term mortality rates. This is an observational cohort study in which data for all patients admitted to the University of New Mexico (UNM) Health Sciences Center (HSC) between July 2002 and August 2013 with MRSA-positive blood cultures were recorded. We collected patients' demographics and treatment data, as well as data on genetic markers of the MRSA isolates. Outcomes of interest were determinants of short-term (within 30 days), medium-term (30 to 90 days), and long-term (>90 days) mortality rates. This study included 273 patients with MRSA bacteremia. Short-, medium-, and long-term mortality rates were 18.7%, 26.4%, and 48%, respectively. Thirty-day mortality rates were influenced by host variables and host-pathogen interaction characteristics. Pitt bacteremia scores, malignancy, and health care exposure contributed to 30- to 90-day mortality rates, while treatment duration of >4 weeks had a protective effect. Age remained a significant risk factor for death at >90 days, while admission leukocytosis was protective. Infection represented the most frequent cause of death for all three time frames; rates varied from 72.6% in the first 30 days and 60% for 30 to 90 days to 35.7% for >90 days (P = 0.003). Host characteristics affect short-, medium-, and long-term mortality rates for MRSA bloodstream infections more than do pathogen genetic markers and treatment factors.