Tech University Health Sciences Center Research Articles

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).

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.

1837. Evaluation of Disparities in Beta-Lactam Allergies and Subsequent Antibiotic Use in Outpatients with Acute Bacterial Skin and Skin Structure Infections

Abstract Background Black patients with skin and soft tissue infections are more likely to have a documented penicillin allergy and use of non-beta-lactams than white patients. We sought to compare the prevalence and risk factors for documented beta-lactam allergy (D-BLA) among racial and ethnic minorities (REM) and white patients and beta-lactam (BL) use for outpatient Acute Bacterial Skin and Skin Structure Infections (ABSSSIs). Methods We conducted a cohort study of adult outpatients (18-90 years) seen by the Texas Tech University Health Science Center Physicians group (2012-2021). All patients had an ICD-9 or ICD-10 code for an ABSSSI in the primary or secondary position. Descriptive statistics were reported. Logistic regression models were used to determine which factors were statistically associated with D-BLA and which factors were associated with BL use for the ABSSSI. Multivariable (MV) analysis results were reported as odds ratios (OR) and 95% confidence intervals (95%CI). All analyses were conducted in R. Results REM represented 38% of the 21,673 patients in the cohort. A D-BLA was present for 18% percent of all patients and was higher in white patients than REM (22 vs 13%). Factors associated with D-BLA on MV analysis of the total cohort were age (OR 1.01 per year, 95%CI 1.01-1.01), Medicaid (OR 1.18, 95%CI 1.04-1.34), or Medicare (OR 1.17, 95%CI 1.05-1.31). Factors associated with a lower likelihood of D-BLA on MV analysis of the entire cohort were REM (OR 0.55, 95%CI 0.51-0.60) and male sex (OR 0.56, 95%CI 0.52-0.60). Regarding BL use, white patients were less likely to receive a BL than REM (26 vs 30%). Factors associated with a reduced likelihood of BL use on MV analysis of the total cohort were D-BLA (OR 0.60, 95%CI, 0.54-0.67), Medicaid (OR 0.83, 95%CI 0.74-0.93), or Medicare (OR 0.64, 95%CI 0.58-0.70). Factors associated with BL use on MV analysis of the entire cohort were REM (OR 1.20, 95%CI 1.12-1.28), male sex (OR 1.45, 95%CI 1.36-1.54), or self-pay (OR 1.52, 95%CI 1.37-1.68). The interaction term between REM and D-BLA was not significant for BL use. Conclusion REM were at a reduced risk of a D-BLA in our cohort and were more likely to receive a BL for ABSSSIs. Payor status and sex also significantly impacted rates of D-BLA and BL use. Disclosures Ronald G. Hall, II, PharmD, MSCS, Merck: Grant/Research Support Carlos Alvarez, PharmD, MSc, MSCS, Boehringer Ingelheim: Grant/Research Support|Bristol Myer Squibb: Grant/Research Support|Merck: Grant/Research Support

Judge rules in favor of former medical resident

Case name: Corbett v. Texas Tech University Health Sciences Center, No. 5:21‐CV‐281 (N.D. Tex. 07/10/23).

Conditional knock out of cytosolic thioredoxin (Trx) in cardiomyocytes impairs cardiac function and exacerbates ischemia-reperfusion injury

Abstract Introduction Coronary heart disease with myocardial infarction (MI) is a leading cause of mortality in the world despite timely reperfusion of occluded coronary artery. Myocardial damage due to restoration of blood flow, known as reperfusion injury account for about 50% of final MI size. The role of Trx in protection against myocardial ischemia reperfusion has been reported; however, these studies were mostly performed using ex vivo isolated mouse/rat heart with retrograde perfusion or with injected rhTrx. However, the role of loss of Trx specifically in the myocytes using a conditional deletion has never been reported. Here, we determined whether loss of Trx in myocytes would promote ischemia-reperfusion injury, even if the endocardial endothelial cells express normal levels of Trx. Purpose We investigated the effect of specific deletion of Trx in cardiomyocytes on base-line cardiac function and cardiac function in ischemia-reperfusion of heart using conditional knockout of Trx (aMHC-Trx-KO) in the cardiomyocytes with normal levels of Trx in the endothelial cells to determine specifc contribution of Trx in cardiac function in I/R. Methods A Trx floxed mouse line was created with introduction of loxP sites flanking the mouse Trx gene. Further, the conditional deletion of Trx in cardiomyocytes was produced by breeding homozygous Trx-floxed (Trxfl/fl) mice with aMHC-Cre mice strain. The resulting aMHC-Trx-KO mice was identified by genotyping and conditional deletion of Trx in myocytes was achieved by injecting Tomoxifen (75mg/Kg in oil). The aMHC-Trx-KO mice were subjected to 30 minutes of ischemia by ligation of left descending coronary artery(LAD) and reperfusion was performed by release of slipknot and allowing blood flow of 60 minutes before sacrificing animals. The animal protocol was approved by the IACUC of the Texas Tech University Health Sciences Center, Lubbock. Echocardiography on animals was performed using Vevo 3100 (Visual Sonic). Statistical analysis was performed by Prism 8.0 (GraphPad). Results Deletion of Trx caused significant cardiac dysfunction in aMHC-Trx-KO mice compared to Trxfl/fl mice without treatment with tomoxifen. The ejection fraction (EF%, 52.82 vs. 73.83) and fractional shortening (FS%, 41.42 vs.25.89) were significantly reduced. Further, these mice subjected to I/R showed exacerbated cardiac dysfunction with significant decrease in heart rate and did not survive the reperfusion. We also found significant mitochondrial structural abnormalities and mitochondrial dysfunction in aMHC-Trx-KO mice compared to non-transgenic or Trxfl/fl mice without tomoxifen treatment. Conclusion Deletion of Trx in cardiomyocyte causes significant myocardial dysfunction. Further, Trx is required to protect against myocardial dysfunction in ischemia-reperfusion injury. Our data also suggest that cardiac mitochondria is specifically impacted by loss of Trx deletion.Figure-1

Court rules against medical resident

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

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).

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).

Editorial introductions.

Editorial introductions.

Editorial: from albuminuria to uric acid - emerging risk factors beyond lipids.

aDepartment of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA bDepartment of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, UK Correspondence to Debabrata Mukherjee, MD, FACC, Chairman, Department of Internal Medicine, Professor of Internal Medicine, Texas Tech University, 4800 Alberta Avenue, El Paso, TX 79905, USA. Tel: +1 (915) 215 5223; fax +1 (915) 215 8641; e-mail: [email protected]

From the Editors.

From the Editors.

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.

Navigating Cultural Diversity in the Selection of Cardiovascular Device Treatments: A Comprehensive Review.

In cardiology, patients' cultural beliefs, linguistic differences, lack of knowledge, and socioeconomic status can create barriers to choosing device treatment. To address this issue, we conducted a thorough literature review using online databases such as PubMed, Google Scholar, and Texas Tech University Health Sciences Center's research portal. Our review found that cultural, religious, and linguistic barriers can contribute to patients' apprehension and reservations about device placement. These barriers can also impact patients' adherence to treatment and clinical outcomes. Patients from lower socioeconomic backgrounds may have difficulty accessing and affording device-based treatments. Additionally, fear and inadequate understanding of surgical procedures can deter patients from accepting device treatment in cardiology.To overcome these cultural barriers, healthcare providers must raise awareness about the benefits of device treatment and provide better training to overcome these challenges. It is crucial to address the unique needs of patients from different cultural backgrounds and socioeconomic statuses to ensure they receive the care they need.

Student performance and satisfaction in the first iteration of an integrated renal and respiratory systems course in a redesigned one-pass preclinical curriculum

Texas Tech University Health Sciences Center School of Medicine converted its legacy two-pass preclinical curriculum to a one-pass organ system-based format and changed the grading system from categorical to pass/fail (>70%). Our objective was to assess first-year medical student (MS1) performance and satisfaction in the first iteration of Organ Systems-2:Renal and Respiratory ( RNR), an 8-week block taught at the end of Year I. RNR integrates the physiology, pathophysiology, infectious diseases, and pharmacology of the renal system (Weeks 1-4) and respiratory system (Weeks 5-8), using reorganized and updated material from legacy Year-I blocks ( General Principles & Infectious Diseases and Structure & Function of Major Organ Systems) and Year-II blocks ( Immunity & Multisystem Disorders and Systems Disorders). Instruction was delivered via didactic lectures, team-based activities, case-based reviews, dry labs, cognitive integration of clinical reasoning (CICR) sessions, and simulations. Formative weekly quizzes and practice exams were assigned before each exam. Learning in the renal physiology, renal pathophysiology, and respiratory physiology units was assessed by instructor-generated exams at the end of Weeks 2, 4 and 6, respectively, and a final customized, comprehensive NBME exam at the end of Week 8. Aggregate performance on instructor-generated renal and respiratory exam questions was compared to that on similar questions from legacy curriculum exams. Aggregate performance on the NBME exam was compared to USMLE Step 1 exam difficulty, as the legacy curriculum did not include a dedicated renal/respiratory NBME exam. Aggregate performance on instructor-generated renal physiology and pathophysiology and respiratory physiology questions was comparable to that in the legacy curriculum. Average performance on the renal portion of the NBME exam was 0.76 vs. Step 1 exam difficulty of 0.78; average performance on the respiratory portion of the exam was 0.77 vs. Step 1 exam difficulty of 0.78. Per end of block survey and student focus group feedback, overall student satisfaction with RNR was 73%. Thus, the first iteration of the integrated organ systems-based renal and respiratory systems course in Year I yielded a MS1 performance on the NBME that was comparable to USMLE Step 1 source difficulty, and student satisfaction was positive overall. More detailed analysis of exam performance is needed. Further modifications of RNR will include additional simulations and flipped-classroom sessions. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Interprofessional Collaborative Practice: Management of Chronic Disease and Mental Health Issues in Primary Care.

This case study describes the process of implementing and evaluating an interprofessional collaborative practice (IPCP) program for primary care and behavioral health integration focused on chronic disease management. The result was a strong IPCP program in a nurse-led federally qualified health center serving medically underserved populations. The IPCP program at the Larry Combest Community Health and Wellness Center at the Texas Tech University Health Sciences Center spanned >10 years of planning, development, and implementation, supported by demonstration, grants, and cooperative grants from the Health Resources and Services Administration. The program launched 3 projects: a patient navigation program, an IPCP program for chronic disease management, and a program for primary care and behavioral health integration. We established 3 evaluation domains to track the outcomes of the program: TeamSTEPPS education outcomes (Team Strategies and Tools to Enhance Performance and Patient Safety), process/service measures, and patient clinical and behavioral measures. TeamSTEPPS outcomes were evaluated before and after training on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Mean (SD) scores increased significantly in team structure (4.2 [0.9] vs 4.7 [0.5]; P < .001), situation monitoring (4.2 [0.8] vs 4.6 [0.5]; P = .002), and communication (4.1 [0.8] vs 4.5 [0.5]; P = .001). From 2014 to 2020, the rate of depression screening and follow-up improved from 16% to 91%, and the hypertension control rate improved from 50% to 62%. Lessons learned include recognizing partner contributions and the worth of each team member. Our program evolved with the help of networks, champions, and collaborative partners. Program outcomes show the positive impact of a team-based IPCP model on health outcomes among medically underserved populations.

Charge capture in the BICU: Increasing revenue by improving documentation behaviors

Documentation by a healthcare provider is the key to capturing appropriate reimbursement for effort, expertize, and time given to patients. However, patient encounters are known to be under-coded; often describing a level of service that does not reflect the physician’s labor. If there is deficient medical decision making (MDM) documentation, this will ultimately lead to a loss of revenue, as coders can only evaluate service levels from the documentation during the encounter. Physicians at the Timothy J. Harnar Regional Burn Center at Texas Tech University Health Sciences Center were experiencing below-average reimbursement for work performed in the burn center and theorized that deficiencies in documentation (particularly in the area of MDM) were the cause. They hypothesized that poor documentation by physicians was resulting in a substantial proportion of encounters being compulsorily coded at inadequate and imprecise levels of service. To improve the service levels of MDM in physician documentation at the Burn Center and consequently, increase the numbers and levels of billable encounters in the unit with an accompanying increase in revenue, two resources were created and employed with the purpose of providing increased documentation recall and thoroughness. These resources included a pocket card, designed to prevent missed details when documenting patient encounters, and a standardized EMR template that was mandated to be used by all BICU medical professionals rotating through the unit. After completion of the intervention period (July - October 2021), a comparison was made between the 4-month periods of July-October 2019 and 2021. Based on the encounters provided by residents and one fellow assigned to the BICU medical director, inpatient subsequent visit codes showed an average increase in billable encounters of 1500% amid the compared periods. Upon implementation of the intervention, subsequent visit codes 99231, 99232, and 99233 (higher-numbered codes indicating an increased level of service and accompanying reimbursement) raised by 142%, 2158%, and 2200%, respectively. An additional finding since the implementation of the pocket card and revised template, billable encounters have replaced the once-dominate global encounter, 99024 (associated with no reimbursement); realizing an increase in billable inpatient services due to complete and thorough documentation of non-global issues patients experienced throughout their hospital stays. Obtaining buy-in from physicians proved a significant challenge; consistent training and feedback allowed for an improved understanding of billing and coding processes within the BICU. The described findings indicate that a focused effort to improve documentation offers a promising method to yield potentially significant improvements in a unit’s profitability.

Preparing for an interview

Richard L. Pullen, Jr., is a professor of nursing at Texas Tech University Health Sciences Center School of Nursing in Lubbock, Tex., and a Nursing Made Incredibly Easy! Editorial Board Member. The author has disclosed no financial relationships related to this article.

An Evaluation of Nonacademic Predictors of Success in a Doctor of Pharmacy Program

Objective. Pharmacy programs have struggled to predict who will be successful in their programs based solely on cognitive skills. The primary objective of this study was to determine which, if any, nonacademic factors are associated with on-time progression within the school of pharmacy curriculum.Methods. A survey was developed and offered to all Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy students in fall 2020. This survey included questions to collect demographic data and incorporated four validated questionnaires: the Grit-Grid, the Academic Pharmacy Resilience Scale (APRS-16), the Cohen Perceived Stress Scale (CPSS), and the Turkish Time Management Questionnaire (TTMQ).Results. Completed surveys were submitted by 213 students out of 569 (37.4% response rate). On-time progression rate was calculated separately for each class. Through binary logistic regression, we found that on-time progression was significantly associated with prepharmacy grade point average >3.20, high school Grit-Grid score >0.9, APRS-16 score >35, and CPSS score >34. Pharmacy College Admission Test (PCAT) composite scores and admissions committee rubric scores were not associated with on-time progression.Conclusion. Based on the results of this study, it may be reasonable to implement the Grit-Grid, APRS-16, and the CPSS in the admissions process to help determine the most appropriate candidates for our program or use them as screening tools for incoming students to identify who may be at academic risk. However, these factors need to be validated in pharmacy programs in other private and public universities before widespread adoption can be condoned.

Abstract P164: Using Mixed Methods to Assess Community Based Participatory Research Implementation: Assessment of a Walking-Based Health Intervention Program

Introduction: The Border Coalition for Fitness (BCF) is a community-based organization sponsored by Texas Tech University Health Sciences Center El Paso(TTUHSC El Paso) that facilitates walking-based programs. These interventions aim to increase physical activity among a majority Hispanic population in El Paso, TX. To provide programming that effectively meets the community's needs, the BCF aims to operate within a community-based participatory research (CBPR) framework that centers on community engagement and the translation of research into tangible benefits to the community. This mixed methods assessment examines perceptions of the BCF and its impact on the community. Methods: For the quantitative study, depending on the self-selected group (BCF, community leader, or community participant), respondents completed either a leadership (BCF, community leaders) or non-leadership (community participants) questionnaire. Both assess perceptions on a scale from 0 to 10, 10 being the best, across three constructs: leadership(L), resources(R), and ability and commitment to organize(C). For the qualitative study, members of the BCF and former walking intervention participants completed one-on-one interviews consisting of 13 open-ended questions. Qualitative interviews are ongoing. Results: Preliminary results from the quantitative survey (n=103) show high ratings across stakeholder groups and constructs. BCF members consistently represent the highest ratings (L:9.6; R:9.6; C:9.3) across all constructs, followed by the community leaders (L:8.3; R:8.1; C:8.5), and finally, community participants (L:8.0; R:7.7; C:7.6). There is good agreement among BCF members (n=5) and community members (n=2) that the BCF has a strong collaborative relationship with its academic sponsor and the community and provides impactful programming. Areas cited for improvement included a need for more autonomy on the part of the BCF and improved understanding of and interaction with the BCF on the part of community members. Conclusion: In conclusion, early findings from this mixed-methods assessment indicate strong support for the BCF and its programming among leadership and the community. However, insight gained from the qualitative interviews highlights several areas of improvement in terms of community-based participatory research practices, particularly encouraging community engagement with the BCF beyond participation in the walking-based programs.

Grit and Gratitude: Strategies for Novice Nurse Faculty.

Professor and RN to BSN Program Director, Texas Tech University Health Sciences Center School of Nursing, Lubbock. Correspondence: Professor Pullen, Texas Tech University Health Sciences Center School of Nursing, 3601 4th St, Lubbock, TX 79430 ([email protected]). The author declares no conflicts of interest.