Texas Tech University Health Sciences Research Articles

Social media and health: Current and future healthcare provider perspectives

Objective: As over 80% of active United States internet users are using social media (SM) sites, it is important for healthcare students (HCS) and healthcare professionals (HCP) to become educated on proper SM usage behaviors to effectively understand and apply SM policies. This research was designed to examine HCS and HCP motivations for utilizing SM sites, to determine the concerns HCS and HCP have with SM usage, and if these concerns are being addressed through SM policies and education. Methods: In 2012, 4370 HCS and 4269 HCP from the Texas Tech University Health Sciences Center participated in the Institutional Review Board approved online survey. Of those contacted, 187 HCS and 180 HCP completed the survey. Applying uses and gratifications theory, the authors conducted a mixed method survey and analyzed HCS and HCP motivations for utilizing SM sites and the concerns associated with SM usage, while simultaneously analyzing whether concerns are being addressed through SM policies and education. Results: Analysis reveals HCS and HCP were motivated by social entertainment, convenience of information, and professional self-expression. In addition, HCS and HCP top concerns associated with SM use in a professional and academic setting are patient privacy. This study also indicates HCP was more aware of their institutional SM policies. Yet, both view SM policies necessary to help educate them on effective SM use. Analysis of the qualitative responses reveals HCS and HCP’s top concerns with SM usage are Health Insurance Portability and Accountability Act violations and patient privacy. Conclusion: This study offers insight into HCS’ and HCP’ SM motivations and behaviors. It also expands on issues HCS and HCP have with SM usage and if SM policies effectively address these concerns. Future research should examine if and how patients use SM when seeking health information and analyze patient’s opinion of HCS’ and HCP’ usage of SM sites.

Single-Center Experience With the Dual-Focus Storz Modulith SLX-F2 Lithotripter: A Retrospective Study

Background: To calculate the modified efficiency quotient of the mobile Storz Modulith SLX-F2 lithotripter, to identify factors determining clinical succes rate and to identify complications and limitations with this device. Comparison of the results with reported data from other institutions for the same machine and other types in the peer review literature will be made. Methods: The study design is a retrospective chart review. Inclusion criteria include male and female and patients who were treated in the Texas Tech University Health Sciences Center for urinary calculi with the Storz Modulith SLX-F2 lithotripter between September 2006 and June 2011. During this period, 447 patients with single stones were treated, and 10 patients with radiolucent stones and 21 patients with incomplete follow-up were excluded. The patients were followed up with plain radiography and/or renal ultrasound to assess the clinical succes rate. Univariate and multivariate analyses were performed to identify the factors determining the clinical success rate. Results: Follow-up was complete for 416 patients. Mean age was 46.1 ± 14.4 years. The mean numbers of shock waves given were 2,457 and 2,838 for renal and ureteral stones, respectively. Mean stone sizes were 9.3 ± 4.5 mm and 9.7 ± 4.9 mm for renal and ureteral stones, respectively. Mean body mass index was 30.5 ± 7.04 kg/m 2 . The overall clinical success rate after one ESWL treatment was 84.6% (85.4% and 83.6% for renal and ureteral stones, respectively). The modified efficiency quotient was 0.69. On univariate analysis, clinical success rate was associated with smaller stone size ( < 10 mm, P = 0.016), and absence of a ureteral stent (31.7% vs. 10.5%; P = 0.0002). Presence of lower calyx stones (P = 0.04) was a negative predictor of clinical success. On multivariate analysis, lower calyx stones, smaller stone size and the absence of a ureteral stent continued to be significant determinants of clinical success status. All complications were minor with a complication rate of 4.3%. Conclusions: The mobile Storz Modulith SLX-F2 lithotripter is clinically effective in the management of solitary renal and ureteral stones. It has an adequate modified efficiency quotient combined with a favorable safety profile. Major advantages are the increased treatment depth in combination with exceptionally high weight limit and a dual-focus system. World J Nephrol Urol. 2014;3(1):7-17 doi: http://dx.doi.org/10.14740/wjnu111w

The prevalence and reliability of self-reported penicillin allergy in a community hospital

BackgroundPenicillin (PCN) accounts for most cases of antibiotic allergies. Reported PCN allergy deprives the patient from this class of antibiotics and creates hesitancy in using other beta-lactam antibiotics. The aim of this study is to report the prevalence of self-reported PCN allergy among adult patients admitted to the hospital and to examine the probable validity of these reports.MethodsA questionnaire was conducted among 192 patients with self-reported PCN allergy who were admitted to a community hospital between July 25, 2011 and January 25, 2012. Patients admitted with an infection and treated with a beta-lactam were also followed until hospital discharge.ResultsThe mean age of patients at the time of their self-reported allergic reaction was 20.3 years. The most common allergic symptoms reported in decreasing order of frequency were itchy rash, angioedema, and urticaria. Based on analysis of the questionnaires, 121 patients (63.0%) had probable PCN allergy, 54 (28.1%) had possible PCN allergy, and 17 (8.9%) were unlikely to have a PCN allergy. Fifty-one participants (26.6%) had self-reported subsequent exposure to PCN in their life. This subsequent exposure was well tolerated in 86.3% of the participants. Fifty participants (25.9%) had self-reported subsequent exposure to a first generation cephalosporin and it was well tolerated in 78.4% of them.ConclusionTaking a detailed history from patients with self-reported PCN allergy can help to distinguish a true PCN allergy from a false positive report of allergy and hence allow clinicians to use this important class of antibiotics when truly indicated.

Academy of Nutrition and Dietetics 2011 Survey on Member Research Activities, Needs, and Perceptions

Research resulting in evidence-based recommendations is the foundation of nutrition and dietetics practice. The Academy of Nutrition and Dietetics (the Academy) conducted surveys of active members who are registered dietitians (RDs) with a doctorate and members of the Research Dietetic Practice Group (RDPG) in 2000, 2002, and 2006. 1 Myers E.F. Beyer P.L. Geiger C.J. Research activities and perspectives of research members of the American Dietetic Association. J Am Diet Assoc. 2003; 103: 1235-1243 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 2 Member Needs Assessment/Satisfaction Study Review GroupReport on the American Dietetic Association's member needs assessment/satisfaction study. J Am Diet Assoc. 2000; 100: 112-116 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar , 3 Massey L. Ramsay S. Thomsen C. Myers E. Research Activities and Perspectives of the American Dietetic Association Members Participating in Research; Follow-Up to the 2002 Survey. American Dietetic Association, Research Committee, Chicago, IL2006 Google Scholar In 2011, the Academy (then the American Dietetic Association) conducted another survey of members with a doctorate and members of the RDPG with a post-baccalaureate degree (ie, master's degree or doctorate). The main objective of the 2011 Researcher Survey was to better understand member participation in research, defined as preparing applications/proposals, designing and conducting studies, preparing manuscripts for publication, and presenting at professional meetings, as well as supervising any of these activities. The survey also included questions about funding and the degree to which the RDs' research interests correlated to Academy research priorities. The primary aim of this article is to summarize findings from the 2011 survey and discuss implications related to research among RDs. I. M. Anchondo is a pediatric nutritionist and an assistant professor, Texas Tech University Health Sciences Center, El Paso. C. Campbell is an associate professor of nutrition, Sandy S. and Roy W. Uelner Professor of Food Science and Human Nutrition, Department of Food Science and Human Nutrition, Iowa State University, and The Blossom Project principal investigator, Ames, IA. J. Zoellner is an associate professor, Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg.

PRACTITIONER APPLICATION: Reducing Preventable Emergency Department Utilization and Costs by Using Community Health Workers as Patient Navigators

vice president, Patient Care Services, and chief nursing officer, Midland Memorial Hospital, Midland, Texas; dean, Health Sciences Division, Midland College; and adjunct faculty, Texas Tech University Health Sciences Center School of Nursing, Lubbock

Mucormycosis in two community hospitals and the role of infectious disease consultation: a case series

BackgroundMucorales are ubiquitous filamentous fungi that can cause a devastating, invasive infection. This order has become an increasingly important pathogen during the last two decades, due to the dramatic increase in patients with predisposing factors. The aim of this retrospective study was to report the clinical characteristics, therapeutic options, and outcomes of patients diagnosed with mucormycosis in community hospitals in Amarillo, Texas, and to reflect on the role of infectious disease (ID) physicians in managing this potentially life-threatening problem.Patients and methodsThis was a retrospective chart review of patients hospitalized with mucormycosis in two community hospitals in Amarillo between January 1, 2001 and December 31, 2011.ResultsTen patients were diagnosed with mucormycosis during the study period, with a mean age of 58.8 years. There were five cases of pulmonary infection, two cases of cutaneous infection, two cases of rhinocerebral infection, and one case of gastrointestinal infection. Poorly controlled diabetes was the most common risk factor, identified in six patients, followed by hematological malignancy, immunosuppression, and trauma. ID physicians were consulted in all cases, albeit late in some cases. Nine patients received antifungal therapy, and five patients received surgical debridement. Lipid formulations of amphotericin B were prescribed for eight patients, used alone in two cases, and combined with caspofungin and posaconazole in one and five cases, respectively. One patient was treated with posaconazole alone. Eight patients were discharged from the hospital alive. The mortality rate at 6-month follow-up was 40%.ConclusionMucormycosis is an emerging fungal infection that continues to carry significant morbidity and mortality. At-risk patient populations are on the rise, and include those with poorly controlled diabetes mellitus. Early diagnosis, in consultation with an ID physician, and an aggressive combined approach with surgical debridement and combined antifungal therapy is pivotal in improving patients’ outcomes.

Inhibition of Otopathogenic Biofilms by Organoselenium-Coated Tympanostomy Tubes

Tube occlusion and post-tympanostomy tube otorrhea (PTTO) are 2 major sequelae of tympanostomy tube placement. Plugging negates the function of the tympanostomy tubes and, along with chronic PTTO, can be financially burdensome owing to repeated surgical procedures and additional treatments. To investigate the effectiveness of an organoselenium (OSe) coating on Donaldson tympanostomy tubes in inhibiting biofilm formation on the tympanostomy tubes. In vitro microbiologic study; all experiments were performed in a Texas Tech University Health Sciences Center basic sciences laboratory. Inhibition of biofilm formation was investigated by incubating OSe-coated vs uncoated (control) tympanostomy tubes in a nutrient broth containing either Staphylococcus aureus (Sa) expressing green fluorescent protein (GFP), nontypeable Haemophilus influenzae (NTHi) expressing GFP, or Moraxella catarrhalis (Mc) for 48 hours at 37 °C. All biofilms were quantified via colony-forming unit (CFU) assays. The Sa and NTHi biofilms were visualized using confocal laser-scanning microscopy (CLSM) and analyzed using the COMSTAT program. The CFU assays, CLSM, and COMSTAT analysis revealed that compared with uncoated control tympanostomy tubes, OSe-coated tympanostomy tubes are able to inhibit Sa, NTHi, and Mc biofilm formation. The Sa and NTHi developed thick mature biofilms containing considerable biomass on uncoated tympanostomy tubes as determined by CLSM and COMSTAT analysis, while the OSe coating on the tympanostomy tubes drastically inhibited biofilm formation by Sa and NTHi. Quantitative CFU analysis revealed that this reduction in biofilm formation was significant, 6 logs for Sa (P < .001) and 4 logs for NTHi (P = .02). OSe coating also inhibited biofilm formation by Mc with a 4.5-log reduction (P < .001). The OSe coating is a potential long-lasting agent to prevent biofilm development on tympanostomy tubes by otopathogens.

Happy 20th Birthday to the Cochrane Collaboration

To learn more about the history of the Cochrane Collaboration visit the Cochrane Collaboration website (http://www.cochrane.org/about‐us/history), the Cochrane Collaboration 20th Anniversary website (http://anniversary.cochrane.org/), and watch the You Tube Cochrane 20 Video Series (http://www.youtube.com/user/CochraneCollab). To learn more about the history of the Cochrane Collaboration visit the Cochrane Collaboration website (http://www.cochrane.org/about‐us/history), the Cochrane Collaboration 20th Anniversary website (http://anniversary.cochrane.org/), and watch the You Tube Cochrane 20 Video Series (http://www.youtube.com/user/CochraneCollab). Jeannette T. Crenshaw, DNP, RN, LCCE, IBCLC, NEA‐BC, FAAN is an assistant professor, Texas Tech University Health Sciences Center School of Nursing; a family educator at Texas Health Presbyterian Hospital Plano, Plano, TX; and a member of the Cochrane Nursing Care Field (CNCF).

A retrospective look at replacing face‐to‐face embryology instruction with online lectures in a human anatomy course

Embryology is integrated into the Clinically Oriented Anatomy course at the Texas Tech University Health Sciences Center School of Medicine. Before 2008, the same instructor presented embryology in 13 face-to-face lectures distributed by organ systems throughout the course. For the 2008 and 2009 offerings of the course, a hybrid embryology instruction model with four face-to-face classes that supplemented online recorded lectures was used. One instructor delivered the lectures face-to-face in 2007 and by online videos in 2008-2009, while a second instructor provided the supplemental face-to-face classes in 2008-2009. The same embryology learning objectives and selected examination questions were used for each of the three years. This allowed direct comparison of learning outcomes, as measured by examination performance, for students receiving only face-to-face embryology instruction versus the hybrid approach. Comparison of the face-to-face lectures to the hybrid approach showed no difference in overall class performance on embryology questions that were used all three years. Moreover, there was no differential effect of the delivery method on the examination scores for bottom quartile students. Students completed an end-of-course survey to assess their opinions. They rated the two forms of delivery similarly on a six-point Likert scale and reported that face-to-face lectures have the advantage of allowing them to interact with the instructor, whereas online lectures could be paused, replayed, and viewed at any time. These experiences suggest the need for well-designed prospective studies to determine whether online lectures can be used to enhance the efficacy of embryology instruction.

Gut microbe composition and metabolic syndrome

Links between gut microbiota and metabolic diseases have been suggested for many years, but results of studies in human beings and animals are conflicting. Bryant Furlow discusses new research in this area as a new study shows that promoting growth of bifidobacteria reduces risk factors for metabolic syndrome.

Self-Reported Adherence to Medications in a Pediatric Renal Clinic: Psychological Aspects

BackgroundChronically ill children and adolescents comprise a vulnerable population that requires specific considerations in order to positively impact their treatment outcome. Pediatric renal patients can be non-compliant and also forgetful in taking their medications.ObjectiveThe objectives of the study were to (a) assess medication adherence and (b) to identify emotionality and variables that influence non-adherence by use of “The Child & Adolescent Adherence to Medication Questionnaire” (CAAMQ), which was constructed at Texas Tech University Health Sciences Center.MethodsPediatric renal patients from 10 to 21 years-of-age, taking three or more medications, for longer than a three-month period, were eligible to complete the CAAMQ.ResultsThirty-four patients participated in the study. Many of the respondents had problems remembering to take their medications on weekends (P = 0.021). The majority of the patients stated that they were not bothered about having to take their medications (70.6%); and that taking pills did not interfere with their daily activities (85.3%). Open-ended questions in the CAAMQ identified patients’ feelings of sadness, distress, and the importance of strong family support systems. The study participants reported that they preferred to take their medications at school, in the nurses’ office or in a place where privacy was assured. The results indicated that Prednisone was the most disliked of all of the medications. Female patients were more reactive and secretive than males regarding peers knowing about their disease and medication schedules (P<0.017).ConclusionsNon-adherence in pediatric patients is a complex and serious problem, which ultimately affects the patients’ health. Privacy and daily routine were found to impact the patients’ adherence to medications. Creative and individualized reminders for teenagers need to be developed and validated. Further studies that take into consideration developmental and motivational factors may help researchers identify modifiable psychosocial predictors that will lead to improved medication adherence.

For Non-expert Clinical Searches, Google Scholar Results are Older with Higher Impact while PubMed Results Offer More Breadth

Objectives – To compare PubMed and Google Scholar results for content relevance and article quality&#x0D; &#x0D; Design – Bibliometric study. &#x0D; &#x0D; Setting – Department of Internal Medicine at Texas Tech University Health Sciences Center.&#x0D; &#x0D; Methods – Four clinical searches were conducted in both PubMed and Google Scholar. Search methods were described as “real world” (p. 216) behaviour, with the searchers familiar with content, though not expert at retrieval techniques. The first 20 results from each search were evaluated for relevance to the initial question, as well as for quality. &#x0D; &#x0D; Relevance was determined based on one author’s subjective assessment of information in the title and abstract, when available, and then tested by two other authors, with discrepancies discussed and resolved. Items were assigned to one of three categories: relevant, possibly relevant, and not relevant to the question, with reviewer agreement measured using a weighted kappa statistic. The quality of items found to be ‘relevant’ and ‘possibly relevant’ was measured by impact factor ratings from Thomsen Reuters (ISI) Web of Knowledge, when available, as well as information obtained by SCOPUS on the number of times items were cited.&#x0D; &#x0D; Main Results – Google Scholar results were judged to be more relevant and of higher quality than results obtained from PubMEed. Google Scholar results are also older on average, while PubMed retrieved items from a larger number of unique journals.&#x0D; &#x0D; Conclusion – In agreement with earlier research, the authors recommended that searchers use both PubMed and Google Scholar to improve on the quality and relevance of results. Searches in the two resources identify unique items based upon the ranking algorithms involved.

Transthoracic echocardiography screening for the detection of portopulmonary hypertension: A work in progress

Transthoracic echocardiography screening for the detection of portopulmonary hypertension: A work in progress

Pilot of peer assessment within experiential teaching and learning

ObjectivesThe objectives of this study were as follows: (1) to pilot test an instrument for peer assessment of experiential teaching, (2) to compare peer evaluations from faculty with student evaluations of their preceptor (faculty), and (3) to determine the impact of qualitative, formative peer assessment on faculty’s experiential teaching. MethodsFaculty at Texas Tech University Health Sciences Center School of Pharmacy implemented a new peer assessment instrument focused on assessing experiential teaching. For eleven quantitative evaluation questions, inter-rater reliability was compared between faculty and student assessments. Student evaluations from 2003–2004 and 2010–2011 were compared to determine if preceptor performance improved. ResultsEight faculty members participated in this pilot. Comparing peer evaluations and student evaluations of faculty, a median intraclass correlation of 0.85 suggested redundancy. Five of eight faculty members remained seven years later, and three of five reported this assessment helpful and reported making changes to their teaching. Among these faculty members, preceptor performance improvements appeared strongest. ConclusionA peer assessment of experiential teaching was developed and implemented. Aside from evaluation, formative peer assessment seemed important in fostering feedback for faculty in their development.

Left Knee Cellulitis in a 61-Year-Old Carpenter

From the *Amarillo Pathology Group, Amarillo, TX; †Baptist St Anthony’s Hospitalist Group, Baptist St. Anthony’s Health System, Amarillo, TX; and ‡Section of infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX. Correspondence to: Faisal A. Khasawneh, MD, Section of Infectious Diseases, Department of Internal of Medicine, Texas Tech University Health Sciences Center, 1400 S Coulter St, Amarillo, TX 79106. E-mail: [email protected]. The authors have no funding or conflicts of interest to disclose.

Is the sinonasal questionnaire a useful screening instrument for chronic sinonasal diseases in pulmonary clinics?

Dixon and coworkers (Dixon AE, Sugar EA, Zinreich SJ, et al. Criteria to screen for chronic sinonasal disease. Chest 2009; 136: 1324-1332.) recently developed a five-item questionnaire for diagnosing chronic sinonasal disease in patients with asthma. Our study was designed to determine how frequently patients attending pulmonary clinics have chronic sinonasal disease and the relationship between questionnaire results and a history of sinus disease and current treatment for sinus disease. The participants were patients in pulmonary clinics at Texas Tech University Health Science Center, who answered the sinonasal questionnaire (SNQ). Additional information included a history of sinus disease or sinus/nasal surgery, smoking status, and current relevant medications. The participants included 28 men and 51 women. Patient ages ranged from 38 to 94 years (mean 62.2 years). Of all the patients, 28 patients (35.4%) had prior sinus disease, 10 (12.7%) had history of sinus or nasal surgery, 24 (30.4%) had history of asthma, and 10 (12.7%) were current smokers. Of them, 14 patients (17.7%) used nasal steroids, 12 (15.2%) used antihistamines, four (5.1%) used decongestants, nine (11.4%) used leukotriene inhibitors, 13 (16.5%) used oral corticosteroids, and two (2.5%) used combinations. The SNQ identified 39 patients (49.4%) as having chronic sinonasal diseases. Therefore, 14% of the participants had sinonasal symptoms but no prior diagnosis of sinus disease. Patients with prior sinus disease and nasal steroid use were more likely to have positive questionnaire result (p<0.001 and p<0.032, respectively). The SNQ can identify patients with chronic sinonasal disease in pulmonary clinics. However, the significance of sinonasal disease and its treatment in these patients needs more study.

Maintenance of Licensure

Letters5 February 2013Maintenance of LicensureConnie Nugent, MLS and Kenneth M. Nugent, MDConnie Nugent, MLSFrom Texas Tech University Health Sciences Center, Lubbock, Texas.Search for more papers by this author and Kenneth M. Nugent, MDFrom Texas Tech University Health Sciences Center, Lubbock, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-3-201302050-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Chaudhry and colleagues (1) present a thoughtful analysis of the cognitive processes involved in CME. In brief, they identify 3 components—reflective self-assessment, assessment of knowledge and skills, and performance in practice. Their examples include participation in CME, completion of computer-based simulations, and patient or peer surveys. We suggest modifications that should clarify this process.The first component requires critical self-assessment of clinical skills and knowledge necessary for the physician's current practice. This almost certainly involves more than participation in the usual CME activities and probably requires practice review and relevant testing (in effect, pretests). Based on this ...Reference1. Chaudhry HJ, Talmage LA, Alguire PC, Cain FE, Waters S, Rhyne JA. Maintenance of licensure: supporting a physician's commitment to lifelong learning. Ann Intern Med. 2012;157:287-9. [PMID: 22733035] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Texas Tech University Health Sciences Center, Lubbock, Texas.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMaintenance of Licensure: Supporting a Physician's Commitment to Lifelong Learning Humayun J. Chaudhry , Lance A. Talmage , Patrick C. Alguire , Frances E. Cain , Sandra Waters , and Janelle A. Rhyne Maintenance of Licensure Humayun J. Chaudhry , Lance A. Talmage , and Janelle A. Rhyne Maintenance of Licensure Paul Kempen Maintenance of Licensure Marc S. Frager Maintenance of Licensure James J. Glazier Metrics 5 February 2013Volume 158, Issue 3Page: 220KeywordsConflicts of interestDecision makingHand strengthMedical servicesPatientsPeer reviewProblem solvingSimulation and modeling ePublished: 5 February 2013 Issue Published: 5 February 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...

Resolute Integrity drug eluting stent safety and efficacy for the treatment of coronary artery disease

Resolute Integrity drug eluting stent safety and efficacy for the treatment of coronary artery disease Jose D Burgos, Safa Farrag, Debabrata Mukherjee Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA Abstract: The need to develop a local antirestenotic mechanism to prevent in-stent thrombosis has driven the development of new generation stents. The Resolute Integrity&reg; stent is a zotarolimus-eluting system with a new BioLinx&trade; polymer that allows a slower drug elution. Recently available data has shown the clinical efficacy and safety of this stent in randomized and observational studies. The Resolute Integrity stent system has demonstrated noninferiority when compared with other stents and holds the promise to treat more complex coronary lesions. Keywords: zotarolimus, BioLinx, coronary stenosis, stents, restensosis, stent thrombosis

Pediatric News

Pediatric News

The Family Medicine Accelerated Track Model: Producing More Family Doctors Faster

The Texas Tech University Health Sciences Center School of Medicine Family Medicine Accelerated Track reduces costs while encouraging medical students to pursue family medicine.