University Of Mississippi Medical Center Research Articles

Intrathecal Nicardipine as Treatment for Severe Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Retrospective Clinical Study.

Introduction Vasospasm and delayed cerebral ischemia (DCI) are complications of aneurysmal subarachnoid hemorrhage (aSAH) and contribute up to 23% of the disability and deaths from aSAH. The use of intrathecal nicardipine (ITN) as a possible treatment for DCI has been explored with mixed results. We present a retrospective series comparing standard post-aSAH care to standard care plus ITNtherapy. The primary objective of this study was to assess for any difference in functional outcome in terms of modified Rankin scale (mRS) scorebetween the standard therapy group and ITN group at discharge and one month after discharge. Methods The Institutional Review Board (IRB) approval was obtained for a retrospective chart review of patients with aSAH who were treated at the University of Mississippi Medical Center between January 2012 and June 2019. The inclusion criteria included sufficient available medical documentation, aSAH with documentation of an intracranial aneurysm, and age ≥ 18. The exclusion criteria included non-aSAH, patients with insufficient medical records, and mycotic aneurysms. The decision to treat with ITN was based on the individual practice of a single neuro-intensivist in collaboration with the neurosurgical staff. Results A total of 385 patients were included in the study with 31 patients receiving ITN. Those within the nicardipine group presented with significantly worse Hunt and Hess grades and experienced significantly worse cerebral vasospasm, higher transcranial Doppler (TCD) velocities, higher rates of DCI, and higher rates of hydrocephalus. When controlling for placement of an external ventricular drain, the patients in the ITN group experienced higher rates of ventriculitis (10.0% vs. 2.0%, p < 0.05). There was no significant difference between the two groups in the intensive care unit (ICU) stay, hospital stay, mRS at discharge, or mRS at one-month follow-up. Conclusion In our series, ITN therapy did not significantly alter outcomes in terms of mRS at discharge or at one month after discharge. However, there was a significant increase in ventriculitis among patients who received this therapy.

Abstract P415: The Current Cardiac Disease in Pregnancy -II Risk Score as a Predictor of Pregnancy Morbidity is Not Affected by Maternal Obesity

Cardiovascular disease (CVD) is the most common cause of death in adults over 40 years of age. CVD remains a common cause of death in pregnancy and within the first-year post-partum, and Black women have higher cardiovascular risk during pregnancy than White women. There are several established mortality and morbidity prediction models for maternal cardiac complications including the Cardiac Disease in Pregnancy (CARPREG) risk score. CARPREG-II is the newest risk score which uses ten criteria to predict maternal cardiac complications. However, the only study to validate the CARPREG-II risk score had a large sample size with only 15% of patients with obesity (body mass index (BMI) &gt;30 kg/m2). Obesity and increased obesity class are known risks factors for pregnancy related morbidity and mortality. Thus, the validity of CARPREG-II risk score as a predictor of cardiovascular risks and pregnancy outcomes in women with cardiac disease and obesity remains unknown. Therefore, the goals of our study were to assess the validity of the CARPREG-II score in Black and White women as a predictor of risk for cardiovascular morbidity and mortality in obese pregnant women and determine if obesity influences CARPREG-II score and pregnancy morbidity and mortality. For this study, we completed an IRB-approved retrospective chart review of 232 pregnant adult Black and White women who received care at the University of Mississippi Medical Center (UMMC) from January 2013 - 2020. We completed a CARPREG-II risk score and compared morbidity in patients with normal BMI (18-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class I (30-34.9 kg/m2), obesity class II (35-39.9 kg/m2), and obesity class III (&gt;40 kg/m2). By race, the majority of White women were categorized as overweight; whereas the majority of Black women were categorized as obesity class II or III (p=0.0016). Although frequency of BMI category differed by race, CARPREG-II score did not differ as BMI increased in Black or White women, and obesity class did not influence CARPREG-II risk score. Our data indicate that Black women were more likely to have increased obesity, but obesity class did not influence CARPREG-II score. The lack of association between obesity class and CARPREG-II risk score indicate that the current CARPREG-II assessment is not an appropriate risk assessment tool for pregnant obese women and additional studies/tools are warranted to determine cardiovascular risks in pregnant obese women.

Health insurance literacy among patients receiving outpatient cancer treatment.

This study examines patients' understanding of health insurance terms and concepts and quantifies health insurance literacy (HIL) levels by key sociodemographic factors. This study included 393 adult patients with cancer (>18 years old) receiving treatment in two ambulatory infusion centers: Mayo Clinic in Phoenix, Arizona and the University of Mississippi Medical Center in Jackson, Mississippi. Respondents' perceptions of their HIL were assessed using the Health Insurance Literacy Measure (HILM), a validated 21-item measure of a consumer's ability to select and use health insurance (HIL self-efficacy). Respondents' knowledge of health insurance concepts (HIL knowledge) was measured using 10 items created by the Kaiser Family Foundation. The number of correct answers was categorized into three levels: 0-4 (low knowledge), 5-6 (moderate knowledge), and 7-10 (high knowledge). Multivariable logistic regressions were used to compare correct answers to HIL knowledge questions by HIL self-efficacy. Nearly three-quarters of patients had high HIL self-efficacy and high HIL knowledge (70.5%), understanding basic insurance terms, such as premiums and deductibles. Relatively low percentages of patients correctly answered questions about the meaning of provider networks, health insurance formularies, and calculating out-of-pocket spending in scenarios when insurers pay a portion of allowed charges. Lower HIL knowledge was more common among patients with less educational attainment (<college: 15.2%; ≥college: 4.7%), lower household income (<$4999: 11.8%; ≥$5000: 6.1%), and low HIL self-efficacy scores (low: 24.8%; high: 5.2) (all p values <.05). Efforts to improve HIL and navigation of health insurance plan features are required, especially for socioeconomically vulnerable patients.

Tele-Mental Health Service: Unveiling the Disparity and Impact on Healthcare Access and Expenditures during the COVID-19 Pandemic in Mississippi.

During the COVID-19 pandemic, tele-mental health (TMH) was a viable approach for providing accessible mental and behavioral health (MBH) services. This study examines the sociodemographic disparities in TMH utilization and its effects on healthcare resource utilization (HCRU) and medical expenditures in Mississippi. Utilizing a cohort of 6787 insured adult patients at the University of Mississippi Medical Center and its affiliated sites between January 2020 and June 2023, including 3065 who accessed TMH services, we observed sociodemographic disparities between TMH and non-TMH cohorts. The TMH cohort was more likely to be younger, female, White/Caucasian, using payment methods other than Medicare, Medicaid, or commercial insurers, residing in rural areas, and with higher household income compared to the non-TMH cohort. Adjusting for sociodemographic factors, TMH utilization was associated with a 190% increase in MBH-related outpatient visits, a 17% increase in MBH-related medical expenditures, and a 12% decrease in all-cause medical expenditures (all p < 0.001). Among rural residents, TMH utilization was associated with a 205% increase in MBH-related outpatient visits and a 19% decrease in all-cause medical expenditures (both p < 0.001). This study underscores the importance of addressing sociodemographic disparities in TMH services to promote equitable healthcare access while reducing overall medical expenditures.

Epidemiologic Trends of Cleft Lip and Palate in a Southern State: A 30-Year Follow-Up.

Children's of Mississippi at the University of Mississippi Medical Center serves as the state's only American Cleft Palate-Craniofacial Association-approved cleft team at the only pediatric hospital in the state. The goal of this study is to report geographic and demographic patterns of patients with orofacial cleft (OFC) treated at Children's of Mississippi, which are lacking. Patients with OFC treated at Children's of Mississippi from 2015 to 2020 were included. Demographic data were collected, including birth county and total live births from state data. Significant differences between incidence of OFC among public health regions of Mississippi were examined using analysis of variance (P < 0.05). Cases were compared with historical data from 1980 to 1989. There were 184 patients who presented with OFC, with a statewide incidence of 0.83 per 1000 live births among 222,819 live births in the state across 6 years. The incidence of OFC was 0.83/1000 for Whites and 0.82/1000 for non-Whites versus a historical rate of 1.36 and 0.54, respectively. Significantly fewer children in the northern region (0.25/1000) were born with OFC than in central (1.21; P < 0.001) and southern (0.86; P < 0.001) regions. Results from this study suggest changing regional patterns of OFC in Mississippi. Although rates increased among non-White infants, the overall incidence of OFC has decreased compared with historical data. The findings may reflect actual incidence patterns in the state or the proximity of certain regions to Children's of Mississippi. Further study may reveal regional differences in risk factors underlying OFC incidence, and/or issues with access to cleft care for different regions in the state.

Court rules against former employee

Case name: Taylor v. University of Mississippi Medical Center, No. 23‐60246 (5th Cir. 02/09/24).

Report from a text-based blood pressure monitoring prospective cohort trial among postpartum women with hypertensive disorders of pregnancy

BackgroundHypertensive disorders of pregnancy are a main cause of maternal morbidity and mortality in the United States and worldwide, and it is estimated that approximately 60% of maternal deaths in the United States occur during the postpartum period. The utilization of telehealth modalities such as home blood pressure monitoring has shown improvement in blood pressure control and adherence with follow up visits. Our study sought to determine if standardized education improved patient hypertension knowledge and if this when combined with home blood pressure telemonitoring increased participants’ postpartum self-blood pressure monitoring and postpartum visit attendance.MethodsThis is an Institutional Review Board approved prospective cohort study conducted at the University of Mississippi Medical Center. Women with a hypertensive disorder of pregnancy who met the inclusion criteria and provided written informed consent to participate were enrolled. Participants received a baseline pre-education questionnaire designed to assess their knowledge of their hypertensive diagnosis, hypertension management, and postpartum preeclampsia (PreE). Participants then received standard education, a blood pressure monitor, and were scheduled a follow-up visit during the first 10 days following discharge. Remote home blood pressure monitoring was performed via text messages and voice calls for 6-weeks postpartum. At the conclusion of the study, participants repeated their original questionnaire.Results250 women provided informed consent to participate in the study and were included in this analysis. Relative to the baseline survey, there was a significant increase (p = 0.0001) in the percentage of correct responses. There was not an association between study engagement and percentage of correct responses on end of study questionnaire (p = 0.33) or postpartum visit attendance (p = 0.69). Maternal age was found to drive study engagement, even when adjusted for community-level distress (p = 0.03) and maternal race (p = 0.0002).ConclusionImplementing a standardized postpartum education session was associated with improvement in patient’s knowledge. Further studies are needed with more longitudinal follow up to assess if this program would also result in improved long-term outcomes and decreased hospital readmission rates.Trial registrationNCT04570124.

In Utero Overnutrition Influences Placental Nutrient Transport and Fetal Overgrowth

Obesity is defined as a body mass index (BMI) ≥30 kg/m2. Forty-three percent of women of childbearing age are obese, with a greater prevalence noted in Black women. Obesity increases the risk of diabetes (Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM)). Obesity and diabetes are chronic states of overnutrition and metabolic dysregulation, each associated with an increased risk of macrosomia (large weight for gestational age in offspring). Macrosomia not only increases pregnancy complications but also increases the risk of metabolic disorders throughout the lifespan of the offspring. Fetal growth in utero is mediated by the nutritional environment and nutritional transport across the placenta. Maternal-fetal nutrient transport is primarily mediated by placental transporters for glucose, amino acids, free fatty acids, and cholesterol in the syncytiotrophoblast of the placenta. Yet, the mechanistic pathway driving fetal overgrowth in environments of overnutrition are not well defined. Therefore, we will test the hypothesis that diabetes (T2DM or GDM) exacerbates placental nutrient transport and fetal overgrowth in Black pregnant women with obesity. To evaluate the combined influence of obesity and diabetes (T2DM or GDM) on fetal growth, we evaluated n=100 electronic medical records of Black obese women with and without diabetes (T2DM or GDM) from 2012-2022 at the University of Mississippi Medical Center (UMMC). These women were singleton pregnancies with no additional underlying conditions. Gestational age of offspring and maternal age were similar among all groups. This study was approved by the Institutional Review Board at UMMC (IRB-UMMC-2021-0455). We found that Black obese women with diabetes (n=43) had higher BMIs compared to Black women with obesity alone (n=57) (43.50 ± 4.76 kg/m2 vs. 39.19 ± 3.48 kg/m2) (p&lt;0.05), indicating that obesity increases risk of diabetes in Black pregnant women. Additionally, offspring from Black obese women with diabetes had elevated birthweight compared to offspring from women with obesity alone (3345 ± 614.6 g vs. 3099 ± 465.4 g; p&lt;0.05). Male offspring from Black obese women with diabetes had elevated birthweight (3460 ± 695.8 g) compared to female offspring from Black obese women without diabetes (3068 ± 439.8 g) (p&lt;0.05), suggesting the maternal nutritional environment influences males more than females. Yet, the type of diabetes, T2DM or GDM, did not influence birthweight in offspring from Black obese women (T2DM: 3412 ± 743.5 g vs GDM: 3271 ± 439.7 g). To evaluate the influence of obesity plus diabetes on placental nutrient transport, we measured placental protein expression of glucose transporter-1 (Glut-1), a primary glucose transporter in the placenta, in a separate subset of placental tissue from Black obese women with and without diabetes (IRB-UMMC-2019-0058). Protein expression of Glut-1 was increased in placental tissue from Black women with obesity and diabetes (n=4) compared to Black women with obesity alone (n=4) (20.38 ± 5.87 A.U. vs. 9.41 ± 1.46 A.U.; p&lt;0.05). However, BMI was elevated in the group of women with obesity and diabetes compared to obesity alone (49.565 ± 1.39 kg/m2 vs. 43.44 ± 2.44 kg/m2; p&lt;0.05), again indicating that obesity increases risks of diabetes in Black pregnant women. This study indicates that combined obesity with diabetes during pregnancy is associated with increased birthweight and placental protein expression of Glut-1. Additional studies are warranted to decipher the separate influences of elevated BMI and diabetes on fetal growth, along with the associated placental mechanisms that influence nutrient transport and fetal growth in pregnancies complicated by obesity and diabetes. UMMC Department of OBGYN. This is the full abstract presented at the American Physiology Summit 2024 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.

Abstract 1014: Disparities of triple negative breast cancer in Mississippi

Abstract Background: Triple-negative breast cancer (TNBC) accounts for about 10-15% of all breast cancers nationwide with disparities of incidence and outcomes among races, geographic locations, and other factors. This study is aimed to analyze the differences in the rate of TNBC, patient conditions at time of diagnosis, and death from TNBC among women in Mississippi. Methods: A retrospective study was conducted to serially review breast cancer cases diagnosed in the University of Mississippi Medical Center during May 2016 to May 2023. The entire breast cancer population was then stratified by race. The rate of TNBC, age and BMI at time of diagnosis, the rate of expiration were compared between African American (AA) and Caucasian American (CA) women with breast cancer. Two-tailed Student’s T-test was used to calculate the difference in mean values, and Chi-Square Test was used to compare the difference in rates or percentages. The significant p value was set at p&amp;lt;0.05. Results: In total 291 women with breast cancer, AA patients were 195 (67.01%), CA patients were 88 (30.24%), and other were 8 (2.75%). The mean age of all patients was 58.3 years-old (ranged 24-97). The mean BMI was 31.19. The patients with TNBC were 109 (37.46%) in entire studied population. A total of 32 (1.6%) patients, including 14 TNBC and 18 non-TNBC were expired with an average age of 61.84 and an average survival time of 20 months from diagnosis to expiration. As compared to CA patient population, AA breast cancer patients had onset at younger age (58.08±0.88 vs. 59.18±1.36), had a higher BMI (31.79±0.62 vs. 28.25±1.05, p=0.017), higher percentage of TNBC (41.54% vs. 30.68%, p=0.082 and OR=1.605), and higher rate of expiration (11.28% vs, 9.1%). Also, as compared to CA expired patients with breast cancer, AA expired patients had higher BMI (29.57 vs. 28.61), shorter survival time (17.5 months vs. 19.4 months), and died at younger age (61.84-year old vs. 66.38-year old) with a higher proportion of TNBC subtype (54.6% vs 12.5%, p=0.045, OR=9.6). Conclusions: Breast cancer is greatly disparate racially between AA and CA and geographically between Mississippi and US national average. The disparities are manifested in the proportion of TNBC subtype, age at onset of breast cancer, BMI at time of diagnosis, and death rate. Citation Format: Navdeep Kaur, Javaria A. Khan, Jinghe Mao, Diva Melvin, Muhammad M. Hassan, Xinchun Zho. Disparities of triple negative breast cancer in Mississippi [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1014.

Abstract 822: A retrospective study on the disparities of hepatocellular carcinoma

Abstract Background: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults and the third leading cause of cancer-related deaths worldwide. Studies report that the incidence of, and mortality from HCC vary significantly by age, sex, and race/ethnicity; however, disparities in the expression level of tumor biomarkers, liver functions, lipid profiles, and comorbidities have not been thoroughly investigated among subpopulations of patient with HCC. Methods: A retrospective study was conducted to review 247 serial HCC cases enrolled in the University of Mississippi Medical Center during June 2000 to May 2023. The entire HCC population was stratified into subpopulations by race, gender, age and BMI. Then comparisons were performed between two corresponding subpopulations in the expression level of HCC-related biomarkers including Alpha-FP, liver functions including albumin, ALT, AST, and ALP, plasma lipid profiles including cholesterol, and comorbidity conditions including cirrhosis in benign liver tissues, smoking, alcohol using, and illness with viral hepatitis. Two-tailed Student’s T-test was used to calculate the difference in mean values, and Chi-Square Test was used to compare the difference in rates or percentages. The significant p value was set at p&amp;lt;0.05. Results: In total 247 HCC cases, males were 178 (72.1%) and females were 69 (27.9%) with a male to female ratio of 2.6:1; black patients were 108 (43.7%), white patients were 127 (51.4%), and others were 4.9%. The mean age was 59.6 years and mean BMI was 27.04. AFP was the only one of detected tumor biomarkers showing disparities: it was significantly higher in patients of male (p=0.026), younger age (p&amp;lt;0.0001), lower BMI (p=0.039), smokers (p=0.0325) and illness with viral hepatitis (p=0.0007). Disparities in liver functions included: 1) AST was significantly higher in Black HCC patients (p=0.027); 2) no statistical difference of liver functions in gender; 3) younger HCC patients had significantly lower level of Albumin (p=0.006), and higher levels of ALT (p=0.014) and AST (p=0.0032); 4) HCC patients with lower BMI also had lower level of Albumin (p=0.015), and higher levels of AST (p=0.0480 and ALP (p=0.0057). There was no statistical difference of plasma lipid profiles between subpopulations, Black HCC patients except that Black HCC patients had significantly higher levels of cholesterol (p=0.0006) and HDL (p=0.048). In comorbidity, Black HCC patients had higher rates of alcohol using and existence of cirrhosis; and male HCC patients had higher rates of smoking, alcohol usage and viral hepatitis. Conclusions: HCC patients are greatly disparate in the expression level of tumor biomarkers, liver functions, plasma lipid profiles and comorbidity conditions between subpopulations stratified by race, gender, age and BMI. These results could provide useful information for clinical management and prognosis of patients with HCC. Citation Format: Xinchun Zhou, Barrett Aldridge, Nazar Rahmanov, Zhirong Liu, Jinghe Mao, Neha Varshney. A retrospective study on the disparities of hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 822.

Assessing severity of COVID-19 and the development of multi system inflammatory syndrome in children (MIS-C) in pediatric patients with atopic disease.

Background: Research surrounding the coronavirus disease 2019 (COVID-19) pandemic and its impact on patients who are atopic has mainly focused on adults. After the delta variant showed increased rates of COVID-19 in children, the pediatric population needs to be assessed as well. Objective: The objective was to assess and report outcomes in patients with COVID-19 and with and without certain atopic diseases in our patient cohort at the University of Mississippi Medical Center. Methods: We conducted a retrospective review of patients by using a de-identified data base that allows querying via medical claims codes from the University of Mississippi Medical Center's Research Data Warehouse. We searched for patients who were COVID-19 positive and ages 0-21 years from January 1, 2020, to December 31, 2021. We then divided this population into two cohorts: an atopic population and a non-atopic population. The incidence of hospitalizations, intensive care unit (ICU) admissions, death, length of stay, inhaled corticosteroid prescription history, and the incidence of multi-system inflammatory syndrome in children (MIS-C) outcomes in the two populations were collected. Results: There were 5261 patients ages 0-21 years and with confirmed COVID-19. After exclusion criteria were applied, there were 1420 patients in the atopic cohort and 2525 patients in the non-atopic cohort. There were more hospitalizations and a longer length of stay in the atopic population. Mortality was equivalent in the atopic and non-atopic populations. There were more ICU admissions in the atopic population. There were 101 patients total with the diagnosis of MIS-C, and the incidence of MIS-C was similar in the atopic and non-atopic populations. There were more patients who were atopic on inhaled corticosteroid than were the patients who were non-atopic. Conclusion: This study sought to further elucidate whether asthma, atopic dermatitis, and allergic rhinitis in pediatric patients was associated with severe COVID-19. Our study showed increased hospitalizations, length of stay, and intensive care in the atopic population but similar outcomes in mortality and the development of MIS-C. Future longitudinal prospective studies are needed to assess the long-term effects on patient's atopic disease after COVID-19 infection.

The Influence of Age, Gender, and Race on Pediatric Upper Respiratory Infections of COVID-19 and RSV in Mississippi

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Respiratory Syncytial Virus (RSV) are significant respiratory viruses that adversely affect pediatric patients in Mississippi. SARS- CoV-2, a positive-strand RNA virus, causes COVID-19, a contagious respiratory disease that carries profound morbidity and mortality. Infection with RSV, a negative-strand RNA virus, has recently experienced increased inter-seasonal activity in the Southern US, particularly in Mississippi. Symptoms of COVID-19 and RSV commonly overlap within pediatric patients and include clinical manifestations of fever, cough, sore throat, and shortness of breath. Both viruses are spread person-to-person via aerosol penetration into the upper respiratory tract and lungs via inhalation. Of the two viruses, RSV has previously been shown to impact children more frequently. However, the emergence of SARS-CoV-2 has led to a resurgence of interest in upper respiratory viruses within pediatric patients. Methods Nasopharyngeal and buccal samples were collected from pediatric patients at the University of Mississippi Medical Center, a large tertiary referral hospital, from May 2021 to November 2022. The cohort was prospectively enrolled and consisted of 132 patients who reported upper respiratory symptoms such as cough, fever, wheezing, dyspnea, and nasal congestion. Ultimately, 72% of these symptomatic patients tested positive for a viral respiratory infection of RSV or SARS-CoV-2. Results The data showed three specific trends in: age, gender, and race. First, a higher prevalence of certain respiratory viruses was demonstrated amongst specific age groups. In the age cohort of 0-2 years old, there were fewer cases of SARS-CoV-2 and an increased number of cases of RSV. In the age cohort of 7-12 years old, there were an increased number of cases of both SARS-CoV-2 and RSV. Furthermore, the age cohort of 13-17 years old demonstrated an increased number of cases of SARS-CoV-2 and a reduced number of cases of RSV. A two-tailed t-test indicated a significant difference between the mean age of patients infected with RSV verses SARS-CoV-2 (t=2.05, p=.04). Secondly, while analyzing gender and race, black males were disproportionately represented by increased positive viral results, comprising 46% of the positive viral detection results, while only making up 29% of the total patient cohort. Conversely, white females comprised 29% of the total patient cohort, but only 14% of the positive viral testing results. Figure 1: Illustration of the processing of nasopharyngeal swabs utilizing single-cell RNA sequencing. Conclusions This data potentially points to differences in immunologic makeup of different groups within the pediatric population that would protect one age group or racial group from a certain respiratory illness but make them more susceptible to another. Additionally, the collected nasopharyngeal and buccal samples are being further characterized using single cell RNA sequencing. While many efforts to blunt the effects of these viruses in pediatric populations rely on prevention strategies and public awareness, this empirical information could allow scientists to better target the presence of these viruses within high-risk populations.

Telehealth Diabetes Prevention Program for Adults With Prediabetes in an Academic Medical Center Setting: Protocol for a Hybrid Type III Trial.

Diabetes is a costly epidemic in the United States associated with both health and economic consequences. These consequences can be mitigated by participation in structured lifestyle change programs such as the National Diabetes Prevention Program (DPP) led by the Centers for Disease Control and Prevention. Mississippi consistently has among the highest rates of diabetes and prediabetes nationally. Implementing the National DPP through large health care systems can increase reach and accessibility for populations at the highest risk for diabetes. Translational research on the National DPP in Mississippi has not been studied. This study aims to evaluate the implementation and impact of the National DPP delivered using telehealth modalities at the University of Mississippi Medical Center in Jackson, Mississippi. An effectiveness-implementation hybrid type III research design is proposed. The study design is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and the Practical, Robust Implementation and Sustainability Model. Participants are being recruited via provider referral, and the DPP is being delivered by trained lifestyle coaches. Study participants include adult (≥18 years) patients eligible for the DPP with at least 1 encounter at 1 of 3 ambulatory clinic specialties (lifestyle medicine, family medicine, and internal medicine) between January 2019 and December 2023. The National DPP eligibility criteria include a BMI ≥25 kg/m2 and hemoglobin A1c between 5.7% and 6.4%. The University of Mississippi Medical Center criteria include Medicare or Medicaid beneficiaries. The University of Mississippi Medical Center's a priori implementation plan was developed using the Consolidated Framework for Implementation Research and includes 23 discrete strategies. The primary aim will use an embedded mixed method process analysis to identify and mitigate challenges to implementation. The secondary aim will use a nonrandomized quasi-experimental design to assess the comparative effectiveness of the DPP on health care expenditures. A propensity score matching method will be implemented to compare case subjects to control subjects. The primary outcomes include patient referrals, participant enrollment, retention, engagement, the incidence of diabetes, and health care resource use and costs. At baseline, of the 26,151 patients across 3 ambulatory clinic specialties, 1010 (3.9%) had prediabetes and were eligible for the National DPP. Of the 1010 patients, more than half (n=562, 55.6%) were aged 65 years or older, 79.5% (n=803) were Medicare beneficiaries, 65.9% (n=666) were female, and 70.8% (n=715) were obese. This is the first translational study of the National DPP in Mississippi. The findings will inform implementation strategies impacting the uptake and sustainability of the National DPP delivered in an academic medical setting using distance learning and telehealth modalities. ClinicalTrials.gov NCT04822480; https://clinicaltrials.gov/study/NCT03622580. DERR1-10.2196/50183.

Abstract 17986: Impact of Race and Socioeconomic Factors on Hypertensive Emergency

Background: Hypertensive emergency, defined as a blood pressure ≥ 180/110mmHg with target organ damage, is a major cause of cardiovascular morbidity and mortality. There is a lack of data on the impact of race and socioeconomic factors on hypertensive emergency incidence and outcomes. Thus, we investigated these associations in a diverse population at a large tertiary-care academic medical center. Methods: Utilizing the Patient Cohort Explorer Epic electronic health records system at the University of Mississippi Medical Center from 1/1/2013 to 7/31/2021, we identified patients diagnosed with hypertensive emergency. Sociodemographic factors related to hypertension and patient status (alive/deceased) were also examined. Descriptive statistics were used to examine differences in means across groups. Results: 2,483 patients diagnosed with hypertensive emergency were included in this analysis. Among these patients, the mean (SD) age was 52 (17) years, 49% were women, and 82.2% were Black. Nearly half (44.4%) of those diagnosed with hypertensive emergency were uninsured, 46.7% had Medicaid or Medicare, and 7.9% had private insurance. Black patients with hypertensive emergency were significantly younger compared with White patients (51 vs 57 years, p&lt;0.001). There was no significant correlation between race and insurance status in this population. Over the 8-year period, 14.1% were deceased at the time of analysis. Conclusions: Among patients admitted to a large academic medical center with hypertensive emergency, most were Black individuals with Medicaid or lacking health insurance. Black individuals present at significantly younger ages compared to White patients. Our findings are much different than data published from the Nationwide Readmissions Database reporting a mean age of 66 years and nearly 90% insured rate in patients with hypertensive emergency. Further, race was not reported in that analysis. Our findings suggest that hypertensive emergency disproportionately affects minority and underserved populations. Further work is needed to characterize risk factors and improve outcomes for this high-risk population.

Abstract 16318: Using Arterial Recoil for Large Bore Access Closure After Impella Assist Device Removal

Background: The use of Impella assist device for high-risk percutaneous coronary interventions (HR-PCI) and cardiogenic shock (CS) has increased in the last decade and requires a large bore arterial access (LBA). However, LBA closure following Impella removal is associated with significant complications. Objective: To describe the safety and efficacy of a novel method of LBA closure using arterial recoil following Impella removal. Methods: A descriptive, retrospective review of electronic medical records in all patients that underwent LBA closure using this novel method from July 1, 2018, to June 30, 2022, was performed at the University of Mississippi Medical Center. The procedure involves controlled downsizing of the arterial sheath from 12 French (Fr) to 6 Fr with intermittent compression to allow patent hemostasis facilitated by arterial recoil. Baseline characteristics and outcomes including closure success, immediate or delayed (&gt;6 hours) bleeding, and access site hematoma/pseudoaneurysm were included. Results: Of 103 patients with Impella placement, 20 (19%) underwent LBA closure with the arterial recoil method. Patients were predominantly male (80%) and White (55%) with a mean age of 65 + 16 years. The most common indication for Impella placement was HR-PCI (40%), followed by non-acute myocardial infarction (AMI) CS (35%), and AMI-CS (25%). After downsizing of the femoral sheath to 6 Fr, 14 patients (70%) underwent manual compression, 3 patients had a 6 Fr sheath left in place to maintain access, 2 patients underwent placement of a Perclose device, and 1 patient underwent placement of a Vascade device. Successful LBA closure was performed in all patients with no immediate or delayed bleeding complications. A total of 5 patients (25%) died inpatient, including one patient who had palliative removal of the Impella device; the deaths were unrelated to complications of Impella removal. Conclusions: LBA closure post-Impella removal with this novel method is safe and effective. Further prospective studies are needed to ascertain its comparative efficacy.

Health insurance literacy among patients receiving outpatient cancer treatment.

339 Background: Limited health insurance literacy (HIL) has been linked to problems paying medical bills or delaying care among patients with cancer. In this study, we describe the prevalence and correlates of HIL in a cohort of cancer patients measured using a ten-question HIL quiz developed by the Kaiser Family Foundation. Methods: We examined HIL in 393 adult patients (aged &gt;18 years) receiving cancer treatment in two ambulatory infusion centers, Mayo Clinic in Phoenix, Arizona (12/2019 to 2/2020 and 8/2020 to 10/2020) and University of Mississippi Medical Center in Jackson, Mississippi (9/2020 to 1/2021). HIL was categorized as low, moderate, or high based on the total number of correct answers: 0-4 (low), 5-6 (moderate), and 7-10 (high). Descriptive statistics characterized the sample and chi-square statistics compared HIL by sociodemographic factors. Results: Most patients understood basic insurance terms, such as premiums and deductibles (Table). However, fewer patients answered questions correctly about provider networks (46.1%), formularies (48.6%), and calculating out-of-pocket (OOP) spending (16.8%). 53 (13.5%), 69 (17.6%), and 271 (69.0%) patients had low, moderate, and high HIL scores, respectively. Lower HIL was more common among patients of younger age (&lt;65 years: 17.8%, 65+ years: 8.7%), lower educational attainment (less than college: 23.2%; college or higher: 4.4%), and lower household income (&lt;$4999: 21.1%, $5000+: 6.1%) (all p-values&lt;0.05). Conclusions: Although HIL in our cohort of cancer patients was relatively high - 69% answered at least 7 questions correctly - there were gaps in understanding of provider networks, formularies, and calculation of OOP spending. Efforts to improve HIL and help with navigation of health insurance plans may be required, especially for socioeconomically vulnerable patients.[Table: see text]

Association Between Smoking Status and Opioid Dose in Prescriptions Written for Breast Cancer-related Pain

BACKGROUND: Cancer-related pain has historically been undertreated. Prescription opioids have been shown to be an integral part of the treatment of cancer pain. Despite the significant amount of scientific evidence that smoking is associated with variation in pain expression and opioid misuse in both cancer and non-cancer populations, little is known about the association between smoking status and opioid utilization in cancer populations. OBJECTIVES: To assess the association between smoking status and high-risk opioid-prescribing behaviors of oncologists prescribing opioids in the outpatient setting to patients with breast cancer-related pain. STUDY DESIGN: A retrospective cross-sectional study of opioid prescriptions written by oncologists for breast cancer-related pain was conducted using the Patient Cohort Explorer (PCE) database at the University of Mississippi Medical Center (UMMC) from March 15, 2015 to March 15, 2017. SETTING: Tertiary academic medical center. METHODS: De-identified data from UMMC PCE were utilized for this study. Patient-level information, such as age, gender, race, insurance status, and smoking status, were also selected for each prescription. Prescription-level data, such as name of opioid, dose, frequency, route, and primary diagnosis, were also obtained. Prescriptions were included if they are written in the outpatient setting, for breast cancer-related pain, and for women 18 years or older. Prescriptions were excluded if they were written by a specialist other than a medical oncologist or if the information necessary to calculate morphine milligram equivalence (MME) was missing. RESULTS: The sample consisted of 577 opioid prescriptions that were written in the outpatient setting to women ages 18 years and older for breast cancer-related pain. The majority of the sample were ages 46 to 64 years (60.5%), Nonwhite (75.2%), publicly insured (66.2%), and with nonmetastatic disease (86.1%). Almost one-fifth (19.6%) of the prescriptions were written to current smokers, 21.3% to former smokers, and 58.1% to nonsmokers. Nonsmoking status predicted an increased odds of receiving a prescription &gt;= 50 MME (odds ratio [OR] = 1.98, 95% confidence interval [CI]: 1.08-3.60, P = 0.030) and &gt;= 90 MME (OR = 6.29, 95% CI: 1.38-28.58, P = 0.017) compared to current smokers. Nonsmoking status also predicted an increased odds of receiving a prescription &gt;= 90 MME (OR = 4.29, 95% CI: 1.43-12.92, P = 0.009) compared to former smokers. LIMITATIONS: This cross-sectional sample was drawn from a single institution and only included the breast cancer population and may not be generalizable to other populations or institutions. Second, our sample was drawn from secondary data not collected for the purposes of our study. This limits the inclusion of other variables that may impact the opioid-prescribing behaviors of oncologists, potentially resulting in bias. CONCLUSIONS: During a time of heightened awareness of opioid-related harm, as well as implementation of national opioid-prescribing guidelines, current smoking may potentially be impacting how oncologists evaluate the need for opioids to treat breast cancer-related pain. Further studies that examine the relationship between smoking status, perceived need for opioids, and evaluative need for opioids in cancer populations are warranted. KEY WORDS: Cancer pain, opioids, smoking, breast cancer, opioid-prescribing guidelines, health policy, oncology, end of life

Evaluation of Atrial Fibrillation Detection in Short-Term Photoplethysmography (PPG) Signals Using Artificial Intelligence.

Background Atrial fibrillation (AFIB) is a common atrial arrhythmia that affects millions of people worldwide. However, most of the time, AFIB is paroxysmal and can pass unnoticed in medical exams; therefore, regular screening is required. This paper proposes machine learning (ML) methods to detect AFIB from short-term electrocardiogram (ECG) and photoplethysmography (PPG) signals. Aim Several experiments were conducted across five different databases, with three of them containing ECG signals and the other two consisting of only PPG signals. Experiments were conducted to investigate the hypothesis that an ML model trained to predict AFIB from ECG segments could be used to predict AFIB from PPG segments. Materials and methods A random forest (RF) ML algorithm achieved the best accuracy and achieved a 90% accuracy rate on the University of Mississippi Medical Center (UMMC) dataset (216 samples) and a 97% accuracy rate on the Medical Information Mart for Intensive Care (MIMIC)-III datasets (2,134 samples). Results A total of 269,842 signal segments were analyzed across all datasets (212,266 were of normal sinus rhythm (NSR) and 57,576 corresponded to AFIB segments). Conclusions The ability to detect AFIB with significant accuracy using ML algorithms from PPG signals, which can be acquired via non-invasive contact or contactless, is a promising step forward toward the goal of achieving large-scale screening for AFIB.

Welcome to the New Issue (Vol: 29, No: 3, 2023) and Current News of the European Journal of Therapeutics

Welcome to the New Issue (Vol: 29, No: 3, 2023) and Current News of the European Journal of Therapeutics

Exploring Technological Challenges and Growth in Faculty Transition to Remote Teaching during the COVID-19 Pandemic: A Mixed-Methods Study

The COVID-19 pandemic forced institutions of higher education into an emergency remote teaching practice. In this study, the researchers utilized a convergent triangulation mixed-methods study design to investigate the technological challenges and growth that faculty experienced in seven schools at the University of Mississippi Medical Center as a result of the transition to emergency remote teaching during the COVID-19 pandemic. Quantitative data were collected through an anonymous online survey that asked faculty to rate their competency in each of the 14 technology-related tasks twice—once for the pre-pandemic period and once for the current period. Qualitative data were collected through semi-structured interviews conducted virtually or in person. One hundred faculty participated in the quantitative survey. A significant difference between faculty self-rated competency levels in the pre-pandemic period and the current period was observed, suggesting technology knowledge growth from the forced transition. Qualitative interviews of 19 faculty revealed five overarching themes: inconsistency in instructional support, pandemic-induced technological growth, power of togetherness, maintaining continuity through flexibility, and resilience against adversity. This study provided faculty with the experience to perform effective self-reflection and gain insights into their pedagogical practices. Future research should focus on professional development that can help faculty remain up-to-date on technology utilization and establish a contingency plan to better prepare for the unknown.