University Of Mississippi Medical Center Research Articles

The University of Mississippi Medical Center's Path for Quality Improvement.

The University of Mississippi Medical Center's Path for Quality Improvement.

In Memoriam

HomeHypertensionVol. 75, No. 1In Memoriam Free AccessObituaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessObituaryPDF/EPUBIn MemoriamGerry McAlpin Trudie J. Meyer Trudie J. MeyerTrudie J. Meyer Correspondence to Trudie Meyer, Hypertension Managing Editor, American Heart Association National Center, 7272 Greenville Ave, Dallas, TX 75231. Email E-mail Address: [email protected] Managing Editor, Hypertension Search for more papers by this author Originally published2 Dec 2019https://doi.org/10.1161/HYPERTENSIONAHA.119.14365Hypertension. 2020;75:5Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: December 2, 2019: Ahead of Print It is with a heavy heart I report that Gerry McAlpin, Hypertension’s Assistant Managing Editor and longtime Hypertension employee, passed away very unexpectedly on October 24, 2019.Gerry began working for Hypertension in 2002 as Managing Editor with Dr John Hall as Editor-in-Chief. When Dr Hall finished his final term in 2012, Gerry kept her position at the University of Mississippi Medical Center next to Dr Hall, and simultaneously worked part-time for Hypertension as an Assistant Managing Editor under new Editor-in-Chief Anna Dominiczak and Managing Editor Denise Kuo. Gerry recently retired from the University of Mississippi Medical Center and her many years of service beside Dr Hall and moved to Tennessee to be closer to her sister’s family and to aid in the care of her aging mother.Download figureDownload PowerPointDr Hall had the following remembrances of Gerry:“I had the great privilege of working closely with Gerry for over 20 years. I admired her steady, calm professionalism, her intelligence, her superb technical expertise and especially her integrity. She served as the lead administrator for our Department of Physiology and Biophysics and then as Managing Editor of the American Journal of Physiology: Regulatory, Integrative and Comparative Physiology, from 1996 to 2001, and as Managing Editor of Hypertension from 2002 to 2012. We were extremely fortunate to benefit from Gerry’s expertise during the transition of both journals from cumbersome and inefficient systems for submission and review of hard-copy manuscripts (including a reviewer database that consisted mainly of 3 x 5 cards and the editor’s memory) to modern online, electronic processes. Most of us had no idea how to do this. The editors, editor assistants, and many of the authors and reviewers needed quite a bit of tutoring from Gerry. She was patient and unflappable and led us into a highly efficient and effective process for electronic submission as well as rapid review and publishing of manuscripts. Gerry was a reserved and humble person, a valued colleague, and a friend to those who had the privilege of getting to know her. Thank you Gerry. We will remember.”When I transitioned to Hypertension as Managing Editor just over a year ago, Gerry was extremely generous with her time and expertise to help the journal and myself succeed in any way she could. She was a steady and knowledgeable guide always supporting her colleagues and co-workers, Stephanie Allbritton and Renata Gil, at Hypertension. I think I speak for the Hypertension Editorial Office and the AHA journal portfolio when we say Gerry’s experience, guidance, sense of humor, honesty, and long tenure with the AHA journals will be deeply missed.On first glance, you may not expect it, but Gerry was always down for an adventure. She loved to travel and scuba dive. I am told she made a cheesecake so delicious that it made decent churchgoers argue over her last piece at a church event, resulting in a tug-of-war struggle with the cheesecake ending up on the floor. Knowing it was too good for the garbage, they quickly scooped it off the floor and decided maybe it would be better to share.Gerry is survived by her mother, Lena McAlpin; sister and brother in-law Tracie and Shane Woidtke; niece and nephew Skyler and Knox Woidtke; many cousins, 2 aunts and an uncle.Please join us in thinking of her family and our Hypertension Editorial Office as we mourn our friend and colleague.Trudie J. MeyerManaging Editor, HypertensionAcknowledgmentsThank you to Jonathan Schultz, Stephanie Allbritton and Renata Gil for draft review.FootnotesCorrespondence to Trudie Meyer, Hypertension Managing Editor, American Heart Association National Center, 7272 Greenville Ave, Dallas, TX 75231. Email trudie.[email protected]org Previous Back to top Next FiguresReferencesRelatedDetails January 2020Vol 75, Issue 1 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.119.14365PMID: 31786972 Originally publishedDecember 2, 2019 PDF download Advertisement

A Multicenter Study Evaluating Perceptions and Knowledge of Inpatient Glycemic Control Among Resident Physicians: Analyzing Themes to Inform and Improve Care

Objective: In this descriptive study, we evaluated perceptions and knowledge of inpatient glycemic control among resident physicians. Methods: We performed this study at four academic medical centers: the University of Mississippi Medical Center, University of Virginia Health System, University of Louisville Health Sciences Center, and Emory University. We designed a questionnaire, and Institutional Review Board approval was granted at each institution prior to study initiation. We then administered the questionnaire to Internal Medicine and Medicine-Pediatric resident physicians. Results: A total of 246 of 438 (56.2%) eligible resident physicians completed the Inpatient Glycemic Control Questionnaire (IGCQ). Most respondents (85.4%) reported feeling comfortable treating and managing inpatient hyperglycemia, and a majority (66.3%) agreed they had received adequate education. Despite self-reported comfort with knowledge, only 51.2% of respondents could identify appropriate glycemic targets in critically ill patients. Only 45.5% correctly identified appropriate inpatient random glycemic target values in noncritically ill patients, and only 34.1% of respondents knew appropriate preprandial glycemic targets in noncritically ill patients. A small majority (54.1%) were able to identify the correct fingerstick glucose value that defines hypoglycemia. System issues were the most commonly cited barrier to successful inpatient glycemic control. Conclusion: Most respondents reported feeling comfortable managing inpatient hyperglycemia but had difficulty identifying appropriate inpatient glycemic target values. Future interventions could utilize the IGCQ as a pre- and postassessment tool and focus on early resident education along with improving system environments to aid in successful inpatient glycemic control. Abbreviations: DM = diabetes mellitus; Emory = Emory University Healthcare; IGC = inpatient glycemic control; IGCQ = Inpatient Glycemic Control Questionnaire; IRB = Institutional Review Board; PGY = postgraduate year; UMMC = University of Mississippi Medical Center; UVA = University of Virginia Health System; UL = University of Louisville Health Sciences Center.

570. Impact of Discontinuation of Methicillin-Resistant Staphylococcus aureus Contact Precautions on Bloodstream Infection Rates at an Academic Medical Center

BackgroundContact precautions (CP) in methicillin-resistant Staphylococcus aureus (MRSA) patients along with hand hygiene has been considered a gold standard to prevent transmission. The actual impact of these measures in reducing MRSA infections is still controversial. At our institution, we evaluated the impact of discontinuation of MRSA CP on hospital-onset (HO) and community-onset (CO) MRSA bloodstream (BSI) rates. We also analyzed consequential cost savings.MethodsThe University of Mississippi Medical Center is a 700+ bed academic facility located in Jackson, MS. Patients admitted to any inpatient units with diagnoses or history of MRSA infection or colonization were subjected to CP during their stay. In July 2018, we discontinued MRSA CP across all inpatient units (except neonatal intensive care unit). HO MRSA BSI rate was calculated per National Healthcare Safety Network (NHSN) laboratory-identified event. CO MRSA BSI was reported per NHSN admission prevalence rate. One-way Analysis of Variance (ANOVA) was performed to compare pre-and post-intervention data.ResultsThere was a rise in HO MRSA BSI rate after discontinuation of CP (July 2018-March 2019) in comparison to the 9-month pre-intervention period (October 2017-June 2018); however, the difference was not statistically significant (1.79/10,000 patient-days vs. 1.2/10,000 patient-days; P = 0.056). Similarly, CO MRSA BSI prevalence rate did not show a statistically significant difference between pre- and post-intervention period (0.103 vs. 0.08; P = 0.584).The total annualized cost savings on personal protective equipment (PPE) was an estimated $193,398 post-intervention. Hand hygiene (HH) compliance was higher in post-intervention compared with pre-intervention period (83% vs. 78%, P = 0.0007).ConclusionAt our institute, discontinuation of MRSA CP was associated with an insignificant rise in HO MRSA BSI rates. No impact was observed on CO MRSA BSI prevalence. We had a 34% reduction in PPE expenditure. We observed an increase in HH compliance post-discontinuation of CP, but it did not reduce MRSA BSI rates. Further studies are needed to evaluate the impact of bundling hand hygiene practices with other horizontal strategies (prevention bundles, chlorhexidine bathing, environmental disinfection practices) in prevention of MRSA infections. Disclosures All authors: No reported disclosures.

1154. Impact of Educational Feedback on Reducing Hospital-Onset Catheter-Associated Urinary tract Infections at an Academic Medical Center

BackgroundHigh regulatory burden on hospital-onset (HO) infections has increased performance pressure on infection prevention programs. Despite the availability of comprehensive prevention guidelines, a major challenge has been communication with frontline staff to integrate appropriate prevention measures into practice. The objective of our study was to evaluate the impact of educational intervention on HO CAUTI rates and urinary catheter days.MethodsAt the University of Mississippi Medical Center, Infection prevention (IP) reports unit-based monthly HO infections via email to respective unit managers and ordering physician providers. Starting May 2018, IP assessed compliance to CAUTI prevention strategies per SHEA/IDSA practice recommendations (2014). HO CAUTI cases with noncompliance were labeled as “preventable” infections and educational justification was provided in the email report. No other interventions were introduced during the study period. CAUTI data were collected using ongoing surveillance per NHSN and used to calculate rates per 1,000 catheter days. One-way analysis of variance (ANOVA) was used to compare pre- and post-intervention data.ResultsPrior to intervention (July 2017–March 2018), HO CAUTI rate was 1.43 per 1,000 catheter days. In the post-intervention period (July 2018–March 2019), HO CAUTI rate decreased to 0.62 per 1,000 catheter days. Comparison of pre- and post-intervention rates showed a statistically significant reduction in HO CAUTIs (P = 0.04). The total number of catheter days reduced, but the difference was not statistically significant (8,604 vs. 7,583; P = 0.06). Of the 14 HO CAUTIs in post-intervention period, 64% (8/14) were reported preventable. The preventable causes included inappropriate urine culturing practice in asymptomatic patients (5) or as part of pan-culture without urinalysis (2), and lack of daily catheter assessment for necessity (1).ConclusionAt our institute, regular educational feedback by IP to frontline staff resulted in a reduction of HO CAUTIs. Feedback measure improved accountability, awareness and engagement of frontline staff in practicing appropriate CAUTI prevention strategies. Disclosures All authors: No reported disclosures.

1189. Effectiveness of Multimodal Intervention Strategies to Improve Hand Hygiene Compliance at an Academic Medical Center

BackgroundSince the early 19th century, hand hygiene (HH) has been recognized as the most important factor in preventing healthcare-associated infections (HAI). Still, improving HH compliance is a major hurdle for most healthcare facilities. Our study objective was to evaluate effectiveness of bundled intervention tools in increasing hand hygiene (HH) compliance.MethodsThe study was performed at the University of Mississippi Medical Center located in Jackson, MS. A multidisciplinary HH team was established in January 2016. Team members included infection prevention, nurse managers, physician, resident, housekeeping, process engineers, and ancillary staff. Hand hygiene compliance was determined based on room entry and exit observations. Intervention strategies were based on Joint Commission Center’s Targeted Solutions Tool (TST) to identify barriers in HH compliance, standardization of data collection, covert observer training and Just-in-time training of providers. Other strategies implemented included education and feedback, rewards and recognition, and system change measures during the 3-year study period (timeline in Table 1). Hand hygiene compliance was calculated based on number of compliance opportunities/total number of observations. One-way Analysis of Variance (ANOVA) was performed to analyze HH data. We did not assess the concomitant reduction in HAI rates as simultaneous HAI prevention strategies confounded analysis.ResultsBased on total 95,491 observations performed (January 2016- December 2018), there was a statistically significant improvement in HH compliance during the study period from 66.5% in 2016 to 73% in 2017 and 79.5% in 2018 (P = 0.04).ConclusionAt our institution, we observed a 56% improvement in hand hygiene compliance over 36-months timeframe. Multidisciplinary team involvement and multimodal intervention strategies play crucial role in improvement and sustainment of HH compliance. Disclosures All authors: No reported disclosures.

Pharmacist linkage in care transitions: From academic medical center to community

ObjectivesTo improve the care of patients discharged from the University of Mississippi Medical Center (UMMC) after treatment for acute myocardial infarction, heart failure, pneumonia, and chronic obstructive pulmonary disease; reduce preventable hospital readmissions; and inform future care transition collaborations between hospital teams and community pharmacies. SettingStudy was conducted at UMMC, UMMC outpatient pharmacies, and targeted community pharmacies. Practice descriptionUMMC is the state’s only academic health science center, providing all levels of care. Participants were at UMMC’s 722-bed hospital in Jackson, MS. Participating pharmacies included 2 UMMC outpatient pharmacies and community pharmacy research partner sites within 60 miles of UMMC. Practice innovationA pharmacist transitions coordinator (PTC) worked with inpatient and community-based pharmacists to provide predischarge medication reconciliation and 30 days of medications on discharge. The PTC with access to inpatient and outpatient records facilitated communication among settings/providers. Community pharmacists provided telephonic and face-to-face medication therapy management (MTM). EvaluationThe project was structured as a prospective, randomized controlled trial of pharmacist-led care coordination during transition from inpatient to community setting, with follow-up MTM by community pharmacists. In this intention-to-treat analysis, readmission rates were assessed with propensity adjustment. Drug therapy problems (DTPs) identified/resolved were assessed and reported through descriptive statistics. ResultsNinety-six patients were enrolled. Positive outcomes in overall reduced readmission rates were observed in the intervention group at 30, 60, 90, and 180 days, although statistical significance was not achieved because of limited enrollment. Approximately 60% participated in MTM postdischarge, with 453 interventions and 169 DTPs identified and addressed (98% > 1 DTP; 20% > 5 DTPs). Implementation experience includes PTC successes, new partnerships, and connectivity among all providers, as well as enrollment challenges, follow-up, and service delivery timeframe. ConclusionWith access to patient records, pharmacists have the potential to positively affect patient outcomes through medication management during care transitions.

GERD Resolution Rates after Laparoscopic Sleeve Gastrectomy at 3 Years

North Mississippi Medical Center, Tupelo, MS; University of Mississippi Medical Center, Jackson, MS

Health of Lesbian, Gay, Bisexual, Transgender, and Questioning Individuals

THE HEALTH OF ALL PATIENTS remains the central aim of nursing care. Perianesthesia nurses hold a unique space with patients when they are most vulnerable. Hence, by honoring the long-standing tradition of caring for individuals, regardless of their respective identities, nursing can lead the way in promoting the health of lesbian, gay, bisexual, transgender, and questioning persons. Although growing, research on evidence-based practice for the lesbian, gay, bisexual, transgender, and questioning population is limited. Authored by a pediatric psychiatrist, the following article presents the “state of the knowledge” in addressing health issues faced by nonconforming youth. Mary W. Stewart, PhD, RN, School of Nursing, University of Mississippi Medical Center, Jackson, MS

Leo Fabian: A Life of Accomplishment

Leo Fabian played a role in many anesthesia firsts: the first halothane anesthetics in the United States, the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. As was common for men of his generation, Fabian’s first taste of medicine came during World War II, as a pharmacist’s mate aboard the U.S.S. Bountiful. Afterward, he pursued his medical education before joining Dr. C. Ronald Stephen and the anesthesiology department at Duke. There he helped to create one of the first inhalers for halothane, the Fabian Newton Stephen (F-N-S) Fluothane Vaporizer. Fabian left Duke for the University of Mississippi Medical Center, where he consistently worked with the chair of surgery, Dr. James Hardy. Together they performed the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. By the end of his time at Mississippi, Fabian and Hardy had several philosophical disagreements, and Fabian ultimately left for Washington University in St. Louis, where he rejoined Dr. Stephen. He served as Stephen’s right-hand man and would oversee the department when Stephen was away. Fabian spent the final years of his career as chair of the department before his own health forced him to step down.

One Hundred Fifty Liver Transplants at a New Program in the Modern Era: The University of Mississippi Experience

From 1991 to 2013, Mississippi was without liver transplant services. In 2013, a new liver transplant program was established at the University of Mississippi Medical Center. Here, we describe our experience with the first 150 transplants over a 4.5-year period. This study is a review of 147 patients who underwent the first 150 liver transplants at the University of Mississippi Medical Center between March 5, 2013, and January 4, 2018. There were no exclusion criteria for this study. Donor, recipient, and outcome variables were analyzed. Recipients were 46% female and 74% white. Age at the time of transplant was 57 [IQR 49-63]. BMI at transplant was 30 [IQR 25-35]. Thirty per cent of transplants were for alcoholic cirrhosis, 25% non-alcoholic steatohepatitis, 24% hepatitis C, and 12% cholestatic. Mean model for end-stage liver disease (MELD) at the time of transplant was 20 [95% confidence interval 19-21] and MELD-Na was 22 [95% confidence interval 20-23]. One-year patient- and graft survival were 89% and 87%, respectively, which were as expected based on Scientific Registry of Transplant Recipient reports after risk adjustment. The data published here verifies it is possible to establish a new liver transplant center in an underserved area previously lacking comprehensive liver care and to achieve results similar to other high-volume centers across the country.

Supporting Breastfeeding Mothers by Transforming Library Space: A Nursing Mothers Room Project

ABSTRACTLibrarians at Rowland Medical Library collaborated with individuals from across the campus of the University of Mississippi Medical Center (UMMC) to transform an unused library office to a nursing mothers room. This project resulted in a functional and attractive room for breastfeeding students and employees to pump breast milk.

Abstract 4378: The association of enzymes related to cholesterol esters metabolism with hepatocellular carcinoma

Abstract Objectives: The roles of cholesteryl esters (CE) in the pathogenesis of hepatocellular carcinoma (HCC) have not been completely elucidated. This study is aimed to investigate differences in the expression level of enzymes involving in synthesis and degradation of CEs between benign hapatic tissues (BHT) and HCC, and between male and female patients from African American (AA) and Caucasian American (CA). Methods: TMAs were constructed with 97 BHT and 91 HCC samples from patients enrolled in the University of Mississippi Medical Center from 2010 to 2017. Immunochemistry (IHC) was performed on the TMAs for enzymes involved in CE synthesis (acyl CoA:cholesterol acyltransferase 1, ACAT1 and acyl CoA:cholesterol acyltransferase 2, ACAT2), and in CE degradation (lysosomal acid lipase, LAL and neutral cholesterol ester hydrolase 1, NCEH1) following the manufacturer’s instructions. The expression level for each enzyme was expressed as IHC score calculated with a scoring system. Two-tailed Student’s t-test was used to compare the difference in the expression level of each enzyme between two groups. Significant p value was set at p<0.05. Results: The IHC score of ACAT2 was significantly higher in HCC than in BHT in all population (6.21±2.42 vs (4.89.4±2.40, P=0.0006) and in stratified male population (6.15±2.33 vs 5.08±2.32, p=0.046), but not in stratified women, AA and CA populations. There was no significant difference in IHC score for ACAT1 between HCC and BHT in all population and populations stratified by race and gender. The IHC score of LAL was significantly higher in HCC as compared to BHT in all population (3.57±2.31 vs 2.40±1.30, P =0.0001) and in male population (3.33±2.01 vs 2.39±1.16, p=0.015), but not in stratified women, AA or CA population. The IHC score of NCEH1 was not significantly different between HCC and BHT in all studied population and population stratified by gender. However, it was disparate between AA and CA populations: The IHC score of NCEH1 was significantly lower in HCC than in BHT in AA population (5.59±2.04 vs 6.66±1.74, p=0.031) but it was higher in HCC than in BHT in CA population (6.84±1.96 vs 7.12±1.70, p>0.05). Conclusions: These results suggest that alterations in the expression levels of enzymes involving CE metabolism are associated with pathogenesis, progression and disparities in race and gender of HCC. This study also suggest that ACAT2 predominates CE synthesis as compared to ACAT1, and that LAL plays major role in CE degradation as compared to NCEH1 in association with HCC. Citation Format: Zhirong Liu, Akram Shalaby, Charu Subramony, Jinghe Mao, Xinchun Zhou. The association of enzymes related to cholesterol esters metabolism with hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4378.

Construction and preliminary evaluation of the inpatient glycemic control questionnaire (IGCQ): a survey tool assessing perceptions and knowledge of resident physicians

BackgroundUncontrolled hyperglycemia in hospitalized patients, with or without diabetes mellitus, is associated with many adverse outcomes. Resident physicians are the primary managers of inpatient glycemic control (IGC) in many academic and community medical centers; however, no validated survey tools related to their perceptions and knowledge of IGC are currently available. As identification of common barriers to successful IGC amongst resident physicians may help foster better educational interventions (ultimately leading to improvements in IGC and patient care), we sought to construct and preliminarily evaluate such a survey tool.MethodsWe developed the IGC questionnaire (IGCQ) by using previously published but unvalidated survey tools related to physician perspectives on inpatient glycemic control as a framework. We administered the IGCQ to a cohort of resident physicians from the University of Mississippi Medical Center, University of Louisville, Emory University, and the University of Virginia. We then used classical test theory and Rasch Partial Credit Model analyses to preliminarily evaluate and revise the IGCQ. The final survey tool contains 16 total items and three answer-choice categories for most items.ResultsTwo hundred forty-six of 438 (56.2%) eligible resident physicians completed the IGCQ during various phases of development.ConclusionsWe constructed and preliminarily evaluated the IGCQ, a survey tool that may be useful for future research into resident physician perceptions and knowledge of IGC. Future studies could seek to externally validate the IGCQ and then utilize the survey tool in pre- and post-intervention assessments.

205-LB: Use of Internet and Mobile Technology for Health Communications in the Jackson Heart Study

The availability of internet and/or mobile phone technology (IMT) provides an opportunity to explore more practical approaches to collect and disseminate information related to diabetes prevention and control in cohort studies. However, the extent of use of IMT in cohort studies of high-risk populations is unclear. In the Jackson Heart Study (JHS), a community-based cohort study of cardiovascular disease among African Americans with an increased prevalence of diabetes, we evaluated the prevalence and demographic correlates of IMT use. As part of annual follow-up telephone interviews of JHS participants in 2017-2018, we conducted a survey on IMT use and examined prevalence and demographic correlates of IMT use. Of 3,810 JHS participants in annual follow-up interviews, 2,564 (67.3%) completed the IMT use survey, of whom 2,262 (88.2%) reported IMT use. Compared to non-users, IMT users were more likely to be men (37% vs. 26%), younger (mean age 70 vs. 81years), and to have attained high school or more years of education (89% vs. 57%) and middle-affluent income status (91% vs.78%) (Table 1). For a majority of JHS participants, it may be feasible to use IMT to conduct intensive interviews and pilot diabetes-related communications. For participants with more limited use of IMT, standard methods will continue to be needed and novel methods developed to capture and disseminate information on diabetes prevention and control. Disclosure P.R. Anugu: None. K.A. Valle: None. K. Winters: None. A. Correa: None. Funding Jackson State University (HHSN268201800013I); Tougaloo College (HHSN268201800014I); Mississippi State Department of Health (HHSN268201800015I); University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I, HHSN268201800012I); National Heart, Lung, and Blood Institute; National Institute for Minority Health and Health Disparities

Improving Staff Knowledge and Attitudes Toward Provision of Psychosocial Support to NICU Parents Through an Online Education Course

This study sought to determine whether NICU staff would demonstrate improved knowledge and attitudes about their ability to provide psychosocial support to parents as a result of taking an online education course. This was a time series pre–posttest comparison of responses provided to a 33-item survey among NICU staff before and after taking an online education course on providing psychosocial support to parents. Content in the 7-hr course covered the categories as described in the article “Interdisciplinary Recommendations for the Psychosocial Support of NICU Parents”. Two NICUs participated in this project: St. John’s Regional Medical Center (SJRMC), a 16-bed Level III community NICU with 250 admissions annually, and the University of Mississippi Medical Center (UMMC), a Level IV academic NICU with 102 beds. Staff at both NICUs, including nurses, were invited to take the online course and participate in the study. Participants provided demographic information, then took a 33-item survey before (pretest) and after (posttest) taking the comprehensive course called “Caring for Babies and Their Families,” using a Likert-type scale of 1–6 (1 = strongly disagree, 6 = strongly agree). Pre- and posttest scores were analyzed using nonparametric paired t tests. Of the 114 staff who registered for the course and provided demographic information, 87.9% were nurses; mean years of NICU service was 9.6. All survey items showed posttest mean scores higher than pretest mean scores; in 30/33 (90.9%) these differences were significant, p < 0.05. Night shift staff and staff with shorter periods of NICU service had lower pretest scores on several items; these differences were eliminated on the posttest. Educational needs for staff were identified on both the pretest and posttest. Ninety percent of participants would recommend the course to their peers. This education course was highly effective in improving staff knowledge and attitudes about how to support NICU parents and in eliminating differences between day and night staff and between those with shorter versus longer periods of service in the NICU. Areas in need of additional education were identified.

A Dermatologic Perspective to Public Health

Mandy Alhajj, MS, OMS-III, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN. Vinayak K. Nahar, MD, MS, PhD, FRSPH, Center for Animal and Human Health in Appalachia, College of Veterinary Medicine, DeBusk College of Osteopathic Medicine, and School of Mathematics and Sciences, Lincoln Memorial University, Harrogate, TN; and Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS. The authors declare no conflict of interest. Correspondence concerning this article should be addressed to Vinayak K. Nahar, MD, PhD, MS, FRSPH, Center for Animal and Human Health in Appalachia College of Veterinary Medicine, DeBusk College of Osteopathic Medicine, and School of Mathematics and Sciences, Lincoln Memorial University, 6965 Cumberland Gap Parkway, Harrogate, TN 37752. E-mail: [email protected]

Screening duplex ultrasonography in neurosurgery patients does not correlate with a reduction in pulmonary embolism rate or decreased mortality.

Deep vein thrombosis (DVT) is a major focus of patient safety indicators and a common cause of morbidity and mortality. Many practices have employed lower-extremity screening ultrasonography in addition to chemoprophylaxis and the use of sequential compression devices in an effort to reduce poor outcomes. However, the role of screening in directly decreasing pulmonary emboli (PEs) and mortality is unclear. At the University of Mississippi Medical Center, a policy change provided the opportunity to compare independent groups: patients treated under a prior paradigm of weekly screening ultrasonography versus a post-policy change group in which weekly surveillance was no longer performed. A total of 2532 consecutive cases were reviewed, with a 4-month washout period around the time of the policy change. Criteria for inclusion were admission to the neurosurgical service or consultation for ≥ 72 hours and hospitalization for ≥ 72 hours. Patients with a known diagnosis of DVT on admission or previous inferior vena cava (IVC) filter placement were excluded. The primary outcome examined was the rate of PE diagnosis, with secondary outcomes of all-cause mortality at discharge, DVT diagnosis rate, and IVC filter placement rate. A p value < 0.05 was considered significant. A total of 485 patients met the criteria for the pre-policy change group and 504 for the post-policy change group. Data are presented as screening (pre-policy change) versus no screening (post-policy change). There was no difference in the PE rate (2% in both groups, p = 0.72) or all-cause mortality at discharge (7% vs 6%, p = 0.49). There were significant differences in the lower-extremity DVT rate (10% vs 3%, p < 0.01) or IVC filter rate (6% vs 2%, p < 0.01). Based on these data, screening Doppler ultrasound examinations, in conjunction with standard-of-practice techniques to prevent thromboembolism, do not appear to confer a benefit to patients. While the screening group had significantly higher rates of DVT diagnosis and IVC filter placement, the screening, additional diagnoses, and subsequent interventions did not appear to improve patient outcomes. Ultimately, this makes DVT screening difficult to justify.

Impact of maternal obesity on body weight regulation and sleep time in offspring

Mississippi Center for Obesity Research, University of Mississippi Medical Center – Jackson, MS. There is limited understanding of the mechanisms that link parental obesity to adverse metabolic outcomes in their offspring. In this study we examined factors that influence body weight regulation and sleep time in mice fed a high fat diet after weaning (HFD, n=5) that were offspring of dams also fed a HFD (45% fat) and compared them to HFD fed mice (n=5) from dams on a control diet. Food intake was measured daily and body weight and body composition (EchoMRI) were measured weekly. Energy expenditure (EE), oxygen consumption (VO2), motor activity (MA) and sleep time (Sable System 40 sec criterion) were monitored for 5 consecutive days at 22 weeks of age. There were no significant differences in calorie intake (17.3±0.7 vs. 16.2±0.8 kcal/day), fasting blood glucose (170±13 vs. 187±16 mg/dL), total EE (5.7±0.6 vs. 5.7±0.2 kcal/hr), VO2 (1.5±0.1 vs. 1.7±0.1 ml/min) or MA (57±6 vs. 65±5 m/day) in offspring from dams fed a HFD compared to offspring from dams fed a control diet. However, there were significant increases in body weight (47.3±1.5 vs. 42.4±1.1 g) and fat mass (19.8±0.6 vs. 15.7±1.6 g), and decreased sleep time (8.6±0.2 vs. 9.7±0.2 hr/day, p=0.005) in offspring of dams fed a HFD. These results suggest that maternal obesity increases body weight and fat mass in offspring fed a HFD, and reduces sleep time without altering food intake, VO2, EE, MA, or fasting glucose levels in adult mice (NHLBI PO1HL51971, NIGMS P20GM104357 and NIGMS U54GM115428)Support or Funding InformationNHLBI PO1HL51971, NIGMS P20GM104357 and NIGMS U54GM115428This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Improving Student Performance in Medical Pharmacology

PurposeTeaching Medical Pharmacology in a “traditional” curriculum is a challenge. Although, previous metrics for our student outcomes were acceptable, we were concerned about ensuring continuity and continuous quality improvement amidst ongoing and future changes. To pre‐emptively address these concerns, we implemented several significant changes to our Medical Pharmacology course and in its structure.MethodsHistorically, Medical Pharmacology at The University of Mississippi Medical Center has consisted of roughly 150 course hours spread over the Fall and Spring semesters. Six examinations comprised the majority of the final grade with 20% of the final grade derived from student scores on the National Board of Medical Examiners (NBME) Pharmacology Subject Exam. In 2013, we reorganized the course to not only try to improve outcomes as measured by NBME scores, but to also increase faculty accessibility and interactions with students. In addition, we strived to link together and reinforce major concepts that were being built upon throughout the course. To accomplish this, we made several changes. We eliminated one of the six examinations, consolidated similar materials, and reduced any redundancies in the course. Hours that were freed up, were used for more interactive sessions such as Small Group Learning sessions, Thematic Case Based Studies, and Clinical Correlations. Perhaps most importantly, we implemented an end of the course STEP I review session. We were able to accommodate this by using the hours gained by streamlining the course. We created 10 hours near the end of the course for a directed, systems/topic‐driven review of the course content with emphasis on the NBME Subject/STEP I exam material. All faculty involved were charged with reviewing the material they had covered during the year; preparing a succinct summary of the most important topics to be made available to students; writing STEP‐style review questions in a format where the personal response units of the students could be used to poll results, give instantaneous feedback, and guide the reviews; appearing at the appropriate review session to present the materials; and perhaps most importantly fielding any questions from students concerning any of the content areas.ResultsStudent feedback was obtained after each year. It has been increasingly very positive. This was further reflected by a significant increase in overall satisfaction with the Medical Pharmacology course. In addition, the NBME Pharmacology Subject exam scores have steadily increased. Relative to the most appropriate comparison cohort mean, the percentage above that mean for students in Medical Pharmacology has increased from ~5% in 2013 to ~15% above in 2017.ConclusionsThe approaches that we used to improve student performance have been successful based on the available indicators including student satisfaction and NBME outcomes. In addition, these changes have greatly improved the faculty/student interactions. Student feedback also indicates that the course helps them with their national examinations. We are continuing to adapt and adjust the Medical Pharmacology course to continue and enhance these positive and exciting trends.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.