Enhancing nursing home quality through electronic health record implementation.

Background: The quality of care in nursing homes (NHs) in the United States has long been a matter of policy concern. Although electronic health records (EHRs) are argued to improve quality, implementation has lagged due to various factors such as financial constraints and limited research on their impact on NH quality. Objective: This study examined the relationship between EHR implementation and NH quality using Donabedian's structure-process-outcome model. Method: Data on EHR implementation were collected via a 2018 survey of all Federally certified Arkansas NHs (n = 223). Of the 63 responding NHs, 48 reported EHR implementation. Survey data were merged with secondary sources such as Certification and Survey Provider Enhanced Reporting. A total of 744 NH-years for the period 2008-2020 were included in the final sample. A pre-post negative binomial panel data regression was used to examine the relationship between EHR implementation (dichotomous variable) and NH deficiencies (dependent count variable) with facility/community-level control variables. Results were reported as incidence rate ratios (IRR). Results: NHs that had implemented EHR experienced an 18% reduction in the rate of deficiencies compared to those without EHR systems (IRR = 0.82, 95% CI [0.70, 0.99], p = 0.035). Conclusion: EHR implementation had a favourable impact on NH quality. Implications: Past research suggests that higher NH quality may be associated with improved financial performance. Therefore, EHR implementation has the potential to address two critical challenges: enhancing care quality and improving financial outcomes. However, government financial incentives may be necessary to address the high-cost of implementing EHR systems.

Understanding COVID-19 Vaccine Hesitancy in the United States: A Systematic Review.

The COVID-19 pandemic has presented the importance of vaccination as a pivotal strategy for controlling its spread. However, vaccine hesitancy poses a significant barrier to achieving widespread immunization in the United States. This systematic review utilizes the 5C model to examine the factors contributing to hesitancy, which include confidence in vaccines, complacency about disease risk, calculations of individual benefit, convenience of vaccination, and collective responsibility for the protection of others. METHODS: We conducted a comprehensive search across several relevant databases and the gray literature, identifying 544 studies that used quantitative and qualitative methods to explore COVID-19 vaccine hesitancy in the general U.S. RESULTS: This review identifies a complex interplay of factors affecting hesitancy, such as concerns over vaccine safety and efficacy, misinformation and conspiracy theories, demographic variables, and socioeconomic conditions. Key strategies for increasing vaccine uptake include transparent and effective communication along with proactive community engagement. CONCLUSIONS: To effectively mitigate vaccine hesitancy, it is crucial to understand its multifaceted causes. Tailored interventions that consider socioeconomic and cultural contexts and prioritize clear communication, community involvement, and specific strategies to address unique concerns can enhance vaccine acceptance.

Vaccine Uptake and Intentions: Insights from a Texas Survey on Factors Influencing COVID-19 Vaccination Decisions.

The effectiveness of COVID-19 vaccines depends on widespread vaccine uptake. Employing a telephone-administered weighted survey with 19,502 participants, we examined the determinants of COVID-19 vaccine acceptance among adults in Texas. We used multiple regression analysis with LASSO-selected variables to identify factors associated with COVID-19 vaccine uptake and intentions to receive the vaccine among the unvaccinated. The prevalence of unvaccinated individuals (22%) was higher among those aged 18-39, males, White respondents, English speakers, uninsured individuals, those facing financial challenges, and individuals expressing no concern about contracting the illness. In a fully adjusted regression model, higher odds of being unvaccinated were observed among males (aOR 1.11), the uninsured (aOR 1.38), smokers (aOR 1.56), and those facing financial struggles (aOR 1.62). Conversely, Asians, Blacks, and Hispanics were less likely to be unvaccinated compared to Whites. Among the unvaccinated, factors associated with stronger intent to receive the vaccine included age (over 65 years), Black and Hispanic ethnicity, and perceived risk of infection. Hispanic individuals, the uninsured, those covered by public insurance, and those facing financial challenges were more likely to encounter barriers to vaccine receipt. These findings underscore the importance of devising tailored strategies, emphasizing nuanced approaches that account for demographic, socioeconomic, and attitudinal factors in vaccine distribution and public health interventions.

Unsung heroes in health education and promotion: How Community Health Workers contribute to hypertension management.

Rural communities are noted as having poor health outcomes. Rural areas experience barriers to care primarily due to a lack of resources, including education, health insurance, transportation, and social support. Additionally, poor health outcomes are a consequence of poor health literacy skills. Community Health Workers (CHWs) are utilized as a resource to combat these issues. This study focused on a CHW led Self-Management Blood Pressure (SMBP) program offered through the University of Texas at Tyler Health Science Center. The goal of the program was to improve management of hypertension through awareness, education, navigation, advocacy, and resource assistance. The SMBP program included structured workshops and regular follow-up with participants including connections to community resources and social support. CHWs worked closely with physicians providing bi-directional feedback on referrals and engagement of communities through outreach events. Furthermore, CHWs aided to bridge cultural or linguistic gaps between service providers and community members. Data is provided indicating this CHW-led intervention played a significant role in improving hypertension through education of how to make lifestyle changes that impact overall health and quality of life. Participants gained knowledge encouraging them to create lifelong healthy habits, coping skills, stress management, self-care, and accountability. Through this innovative approach, participants thrived in the supportive and encouraging environment led by CHWs as well as improved their blood pressure management.

Modality and terminology changes for behavioral health service delivery during the COVID-19 pandemic: a systematic review.

Introduction: The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used. Methods: To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review. Results: Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail. Discussion: Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals.

Addressing Substance Use and Misuse in East Texas: Stakeholder-Driven Needs and Priorities.

Background-This project sought to assess needs, perceived challenges, and priorities regarding substance use disorder (SUD) in East Texas and develop a community-driven research agenda to address those challenges. Methods-Data were gathered through nine focus-group discussions (FGDs) with stakeholders: people living with SUD, families, medical providers, counselors, representatives of community-based organizations, and law enforcement officers. We asked participants how substance use manifests in their communities, which challenges they confronted in coping with substance use and misuse, and in which order their needs should be prioritized. Findings were reported at community forums to confirm the list of challenges and prioritize needs. Results-Five themes emerged from the FGDs indicating major challenges: (a) access to SUD treatment and recovery resources, (b) mental health and resiliency, (c) education, training, and professional development to facilitate treatments, (d) care and service coordination, and (e) community/social support for people living with SUD and their families. Conclusions-Significant resources such as financing, collaboration across silos, and community education are needed to effectively manage this public health problem. Our findings can inform research and outreach to help East Texans develop interventions, research programs, and educational opportunities for clinicians, community-based organizations, law enforcement officers, and counselors to build capacity for SUD prevention, treatment, and recovery.

Transduction of E2F-1 TAT fusion proteins represses expression of hTERT in primary ductal breast carcinoma cell lines.

BACKGROUND: Telomerase expression is detectable in 81-95% of breast carcinomas and may serve as a therapeutic target. The objective of this study was to investigate repression of telomerase activity in primary ductal breast cancer cells through transcriptional regulation of the catalytic subunit hTERT. We hypothesized that inhibition of telomerase expression could be achieved via Tat mediated protein transduction of the repressor protein E2F-1. METHODS: Protein purification techniques were refined to yield biologically active Tat fusion proteins (TFPs) capable of transducing the breast cancer cell lines HCC1937 and HCC1599. Cell lines were treated with wildtype E2F-1 (E2F-1/TatHA), mutant E2F-1 (E132/TatHA) and a control Tat peptide (TatHA) for 24 hours. Total RNA was isolated from treated cells, reverse transcribed and fold changes in gene expression for hTERT determined via real-time RT-qPCR. RESULTS: Significant repression of the catalytic subunit of telomerase (hTERT) was present in both HCC1937 and HCC1599 cells following treatment with E2F-1/TatHA. In HCC1937 cells, hTERT was repressed 3.5-fold by E2F-1/TatHA in comparison to E132/TatHA (p < 0.0012) and the TatHA peptide controls (p < 0.0024). In HCC1599 cells, hTERT was also repressed with E2F-1/TatHA treatment by 4.0-fold when compared to the E132/TatHA control (p < 0.0001). A slightly lower hTERT repression of 3.3-fold was observed with E2F-1/TatHA in the HCC1599 cells when compared to the TatHA control (p < 0.0001). CONCLUSION: These results suggest that transduction of E2F-1/TatHA fusion proteins in vitro is an effective repressor of hTERT expression in the primary ductal breast cancer cell lines HCC1937 and HCC1599.

Diagnosis and surgical management of nasopalatine duct cysts.

OBJECTIVES/HYPOTHESIS: Nasopalatine duct cysts are the most common cystic lesion of nonodontogenic origin of the maxilla. The purposes of the study were to review the epidemiology and clinical presentation, to describe the radiographic and pathological findings, and to discuss surgical management of this entity. STUDY DESIGN: Case presentations of two patients with nasopalatine duct cysts at a tertiary care institution with a review of the English medical literature from January 1960 to the present. METHODS: A 69-year-old man presented with an asymptomatic swelling of the premaxilla, and a 17-year-old woman presented with a painful swelling of the hard palate. A computed tomography scan, fine-needle aspiration, and preoperative workup were obtained in both cases. Literature was reviewed with respect to epidemiology, etiology, presentation, diagnostic studies, operative management, and recurrence rates. RESULTS: Computed tomography scan demonstrated midline ovoid cystic lesions in both cases. Fine-needle aspiration of both lesions revealed no evidence of malignancy. Surgical treatment consisted of enucleation in the first case and marsupialization in the second case. Both patients did well with no evidence of recurrence. Nasopalatine duct cyst presents in the fourth to sixth decades of life with a male predilection. Recurrence rates range from 0% to 11%. CONCLUSION: Nasopalatine duct cyst occurs in approximately 1% of the population. Presentation may be asymptomatic or include swelling, pain, and drainage from the hard palate. A well-circumscribed, round, ovoid, or heart-shaped radiolucency is seen on computed tomography. Pathological findings reveal squamous or respiratory cell types, or a combination of these, infiltrated by inflammatory cells. Enucleation is the preferred treatment with low recurrence rates.

The effects of carbamazepine on prefrontal activation in manic youth with bipolar disorder.

This preliminary study investigated the neurofunctional effects of carbamazepine-extended release (XR) treatment in 11 manic youth with bipolar disorder during performance of a sustained attention task, the Continuous Performance Task - Identical Pairs version (CPT-IP), during functional magnetic resonance imaging (fMRI). All patients underwent baseline fMRI, and 10 patients were scanned again at endpoint. Nine demographically matched healthy youth, who were scanned once, served as controls. Carbamazepine-XR treatment was associated with normalization of activation in right Brodmann area 10 (BA). These results suggest that carbamazepine-XR treatment may correct prefrontal dysfunction in adolescent mania.

Vancomycin dosing in children and young adults: back to the drawing board.

STUDY OBJECTIVE: To compare the likelihood of alternative vancomycin dosing strategies based on weight, height, or body surface area (BSA) in achieving isometric vancomycin area under the serum concentration-time curve (AUC) values across the body size distribution of children and young adults. DESIGN: Maximum a posteriori probability Bayesian (MAP-Bayesian) pharmacokinetic analysis using retrospectively collected medical record data. SETTING: Children's hospital. PATIENTS: A total of 115 patients 1-20 years of age managed outside of the intensive care unit who were treated with vancomycin between May 1, 2011, and August 31, 2012, and had a minimum of two serum vancomycin concentration measurements. MEASUREMENTS AND MAIN RESULTS: Vancomycin dosing and concentration-time information along with demographic and laboratory data related to kidney function estimation were extracted from the patients' medical records. A previously structured one-compartment model was used to derive MAP-Bayesian estimates of pharmacokinetic system parameters for each patient. Post hoc linear and power function regression were used to compare clearance (Cl) and the volume of distribution of the central compartment (Vc) to body size descriptors (weight, height, and BSA). The relationship of the body size descriptor-indexed parameter across the body size distribution was assessed. The AUC from time 0 to 24 hours (AUC24 ) values associated with vancomycin dosing regimens based on weight, height, and BSA were estimated. The 115 patients (56.5% male) had a mean ± SD age, height, and weight of 9.7 ± 5.4 years, 133 ± 32.3 cm, and 38.0 ± 24.2 kg, respectively. Each patient received a minimum of four doses of vancomycin and had two to nine serum vancomycin concentration measurements, for a total of 313 measurements for all patients. Vancomycin Cl was a nonlinear function of weight and a linear-proportionate function of BSA, whereas the volume of distribution of the central compartment (Vc) was a linear-proportionate function of weight. The expected median (5th-95th percentile) AUC24 values with weight-based dosing of vancomycin 60-70 mg/kg/day were 446 (315-834) mg·hour/L and 649 (385-1165) mg·hour/L in patients weighing less than 40 kg (n=72) and those weighing 40 kg or more (n=43), respectively. In contrast, isometric AUC24 values were predicted with BSA-based dosing across the body size distribution. CONCLUSION: BSA-based dosing is more likely than weight-based (mg/kg) dosing of vancomycin to achieve isometric AUC24 values across the body size distribution of children and young adults. Pharmacokinetic studies that compare these two vancomycin dosing strategies in children are clearly needed to validate these findings.

Evidence-based recommendations for antimicrobial nasal washes in chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) refractory to medical and surgical therapy is a difficult problem for patients and physicians. Topical antimicrobial nasal irrigations are commonly used for treatment with great variation in methodology and without clear scientific support for current treatment formulations. The purpose of this study was to develop a scientific rationale for creating standardized recommendations for clinical practice in the use of topical antimicrobial washes for CRS. METHODS: An extensive review of basic science and clinical literature on the treatment of CRS with topical antimicrobial washes was completed. Pharmacokinetics of and organism susceptibility to appropriate topically applied antimicrobial agents were reviewed. RESULTS: The most common organisms associated with CRS were identified. The relevant pharmacokinetics of drugs targeted at these organisms are presented. Susceptibility breakpoints set by the National Committee for Clinical Laboratory Standards are identified to help establish the most effective concentration of the identified drugs. Recommendations for agent selection, agent concentration, length of treatment, dosing schedule, and methods of irrigation are presented. CONCLUSION: Antimicrobial nasal washes provide a potentially effective treatment for the growing population of patients who remain symptomatic after appropriate medical and surgical intervention. This study establishes the basic principles supporting this treatment option and offers rational, evidence-based treatment guidelines. The study has identified additional areas that need to be investigated before prospective clinical trials can be effectively undertaken.