Reginald S Parker, Will Varner, Murad K. Nazzal, Amy Creecy, Sonali J. Karnik, Rachel J. Blosser, Elizabeth Scott, Alexander Harris, Ashlyn Morris, Hannah S. Wang, Tyler J. Margetts, Marko Dragisic, Upasana Ganguly, Jill C. Fehrenbacher, Kathryn D. Fischer, Alexandru Movila, Adrian L. Oblak, Jessica Hathaway-Schrader, Melissa A. Kacena
Alzheimer's disease (AD), fracture healing, and the gut microbiome are interconnected aspects of health that have gained significant research interest. Recent studies suggest gut dysbiosis may play a role in AD pathogenesis, potentially through the gut-brain axis, a bidirectional communication system. Moreover, the gut microbiome's role in bone health could link dysbiosis and fracture risk. Furthermore, research reports have revealed that the brain communicates with bone, termed the bone-brain axis. Despite these insights, the effect of the gut microbiome on fracture healing in AD remains largely unexplored. To uncover these connections, our study uses the AD mouse models, 3xTg and 5xFAD. We conducted osteotomies on these mice and analyzed fecal samples that were collected at different timepoints. Fecal samples are being examined via qPCR and 16s RNA analysis toidentify and quantify bacterial phyla. These findings will be linked to both AD progression, gauged through behavior and histological analyses, and fracture healing, quantified using X-ray mRUST scoring, microCT, and histology. We hypothesize that the progression of AD could alter the gut microbiome, potentially affecting fracture healing. This might occur through inflammation pathways triggered by specific gut bacteria. We may identify specific gut bacteria that play critical roles in both fracture healing and AD. We anticipate finding a shift towards pro-inflammatory bacterial phyla in the context of AD progression and during the fracture healing process. If this hypothesis is validated, it could unlock new therapeutic strategies aimed at targeting the gut microbiome to improve bone health, fracture healing, and AD progression in patients.
阿尔茨海默病（AD）、骨折愈合和肠道微生物组是相互关联的健康问题，已引起了研究人员的极大兴趣。最近的研究表明，肠道菌群失调可能通过肠道-大脑轴这一双向交流系统在阿尔茨海默病发病机制中发挥作用。此外，肠道微生物组在骨骼健康中的作用可能将菌群失调与骨折风险联系起来。此外，研究报告还揭示了大脑与骨骼之间的沟通，即骨-脑轴。尽管有了这些见解，但肠道微生物组对艾滋病患者骨折愈合的影响在很大程度上仍未得到探讨。为了揭示这些联系，我们的研究使用了 AD 小鼠模型 3xTg 和 5xFAD。我们对这些小鼠进行了截骨手术，并分析了在不同时间点采集的粪便样本。粪便样本正在通过 qPCR 和 16s RNA 分析进行检验，以确定细菌门类并对其进行量化。这些发现将与注意力缺失症的进展（通过行为和组织学分析进行衡量）和骨折愈合（通过 X 射线 mRUST 评分、microCT 和组织学进行量化）相关联。我们假设，AD 的进展会改变肠道微生物群，从而可能影响骨折愈合。这可能是通过特定肠道细菌引发的炎症途径发生的。我们可能会找出在骨折愈合和 AD 中发挥关键作用的特定肠道细菌。我们预计，在 AD 发展过程中和骨折愈合过程中，会发现向促炎细菌门类的转变。如果这一假设得到验证，它将开启以肠道微生物组为靶点的新治疗策略，从而改善患者的骨骼健康、骨折愈合和 AD 进展。
{"title":"The Potential Tripartite Connection: Alzheimer's Disease, Fracture Healing, and the Gut Microbiome","authors":"Reginald S Parker, Will Varner, Murad K. Nazzal, Amy Creecy, Sonali J. Karnik, Rachel J. Blosser, Elizabeth Scott, Alexander Harris, Ashlyn Morris, Hannah S. Wang, Tyler J. Margetts, Marko Dragisic, Upasana Ganguly, Jill C. Fehrenbacher, Kathryn D. Fischer, Alexandru Movila, Adrian L. Oblak, Jessica Hathaway-Schrader, Melissa A. Kacena","doi":"10.18060/27756","DOIUrl":"https://doi.org/10.18060/27756","url":null,"abstract":"Alzheimer's disease (AD), fracture healing, and the gut microbiome are interconnected aspects of health that have gained significant research interest. Recent studies suggest gut dysbiosis may play a role in AD pathogenesis, potentially through the gut-brain axis, a bidirectional communication system. Moreover, the gut microbiome's role in bone health could link dysbiosis and fracture risk. Furthermore, research reports have revealed that the brain communicates with bone, termed the bone-brain axis. Despite these insights, the effect of the gut microbiome on fracture healing in AD remains largely unexplored. \u0000To uncover these connections, our study uses the AD mouse models, 3xTg and 5xFAD. We conducted osteotomies on these mice and analyzed fecal samples that were collected at different timepoints. Fecal samples are being examined via qPCR and 16s RNA analysis toidentify and quantify bacterial phyla. These findings will be linked to both AD progression, gauged through behavior and histological analyses, and fracture healing, quantified using X-ray mRUST scoring, microCT, and histology. \u0000We hypothesize that the progression of AD could alter the gut microbiome, potentially affecting fracture healing. This might occur through inflammation pathways triggered by specific gut bacteria. We may identify specific gut bacteria that play critical roles in both fracture healing and AD. We anticipate finding a shift towards pro-inflammatory bacterial phyla in the context of AD progression and during the fracture healing process. If this hypothesis is validated, it could unlock new therapeutic strategies aimed at targeting the gut microbiome to improve bone health, fracture healing, and AD progression in patients.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristina Delgado, Peyton Robinson, Khalid Khan, Vijay Ramakrishnan
Background and Hypothesis: Chronic rhinosinusitis (CRS) is defined as persistent inflammation of the mucosa of the nose and paranasal sinuses, either with or without nasal polyps. The pathophysiology of CRS is thought to occur due to a dysfunction of the immune response leading to prolonged NF-kB signaling. Many chronic diseases like CRS have been shown to have chronic NF-kB dysregulation. One hypothesis for the persistent inflammation seen in CRS patients is that they have a less robust pro-resolution response that aids in termination of the NF-kB pathway. In this study, we sought to validate our previous results from nasal polyp tissue using qPCR for key inflammatory mediators, CXCL1, CSF3, and myd88. Methods: Human CRS nasal polyp tissue was collected during functional endoscopic sinus surgery to be grown in cell culture. The nasal polyp tissue was grown in 10 ug/ml of LPS to mimic gram-negative conditions commonly seen in CRS. Tissue cDNA was extracted and frozen at – 80° C. Tissue cDNA for control, RvD2, LPS, and LPS+RvD2 was thawed and used to run qPCR for myd88, CXCL1, and CSF3. Results: qPCR data was normalized using GAPDH and B-actin. When normalized with GAPDH and B-actin, CSF3 was found to be downregulated with RvD2 exposure, while both myd88 and CXCL1 showed inconsistent results. Downregulation of CSF3 with RvD2 exposure, is consistentwith our hypothesis that RvD2 plays a role in NF-kB resolution. Conclusion: Downregulation of the NF-kB pathway can play an important role in reducing the chronic inflammation seen in CRS. CSF3 was one gene target of the NF-kB pathway that was continuously found to be downregulated when nasal polyp tissue was treated with RvD2. Ourfindings demonstrate that when nasal polyp tissue is treated with pro-resolving mediators such as RvD2, at least one or more of the NF-kB-associated genes are downregulated.
{"title":"Validation of Blunting of Inflammatory Markers in LPS Induced Tissue with SPM Treatment","authors":"Cristina Delgado, Peyton Robinson, Khalid Khan, Vijay Ramakrishnan","doi":"10.18060/27799","DOIUrl":"https://doi.org/10.18060/27799","url":null,"abstract":"Background and Hypothesis: Chronic rhinosinusitis (CRS) is defined as persistent inflammation of the mucosa of the nose and paranasal sinuses, either with or without nasal polyps. The pathophysiology of CRS is thought to occur due to a dysfunction of the immune response leading to prolonged NF-kB signaling. Many chronic diseases like CRS have been shown to have chronic NF-kB dysregulation. One hypothesis for the persistent inflammation seen in CRS patients is that they have a less robust pro-resolution response that aids in termination of the NF-kB pathway. In this study, we sought to validate our previous results from nasal polyp tissue using qPCR for key inflammatory mediators, CXCL1, CSF3, and myd88. \u0000Methods: Human CRS nasal polyp tissue was collected during functional endoscopic sinus surgery to be grown in cell culture. The nasal polyp tissue was grown in 10 ug/ml of LPS to mimic gram-negative conditions commonly seen in CRS. Tissue cDNA was extracted and frozen at – 80° C. Tissue cDNA for control, RvD2, LPS, and LPS+RvD2 was thawed and used to run qPCR for myd88, CXCL1, and CSF3. \u0000Results: qPCR data was normalized using GAPDH and B-actin. When normalized with GAPDH and B-actin, CSF3 was found to be downregulated with RvD2 exposure, while both myd88 and CXCL1 showed inconsistent results. Downregulation of CSF3 with RvD2 exposure, is consistentwith our hypothesis that RvD2 plays a role in NF-kB resolution. \u0000Conclusion: Downregulation of the NF-kB pathway can play an important role in reducing the chronic inflammation seen in CRS. CSF3 was one gene target of the NF-kB pathway that was continuously found to be downregulated when nasal polyp tissue was treated with RvD2. Ourfindings demonstrate that when nasal polyp tissue is treated with pro-resolving mediators such as RvD2, at least one or more of the NF-kB-associated genes are downregulated.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Objective: For veterans suffering from chronic musculoskeletal pain, finding alternative treatments to analgesics is critical for safer, more effective pain management. While music interventions have shown promise for acute pain, their acceptability for chronic pain and telehealth delivery needs more rigorous examination. Methods: The Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia (FAMILIA) study randomized 60 veterans with chronic musculoskeletal pain to receive usual care, telehealth music listening (ML), or telehealth music imagery (MI). ML involved independent listening to songs of each participant’s choosing, while MI consisted of one-on-one music therapist-led sessions combining ML, imagery, and verbal processing. To complement quantitative analysis of patient-reported outcomes, qualitative interviews of participants were conducted to understand perceived benefits, acceptability, barriers, and facilitators of study interventions. We analyzed 15 interviews using thematic analysis to assess acceptability of the music interventions. Results: All interviewees perceived mental-emotional benefits and almost all experienced physical pain relief during their music listening or therapy sessions. However, many noted that the pain relief was short term, and for some veterans randomized to ML, certain songs evoked negative associations. Participants also benefited from study participation and its formal structure, in contrast to their prior informal music listening experiences. Planned study activities like participant check-ins with staff and interactions with therapists fostered a deeper understanding of how music can be therapeutic and increased veterans’ confidence in their own ability to use music therapeutically. Study acceptability was further evidenced by interviewees’ intention to continue using music listening and imagery techniques after study completion and their strong support for expanding access to music interventions to other veterans. Conclusion/Implications: The FAMILIA study not only supports telehealth music interventions as acceptable treatments for chronic musculoskeletal pain, but the reported physical pain and mental-emotional benefits necessitate a larger, fully powered study.
背景/目的：对于患有慢性肌肉骨骼疼痛的退伍军人来说，找到镇痛剂的替代疗法对于更安全、更有效的疼痛管理至关重要。虽然音乐干预已显示出治疗急性疼痛的前景，但其对慢性疼痛和远程医疗服务的可接受性还需要更严格的审查。方法：音乐想象和聆听镇痛干预的可行性和可接受性（FAMILIA）研究将 60 名患有慢性肌肉骨骼疼痛的退伍军人随机分组，分别接受常规护理、远程保健音乐聆听（ML）或远程保健音乐想象（MI）。ML 包括独立聆听每位参与者自选的歌曲，而 MI 则包括由音乐治疗师指导的一对一疗程，其中结合了 ML、想象和语言处理。为了补充对患者报告结果的定量分析，我们还对参与者进行了定性访谈，以了解他们对研究干预措施的益处、可接受性、障碍和促进因素的看法。我们使用主题分析法对 15 个访谈进行了分析，以评估音乐干预的可接受性。 结果所有受访者都认为在聆听音乐或接受治疗的过程中，精神和情感都得到了愉悦，几乎所有受访者的身体疼痛都得到了缓解。然而，许多人指出，疼痛缓解是短期的，而且对于一些被随机分配到 ML 的退伍军人来说，某些歌曲会唤起他们的负面联想。与之前的非正式音乐聆听经历相比，参与者还从参与研究及其正式结构中获益匪浅。有计划的研究活动，如参与者与工作人员的签到以及与治疗师的互动，加深了他们对音乐如何起到治疗作用的理解，并增强了退伍军人对自己使用音乐进行治疗的能力的信心。受访者有意在研究结束后继续使用音乐聆听和想象技巧，并强烈支持将音乐干预措施推广到其他退伍军人，这进一步证明了研究的可接受性。结论/意义： FAMILIA 研究不仅支持将远程医疗音乐干预作为可接受的慢性肌肉骨骼疼痛治疗方法，而且报告的身体疼痛和精神情感方面的益处表明有必要进行更大规模的、全面的研究。
{"title":"“There’s Healing in Music”: Veteran Perceptions of Music Interventions for Their Chronic Musculoskeletal Pain","authors":"Claire Whalen, K. M. Story, Matthew J. Bair","doi":"10.18060/27821","DOIUrl":"https://doi.org/10.18060/27821","url":null,"abstract":"Background/Objective: For veterans suffering from chronic musculoskeletal pain, finding alternative treatments to analgesics is critical for safer, more effective pain management. While music interventions have shown promise for acute pain, their acceptability for chronic pain and telehealth delivery needs more rigorous examination. \u0000Methods: The Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia (FAMILIA) study randomized 60 veterans with chronic musculoskeletal pain to receive usual care, telehealth music listening (ML), or telehealth music imagery (MI). ML involved independent listening to songs of each participant’s choosing, while MI consisted of one-on-one music therapist-led sessions combining ML, imagery, and verbal processing. To complement quantitative analysis of patient-reported outcomes, qualitative interviews of participants were conducted to understand perceived benefits, acceptability, barriers, and facilitators of study interventions. We analyzed 15 interviews using thematic analysis to assess acceptability of the music interventions. \u0000 \u0000Results: All interviewees perceived mental-emotional benefits and almost all experienced physical pain relief during their music listening or therapy sessions. However, many noted that the pain relief was short term, and for some veterans randomized to ML, certain songs evoked negative associations. Participants also benefited from study participation and its formal structure, in contrast to their prior informal music listening experiences. Planned study activities like participant check-ins with staff and interactions with therapists fostered a deeper understanding of how music can be therapeutic and increased veterans’ confidence in their own ability to use music therapeutically. Study acceptability was further evidenced by interviewees’ intention to continue using music listening and imagery techniques after study completion and their strong support for expanding access to music interventions to other veterans. \u0000Conclusion/Implications: The FAMILIA study not only supports telehealth music interventions as acceptable treatments for chronic musculoskeletal pain, but the reported physical pain and mental-emotional benefits necessitate a larger, fully powered study.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Rigid silicon electrodes like Utah array grids and Neuropixel probes have been used in human and animal brain models to understand the dynamics of neural computation, treat neurodegenerative disorders, and act as brain-machine-interfaces. However, when implanted chronically, glial proliferation can rapidly disrupt the interaction between neurons and electrodes, drastically reducing recording fidelity. The development of flexible electrodes has the potential to minimize tissue damage and inflammation, which allows for long-term recordings over several months. In line with this objective, the Nano-neurotechnology Lab at Purdue University has developed a 6-µm thick, flexible, and biocompatible Parylene probe to facilitate chronic recordings in awake mice. However, flexible electrodes present a unique engineering challenge as the force required to insert into the brain causes the probe to buckle and fail during insertion. Methods and Results: Here, I designed a micropipette shuttle using a glass micropipette and custom insertion system which provided reproducible probe implantation into the cortex. The implantation device was designed in CAD software and 3D-printed for rapid prototyping. The procedure was developed on brain phantoms made of 0.6% agarose with a comparable Young’s modulus to mouse brain tissue. Utilizing 3D-printed pieces and the surface tension of diluted poly-vinyl-acrylate adhesive to align the probe to a micropipette, insertion of the electrode and retraction of the shuttle was accomplished in awake mice. Conclusion: The implications of flexible recording electrodes are extensive. Long-term implantation opens the door for understanding behavioral and learning dynamics over time. Moreover, the flexibility of these probes allows for the combination of 2-photon optical microscopy, thus enabling multi-modal investigation of neuronal physiology. A low-cost, consistent procedure is the first step in the implementation of these flexible probes for further advancements in fundamental neuroscience research and its potential applications in human and animal studies.
{"title":"Implantation of Flexible Electrodes for Simultaneous in-vivo Extracellular Recording and Two-Photon Imaging","authors":"Alec Booth, Hammad Khan, Om Kolhe, Krishna Jayant","doi":"10.18060/27949","DOIUrl":"https://doi.org/10.18060/27949","url":null,"abstract":"Introduction: Rigid silicon electrodes like Utah array grids and Neuropixel probes have been used in human and animal brain models to understand the dynamics of neural computation, treat neurodegenerative disorders, and act as brain-machine-interfaces. However, when implanted chronically, glial proliferation can rapidly disrupt the interaction between neurons and electrodes, drastically reducing recording fidelity. The development of flexible electrodes has the potential to minimize tissue damage and inflammation, which allows for long-term recordings over several months. In line with this objective, the Nano-neurotechnology Lab at Purdue University has developed a 6-µm thick, flexible, and biocompatible Parylene probe to facilitate chronic recordings in awake mice. However, flexible electrodes present a unique engineering challenge as the force required to insert into the brain causes the probe to buckle and fail during insertion. \u0000Methods and Results: Here, I designed a micropipette shuttle using a glass micropipette and custom insertion system which provided reproducible probe implantation into the cortex. The implantation device was designed in CAD software and 3D-printed for rapid prototyping. The procedure was developed on brain phantoms made of 0.6% agarose with a comparable Young’s modulus to mouse brain tissue. Utilizing 3D-printed pieces and the surface tension of diluted poly-vinyl-acrylate adhesive to align the probe to a micropipette, insertion of the electrode and retraction of the shuttle was accomplished in awake mice. \u0000Conclusion: The implications of flexible recording electrodes are extensive. Long-term implantation opens the door for understanding behavioral and learning dynamics over time. Moreover, the flexibility of these probes allows for the combination of 2-photon optical microscopy, thus enabling multi-modal investigation of neuronal physiology. A low-cost, consistent procedure is the first step in the implementation of these flexible probes for further advancements in fundamental neuroscience research and its potential applications in human and animal studies. ","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brendan Jones, Brianna Chandler, Kelly DeMichael, Baraka Muvuka, Jonathan E. Guerrero, Kyle Gosporadek
Background: Brain health equity remains an underexplored research area despite high prevalence of neurovascular conditions and related health impacts. This study examined the associations between socio-demographic, behavioral factors, and hospital admissions for neurovascular-related morbidity in an urban underserved community. It is part of a multi-phased Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to examine the prevalence, distribution, and relationships between social determinants of health (SDOH), demographics, health behaviors, and health outcomes in Northwest Indiana. Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral and health outcomes data for adult inpatient visits from January 2021 to March 2023. Neurovascular admission was determined by ICD-10 Codes I67-69. Data analysis was conducted in SPSS 29.0 using descriptive statistics (i.e., frequencies and central tendency), bivariate analysis (Chi-square; p<0.05), and multivariate analysis (binary logistic regression; p<0.05). This study received exemption from Indiana University Human Research Protection Program (IRB #14040). Results: There were 1,489 participants included in this study. The majority were white (77.7%), older adults (67 ± 21.5) and publicly insured (77.8%). The bivariate analysis demonstrated significant relationships between admission for neurovascular conditions and age group (p<0.001), veteran status (p<0.001), insurance type (p<0.037), and physical activity (p<0.001). After adjusting for these factors in multivariate analysis, age group (p< 0.003) and physical inactivity (p<0.008) were significantly associated with admission for neurovascular conditions. Conclusion: Understanding how SDOH and behavioral factors influence neurovascular admissions and inequities in urban settings will enhance collaborative efforts to develop, implement, and evaluate evidence-based interventions. The subsequent CBPR phases will utilize these findings to explore how socioeconomic status affects these patients’ ability to seek emergent and/or surgical care. This will enable implementation of strategies that better account for SDOH in patient care.
{"title":"Neurovascular Conditions and Associated Socio-Demographic and Behavioral Factors in an Urban Hospital in Northwest Indiana","authors":"Brendan Jones, Brianna Chandler, Kelly DeMichael, Baraka Muvuka, Jonathan E. Guerrero, Kyle Gosporadek","doi":"10.18060/27849","DOIUrl":"https://doi.org/10.18060/27849","url":null,"abstract":"Background: Brain health equity remains an underexplored research area despite high prevalence of neurovascular conditions and related health impacts. This study examined the associations between socio-demographic, behavioral factors, and hospital admissions for neurovascular-related morbidity in an urban underserved community. It is part of a multi-phased Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to examine the prevalence, distribution, and relationships between social determinants of health (SDOH), demographics, health behaviors, and health outcomes in Northwest Indiana. \u0000Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral and health outcomes data for adult inpatient visits from January 2021 to March 2023. Neurovascular admission was determined by ICD-10 Codes I67-69. Data analysis was conducted in SPSS 29.0 using descriptive statistics (i.e., frequencies and central tendency), bivariate analysis (Chi-square; p<0.05), and multivariate analysis (binary logistic regression; p<0.05). This study received exemption from Indiana University Human Research Protection Program (IRB #14040). \u0000Results: There were 1,489 participants included in this study. The majority were white (77.7%), older adults (67 ± 21.5) and publicly insured (77.8%). The bivariate analysis demonstrated significant relationships between admission for neurovascular conditions and age group (p<0.001), veteran status (p<0.001), insurance type (p<0.037), and physical activity (p<0.001). After adjusting for these factors in multivariate analysis, age group (p< 0.003) and physical inactivity (p<0.008) were significantly associated with admission for neurovascular conditions. \u0000Conclusion: Understanding how SDOH and behavioral factors influence neurovascular admissions and inequities in urban settings will enhance collaborative efforts to develop, implement, and evaluate evidence-based interventions. The subsequent CBPR phases will utilize these findings to explore how socioeconomic status affects these patients’ ability to seek emergent and/or surgical care. This will enable implementation of strategies that better account for SDOH in patient care.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kylie Wertz, Julia Amstutz, Michael Scanlon, Debra K. Litzelman
Background: Community health workers (CHWs) promote health education, address social determinants of health, and bridge the gap between healthcare systems and underserved populations, but the lack of sustainable funding remains a challenge to greater CHW utilization. Medicaid reimbursement has been identified as a promising mechanism to fund CHWs, however, state policies vary widely. A comparative policy analysis can guide future reimbursement strategies. Methods: We conducted a comparative policy analysis of Medicaid reimbursement for CHWs. State government websites and legal databases were searched utilizing keyword search terms related to CHWs and Medicaid reimbursement. We identified and analyzed relevant statutes, regulations, and administrative codes for reimbursement mechanism, rates, supervision, certification, and scope of practice. Results: 26 states currently reimburse CHWs through Medicaid; 3 states started reimbursement in the last six months. 16 states authorize payment through State Plan Amendments (SPAs), 3 use Section 1115 demonstration waivers, 10 use Medicaid managed care organization contracts, and 4 use blended strategies. 13 states require certification and supervision for reimbursement, although the supervising licensed professional can vary. The scope of practice of CHW also varies between states. There is a large range for reimbursement rates; for example, billing code 98960 currently used by 14 states varies from $9.70 in Indiana to $55.25 in Arizona for a 30 minute visit. Policy Implications: This study can inform sustainable reimbursement models through Medicaid for CHWs in Indiana and other states. An SPA may be the most expedient way for Indiana to increase reimbursement for CHWs, but its narrowness and inflexibility could hinder CHWs' positive impact. The variety of strategies currently in use demonstrates that there is no single path to sustainable financing. Protocols for a set of scoping reviews will result from this comparative analysis for more in-depth investigations of key peer-reviewed and grey literature.
{"title":"Medicaid Reimbursement for Community Health Workers: A Comparative State Policy Analysis with Implications for Indiana","authors":"Kylie Wertz, Julia Amstutz, Michael Scanlon, Debra K. Litzelman","doi":"10.18060/27824","DOIUrl":"https://doi.org/10.18060/27824","url":null,"abstract":"Background: Community health workers (CHWs) promote health education, address social determinants of health, and bridge the gap between healthcare systems and underserved populations, but the lack of sustainable funding remains a challenge to greater CHW utilization. Medicaid reimbursement has been identified as a promising mechanism to fund CHWs, however, state policies vary widely. A comparative policy analysis can guide future reimbursement strategies. \u0000Methods: We conducted a comparative policy analysis of Medicaid reimbursement for CHWs. State government websites and legal databases were searched utilizing keyword search terms related to CHWs and Medicaid reimbursement. We identified and analyzed relevant statutes, regulations, and administrative codes for reimbursement mechanism, rates, supervision, certification, and scope of practice. \u0000Results: 26 states currently reimburse CHWs through Medicaid; 3 states started reimbursement in the last six months. 16 states authorize payment through State Plan Amendments (SPAs), 3 use Section 1115 demonstration waivers, 10 use Medicaid managed care organization contracts, and 4 use blended strategies. 13 states require certification and supervision for reimbursement, although the supervising licensed professional can vary. The scope of practice of CHW also varies between states. There is a large range for reimbursement rates; for example, billing code 98960 currently used by 14 states varies from $9.70 in Indiana to $55.25 in Arizona for a 30 minute visit. \u0000Policy Implications: This study can inform sustainable reimbursement models through Medicaid for CHWs in Indiana and other states. An SPA may be the most expedient way for Indiana to increase reimbursement for CHWs, but its narrowness and inflexibility could hinder CHWs' positive impact. The variety of strategies currently in use demonstrates that there is no single path to sustainable financing. Protocols for a set of scoping reviews will result from this comparative analysis for more in-depth investigations of key peer-reviewed and grey literature.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Objective: Atrial fibrillation (AF) and venous thromboembolism (VTE) are conditions with significant morbidity and mortality when left untreated. American Heart Association guidelines changed in 2019 to make non-vitamin K antagonist oral anticoagulants (NOACs) the preferred method for preventing stroke and systemic embolism in patients with AF or history of VTE. NOACs were first introduced to the United States in 2010 and now include dabigatran, apixaban, rivaroxaban, and edoxaban. There is a dearth of research concerning the speed with which new treatments are prescribed to those in different socioeconomic status (SES) groups. We hypothesized that patients with lower SES were prescribed NOACs later than higher SES counterparts following the introduction of NOACs in 2010. Methods: The IU Cardiovascular Research Consortium/Sidus Dataset was mined for AF and VTE patients prescribed a NOAC between 2010 and 2022. The SES groups were determined using 2020 U.S. Census income data that correlated to patients’ zip codes. The yearly number ofpatients in each SES group were compared to assess for proportional uptake of NOAC prescribing. The primary outcome was the proportion of low SES to high SES prescribing over each year between 2010 and 2022. Results: Low SES patients (n=101,945) were prescribed NOACs at an average of 0.65 times the rate of high SES patients (n= 89,130) from 2010 to 2012, the first three years of NOAC market availability. Prescribing rates equilibrated in 2013 and low SES prescribing has outpaced high SES prescribing since 2021. Conclusion/Impact: Low SES patients experienced a three year delay in receiving NOAC prescriptions at the same rate as their high SES counterparts. Systemic changes, like more frequent prescribing guideline updates and improved evidence-based education amongst providers in low-income areas, could prevent a similar delay when introducing similarly transformative treatments in the future.
背景/目的：心房颤动（AF）和静脉血栓栓塞症（VTE）如不及时治疗，会导致严重的发病率和死亡率。美国心脏协会指南于 2019 年做出改变，将非维生素 K 拮抗剂口服抗凝药（NOAC）作为房颤或有 VTE 病史患者预防中风和全身性栓塞的首选方法。NOACs 于 2010 年首次引入美国，目前包括达比加群、阿哌沙班、利伐沙班和埃多沙班。关于不同社会经济地位（SES）群体接受新疗法的速度，目前还缺乏相关研究。我们假设，自 2010 年引入 NOACs 后，社会经济地位较低的患者获得 NOACs 处方的时间晚于社会经济地位较高的患者。研究方法从 IU Cardiovascular Research Consortium/Sidus Dataset 数据集中挖掘出 2010 年至 2022 年期间被处方 NOAC 的房颤和 VTE 患者。根据与患者邮政编码相关的 2020 年美国人口普查收入数据确定 SES 组别。对每个 SES 组别中每年的患者人数进行比较，以评估 NOAC 处方的使用比例。主要结果是 2010 年至 2022 年期间每年低 SES 与高 SES 的处方比例。结果2010 年至 2012 年，即 NOAC 上市的前三年，低 SES 患者（n=101,945）的 NOAC 处方率平均是高 SES 患者（n=89,130）的 0.65 倍。2013 年处方率趋于平衡，自 2021 年以来，低 SES 处方率超过了高 SES 处方率。结论/影响：低社会经济地位患者延迟三年接受 NOAC 处方的比例与高社会经济地位患者相同。系统性变革，如更频繁地更新处方指南和改善低收入地区医疗服务提供者的循证教育，可避免未来引入类似变革性治疗时出现类似的延迟。
{"title":"Delayed Prescribing of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) in Patients with Low Socioeconomic Status","authors":"Gillian Coffey, Puja Unni, James Butler","doi":"10.18060/27744","DOIUrl":"https://doi.org/10.18060/27744","url":null,"abstract":"Background/Objective: Atrial fibrillation (AF) and venous thromboembolism (VTE) are conditions with significant morbidity and mortality when left untreated. American Heart Association guidelines changed in 2019 to make non-vitamin K antagonist oral anticoagulants (NOACs) the preferred method for preventing stroke and systemic embolism in patients with AF or history of VTE. NOACs were first introduced to the United States in 2010 and now include dabigatran, apixaban, rivaroxaban, and edoxaban. There is a dearth of research concerning the speed with which new treatments are prescribed to those in different socioeconomic status (SES) groups. We hypothesized that patients with lower SES were prescribed NOACs later than higher SES counterparts following the introduction of NOACs in 2010. \u0000Methods: The IU Cardiovascular Research Consortium/Sidus Dataset was mined for AF and VTE patients prescribed a NOAC between 2010 and 2022. The SES groups were determined using 2020 U.S. Census income data that correlated to patients’ zip codes. The yearly number ofpatients in each SES group were compared to assess for proportional uptake of NOAC prescribing. The primary outcome was the proportion of low SES to high SES prescribing over each year between 2010 and 2022. \u0000Results: Low SES patients (n=101,945) were prescribed NOACs at an average of 0.65 times the rate of high SES patients (n= 89,130) from 2010 to 2012, the first three years of NOAC market availability. Prescribing rates equilibrated in 2013 and low SES prescribing has outpaced high SES prescribing since 2021. \u0000Conclusion/Impact: Low SES patients experienced a three year delay in receiving NOAC prescriptions at the same rate as their high SES counterparts. Systemic changes, like more frequent prescribing guideline updates and improved evidence-based education amongst providers in low-income areas, could prevent a similar delay when introducing similarly transformative treatments in the future.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannah Dillon, B. Whittam, Richard Rink, M. Kaefer, Kirstan D Meldrum, Joshua Roth, Pankaj Dangle, Yifan Meng, Jeremy Koehlinger, R. Misseri, Konrad Szymanski
Background and Hypothesis: Children with voiding dysfunction (VD), such as incontinence or urinary frequency, may report lower quality of life (QOL) compared to their peers. QOL questionnaires which could be used in this population have several limitations. PinQ is a bladder-specific, health-related QOL questionnaire, but it was developed without stakeholder input and fails to separate symptoms from QOL. Kidscreen-10 is a generic QOL questionnaire. We aimed to understand how QOL captured using existing instruments correlates with VD severity in a cross-sectional study. We hypothesized that large differences in symptoms would correspond with large differences in bladder-specific QOL but small differences in generic QOL. Methods: We recruited children 8-18 years old with VD at a pediatric urology clinic (June-July 2023). VD included daytime incontinence, enuresis, frequency, urgency, and dysuria. We excluded children with severe developmental delay, anatomical urological abnormalities, or history ofurologic surgery. We captured demographics, symptoms (Vancouver Dysfunction Voiding Symptom Score, DVSS), and QOL (PinQ and Kidscreen-10). Questionnaire scores were compared to weighted means from previous studies. We calculated Spearman correlations and QOL differences corresponding with the reported 20-point range of DVSS scores. Results: Twenty children (11 girls) at a median age of 10 years old participated (Table 1). Mean DVSS score was 14, similar to previous studies (weighted mean: 15). PinQ scores had a moderate positive correlation with DVSS scores (r = 0.37) with a 20-point DVSS difference corresponding to a 24% difference in PinQ scores (Figure 1). Kidscreen-10 scores had a moderate negative correlation with DVSS scores (r = -0.33) with a 20-point DVSS difference corresponding to a 12% difference in Kidscreen-10 scores (Figure 2). Conclusions: Previously published QOL questionnaires have significant limitations, limiting their clinical use in the care of patients with VD. A new, patient-centered, highly specific, and sensitive healthrelated QOL questionnaire is needed.
背景与假设：与同龄人相比，患有尿失禁或尿频等排尿功能障碍（VD）的儿童的生活质量（QOL）可能较低。可用于此类人群的 QOL 问卷存在一些局限性。PinQ 是一种针对膀胱的、与健康相关的 QOL 问卷，但它在开发过程中并未征求利益相关者的意见，也未能将症状与 QOL 区分开来。Kidscreen-10 是一份通用的 QOL 问卷。我们的目的是在一项横断面研究中了解使用现有工具获得的 QOL 与 VD 严重程度的相关性。我们假设，症状的巨大差异会导致膀胱特异性 QOL 的巨大差异，但通用 QOL 的差异较小。研究方法我们在一家儿科泌尿科诊所招募了 8-18 岁患有 VD 的儿童（2023 年 6 月至 7 月）。尿失禁包括日间尿失禁、遗尿、尿频、尿急和排尿困难。我们排除了严重发育迟缓、泌尿系统解剖异常或有泌尿系统手术史的儿童。我们收集了人口统计学资料、症状（温哥华功能障碍排尿症状评分，DVSS）和 QOL（PinQ 和 Kidscreen-10）。问卷得分与以往研究的加权平均值进行了比较。我们计算了斯皮尔曼相关性以及与报告的 20 分 DVSS 评分范围相对应的 QOL 差异。结果：共有 20 名中位数年龄为 10 岁的儿童（11 名女孩）参加（表 1）。DVSS 平均分为 14 分，与之前的研究结果相似（加权平均分：15 分）。PinQ 分数与 DVSS 分数呈中度正相关（r = 0.37），20 分的 DVSS 差异对应于 24% 的 PinQ 分数差异（图 1）。Kidscreen-10 分数与 DVSS 分数呈中度负相关（r = -0.33），20 分的 DVSS 差异对应于 12% 的 Kidscreen-10 分数差异（图 2）。结论以前公布的 QOL 问卷有很大的局限性，限制了它们在 VD 患者护理中的临床应用。我们需要一种新的、以患者为中心的、高度特异性和敏感性的健康相关 QOL 问卷。
{"title":"Health-Related Quality of Life Correlates with Bladder and Bowel Dysfunction: the Need for a New Patient-Centered Questionnaire","authors":"Hannah Dillon, B. Whittam, Richard Rink, M. Kaefer, Kirstan D Meldrum, Joshua Roth, Pankaj Dangle, Yifan Meng, Jeremy Koehlinger, R. Misseri, Konrad Szymanski","doi":"10.18060/27802","DOIUrl":"https://doi.org/10.18060/27802","url":null,"abstract":"Background and Hypothesis: Children with voiding dysfunction (VD), such as incontinence or urinary frequency, may report lower quality of life (QOL) compared to their peers. QOL questionnaires which could be used in this population have several limitations. PinQ is a bladder-specific, health-related QOL questionnaire, but it was developed without stakeholder input and fails to separate symptoms from QOL. Kidscreen-10 is a generic QOL questionnaire. We aimed to understand how QOL captured using existing instruments correlates with VD severity in a cross-sectional study. We hypothesized that large differences in symptoms would correspond with large differences in bladder-specific QOL but small differences in generic QOL. \u0000Methods: We recruited children 8-18 years old with VD at a pediatric urology clinic (June-July 2023). VD included daytime incontinence, enuresis, frequency, urgency, and dysuria. We excluded children with severe developmental delay, anatomical urological abnormalities, or history ofurologic surgery. We captured demographics, symptoms (Vancouver Dysfunction Voiding Symptom Score, DVSS), and QOL (PinQ and Kidscreen-10). Questionnaire scores were compared to weighted means from previous studies. We calculated Spearman correlations and QOL differences corresponding with the reported 20-point range of DVSS scores. \u0000Results: Twenty children (11 girls) at a median age of 10 years old participated (Table 1). Mean DVSS score was 14, similar to previous studies (weighted mean: 15). PinQ scores had a moderate positive correlation with DVSS scores (r = 0.37) with a 20-point DVSS difference corresponding to a 24% difference in PinQ scores (Figure 1). Kidscreen-10 scores had a moderate negative correlation with DVSS scores (r = -0.33) with a 20-point DVSS difference corresponding to a 12% difference in Kidscreen-10 scores (Figure 2). \u0000Conclusions: Previously published QOL questionnaires have significant limitations, limiting their clinical use in the care of patients with VD. A new, patient-centered, highly specific, and sensitive healthrelated QOL questionnaire is needed.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Deckbar, Kelly DeMichael, Wael Gad, Baraka Muvuka, Jonathan E. Guerrero
Introduction: The CDC and American Lung Association estimate that congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disorder (COPD), and asthma (COPD/asthma) cost Americans $30.7 billion, $327 billion, and $50 billion respectively each year. They account for most inpatient readmissions at St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana. There is need for further research on the social, behavioral, and demographic determinants associated with these conditions. This study examined the social, behavioral, and demographic determinants associated with inpatient admission for CHF, diabetes, COPD/asthma in SMMC’s service area. Methods: This retrospective study was part of a multi-phased Community-Based Participatory Research partnership between SMMC and Indiana University School of Medicine Northwest. SMMC implemented a pilot screening and referral program to assess social determinants of health in their service area as part of their Hospital Readmission Reduction Program. This study included data from 10,953 inpatient admissions between January 2021 to March 2023, majority of whom were transferred from the emergency department. Data analysis consisted ofunivariate, bivariate (Chi-square), and multivariate (binary logistic regression) analysis in SPSS 29.0. Results: Bivariate analysis revealed a statistically significant association between CHF and smoking, age, insurance type, and income. Diabetes was significantly associated with smoking, smokeless tobacco use, age group, race, income, and sex. COPD/asthma was significantly associated with smoking, age group, transportation needs, stress, insurance, ethnicity, and sex. Multivariate analysis found the following significant associations: age group with both CHF (p<0.001) and diabetes (p<0.001), former smoking with both CHF (p = 0.007) and COPD/asthma (p = 0.049), current smoking with COPD/asthma (p = 0.016), and sex with diabetes (p <0.001). Conclusions: These findings indicate significant associations between multiple sociobehavioral factors and admission for CHF, diabetes, COPD/asthma. Multi-risk-factor interventions may address these interactions and contribute to reducing readmission.
{"title":"Social Determinants of Health Associated with Inpatient Admissions for Congestive Heart Failure, Diabetes, Chronic Obstructive Pulmonary Disease, and Asthma","authors":"John Deckbar, Kelly DeMichael, Wael Gad, Baraka Muvuka, Jonathan E. Guerrero","doi":"10.18060/27798","DOIUrl":"https://doi.org/10.18060/27798","url":null,"abstract":"Introduction: The CDC and American Lung Association estimate that congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disorder (COPD), and asthma (COPD/asthma) cost Americans $30.7 billion, $327 billion, and $50 billion respectively each year. They account for most inpatient readmissions at St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana. There is need for further research on the social, behavioral, and demographic determinants associated with these conditions. This study examined the social, behavioral, and demographic determinants associated with inpatient admission for CHF, diabetes, COPD/asthma in SMMC’s service area. \u0000Methods: This retrospective study was part of a multi-phased Community-Based Participatory Research partnership between SMMC and Indiana University School of Medicine Northwest. SMMC implemented a pilot screening and referral program to assess social determinants of health in their service area as part of their Hospital Readmission Reduction Program. This study included data from 10,953 inpatient admissions between January 2021 to March 2023, majority of whom were transferred from the emergency department. Data analysis consisted ofunivariate, bivariate (Chi-square), and multivariate (binary logistic regression) analysis in SPSS 29.0. \u0000Results: Bivariate analysis revealed a statistically significant association between CHF and smoking, age, insurance type, and income. Diabetes was significantly associated with smoking, smokeless tobacco use, age group, race, income, and sex. COPD/asthma was significantly associated with smoking, age group, transportation needs, stress, insurance, ethnicity, and sex. Multivariate analysis found the following significant associations: age group with both CHF (p<0.001) and diabetes (p<0.001), former smoking with both CHF (p = 0.007) and COPD/asthma (p = 0.049), current smoking with COPD/asthma (p = 0.016), and sex with diabetes (p <0.001). \u0000Conclusions: These findings indicate significant associations between multiple sociobehavioral factors and admission for CHF, diabetes, COPD/asthma. Multi-risk-factor interventions may address these interactions and contribute to reducing readmission.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objective:In the emergency department, providers are expected to evaluate patients who have experienced strangulation resulting from sexual assault or interpersonal violence. Non-fatal strangulation can lead to significant injuries, including carotid artery dissection. Given the prevalence of strangulation injuries, providers must feel confident in their decision-making for this population. Previous educational interventions effectively improved provider knowledge of sexual assault and domestic violence patients, however, no studies have been conducted with the goal of improving provider knowledge about strangulation injuries in this population. We aimed to assess and improve emergency department provider knowledge surrounding nonfatal strangulation injuries. Project Methods:Preintervention and postintervention surveys were administered to emergency department physicians and advanced practice providers assessing both provider comfort and knowledge regarding treatment of survivors of sexual assault, domestic violence, and strangulation. Key content areas included: physician comfort in treating sexual assault survivors, understanding of trauma-informed care, satisfaction with prior training regarding nonfatal strangulation, and physician attitudes. 6 vignette-style questions designed to evaluate knowledge in clinical scenarios were also administered. A 15-minute, interactive, educational presentation was administered during the pre-existing departmental meeting. Survey responses were collected via email and data was stored in REDCAP. Preintervention and postintervention results were compared via t-tests. Results:There were 22 pre-intervention and 10 post-intervention responses. Median years of practice were 8. Survey participants tended to rate awareness of imaging recommendations and resources, decisionmaking, history taking, and use of trauma-informed care higher than preintervention participants. Postintervention participants tended to answer more clinical vignettes correctly than preintervention participants. Conclusion and Potential Impact:A 15-minute educational intervention was effective in improving provider knowledge, confidence, and comfort in treating patients who have experienced non-fatal strangulation. In the future, similar interventions may be implemented in other emergency departments to increase awareness about the evaluation and treatment of nonfatal strangulation injuries.
{"title":"Non-Fatal Strangulation Injuries: Improving Physician Knowledge and Attitudes","authors":"Sarah Pankratz, Christine Motzkus","doi":"10.18060/27755","DOIUrl":"https://doi.org/10.18060/27755","url":null,"abstract":"Background and Objective:In the emergency department, providers are expected to evaluate patients who have experienced strangulation resulting from sexual assault or interpersonal violence. Non-fatal strangulation can lead to significant injuries, including carotid artery dissection. Given the prevalence of strangulation injuries, providers must feel confident in their decision-making for this population. Previous educational interventions effectively improved provider knowledge of sexual assault and domestic violence patients, however, no studies have been conducted with the goal of improving provider knowledge about strangulation injuries in this population. We aimed to assess and improve emergency department provider knowledge surrounding nonfatal strangulation injuries. \u0000Project Methods:Preintervention and postintervention surveys were administered to emergency department physicians and advanced practice providers assessing both provider comfort and knowledge regarding treatment of survivors of sexual assault, domestic violence, and strangulation. Key content areas included: physician comfort in treating sexual assault survivors, understanding of trauma-informed care, satisfaction with prior training regarding nonfatal strangulation, and physician attitudes. 6 vignette-style questions designed to evaluate knowledge in clinical scenarios were also administered. A 15-minute, interactive, educational presentation was administered during the pre-existing departmental meeting. Survey responses were collected via email and data was stored in REDCAP. Preintervention and postintervention results were compared via t-tests. \u0000Results:There were 22 pre-intervention and 10 post-intervention responses. Median years of practice were 8. Survey participants tended to rate awareness of imaging recommendations and resources, decisionmaking, history taking, and use of trauma-informed care higher than preintervention participants. Postintervention participants tended to answer more clinical vignettes correctly than preintervention participants. \u0000Conclusion and Potential Impact:A 15-minute educational intervention was effective in improving provider knowledge, confidence, and comfort in treating patients who have experienced non-fatal strangulation. In the future, similar interventions may be implemented in other emergency departments to increase awareness about the evaluation and treatment of nonfatal strangulation injuries.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"56 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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