MEDICA@MUSC (Medical University of South Carolina)
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Telehealth Utilization in Clinical Trials: Facilitators, Barriers, and Future Directions
Get PDFPurpose: Telehealth implementation in clinical trials is not as well developed as compared to telehealth utilization in other areas of medical care. The focus of this project will explore the factors that foster and hinder the effective use of telehealth in clinical trials and how these insights can inform future strategies and policies.
Method: The project synthesizes empirical research and theoretical literature on the integration of telehealth into clinical trial. The research utilizes an online survey via REDCap to gauge the level of acceptance, perceived effectiveness, and potential barriers to the implementation of telehealth in clinical research.
Results: The responses of 25 professional participants highlight the optimistic perspective on the contribution of telehealth to clinical research and acknowledge the obstacles and opportunities that arise from the integration of artificial intelligence. The results provide insights into the factors that foster and hinder telehealth implementation for future expansion.
Conclusion: The project supported the expanded use of telehealth in clinical research to improve participant accessibility, diversity and recruitment, cost reductions, an increase efficiency. The policy implications include standardizing state licensure requirements and consistency in Investigational Review Boards (IRBs). Future research is recommended with larger sample sizes across a larger national or international region
Interventions to Modify Negative Perceptions of the Need for Behavioral Health Care for African American Patients
Get PDFBackground: African Americans underutilized mental health care services, compared to other population groups, in the past decades. While African Americans have the same mental health needs and rates of mental health diagnosis as other races, for some groups, there are additional cultural or environmental factors that create additional barriers to utilizing care (Alang, 2019). Methods: This project will be a cross-sectional study using an online survey of behavioral health practitioners. Results: Respondents were predominantly females (69%) and African Americans (69%). Their work medical specialties included: licensed counseling social workers and clinical social workers, mental health therapists, and psychiatrists. The average work experience is 13 years, and most work within government facilities (54%). Conclusion: This study was designed to establish initiatives to encourage black or African Americans to seek behavioral health care from the provider\u27s point of view. Teaching the African American communities and behavioral providers was a shared effort by all respondents; via offering culturally sensitive education (DEI) training to the providers
Increasing Social Inclusion and Engagement of Exercise for Individuals with Spinal Cord Injuries: A Universal Resource Development for Wellness Facilities
Get PDFIndividuals with spinal cord injuries (SCIs) are 1.5 times more likely to disengage in exercise one-year post-injury despite 80% of these individuals agreeing that exercise is critical to their overall health and quality of life (Baehr. Et al., 2022). A needs assessment was conducted on why the lack of engagement in exercise exists for individuals with SCIs within fitness facilities to identify barriers preventing participation. A quality improvement program called the Spinal Cord Injury Wellness Toolkit was created based off these findings and implemented at the MUSC Wellness Center. 14 individuals with SCIs participated at wellness center; REDCap surveys were given before and after their visitation. It was found that participant’s overall confidence in the wellness facility, gym equipment, exercise knowledge, and staff awareness of SCI precautions showed a significant increase. Thematic analyses from post-implementation surveys showed that participants agreed the toolkit provided security & safety, showed adaptability, provided various kinds of equipment, versatile, easily understood, catered to a wide variety of injury levels, and increased confidence & quality of life. Feedback was taken into consideration to create a final copy, which was then copyrighted. The wellness program was disseminated to the MUSC Wellness Center and other fitness facilities, hospital-based therapy facilities, MUSC research affiliates, and SCI support groups within SC. This toolkit will further be distributed across the US to increase overall social inclusion and exercise engagement for individuals with SCIs
Tier One Tools: Improving Educators’ Understanding of the Multi-Tiered System of Supports Within the School System Including a Case Example
No full textSouth Carolina public school teachers provide intervention services via 2 models: Response to Intervention (RtI) and the Multi-Tiered Support System (MTSS). Research shows that there is currently a gap in teacher understanding and implementation of MTSS versus RtI within South Carolina public school districts. Teachers noted lack of training, time, and resources as the major barriers to implementation and would benefit from two sets of modules: 1) an educational training module on MTSS and 2) example intervention modules that can be implemented within their classrooms at a tier one level in K-5 classrooms within the public school system in Florence School District 1. Data collected at the end of the 14-week capstone experience showed that teachers had an improved understanding of MTSS referrals when utilizing the training information provided. Teachers also showed confidence in implementing Tier One interventions in their classrooms to meet the needs of their students
The Heart-Brain Axis: Exploring Shared Genetic Signatures and Environmental Modifiers on Heart Failure and Alzheimer’s Disease Pathology
No full textHeart failure (HF) and Alzheimer’s Disease (AD) are two leading causes of death in the United States. Conventionally viewed as independent conditions, HF/AD coexist in ~30% of patients and are mechanistically linked by shared genetic and biochemical characteristics. The del Monte lab has established the concept of the heart-brain axis through human samples and murine models, providing a framework for this dissertation which focuses on the interplay between genetics and the environment in shaping the heterogeneity of disease phenotypes.
1) Loss of function mutations in presenilin (PSEN1/2) genes represent overlapping genetic signatures in AD/HF. Presenilins form the g-secretase catalytic subunit but also serve to regulate Ca2+, critical for neuron and cardiomyocyte function. Effects of PSEN2 loss concurrently in the heart and brain is unknown. Leveraging a mouse model of PSEN2 deletion (PS2KO), we found PS2KO mice have increased anxiety and diastolic dysfunction in-vivo and in vitro. Our data demonstrates PSEN2 loss induced Ca2+ handling defects, contributing to the development of coexistent myocardial and cognitive decline.
2) Familial HF, like AD, accounts for ~5% of cases, whereas majority are sporadic with/without genetic mutation. As such, investigating interactions between genetics and exposures to environmental modifiers is crucial to understanding the factors that influence prevalence and progression of disease. In AD and HF, environmental modifiers may influence organ(s) dysfunction through accelerating the misfolding of proteins. Air particulate matter (PM) has been independently linked to adverse cognitive and cardiovascular effects. However, its pathological effect concurrently on both organs and by which mechanism(s) is unknown. We found that exposure to PM in wildtype and AD model mice (APPswe/PSEN1DE9) affects cognition and cardiac function through amyloid-beta pathology, oxidative stress, and lung microbial dysbiosis. These data suggest that PM works independently, and in synergy with AD genetics, to influence disease in the heart and brain.
We demonstrated that AD pathology and functional deficits extend beyond the brain to affect the heart due to both genetics alone and when interplayed with environmental modification. Our data provides an explanation for the heterogeneity of HF/AD phenotypes, and suggests that early intervention is crucial to modify disease progression in both organs
Hiding in Plain Sight: Medical Theses, Slavery, and Reparative Archival Practices
Get PDFDespite the prevalence of the use and abuse of enslaved individuals in the pursuit of medical education at the Medical College of South Carolina during the pre-Civil War era, evidence of the institution\u27s involvement with slavery is scarce in the discoverable archival resources at the Waring Historical Library. The Waring Historical Library Inaugural Theses Project aims to identify and bring these hidden narratives into focus through reparative description work. Key outcomes include enhancing the outdated index, transferring it to a LibGuide format, and improving descriptions, subject headings, and transcripts within catalog records. The project emphasizes how interdisciplinary cooperation between archivists and historians can shape reparative description work to benefit researchers and expedite project workflows
Characteristics and Patterns of Diagnoses for Patients Admitted from and Discharged to Court or Law Enforcement in the State of Florida
Get PDFOBJECTIVE: The role of prison healthcare is to provide safe, high-quality, and timely healthcare for prisoners. This study examines the characteristics of patients discharged from healthcare in the nation’s third-largest prison system, the state of Florida.
METHODS: This was a study of adults (18-64) admitted from or discharged to law enforcement agencies in Florida in 2018 for healthcare in Florida hospitals. Patients were divided among distinguishable characteristics of gender, zip code, income quartile, rural/urban locality, and insurance type. Data was collected within the Office of Data Collection & Quality Assurance (DCQA) within the Florida Agency for Health Care Administration (Florida AHCA) and the data within the Healthcare Cost and Utilization Project (HCUP). Financial data was also analyzed.
RESULTS: 20,491 encounters were analyzed, with the patients being 65.4% male and 34.6% female. 21% of the patients had Medicaid, while 12.5% were uninsured. 73% of patients were 5 admitted from law enforcement but discharged home, and 44.8% of patients were from the poorest zip code quartile. Nine of the top 10 admission diagnoses were for behavioral health.
CONCLUSIONS: The study found that Florida has some inequities within its prison healthcare system, with the majority of those patients who are incarcerated coming from zip codes in the poorest areas within the state
The Impact of Covid-19 on the Utilization of Early Magnetic Resonance Imaging (eMRI) in the Assessment of Acute Uncomplicated Low Back Pain (LBP) and the Subsequent Effect on Health Care Service Utilization and Patient Outcomes
Get PDFOBJECTIVES: To examine changes in MRI rates between Pre-COVID-19 period (Feb-April 2019) and COVID-19 period (Feb-April 2020) among commercially insured patients aged 18-60 with a diagnosis of acute LBP, and to analyze differences in patient characteristics and outcomes between the time periods. Additionally, to examine the impact of eMRI on patient outcomes and health care costs for patients in the COVID-19 period.
DESIGN/METHODS: Using IBM® MarketScan® Commercial Database (MarketScan) we performed a quantitative pre-post comparative retrospective observational study of 117,150 total patients to examine adjusted differences in patient characteristics and rates of MRIs between time periods. We analyzed 49,020 patients in COVID-19 period to examine the impact of eMRIs on odds of having lumbar surgery (OR and 95% CI), and on adjusted total cost for health care services in a one-year follow up time.
RESULTS: The most significant between time periods was that eMRI rates decreased 1.41 percentage points from Pre-COVID-19 to COVID-19 period (P,0.0001). In COVID-19 analysis, patients with noMRI had 97.6% lower odds of having lumbar surgery vs eMRI (P
CONCLUSION: COVID-19 time period correlated with a statistically and clinically significant reduction in eMRIs for acute LBP, considering that prior to COVID-19, rates of MRIs were increasing exponentially each year. Results proved the hypothesis and confirmed literature review findings, that eMRIs result in worst patient outcomes, as measured by odds of surgery, and also result in significantly higher health care costs. Even the modest reduction in eMRI rates shown in this study could have a significant impact on costs, estimated at eight billion dollars of annualized savings, based on how many Americans suffer from LBP
Insulin as a Mediator of Obesity-Related Cognitive Decline
No full textObesity afflicts nearly half of the adult population in the United States and is strongly associated with age-related dementia. Hyperinsulinemia-induced insulin resistance is a common comorbidity amongst obese individuals and is linked to both poor cerebral perfusion and brain insulin deficiency. Insulin plays vital roles in the regulation of blood flow and various cognitive processes, including memory. As such, poor insulin action within and transport across the cerebrovasculature may predispose obese individuals to cognitive impairment. The central hypothesis of this dissertation was devised following an extensive literature review (Chapter 1) and asserts that obesity-associated hyperinsulinemia impairs insulin receptor endocytosis into the cerebrovascular endothelium, thereby preventing the propagation of insulin signaling cascades, reducing blood flow to the brain, and promoting cognitive decline.
To test our hypothesis, we devised a multifaceted approach that assessed both physiologic function and biologic mechanisms (Chapter 2). We assessed metrics of cognition and cerebrovascular function in a preclinical murine model of diet-induced obesity, where we discovered that high-fat feeding influenced spatial working memory and damaged cerebrovascular structure and function (Chapter 3). Diet-induced obesity further hindered insulin receptor transport within the brain microvasculature, a finding which was replicated in hyperinsulinemic brain endothelial cell cultures (Chapter 4). The observed failure of insulin receptor endocytosis into hyperinsulinemic brain endothelial cells (Chapter 4) occurred alongside aberrant phosphorylation of key internalization- and insulin signaling-effectors (Chapter 5). A downstream impairment in insulin-mediated vasodilatory capacity was further observed in hyperinsulinemic endothelial cells (Chapter 5), highlighting the functional consequences of hyperinsulinemia-induced insulin resistance on cerebrovascular function.
As discussed collectively in Chapter 6, we conclude that diet-induced obesity and hyperinsulinemia impair signaling through and internalization of the insulin receptor, an event which holds significant implications for cerebral perfusion, brain insulin availability, and cognitive performance