MEDICA@MUSC (Medical University of South Carolina)
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Not Home Alone: Leveraging Telehealth and Informatics to Create a Lean Model for COVID-19 Patient Home Care
Get PDFIn response to the emerging COVID-19 public health emergency in March 2020, the Medical University of South Carolina rapidly implemented an analytics-enhanced remote patient monitoring (RPM) program with state-wide reach for SARS-CoV-2-positive patients. Patient-reported data and other analytics were used to prioritize the sickest patients for contact by RPM nurses, enabling a small cadre of RPM nurses, with the support of ambulatory providers and urgent care video visits, to oversee 1234 patients, many of whom were older, from underserved populations, or at high risk of serious complications. Care was escalated based on prespecified criteria to primary care provider or emergency department visit, with 89% of moderate- to high-risk patients treated solely at home. The RPM nurses facilitated the continuity of care during escalation or de-escalation of care, provided much-needed emotional support to patients quarantining at home and helped find medical homes for patients with tenuous ties to health care
Telehealth Technology, Information, and Data System Considerations
No full textThis chapter explores the specific technologies that enable telehealth services in the areas of evaluation, monitoring, consultation, treatment, and care coordination. Historical, current, and future state applications are explored through case examples as a way to demonstrate technical functionality and capabilities. The foundational underpinning of broadband networks and the technological processes supported through telehealth vendors are presented. Additional discussions present examples of established systems, areas where interoperability is functional and the need for advancements in HIT technologies to better address security protocols and validate health analytics.https://medica-musc.researchcommons.org/faculty-books/1001/thumbnail.jp
Complement Targeted Strategies to Limit Early Injury and Promote Long Term Tolerance of Allografts
No full textImmunosuppressants used in organ transplantation (Tx), including vascularized composite allograft (VCA) Tx, have had limited success controlling chronic rejection. They are also associated with multiple serious adverse effects. Therefore, there is an unmet need for therapies that maintain long-lived graft tolerance with minimal systemic effects. Donor brain death (DBD) induced injury and ischemia reperfusion injury (IRI) are major factors known to promote early graft inflammation, the severity of which is associated with poorer outcomes. Complement is activated and deposited within allografts following DBD and has been shown to exacerbate IRI, and we therefore explored two novel complement targeted strategies to reduce graft injury and promote tolerance. In our first approach we investigate the therapeutic potential of pretreating VCAs (hindlimb grafts) with CR2-Crry, a graft targeted fusion protein; Crry inhibits all complement pathways, while CR2 binds C3d, a complement activation product deposited on brain dead donor (BDD) grafts. VCAs were procured from BDD or living donor (LD) Balb/C mice, perfused in situ with CR2-Crry, then transplanted into C57BL/6 recipients after graft cold-storage. We first showed that CR2-Crry bound and persisted at significantly higher levels in grafts from BDD vs LD, both before and after Tx. Moreover, BDD VCAs showed more severe IRI and rejected earlier compared to LD VCAs. These effects were reversed with CR2-Crry pre-treatment of grafts. In our second approach, we investigated whether the same complement targeting strategy using CR2 can be utilized to direct Treg cells to graft deposited C3d. For this purpose, graft specific Tregs can be created by genetically engineering them to express allospecific chimeric antigen receptors (CAR). In our approach, however, we utilized CR2 as a CAR to target C3d, which is universally deposited in grafts regardless of donor-recipient alloantigens. To enforce a Treg phenotype, we also co-expressed FoxP3. Isolated mouse T-cells were genetically modified to express CR2-CAR-FoxP3 using retrovirus. Following several rounds of construct redesign to optimize expression and stability, we prepared CR2-CAR-FoxP3 Tregs that exhibited a stable and suppressive phenotype in vitro. These CAR Tregs, together with engineered controls cells were investigated in a cardiac transplant model and an experimental autoimmune encephalomyelitis model but failed to show a protective effect. Future studies should investigate the use of these cells in an adjuvant setti
Instructing Library Users to Access eBooks Collections During COVID-19 through the Creation of a Virtual Workshop
No full textPoster presented at the inaugural conference of the South Carolina Conference on Information Literacy (SCCIL), August 2021.https://medica-musc.researchcommons.org/posters/1016/thumbnail.jp
The Experience of Social Isolation in Adults with Cystic Fibrosis: Results of a Mixed-Methods Feasibility Study
Get PDFThere is a lack of exploration into if, and how, adults with cystic fibrosis experience social isolation, a social condition associated with detrimental physical and psychological effects. Adults with cystic fibrosis experience barriers that may enhance the risk of social isolation, such as time-consuming treatment modalities, hospitalizations, fatigue, activity intolerance, and recommendations encouraging segregation from others with cystic fibrosis to prevent respiratory pathogen transmission. Additionally, these barriers may be augmented by social distancing guidelines related to the SARS-CoV-2 pandemic. While adults with cystic fibrosis have needed to long adhere to infection control guidelines with others with cystic fibrosis, this social distancing now extends to their whole social network. The purpose of this dissertation was to address this gap in knowledge. The concepts of social isolation and social support and their relationship to this population were investigated through an integrative review, which further supports this gap. A subsequent integrative review explored coping in adolescents and adults with cystic fibrosis; the findings of this review will be relevant when designing future studies. The final step in this dissertation was gaining a preliminary understanding of objective and subjective social isolation in adults with cystic fibrosis through the following aims, using Cornwell and Waite’s Model of Social Isolation: Aim 1: To evaluate the process and resources of the proposed study methodology using Tickle-Degnen’s feasibility model in preparation for future studies of social isolation in adults with cystic fibrosis; Aim 2: To develop a preliminary characterization of social isolation in adults with cystic fibrosis using a parallel convergent mixed methods approach; Sub Aim 2a: To measure objective and subjective social isolation using the Patient-Reported Outcomes Measurement Information System - Social Isolation Short Form 8a Scale and the Lubben Social Network Scale – Revised version; Sub Aim 2b: To identify preliminary signals of relationships between objective and subjective social isolation, demographic data, health information, and health-related quality of life; Sub Aim 2c: To elucidate experiences and perceptions of objective and subjective social isolation using semi-structured interviews; Sub Aim 2d: To compare and contrast the relationship of objective and subjective isolation through the triangulation of quantitative and qualitative data. The results of this mixed-methods feasibility study indicate that while there are opportunities to improve recruitment strategies, survey methods, and interview questions, this study design is a feasible approach for future work. Results reveal that participants were relatively healthy and, overall, experienced less social isolation than others with chronic illness. While exploring preliminary signals, relationships between objective and subjective social isolation, as well as relationships between many of the Cystic Fibrosis Questionnaire - Revised domains and subjective social isolation were discovered. Qualitative exploration revealed five main themes: importance of socialization and social support, effect of cystic fibrosis on socialization, feelings of isolation, importance of cystic fibrosis-specific support, and COVID-19-related socialization and support. Quantitative data was supported by qualitative data during triangulation. This study provides an initial glimpse of how adults with cystic fibrosis experience social isolation
Barriers and Facilitators Regarding Awareness, Selection, and Implementation of School-Based Interventions Addressing Physical Activity and Healthy Eating Behaviors: Perspectives of South Carolina Public School Administrators and Personnel
Get PDFPurpose: This dissertation explores the perceptions and experiences of South Carolina (SC) public school administrators and personnel regarding barriers and facilitators to school-based interventions, with a focus on physical activity (PA) and healthy eating behaviors, to address childhood obesity. An integrative review was completed to identify challenges and supports to school-based weight management interventions.1-35 Findings from the integrative review provided the framework for the dissertation study, which used a concurrent multi-methodological design to investigate the barriers and facilitators regarding awareness, selection, and implementation of school-based interventions addressing PA and healthy eating behaviors in the SC education system and to examine how the coronavirus disease 2019 (COVID-19) pandemic affected these interventions. Problem: In SC, approximately 37% of children and adolescents are overweight or obese, and the state ranks 3rd in the nation for the number of youth ages 10-17 who are obese.36,37 Behaviors that lead to excess weight gain include inadequate participation in PA and consumption of high-calorie, low-nutrient foods.38 Substantial negative health outcomes are associated with obesity, including increased rates of chronic illnesses, diminished quality of life, and shorter life span.38-42 Childhood obesity is also linked to psychological and social problems, such as anxiety, depression, and stigmatization.38,43,44 School-based weight management interventions have successfully improved PA and eating behaviors; however, not all schools offer these types of interventions and some interventions are not implemented to their fullest extent.45-49 It is important to understand the factors that hinder and promote the delivery of school-based interventions. The following research question guided the study: What do public school administrators and personnel in South Carolina perceive and experience as barriers and facilitators regarding awareness, selection, and implementation of school-based interventions addressing physical activity and healthy eating behaviors? The specific aims of the dissertation were: • Aim 1: Describe actual and perceived barriers and facilitators public school administrators and personnel in South Carolina encounter regarding awareness, selection, and implementation of school-based physical activity and healthy eating interventions. ‒ Aim 1a. Identify actual and perceived concerns and experiences within school settings regarding the use of weight-related terminology and any stigma that may exist. ‒ Aim 1b. Assess ability to recruit and engage public school administrators and personnel in South Carolina to participate in an exploratory study on school-based interventions. • Aim 2: Identify greatest challenges and supports, priority focal areas, and school-based interventions that have been implemented along with their outcomes. Design: A concurrent multi-methodological study, informed by the Social Ecological Model (SEM)50-54 and the Steps in Quality Intervention Development (6SQuID) Model,55,56 was completed to form a comprehensive understanding of the phenomena.57,58 The qualitative descriptive component included one-time Key Informant Interviews (KIIs) with SC public school administrators. The quantitative descriptive component involved conducting a needs assessment survey of SC public school personnel. Findings: KII participants (N = 28) reported that negative beliefs, comments, and bullying behaviors were more prevalent toward students perceived as being overweight. School administrators also indicated that school-based interventions addressing PA and healthy eating behaviors were present in schools. Participants identified insufficient time as the main barrier and adequate support as the primary facilitator to school-based interventions. These factors inhibited or enhanced intervention implementation, based on the extent to which they were present. Survey respondents (N = 1311) reported the foremost barriers as insufficient time for PA (n = 514, 39.2%) and limited access to healthy foods for healthy eating behaviors (n = 271, 20.7%). The key facilitators were adequate support from school-level administrators for PA (n = 264, 20.1%) and adequate support from cafeteria staff for healthy eating behaviors (n = 234, 17.8%). Both interview and survey participants described the COVID-19 pandemic as causing changes in school-based interventions addressing PA and healthy eating behaviors and in academic delivery impacting PA and healthy eating behaviors. Responses revealed that schools’ abilities to address PA and healthy eating behaviors were negatively affected by COVID-19, and the pandemic was predicted to disrupt future school-based interventions related to PA and healthy eating behaviors. Conclusions: Information from this dissertation provides the foundation for future studies on mitigating barriers and maximizing facilitators to school-based interventions addressing PA and healthy eating behaviors, with the ultimate goal of decreasing rates of childhood obesity. Additionally, findings may help school systems to adapt school-based interventions to changes from the COVID-19 pandemic so that students can still receive and benefit from content on healthy lifestyle practices.59,60 A promising opportunity for interprofessional collaboration exists for health care and education professionals to work together on school-based interventions that address students’ health and academic needs
Preventing Fetal Valproate Syndrome: Does Practice Reflect FDA Advisement for the Use of Valproate in Women of Childbearing Age?
Get PDFUntil recently, there were very little data on the effects of antiepileptic drug (AED) exposure in utero. However, in the past two decades, data from several prospective pregnancy registries have significantly increased the understanding of the critical risks for major congenital malformations associated with several AEDs (Gerard & Meador, 2015). This research examined the risks associated with valproate among women of childbearing age (18-44 years of age) and the risks valproate poses for a child through maternal exposure. The study population came from the 2016-2018 MarketScan® Commercial dataset obtained by the Medical University of South Carolina. In total, there were n=877 women aged 18-44 years of age. There were n=318 women with greater than 3 months prescribed valproate, and there were n=149 women based on 6 month pre-index insurance and 12 months post-index insurance where the data index was the date from which the first valproate prescription was filled. This led to a final cohort size of 149 women. The data was analyzed using measures of central tendency. Tests for differences between those on birth control and those not on birth control were made using Student’s t-test for normally distributed data, Wilcoxon-Mann-Whitney for non-normally distributed data, and chi-squared tests for categorical data. Results include 14.5% of the original population being prescribed valproate for 3 or more months, 33.6% being for migraines, followed by 31.5% for bipolar disorder despite research being conducted primarily for those with epilepsy. In conclusion, the research shows the need for further education on the risks of valproate and women of childbearing age. This is based on the lack of studies focusing on the risks and prescribing patterns outside of the epilepsy community. The research limitations included the length and type of contraceptive use, which the study could not account for as only measurable pregnancy prevention methods were studied. Future research could explore different funding streams as our research focused on commercial payor billing data, which garnered a small sample size
The Evaluation of the Effectiveness of Two Pipeline Programs for Matriculation and Retention of Minority Students in a Medical School Program
Get PDFThere is a constant need for diversity in the physician workforce, which means that there is also a critical need to diversify the medical school population. The Liaison Committee on Medical Education, the accrediting body of all U.S. medical schools monitors the compliance of medical education programs with recognized accepted standards including includes diversifying the physician workforce through pipeline programs and partnerships. The objective of this project is to evaluate outcomes of the Medical University College of Medicine’s Summer Institute (SI) program and the Postbaccalaureate Reapplication Program (PREP) in matriculating and retaining underrepresented minorities (URM) in medicine students. Out of one-hundred and thirty-five underrepresented in medicine pipeline program participants between 2006-2016, sixty-two (46%) successfully graduated from the College of Medicine at the Medical University of South Carolina. Data suggest that the PREP and SI pipeline programs are effective in matriculating minority students to medical school and retaining them to graduation. Future studies should evaluate the effectiveness pipelines programs and include additional variables to identify the specialties of medical school graduates and variable to determine if they are working in underserved areas
Uncovering the ‘Hidden Fibrosis’ of Pediatric Congenital Aortic Valve Stenosis via Targeted Mass Spectrometry Approaches
Get PDFCongenital aortic valve stenosis (CAVS) affects up to 10% of the world population without medical therapies to treat the disease. New molecular targets are continually being sought that can halt CAVS progression, particularly in pediatric patients where bioengineered solutions are not ideal. Collagen deregulation is a hallmark of pediatric CAVS yet remains mostly undefined. Here, histological studies were paired with high resolution accurate mass (HRAM) collagen-targeting proteomics and imaging mass spectrometry to investigate collagen fiber production with localized collagen regulation associated with human AV development and pediatric end-stage CAVS (pCAVS). Histological studies identified collagen fiber realignment and unique regions of high-density collagen in pCAVS. Proteomic analysis reported specific collagen peptides are modified with hydroxylated prolines (HYP), a post-translational modification critical to stabilizing the collagen triple helix. Quantitative data analysis reported significant regulation of collagen HYP sites across patient categories, providing insight to collagen-cell receptor binding. In addition to chromatographic-based proteomic analysis, Matrix Assisted Laser Desorption Ionization imaging mass spectrometry (MALDI-IMS) methods were developed to further address the localized structure-function relationship of the extracellular matrisome in aortic valve tissue. Here, a novel serial enzyme strategy was developed to define the glycosaminoglycome, N-glycome, as well as the collagen and elastin proteome from a single tissue section for MALDI-IMS applications. These multimodal MALDI-IMS techniques could define unique matrisome profiles based off tissue hemodynamics, as well as identify collagen localization unable to be detected by tradition histopathology. Finally, as a proof-of-concept study toward biomaterials applications, MALDI-IMS was used to localize human collagen-based hydrogels within an infarcted mouse heart, as well as analyze its impact on endogenous extracellular matrix (ECM) remodeling. The studies presented in this dissertation are the first of their kind to detail the collagen types and HYP modifications associated with human AV development and pediatric CAVS. Additionally, our findings show evidence for the use of MALDI-IMS in assessing the therapeutic application of collagen-based biomaterials. We anticipate that this study will inform new therapeutic avenues that inhibit valvular degradation in pCAVS and bioengineered options for valve replacement