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Utilizing the 4Ms Framework to Create a Structure and Process to Support Voluntary Health Assessments in Affordable Housing
Get PDFBACKGROUND: A growing number of older adults live in senior affordable housing, many with limited support systems and representing underserved or disadvantaged populations. Staff in these buildings are in a unique position to identify and address the healthcare and biopsychosocial needs of their residents and link them to services and supports.
METHODS: Staff in four affordable housing sites received training on the 4Ms approach to caring for older adults and conducting resident health assessments. They learned to collect comprehensive health information using a 4Ms Resident Health Risk Assessment (4Ms-RHRA) and results are entered into a customized electronic database. Embedded flags identify potential risk factors and initiate a follow-up process for documenting interventions and tracking referrals to healthcare and supportive services.
RESULTS: Eighty-one percent of the 221 4Ms-RHRAs completed with residents (63% female, mean age 71.1 years, 73% live alone) were flagged for at least one concern (Mean = 2.2 flags). Items addressing What Matters were most frequently flagged: resident\u27s most important health issue (55%) and Advance Care Planning (ACP: 48%). In response, staff provided Advance Directive forms and Five Wishes pamphlets to interested residents and reminded residents to review ACP documents annually.
CONCLUSION: Training affordable housing staff, precepting faculty, and students to conduct health assessments based on the 4Ms framework and longitudinally track interventions related to resident-centered needs and manage long-term service and supports is a first step in creating an interprofessional workforce capable of addressing the complex needs of older individuals in affordable housing
Clinical Outcomes for Impella Patients Associated with Hyperlipidemia: An Analysis of the National Inpatient Sample
Get PDFThe Impella, a ventricular assist device, is crucial for managing severe heart failure and cardiogenic shock. Despite its widespread use, there\u27s scant information on how hyperlipidemia affects Impella patients. To address this gap, we delved into the National Inpatient Sample Database from 2019 and 2020. Our aim was to scrutinize in-hospital outcomes among these patients. We identified 8233 Impella patients, among whom 1012 (12.3%) had hyperlipidemia. Those with hyperlipidemia displayed higher rates of hypertension, diabetes mellitus, and chronic kidney disease compared to their counterparts without hyperlipidemia. Shockingly, in-hospital mortality was notably elevated in the hyperlipidemia group, emphasizing its clinical significance. After meticulous multivariate regression analysis, it became evident that hyperlipidemia was a significant risk factor for heightened inpatient mortality and escalated total hospital charges. Additionally, these patients endured prolonged hospital stays. Further analysis unveiled that hyperlipidemia amplified the odds of complications such as acute kidney failure, ventricular arrhythmia, stroke, deep vein thrombosis, and sepsis. In summary, our nationally representative retrospective cohort study underscores the detrimental impact of hyperlipidemia on Impella patients. These findings advocate for tailored management strategies and heightened vigilance in this high-risk subgroup to ameliorate outcomes and enhance patient care
Evaluating the Effectiveness of a School-Based Cognitive Behavioral Youth Depression Prevention Program in Improving Life Satisfaction
Get PDFDepression is the leading cause of disability worldwide, known as the global burden of disease. Incident cases from 1990 to 2017 have increased by 49.86%. Additionally, rates have been seen to dramatically rise in adolescents aged 18-25 (17%) compared to rates in individuals aged 10-14 (1.1%). This makes it beneficial to have prevention programs for middle school aged children. The Penn Resiliency Program (PRP) is a youth depression prevention program focused on cultivating healthy thinking styles and behavioral coping skills. In our study, we used archival data from a randomized control trial of PRP to evaluate whether the program led to improvements in life satisfaction in adolescents. Life satisfaction was reported using the Satisfaction with Life Scale by Diener. We used mixed effects modeling to evaluate the data collected from the PRP clinical trial. It was found that children in PRP tended to report slightly higher levels of life satisfaction, but these differences were not statistically significant. We did not find compelling evidence that children in PRP reported higher life satisfaction levels than those who received no intervention. Residual diagnostic analyses showed minor departures from normality in our residuals at high and low ends of the distribution, but overall the statistical model assumptions appeared to be reasonable. In conclusion, the data does not show enough evidence to conclude that life satisfaction was improved. Future research should look at functional outcomes, e.g., the child’s academic and social wellbeing
Impact of Rotenone Treatment on Respiration and Swallowing Rate in Drinking Rats
Get PDFParkinson’s disease is a neurodegenerative disorder known to cause dysphagia, the major contributor to mortality via aspiration pneumonia. The neurological basis of swallowing dysfunction in Parkinson patients is poorly understood. To explore the mechanisms of swallowing dysfunction, we studied the impact of rotenone treatment on respiration rate and swallowing rate in liquid-drinking rats. We hypothesized that rotenone treatment will cause a decrease in respiratory and swallowing rate compared to untreated liquid-drinking rats. Six rats were injected with 2.75 mg/kg/day intraperitoneal rotenone for 16 days to create the parkinsonian phenotype and subsequently recorded with 200fps video fluoroscopy during barium-infused liquid drinking. Before the first injection and on day 4, 7, 10 and 16, the number of swallows and number of breaths in a ten second period of continuous drinking were scored. The data was then analyzed using a type 3 Analysis of Variance with Satterthwaite\u27s method to determine whether the rotenone injections impacted the respiration or swallowing rate. Rotenone injections led to a decrease in respiration rate, but no change in swallowing rate over a 16-day period. The p-value for respiration rate was less than 0.05 (0.02731) indicating a significant result, however the p-value for swallow rate was greater than 0.05. Immunohistochemistry of the dorsolateral striatum of rats that received rotenone treatment for 8 days and 16 days showed significant reduction in tyrosine hydroxylase (TH) immunofluorescence with increased impact due to prolonged treatment. TH is the rate limiting step of catecholamine synthesis from tyrosine, confirming that rotenone is affecting dopamine production in order to influence swallowing dynamics. These results indicated that rotenone induced parkinsonian treatment has differential impacts on different brainstem mediated processes, swallowing and respiration. Thus, swallow-respiration coordination is likely impacted in these animals, potentially increasing risk of airway protection failure
Interprofessional Team Collaboration to Study Integrated Behavioral Health Services in Primary Care
Get PDFIn Rowan Family Medicine (Sewell, NJ), an interprofessional team of medical and clinical psychology professionals and trainees collaborate to investigate the integration of behavioral health in patients’ primary care visits.
We screen patients for PTSD symptoms using the DSM CAPS-5 during their primary care visits
The PTSD Coach app is then encouraged to use 3x a day
By making mental health care more accessible to patients, we strive to help meet the increased demand and alleviate the strain our healthcare system is currently experiencing.
The team composed of Medicine and Clinical Psychology allows students to gain invaluable experience in interdisciplinary collaboration
Overall, patients and providers feel satisfied and positively receive this Integrated Behavioral Health Mode
Neoadjuvant versus Adjuvant Therapy for Stage IIIB-IIID Melanoma
Get PDFThe treatment landscape for advanced stage melanoma is rapidly evolving due to advancements in our understanding of melanoma biology and the emergence of novel therapies. This necessitates a comprehensive review to guide clinicians in adopting evidence based and patient centric approaches to treat stage IIIB-IIID melanoma. A literature review was conducted to synthesize current information on the most optimal treatment available. Data available from different clinical trials found that neoadjuvant therapy was a more effective treatment compared to adjuvant therapies alone. Furthermore, neoadjuvant therapy with combination therapy was more efficacious in producing a complete pathological response compared to monotherapy. A follow-up study on patients treated with neoadjuvant therapy with PD1 inhibitor pembrolizumab found that patients who produced a major pathologic response (MPR) or complete response (pCR) had higher 5 year Overall Survival rates. The trial highlights the importance of tailoring pharmacological treatment to patients to receive a significant pathological response. In addition, finding robust biomarkers is important in assessing therapies to personalize them to the patient. Longer term follow-up should be emphasized due to observed differences in median time to recurrence
Nutrition and Exercise Resources for Uninsured Patient Populations
Get PDFProper nutrition and exercise is integral for the prevention and management of chronic diseases such as type two diabetes, hypertension, high cholesterol, and cardiovascular disease. However, health care disparities in the United States, such as lack of access to primary health care, has been an ever growing problem. The purpose of this study is to determine if there is a correlation between being uninsured and having worse health outcomes, and to determine if there is a need for accessible nutrition and/or exercise resources for this population. To conduct this research, a survey was distributed at the Cherry Hill Free Clinic and the Cooper Rowan Clinic in South Jersey. The survey data was imported into Qualtrics and then exported into SPSS Statistics. In SPSS, a combination of chi square tests and t-tests were conducted. The results showed that there is a correlation between BMI, age, and less access to exercise, to the prevalence of chronic conditions. The results also showed that participants with a BMI greater than thirty and those that have one or more chronic conditions ranked their health lower on a scale of poor to excellent and expressed interest in receiving nutrition and exercise resources if made accessible to them. Understanding the health care disparities that exist for uninsured individuals and the risk factors that lead to poor health outcomes will provide awareness to the importance for more accessible care as it is related to nutrition and exercise
Relationship Between Gut Microbiota and Dementia
Get PDFThis paper explores the complex relationship between gut microbiota, dietary habits, and dementia, focusing particularly on Alzheimer\u27s disease (AD). Growing evidence suggests a significant link between the composition of gut bacteria, dietary choices, and susceptibility to dementia. Notably, individuals with dementia demonstrate a noticeable reduction in gut bacteria diversity, highlighting the crucial role of a balanced microbiome in maintaining cognitive health. Conversely, dietary preferences characterized by excessive consumption of processed foods and sugars are associated with an increased risk of dementia, emphasizing the critical influence of diet on shaping gut microbiota and subsequent neurocognitive outcomes. Importantly, dietary interventions featuring a diverse range of fiber and fermented foods emerge as promising strategies for reducing dementia risk, creating an optimal gut environment conducive to the production of anti-inflammatory agents and short-chain fatty acids. While ongoing research continues to elucidate the intricate mechanisms governing the gut-brain axis, current evidence underscores the importance of dietary modifications as a fundamental approach in dementia prevention and management. Specifically, adherence to dietary patterns resembling the Mediterranean diet or emphasizing high-fiber intake holds significant potential in alleviating the burden of dementia. Through a comprehensive examination of existing literature, this study provides valuable insights into the complex interplay between gut microbiota, dietary influences, and dementia risk, laying the groundwork for future medical interventions aimed at preserving cognitive function and mitigating the impact of dementia
Assessment of Sexual Violence Risk Perception in Men Who Have Sex With Men: Proposal for the Development and Validation of G-Date .
Get PDFBACKGROUND: Sexual violence (SV) is a significant problem for sexual minorities, including men who have sex with men (MSM). The limited research suggests SV is associated with a host of syndemic conditions. These factors tend to cluster and interact to worsen one another. Unfortunately, while much work has been conducted to examine these factors in heterosexual women, there is a lack of research examining MSM, especially their SV risk perception. Further, MSM are active users of dating and sexual networking (DSN) mobile apps, and this technology has demonstrated usefulness for creating safe spaces for MSM to meet and engage partners. However, mounting data demonstrate that DSN app use is associated with an increased risk for SV, especially given the higher likelihood of using alcohol and other drugs before sex. By contrast, some researchers have demonstrated that DSN technology can be harnessed as a prevention tool for HIV; unfortunately, no such work has progressed regarding SV.
OBJECTIVE: This study aims to (1) use qualitative and quantitative methods to tailor an existing laboratory paradigm of SV risk perception in women for MSM using a DSN mobile app framework and (2) subject this novel paradigm to a rigorous validation study to confirm its usefulness in predicting SV, with the potential for use in future prevention endeavors.
METHODS: To tailor the paradigm for MSM, a team of computer scientists created an initial DSN app (G-Date) and incorporated ongoing feedback about the usability, feasibility, and realism of this tool from a representative sample of MSM. We used focus groups and interviews to assist in the development of G-Date, including by identifying relevant stimuli, developing the cover story, and establishing the appropriate study language. To confirm the paradigm\u27s usefulness, we are conducting an experimental study with web-based and face-to-face participants to determine the content, concurrent, and predictive validities of G-Date. We will evaluate whether certain correlates of SV informed by syndemics and minority stress theories (eg, history of SV and alcohol and drug use) affect the ability of MSM to detect SV risk within G-Date and how paradigm engagement influences behavior in actual DSN app use contexts.
RESULTS: This study received funding from the National Institute on Alcohol Abuse and Alcoholism on September 10, 2020, and ethics approval on October 19, 2020, and we began app development for aim 1 immediately thereafter. We began data collection for the aim 2 validation study in December 2022. Initial results from the validation study are expected to be available after December 2025.
CONCLUSIONS: We hope that G-Date will enhance our understanding of factors associated with SV risk and serve as a useful step in creating prevention programs for this susceptible population
IMPROVING LIGAND PHARMACOKINETICS VIA BIOISOSTERIC SUBSTITUTION OF AMIDES WITH 1, 2, 3-TRIAZOLES WHILE MAINTAINING DOPAMINE D4 RECEPTOR SELECTIVITY AND POTENCY
No full textSeveral neurophysiological functions, such as attention, cognition, and emotional regulation, are regulated by the binding of dopamine on G-Protein coupled receptors. D4Rs are mainly located in the prefrontal cortex and the hippocampus and are known to have a key role in decision-making, memory formation, cognition, and attention. Administration of D4Rs- selective ligands during the preclinical studies enhance the outcomes and the results in animal models suffering from neuropsychiatric disorders, including ADHD, substance use disorders (SUD), and Alzheimer\u27s disease. Recently, we reported a group of D4R-selective ligands with different efficacies depending on their phenylpiperazine ring scaffold to illustrate D4R function during the preclinical studies. However, in-vivo studies reported the rapid metabolism of some compounds due to the cleavage of amide linkage during phase I metabolism, limiting further investigation. Therefore, using click chemistry methods, we bioisosterically replace the amide bond with a 1,2,3-triazole linkage and reveal a novel of D4R-selective ligands. In-vitro studies indicate that the pharmacodynamics profile for 1,2,3-triazole compounds has similar functional and binding characteristics to the amide linkage analogs with more tolerability profiles towards phase I metabolism. Behavioral studies in rats using 1,2,3-triazoles are still ongoing