Menu Close

PROJECTS & PUBLICATIONS

The Asthma 411 program provides school nurses equipment, training and communication channels to reduce asthma-related emergencies, link children to primary care providers, and reduce absenteeism among children in their schools. The program has grown throughout Tarrant County where it currently covers more than 250,000 children.

Learn more…

Authors: Xidong DengTerese Finitzo, Subhash Aryal

Abstract

Improving quality measurement while reducing costs helps public health programs identify and better support critical aspects of the care and services delivered to the patients they serve. This is true for state-based early hearing detection and intervention (EHDI) programs as they strive to develop robust clinical quality measures to help track the quality of hearing health services provided during the EHDI processes. Leveraging today’s electronic health records and public health surveillance system functionalities, state reporting requirements facilitate and yield efficient collection and analysis of data for quality measurement. In this study, we tested three EHDI quality measures endorsed by the National Quality Forum using a retrospective sample of more than 1,100,000 newborns from 3 states using electronic health data available in the state EHDI Information Systems (EHDI-IS). The results of the analysis reported herein from a large multi-state cohort provide a “real life” benchmark for future quality improvement projects and of where EHDI stands today. Reflecting on these findings, suggestions are posed for enhancing the EHDI quality measures in future updates.

Read more…

Authors: Patricia A. Kelly, Kellie A. Classen, Craig G. Crandall, Jeannette T. Crenshaw, Stephanie A. Schaefer, Darlene A. Wade, Matthew N. Cramer, Subhash Aryal, Kelly R. Fossee

Abstract

Objective

To determine if a healthy newborn’s age in hours (3, 6, or 9 hours after birth) affects thermoregulatory status after the first bath as indicated by axillary and skin temperatures.

Design

Quasi-experimental, mixed-model (between subjects and within subjects) design with hours of age as the nonrepeated variable and prebath and postbath temperatures as the repeated variables.

Setting

Family-centered care unit at an urban hospital in the southwestern United States.

Participants

Healthy newborns (N = 75) 37 weeks or more completed gestation.

Methods

Mothers chose time of first bath based on available time slots (n = 25 newborns in each age group). Research nurses sponge bathed the newborns in the mothers’ rooms. Axillary temperature, an index of core temperature, was measured with a digital thermometer, and skin temperature, an index of body surface temperature, was measured with a thermography camera. Temperatures were taken before the bath; immediately after the bath; and 5, 30, 60, and 120 minutes after the bath. Immediately after the bath, newborns were placed in skin-to-skin care (SSC) for 60 or more minutes.

Results

We found a difference (p = .0372) in axillary temperatures between the 3- and 9-hour age groups, although this difference was not clinically significant (0.18 °F [0.10 °C]). We found no statistically significant differences in skin temperatures among the three age groups. Regardless of age group, axillary and skin temperatures initially decreased and then recovered after the bath.

Conclusion

For up to 2 hours postbath, axillary and skin temperatures were not different between healthy newborns bathed at 3, 6, or 9 hours of age. Thermography holds promise for learning about thermoregulation, bathing, and SSC.

Read more…

Authors: John C Licciardone, Robert J Gatchel, Nicole Phillips, and Subhash Aryal

Abstract

Low back pain is the leading cause of disability worldwide. Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as the first-line pharmacologic therapy for subacute or chronic low back pain, with opioids reserved for patients who fail on NSAIDs. CYP2D6, CYP2C9, and CYP2C19 genes have variants that place patients using analgesics at risk for adverse events. However, precision medicine based on pharmacogenetically informed prescribing is becoming more feasible as genotyping costs decline. This study aims to compare opioids vs NSAIDs in treating adults with subacute or chronic low back pain under the alternative models of usual care and precision medicine.

Read more…

 
Authors: Teresa Wagner, Denise Blevins, Jennifer Lopez & Jialing Liu
 
Abstract
 
The number of seniors over age 65 aging at home is increasing. They require usable health information to make informed decisions to maintain health and independence. This study partnered with Meals On Wheels, Inc., of Tarrant County, Texas, to assess the homebound over age 65 population’s ability to use of National Network of Libraries of Medicine online health information. Only 1% of participants utilized online resources and only 8% of available resources met their needs. Recommendations included using community outreach to extend online formatting, applying AHRQ’s “Health Literacy Universal Precautions,” to online information, or improving seniors’ eHealth skills and access.

Abstract

Purpose: Chronic abdominal pain (CAP) is a common reason for health care visits affecting approximately 25% of adults. Often opioids are prescribed to treat CAP, though there is not much evidence to support this. Opioid use has been connected to increased morbidity and mortality of patients including drug misuse, abuse and exacerbation of abdominal pain. The purpose of this study is to examine national trends in prescriptions of opioids for treating CAP using National Ambulatory Medical Care Survey (NAMCS).

Methods: NAMCS data were retrieved from the National Center for Health Care Statistics (2009-2014). The original data were paired into two-year groupings. We conducted stratified analysis and combined analysis for each 2-year period. We categorized patient diagnoses via the clinical classification software (CCS). Patient data were included if they were 18 or older and the reason for visit was CAP (including: Stomach pain, cramps, spasms, generalized lower or upper abdominal pain, and liver, gallbladder, or biliary tract pain). Certain types of abdominal pain were excluded including: pain from injury, infectious/parasitic diseases, neoplasms, diseases of the genitourinary system and pregnancy/childbirth complications. Logistic regression was used to determine trends in the number of visits where opioids were prescribed, and factors related to opioid prescriptions.

Results: Visits for 2009-2010, 2011-2012, 2013-2014 were 10.3 million, 9.7 million and 10.2 million respectively. During the same time periods the estimated number of opioid prescriptions for treating CAP were 300 thousand, 400 thousand and 100 thousand respectively. There were no significant differences in the number of opioid prescriptions between time periods (p > 0.05).

Conclusions: Even though an increasing trend for opioid prescriptions was reported in the literature for treating abdominal pain for 1997-1999 (7.9% increase) and 2006-2008 (15.5% increase), this analysis revealed the opioid prescription rate during this study period was not statistically different from year to year. Further analyses will incorporate additional data from the National Hospital Ambulatory Medical Care Survey (collected with NAMCS) which only contains hospital outpatient visits. This will contribute to a more robust, evidence-based analysis about practices in opioid prescribing, and inform the work of clinicians and public health officials working to address the US opioid epidemic today.

Learn More…